HHS in the 21st Century Charting a New Course for a Healthier America (2009) / Chapter Skim
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6 Improve Accountability and Decision Making
6 Improve Accountability and Decision Making
Pages 125-146
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From page 125... ...
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 flexibility in its internal operations and decision making.
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From page 126... ...
The committee believes that improved accountability and more rigorous decision making will be fundamental to the department's success in creating more value from its activities, in responding to the key health and cost challenges of the twenty-first century, and in earning congressional support for increased flexibility in executing its responsibilities. To the committee, a strong system of accountability provides the information needed to continuously improve program performance in ways that result in better health for Americans.
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From page 127... ...
The department currently operates under a complex web of internally and externally generated goal-setting and reporting requirements. These requirements include exercises that relate to Healthy People 2010, the Government Performance and Results Act of 1993 (GPRA)
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From page 128... ...
of 1993 -- GPRA requires agencies to develop five-year strategic plans, updated every three years, as well as annual plans or annual performance budgets, and annual program performance reports. The strategic plan defines broad, long-term goals and describes broad strategies for their implementa tion.
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From page 129... ...
1 The State of the USA, Inc., in partnership with the National Academies, is developing a web-based system of tracking trends to inform public policy decision making and research, and an IOM committee is participating in that effort by attempting to identify appropriate health indicators to track. 2 Note that the "public health promotion and protection, disease prevention, and emergency preparedness" goal accounts for 1 percent of the President's proposed 2009 HHS budget, while the "health care" goal accounts for 93 percent.
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From page 130... ...
3 These priorities are: every American insured, insurance for children in need, valuedriven health care, information technology, personalized health care, health diplomacy, prevention, Louisiana health care system, pandemic preparedness, and emergency response. 4 These principles are: care for the truly needy, foster self-reliance; national standards, neighborhood solutions; collaboration, not polarization; solutions transcend political boundaries; markets before mandates; protect privacy; science for facts, progress for priorities; reward results, not programs; change a heart, change a nation; and value life.
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From page 131... ...
However, OMB acknowledges that ratings will not necessarily be reflected in increases or decreases in program budgets, depending on circumstances. The White House, too, has an initiative to improve governmental operations, called the President's Management Agenda.
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From page 132... ...
Current performance assessment systems, described above, do not support true accountability, as defined by the committee. In its view, true accountability requires a dual focus on program implementation (process)
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From page 133... ...
This holds equally true within agencies whose leaders are appointed. The laborious federal appointment process that frequently keeps key positions vacant or with acting directors for months at a time not only hinders HHS performance, but also militates against accountability.
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From page 134... ...
IMPROVE CAPABILITY TO MEASURE AND EVALUATE VALUE The IOM committee takes a broad perspective on the accountability issue, one that distinguishes between "data" and "information." Data are discrete facts; when data are organized, combined, and presented in ways that enables response and action, they become "information." PART and the HHS strategic plan provide data. The committee, by contrast, endorses a higher-level, department-wide information system, described below.
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From page 135... ...
8 This system enables closer monitoring of product performance and gives rapid indication of any problems that arise, through analysis of existing national electronic claims and medical records data maintained by participating private-sector organizations and government entities, in cluding VA [Department of Veterans Affairs] , DoD [Department of Defense]
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From page 136... ...
Current data collection approaches used in the department are too infrequent, too late, and insufficiently detailed for these management purposes; further, they document specific program activities rather than cross-departmental, coordinated achievement of broader goals. (Insofar as these specific program data remain useful to the program managers, they could continue to be collected.
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From page 137... ...
Funding for such a system would benefit all department units. Uses of the New Information System As indicated, the kind of system envisioned by the IOM committee would generate actionable feedback about how health and human services programs are working, whether they need midcourse corrections, or whether they are performing poorly -- in ways that cannot be corrected or are too costly for the benefit achieved -- and should be terminated.
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From page 138... ...
The department should use the data, evaluation, and information system to • enable the secretary to provide Congress with regular reports on progress toward achieving de partmental goals, • inform policy development, • facilitate cross-department activities, • provide operational information to program man agement for quality improvement and midcourse corrections, and • support effective long-range planning.
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From page 139... ...
2. A responsible appointment process: The committee recommends that the appointment process for key HHS officials not only en sure that its executives have the administrative, leadership, and technical or scientific expertise to manage their respective areas, but also that vacancies are promptly filled, so that agencies do not experience gaps in leadership.
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From page 140... ...
The secretary can work with the Office of Personnel Management (OPM) to foster flexibility in the hiring process for people who are outside government, in the structuring of benefits and work schedules to retain employees who would otherwise retire, and in supporting the education of a new generation of public health professionals and health scientists.
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From page 141... ...
In a particularly troubling example, over the past two decades, Congress has enacted 125 statutes that directly affect FDA's regulatory responsibilities -- requiring new regulations, regulatory programs, or policy. In most cases these new requirements need scientific knowledge or expertise to develop and administer; in some cases they require laboratory research; but in no case has Congress provided an appropriation for staff or other re 9 The Medicare Improvement for Patients and Providers Act of 2008, passed in July 2008, allows the Centers for Medicare and Medicaid Services to make national coverage decisions regarding prevention policies and authorizes the secretary of HHS to extend coverage to additional preventive services through the national coverage determination process.
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From page 142... ...
. Amid positive comments on the value of congressional engagement and "the salutary benefits of a close and positive working relationship with their authorizing and appropriating committees and subcommittees," the former secretaries who were interviewed had some significant complaints (see Appendix G)
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From page 143... ...
The fund could also be used to respond to new, unforeseen, or expanding public health threats that require quick departmental response. The secretary would, of course, be accountable to Congress for the use of this fund, which could -- if the added flexibility proves useful -- grow over time.
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From page 144... ...
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. REFERENCES FDA (Food and Drug Administration)
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From page 145... ...
2005. Promoting health information technology: Is there a case for more-aggressive government action?
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