HHS in the 21st Century Charting a New Course for a Healthier America (2009) / Chapter Skim
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Pages 1-20
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, the largest department in the federal government in terms of budget, spends approximately $2 billion a day. The department's activities touch the lives of virtually all Americans -- financing health care for elderly, disabled, and indigent individuals; protecting against domestic and global health threats; ensuring the safety of food and medications; advancing the science of fighting disease; and improving health care for everyone.
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What are the missions of its constituent agencies, and how do their activities relate to the public health, health care quality, and health care cost challenges facing the United States?
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Such challenges partially explain the lack of progress in achieving the nation's health goals, enumerated in the best-known of several sets of departmental aims, the Healthy People 2010 objectives. The most critical conclusion that the committee came to (especially in light of the representatives' request that recommendations consider a shorter time frame and require minimal resources)
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To meet twenty-first cen tury challenges to America's health, the secretary of HHS should clearly articulate and actively promote a vision for the nation's health, ensure that the department's mission supports that vision, and establish a small number of measurable goals focused on critical challenges (Recommendation 1)
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A "new com pact" between Congress and the department is essential as HHS works toward achieving its vision for a healthy nation, depart mental mission, and key health goals. Under this compact, the secretary would provide Congress and the nation regular, rigorous reports about departmental activities and assume greater accountability for improving performance and obtaining results; in return, Congress should allow the department greater flexibil ity in its internal operations and decision making (Recommenda tion 5)
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Recommendation 1 To meet twenty-first century challenges to America's health, the secretary of HHS should clearly articulate and actively promote a vision for the nation's health, ensure that the department's mission supports that vision, and establish a small number of measurable goals focused on critical challenges.
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Public health focuses on the health of populations, rather than individuals. It protects the public from health risks, promotes beneficial health behavior, prevents disease and disability, and provides basic health services for vulnerable populations.
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food safety agencies are ill-equipped and understaffed and cannot keep pace with the globalization of the food supply or advances in food science and technology. Recommendation 2 To improve the public's health and achieve the de partment's goals, the secretary should align and fo cus the department on performance and encourage creative use of scientifically based approaches to meet new and enduring challenges.
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f. The secretary should ensure that all department health programs, including the reimbursement pro grams, reinforce public health priorities and strategies in order to provide a consistent frame work for protecting the public from health risks, promoting health, preventing disease and disabil
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Worse, our high national health care expenditures have not produced commensurate gains in the health of the nation or in the quality of care Americans receive. Research comparing the marked differences in care patterns (frequency of surgery, for example)
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These analyses should build on existing data collection efforts in agencies such as CDC, FDA, NIH, CMS, and AHRQ -- as well as on external data sources -- and will require transparent and credible analytic tools. The committee sees this type of research as providing useful guidance in clinical decision making, but recognizes it cannot be an absolute guide to the clinical care of individual patients, whose circumstances vary widely.
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For the public health system, health information technology can facilitate early detection of disease outbreaks and environmental hazards, improve monitoring of chronic diseases, and quickly identify adverse events involving drugs or other agents. Recommendation 3 The secretary should accelerate the establishment of a collaborative, robust system for evaluating the health care system that would incorporate existing department and external research, stimulate new studies as needed, synthesize findings, and provide actionable feedback for policy makers, purchasers, payers, providers, health care professionals, and the public.
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To facilitate collection of these data, the department should actively promote the universal adoption of electronic information capa bilities -- including health information exchange and electronic medical, personal health records -- for administrative and clinical purposes.
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2009 budget, despite the difficulties recruiting staff in these disciplines, as reported by state and local health departments. To continue advances in the health-related sciences, the nation needs biomedical scientists, health economists, other health service researchers,
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e. To help close projected gaps, the department should evaluate existing health care professional training programs, continued education pro grams, and graduate medical education funding
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To facilitate improved accountability, HHS needs a department-wide information system that would provide a panoramic view of how its health and human services programs work together to achieve departmental goals. Data supporting this system should come from within the department and from its key government partners.
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The committee determined that increased congressional involvement in HHS management and operations has hindered the department's flexibility. For example, during the past two decades, Congress has acted 125 times to give FDA increased regulatory responsibilities, but without providing the additional resources needed to meet them.
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c. The department should use the data, evaluation, and information system to • enable the secretary to provide Congress with regular reports on progress toward achieving departmental goals, • inform policy development, • facilitate cross-department activities, • provide operational information to program management for quality improvement and midcourse corrections, and • support effective long-range planning.
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g. Congress should establish a new, strategic initia tive fund to enable the secretary to support cross agency and cross-departmental activities that ex hibit innovation in responding to twenty-first century challenges, and to respond quickly to new, unforeseen, or expanding public health threats.
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20 HHS IN THE 21ST CENTURY This informal advice is not meant to be a rigid blueprint, but is intended to help a new secretary manage the political, budgetary, personnel, policy, and planning challenges that come with the appointment to this vital post.
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