HHS in the 21st Century Charting a New Course for a Healthier America (2009) / Chapter Skim
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2 Define a Twenty-First Century Vision
2 Define a Twenty-First Century Vision
Pages 39-54
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From page 39... ...
b. The secretary should, in this process, consult widely with internal department leaders, others in the execu tive branch, Congress, governors and state-level offi cials, health care providers, scientific and professional organizations, and public interest and advocacy groups.
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From page 40... ...
The first step is to identify and prioritize key health challenges, which would then be used to guide the development of a compelling, well-articulated vision for the nation's health, to ensure that the department's mission statement adequately describes its role in achieving the vision, and to identify a relatively small number of explicit, measurable goals that are geared to meeting the nation's greatest health challenges. The secretary should launch a formal process for establishing these guidelines for action, building on, as appropriate, the department's current mission and commitments, as well as its long history of ensuring health and human services, and special attention should be paid to the needs of vulnerable populations served by the department.
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From page 41... ...
. Participation in the priority-setting process might improve the department's responsiveness to public concerns while also helping members of Congress take into account the enormous number of challenges the department faces, stem the number of legislatively mandated programs layered on the department, and persuade members to allow the department more flexibility in program implementation (see Chapter 6)
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From page 42... ...
State involvement in setting priorities is crucial, because Medicaid, health care financing innovations, and most public health activities -- such as disease control and surveillance, emergency preparedness, and public information campaigns about tobacco and obesity -- are carried out not just at the federal level, but in states and communities, as well. Greater inclusion of states in HHS strategic planning would be an important step forward, as states, despite their vital role in implementing HHS programs, frequently perceive that they are treated as an "interest group just like any other" (Boufford and Lee, 2001)
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From page 43... ...
Such a broad effort to obtain input about the nation's key health challenges and priorities would ensure that the result will reflect a comprehensive awareness of the problems, promote acceptance of the goals the department ultimately chooses, facilitate implementation of related programs, generate partnerships, encourage longer-term investments, and foster continuity. Related Recommendations a.
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From page 44... ...
Vision The analysis of current, emerging, and potential health challenges and priorities facing the nation would provide the department with consensus-based background information -- a type of "environmental scan" -- necessary to construct a twenty-first century vision for the nation's health. It would describe what the department sees as a compelling vision for the future state of the nation's health, and it should combine elements of aspiration and inspiration -- not only desire, but also motivation to work toward that desire: • "I have a dream today" (Martin Luther King, Jr., March on Washington, August 28, 1963)
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From page 45... ...
The current HHS mission statement, which encompasses both its health and human services roles, accomplishes these purposes well (HHS, 2008b) : to enhance the health and well-being of Americans by providing for effective health and human services and by fostering strong, sustained advances in the sciences un derlying medicine, public health, and social services.
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From page 46... ...
• The dominance of entitlement programs and other mandatory spending in the department's annual budget leaves department leaders little flexibility in spending, while federal budget con straints limit new funding. • At present, there is no mechanism to finance an effective re sponse to public health emergencies (Lister, 2008)
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From page 47... ...
. • The department has made insufficient progress toward achieving the nation's current health goals -- for example, of the Healthy People 2010 objectives set a decade ago, only one-third have seen progress (HHS Office of Disease Prevention and Health Promotion, 2005)
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They should provide program continuity in the face of presidential transitions and when new secretaries and new executive leadership comes aboard. Also, the vision and mission statements should encourage rather than stifle creativity and innovation.
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High health care costs, lack of access to care, poor quality and outcomes -- a Venn diagram of overlapping influences -- are the major sources of mounting pressure for health reform -- among the public, health professionals and providers, and policy makers. When Congress requested this report, it asked that the Institute of Medicine (IOM)
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From page 50... ...
A September 2008 Congressional Budget Office (CBO) report concluded that current trends in federal spending and revenues are "unsustainable." The CBO identified health care spending and, "to a lesser extent," the aging population (which requires Social Security spending, as well as increased health care spending)
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From page 51... ...
Because it is the principal advocate within the federal government for public health and advancing the health of the population, it may be up to the secretary to make the critical case that "health reform" is more than just reforming the insurance coverage and payment systems. HHS has paramount operational knowledge about the complex workings of the health sector, and the secretary will want to use the extensive data available from Medicare, Medicaid, CDC, FDA, the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, and other federal, state, and private-sector agencies to help
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From page 52... ...
The combination of a health system that is widely considered fundamentally flawed, competing external demands, internal organizational complexity, and impending large workforce losses due to retirement presents HHS with serious challenges, as well as opportunities for new thinking about the important themes the IOM committee considers in this report: vision, focus, alignment, effectiveness, and accountability.
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From page 53... ...
Washington, DC: HHS. HHS Office of Disease Prevention and Health Promotion.
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From page 54... ...
2008b. A sketch of community health centers: Chartbook 2008.
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