2021 Top Management & Performance Challenges Facing HHS

The 2021 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) that 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 challenges reflect overarching issues that affect multiple HHS programs and responsibilities. These are not the only challenges that confront HHS. 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. Pandemic response and recovery efforts have exacerbated the Department’s challenge to safeguard public health. With more than 730,000 deaths attributable to COVID-19 and more than 45 million cases of the disease in the United States as of October 28, 2021, HHS must act vigilantly to mitigate the loss of life and negative short- and long-term health consequences associated with COVID-19 while effectively operating a range of programs and services that are essential to protecting individuals and communities. This work includes effectively preparing for future emergencies while advancing response capabilities, ensuring that products regulated by the Food and Drug Administration (FDA) are safe and effective, and combating the opioid epidemic while helping ensure access to treatment. To operate effective public health programs, the Department must ensure that its OpDivs and StaffDivs coordinate efforts internally as well as with partners at all levels of government and other stakeholders.

Ensuring the Financial Integrity of HHS Programs

HHS is the largest civilian agency in the Federal government, with $2.8 trillion in budgetary resources. HHS’s Medicare program is the Nation’s largest health insurer by expenditures and handles more than 1 billion claims per year. Medicaid is the largest health insurer in terms of lives covered, with 81 million Medicaid beneficiaries and 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 41 cents of every dollar spent on health care annually in the United States. CMS’s Office of the Actuary estimates that Medicare expenditures totaled $915.4 billion and Medicaid expenditures totaled $682.7 billion in 2020.52, 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. 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. Reforms underway touch virtually every type of health care service and offer opportunities for better care and health outcomes, improved access and health equity, lower costs, more transparency and choices for consumers, and reduced administrative burden. Reforms also come with an array of operational and program integrity challenges.

Protecting the Health and Safety of HHS Beneficiaries

HHS programs provide critical services to diverse populations across a broad range of settings including hospitals, clinics, child care facilities, shelters, and beneficiaries’ own homes. Some services are directly provided by HHS personnel, some delivered via HHS grant programs, some delivered by contractors working for HHS, and others rendered by professionals of a beneficiary’s choosing who then claim reimbursements from Federal programs. Services include health care, education, child care, and, in limited circumstances, taking legal 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 Nation’s efforts to respond to and recover from the COVID-19 pandemic, there will be challenges to ensuring safety and quality for beneficiaries receiving all varieties of care and services.

Harnessing Data To Improve Health and Well-Being of Individuals

The Department continues to improve how it collects, manages, shares, and secures its data. Yet, HHS faces significant challenges to both protect data from persistent cybersecurity threats and improve how the Department and related entities share an increasingly large amount of critical data, including public health data. The demands of these dual challenges have been made readily apparent during the pandemic. Responding to COVID-19 has required HHS to collect and report a wide range of data on an unprecedented scale. At the same time, large-scale cybersecurity attacks such as the SolarWinds hack demonstrated the need to improve cybersecurity governmentwide. HHS will need to apply lessons learned during its pandemic response in order to sustain and accelerate its efforts to get the right information to the right people at the right time.

Improving Collaboration To Better Serve Our Nation

HHS faces some of the largest and most complex issues confronting 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. To achieve its mission, HHS needs to collaborate effectively across HHS programs and with 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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