Health Reform WK-EDGE HHS’ role complicated by COVID-19
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Friday, November 20, 2020

HHS’ role complicated by COVID-19

By Jeffrey H. Brochin, J.D.

The HHS OIG has identified six top management and performance challenges faced by HHS as it strives to fulfill its mission during the COVID-19 pandemic.

The HHS Office of Inspector General (OIG) has issued its annual report on the top management and performance challenges (TMCs) at a time when the agency faces unprecedented challenges because of the emergence of novel coronavirus disease 2019 (COVID-19). As noted throughout the report, the cross-agency support and coordination responses to COVID-19 demanded of HHS affects nearly every aspect of department’s operations (OIG Report, November 17, 2020).

The lead federal agency during pandemic. As the lead federal agency for medical support and coordination during public health emergencies, HHS has numerous significant responsibilities to assist communities throughout the U.S. to prepare for, respond to, and recover from the fast-moving COVID-19 pandemic. HHS’s responsibilities include: working with federal, state, tribal, and local and international governments to effectively respond; supporting the development of vaccines, treatments, and other research on COVID-19; assisting the health care system by providing flexibility, resources, and funding; ensuring the safety of the health care workforce and protecting the health and well-being of the public. The COVID-19 response affects nearly every aspect of department’s operations, and challenges related to it are addressed throughout the six identified TMCs.

Identifying the TMCs. HHS is responsible for a $2.5 trillion portfolio, and its programs impact the lives of virtually all Americans. To identify the six TMCs, the OIG integrated oversight, enforcement, data analytics, and risk analysis work. For each TMC, described the dimensions of the challenge, highlighted the progress that the department has made in addressing the challenge, and identified what remains to be done. The TMCs reflect how multiple HHS Staff Divisions and Operating Divisions are addressing the pressing issues, and how, for example, the challenge of financial integrity highlighted in TMC 2 has natural intersections with the challenge of delivering value, quality, and improved outcomes in Medicare and Medicaid which is the subject of TMC 3. Given that challenges cross both internal HHS boundaries and externally with federal and state agencies, coordination among HHS agencies and across government is integral to addressing these challenges.

TMC 1: public health. Because HHS’ core mission is to enhance the health and well-being of all Americans, the emergence and spread of COVID-19 has greatly exacerbated the department’s challenge to ensure public health and safety. HHS must act vigilantly to mitigate the loss of life and negative health consequences associated with COVID-19, while continuing to operate a range of programs and services that are essential to protecting individuals and communities. This includes facilitating the safe delivery of necessary medical care unrelated to COVID-19 and ensuring that medical products regulated by the FDA are safe and effective.

TMC 2: financial integrity. HHS is the largest civilian agency in the federal government, with a $2.5 trillion budget, representing one-third of the total federal budget. HHS’s Medicare program is the nation’s largest health insurer by expenditures, handling more than 1 billion claims per year, and Medicaid is the largest health insurer in terms of lives covered, with 76.5 million beneficiaries in Medicaid and the Children’s Health Insurance Program (CHIP) enrolled individuals. HHS’ financial challenge is to control costs by ensuring prudent pricing for goods and services, reducing improper payments, combating fraud, waste, and abuse, and monitoring and reporting on the integrity of HHS programs.

TMC 3: quality. As it continues to reform Medicare and Medicaid to promote quality, efficiency, and value of care, HHS will be faced with having to align program incentives with health outcomes, strengthen program integrity, and deliver on the promise of innovative technology to improve health outcomes.

TMC 4: beneficiaries. HHS programs provide critical services to diverse populations across a broad range of settings, including hospitals, child care facilities, and beneficiaries’ own homes. Some services are directly provided by HHS personnel, some delivered via HHS grant programs, and others rendered by professionals of the beneficiary’s choosing. The challenge in this area is to ensure safety and quality of care for beneficiaries of federal health care programs, protect the health and safety of children served by HHS programs, and prevent abuse and neglect.

TMC 5: data collection. Improving how the federal government manages, shares, and secures its data is a priority for both Congress and the Administration. The COVID-19 pandemic has underscored the need for significant and sustained efforts to modernize data practices across HHS. The response to COVID-19 is directly dependent on data that HHS collects or generates. HHS is challenged in this regard with expanding the capacity to use and share data to support evidence-based policymaking, program management and program improvement; providing data to HHS partners and promoting the public data access and sharing; and protecting data from misuse or unlawful disclosure.

TMC 6: collaboration. HHS faces some of the largest and most complex issues that challenge our government and the nation which transcend a single HHS program. Often, HHS' mission is only one piece in a larger puzzle of overlapping and coordinating responsibilities. For HHS to achieve its mission, it needs to collaborate effectively, including across HHS programs and other federal agencies, as well as outside the federal government, including with tribal, state and local governments, international entities, industry, and other stakeholders.

MainStory: TopStory AccessNews AgencyNews CHIPNews EnrollmentNews GeneralNews MedicaidNews MedicarePartANews MedicarePartBNews MedicarePartCNews MedicarePartDNews ProviderPaymentNews ProgramIntegrityNews QualityNews

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