2020 Top Management & Performance Challenges Facing HHS

The 2020 Top Management and Performance Challenges Facing HHS is an annual publication of the Department of Health and Human Services (HHS or the Department) Office of Inspector General (OIG). In this edition, OIG has identified six top management and performance challenges (TMCs) the Department faces as it strives to fulfill its mission "to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services." These top six challenges reflect overarching issues that affect multiple HHS programs and responsibilities. These are not the only challenges that confront HHS, and OIG reports are a key resource that highlight specific opportunities to improve HHS programs and operations.

Safeguarding Public Health

HHS's 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 (e.g., routine screenings, vaccinations, and mental health and substance use disorder services), ensuring that medical products regulated by the Food and Drug Administration (FDA) are safe and effective, and working to identify and combat health disparities. To operate effective public health programs, the Department must ensure that its agencies coordinate with each other, as well as with partners at all levels of government.

Ensuring the Financial Integrity of HHS Programs

HHS is the largest civilian agency in the Federal government, with a $2.4 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. 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. Medicare and Medicaid are the Department's largest programs; funding for these programs (including State funding) represents 37 cents of every dollar spent on health care. Almost 140 million beneficiaries, or more than 40 percent of Americans, rely on these programs for their health insurance, including senior citizens, individuals with disabilities, low-income families and individuals, and patients with end-stage renal disease. CMS bears the responsibility at HHS for administering these programs. Medicare expenditures totaled $796 billion in 2019. The Federal Medicaid budget totaled $411.3 billion in FY 2019 (with an additional $17.5 billion for CHIP). As many providers faced fiscal uncertainty due to COVID-19, CMS took steps to provide increased flexibility and advance payments to mitigate the financial effects of the pandemic.

Delivering Value, Quality, and Improved Outcomes in Medicare and Medicaid

HHS continues to reform Medicare and Medicaid to promote quality, efficiency, and value of care. Changes affect virtually every type of health care service and come with an array of operational and program integrity challenges. The changes also offer opportunities for better health outcomes, better quality of care, lower costs, improved transparency and choices for consumers, and reduced administrative burden on providers.

Protecting the Health and Safety of HHS 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, who then claim reimbursement from Federal programs. Services include health care, education, child care, and even physical custody for select populations. Ensuring that intended beneficiaries receive appropriate services that meet standards for quality, are free from abuse or neglect, and are not exposed to infectious agents represents a major challenge for the Department. As the Department supports the current race to develop treatments for and immunizations to protect against COVID-19, there will be challenges to ensure equitable distribution of risks and benefits of participation in clinical trials, as well as access to and safety and efficacy of immunizations and treatments.

Harnessing Data To Improve Health and Well-Being of Individuals

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 the Department. The response to COVID-19 is directly dependent on data that HHS collects or generates. Ensuring that government officials, researchers, the public, and other stakeholders can access timely, accurate data is critical. Data that HHS generates or collects are used to support nearly all COVID-19 response efforts, including tracking spread within nursing facilities, allocating health care resources across the country, and distributing health care Provider Relief Funds.

Improving Collaboration To Better Serve Our Nation

HHS faces some of the largest and most complex issues that challenge our government and the Nation. These problems commonly transcend a single HHS program. Often, HHS's 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.

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