2022 Top Management & Performance Challenges Facing HHS

The 2022 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. In selecting these TMCs, OIG considered our oversight, enforcement, data analytics, and risk analysis work, as well as Department information and developments in law and HHS’s responsibilities.

1. Safeguarding Public Health

Outbreaks of COVID-19 and monkeypox in 2020–22 tested the Department’s capacity to safeguard public health. As of October 4, 2022, the United States had reported more than 96.25 million cases of COVID-19, losing more than 1.05 million people to the disease, and had confirmed more than 26,194 cases of monkeypox. In addition to infectious diseases, the United States continues to experience a variety of emergencies that require Federal assistance due to hurricanes, extreme heat, flooding, and wildfires. HHS must be able to foresee and combat major outbreaks and provide public health and medical emergency assistance 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 mental health and drug overdose crises

2. Ensuring the Financial Integrity of HHS Programs

HHS is the largest civilian agency in the Federal government, with $2.9 trillion in budgetary resources. Sound stewardship that ensures the transparency and accountability of HHS funds is paramount to making sure people served by HHS and the American public benefit from this substantial financial investment.

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 nearly 89 million individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) as of May 2022. Spending for the Medicare and Medicaid programs (including State spending) represents 38 cents of every dollar spent on health care annually in the United States. Medicare expenditures totaled $857.1 billion and Medicaid expenditures totaled $521.8 billion in 2021. HHS is the largest grantmaking and second-largest contracting agency in the Federal government. In FY 2021, HHS awarded $236.4 billion in grants (excluding CMS grants) and $38.9 billion in contracts.

3. Delivering Value, Quality, and Improved Outcomes in CMS Programs

CMS is tasked with administering the two largest Federal health care programs, Medicare and Medicaid, as well as CHIP and the Health Insurance Marketplaces. More than 147 million people (43 percent of Americans) rely on Medicare and Medicaid for their health insurance including senior citizens, individuals with disabilities, low-income families and individuals, and individuals with end-stage renal disease.

Effectively and efficiently managing this complex suite of programs is a top HHS challenge. These programs use multiple delivery models (including FFS, managed care, and value-based care); cover a broad array of health conditions, providers, services, settings, and insurance plans; and operate pursuant to intricate statutory directives and regulatory schemes. Spending on these programs is massive, totaling $1.3 trillion in FY 2021.

4. Safeguarding the Well-Being of HHS Beneficiaries

HHS programs provide critical services to diverse populations across a broad range of settings including hospitals, clinics, child care facilities, shelters, nursing homes, and peoples’ own homes. Services are directly provided by HHS personnel, delivered via HHS grant programs, delivered by contractors supporting HHS, or rendered by professionals chosen by individuals 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. This imperative is particularly pronounced for nursing home care that serves many Americans whose health is most fragile. 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.

5.Harnessing and Protecting Data and Technology To Improve the Health and Well-Being of Individuals

The Department continues to improve how it collects, manages, shares, and secures its data. In parallel, HHS is refining its approach to influence and shape how other entities use technology. Yet HHS faces significant challenges to both protect data and technology from persistent cybersecurity threats and improve how the Department and related entities share large amounts of critical data from disparate sources, including public health data, on an unprecedented scale. The importance of managing these challenges is highlighted by critical issues such as addressing inequities across health and human service programs, which often requires foundational improvements to data collection and analysis to better understand the effects on disadvantaged individuals and communities. Continued modernization of HHS data and technology capabilities is needed for HHS and its divisions to fulfill their missions, improve situational awareness, and better prepare for future public health threats and emergencies.

6. Strengthening Coordination for Better Programs and Services

The importance of HHS’s mission and the breadth of its programs and authorities put the Department at the center of some of the largest and most complex problems facing the Nation. To solve these problems—and address issues on the horizon—HHS needs to coordinate, collaborate, and communicate effectively across HHS programs and with other Federal agencies as well as outside the Federal Government with Tribal, State, and local Governments, international entities, industry, and other stakeholders.

Strengthening HHS’s coordination, collaboration, and communication can help Americans receive more efficient, higher quality health programs and human services and benefit from greater advances in the sciences underlying them. Interagency efforts led by the Department such as the HHS Task Force to Prevent Human Trafficking and the Behavioral Health Coordinating Council provide opportunities for HHS programs to work more efficiently and in closer alignment.

---