Share your ideas on Leadership and Governance
How can Open Government efforts be led and managed at HHS on an ongoing basis – and how HHS incorporate these efforts into the fabric of HHS governance and operations? (Example: changes in current HHS practices and policies, etc.)
I think the ideas presented here have been good, for the most part. Nobody's plan is perfect, but I think we could have some improvement in the nation if the government would listen to the common people.
not knowing current HHS practices & policies in any detail makes an informed comment difficult, if not impossible; would it be more worthwhile to set forth such P&Ps as may be in Q & ask comments re them?
HealthGrades relies on access to a number of data sets to accomplish its mission of Guiding America to Better Healthcare. The federal government is an important partner, allowing HealthGrades to purchase or access data that is then processed through HealthGrades filters and equations and then provided free to patients and consumers seeking health care providers. The end product is easily accessible and interpretable information about hospital, physician and nursing home characteristics and performance. Our studies have shown there can be major differences among providers. For example, across 17 common procedures and diagnoses, patients admitted to top-performing hospitals have a 72% lower chance of dying than if they were admitted to the worst performing hospitals, according to HealthGrades Twelfth Annual Study of Hospital Quality released last fall. As comprehensive as the data is today, there are still some important gaps that can be filled to provide patients with more insightful and actionable information. On behalf of the 8 million patients who visit HealthGrades.com each month to research health care providers, we have a specific recommendation for HHS to consider within its open government plan. LEADERSHIP AND GOVERNANCE Modifying the Usage Terms for Healthcare Cost and Utilization Project (HCUP) Data HealthGrades believes that full transparency can be advanced by making the majority of the HCUP information available to the public under more flexible usage terms. HCUP data includes information not available in other data sets, including all-payer data for most states pediatric information, emergency room visit information and data from ambulatory surgery databases. Of particular interest is increased usage flexibility for the following data sets: a) The Nationwide Inpatient Sample (NIS) with inpatient data from a national sample of over 1,000 hospitals. b) The Kids' Inpatient Database (KID) is a nationwide sample of pediatric inpatient discharges. c) The Nationwide Emergency Department Sample (NEDS) is a database that yields national estimates of emergency department (ED) visits. d) The State Inpatient Databases (SID) contain the universe of inpatient discharge abstracts from participating states. e) The State Ambulatory Surgery Databases (SASD) contain data from ambulatory care encounters from hospital-affiliated and sometimes freestanding ambulatory surgery sites. f) The State Emergency Department Databases (SEDD) contain data from hospital-affiliated emergency departments for visits that do not result in hospitalizations. Although HCUP data is currently available, the user agreement and data use policy is overly restrictive, prohibiting disclosure or identification of the individual institutions providing information. To continue to innovate and provide more information to the general public, HealthGrades recommends a review of the current data use policy to allow for identification of the individual hospitals and other institutions. Why is this important to patients? While Medicare represents a large portion of US hospitalizations, many patients are not yet of Medicare eligibility, but still in need of finding the best hospital. Not all states provide and/or collect all-payer hospital discharge information. As a result, the under 65 year old American does not have equal access to robust hospital quality information as compared to their Medicare fee-for-service counterparts.
The HHS has to become an effective steward of the health system. To do this, it should have a core objective to enact good governance or participatory and transparent processes, which is aligned with the Open Government initiative. In health systems, health systems literature (Travis et al. 2003)* has defined six domains within which stewardship can be enacted: (i) the generation of intelligence; (ii) formulating strategic policy framework; (iii) ensuring tools for implementation: powers, incentives, and sanctions; iv) building coalitions and/or partnerships; (v) ensuring a fit between policy objectives and organizational structure and culture; and, finally, (vi) Ensuring accountability. This last one is important to the Open Government initiative, in particular because it includes ensuring oversight and accountability of ALL the actors involved in a whole health system (including public, private and voluntary sectors as well as all functions of a health system such as financing and resource generation and considering all levels of government within the health system). It is the responsibility of the primary steward of the health system (that is in the case of the US, the HHS) to ensure that all health system actors (public, private, providers, payer, producers of other resources) are held accountable for their actions and inactions. This accountability is to the population creates a way of balancing the powers accorded directly and indirectly by the population to other health system actors. It helps to detect and therefore reduce waste or other misuse of resources, malpractice, or negligence. Importantly, it involves ensuring that mechanisms for accountability are fair and do not exclude particular groups. There are a variety of potential instruments or mechanisms (that are political, bureaucratic, technical financial and the media) that exist to help ensure accountability. There are also a number of health system specific procedures and mechanisms for accountability (including disciplinary procedures for doctors). As the ultimate steward, the HHS is responsible for ensuring that these tools and mechanisms as well as the necessary intelligence for their use are in place and can be implemented. Some of the commonly cited markers of strong accountability include (Travis et al. 2003)*: (i) the existence of rules about publishing plans, reports codes of conduct, financial accounts, fee schedules, etc.; (ii) their actual publication, availability, and wide dissemination in a comprehensible form; (iii) existence of independent watch-dog committeesâ€”political and administrativeâ€”with oversight powers: facility boards, health authority committees, e.g. ombudsman, audit commissions, parliamentary committees; (iv) access to political representatives; (v) operation of self-audit, e.g. through professional bodies; (vi) operation of other sorts of NGOs, representing different interest groups (both user and producers or providers); (vii)through the existence of a free popular and scientific press. Given the sheer number of these instruments and mechanisms, all of which vary in effectiveness, the HHS would need to devise a plan for accountability that is coherent with the Open Government initiative and that contains the detailed instruments and mechanisms that best capture accountability in the current context of the US health system as well as the guidelines for their execution. *Travis et al. (2003) Towards better stewardship: concepts and critical issues, IN: Health Systems Performance Assessment, WHO: Geneva.
Government needs to be able to conduct better consumer research so that it can better serve information consumers.
SUBJECT: Request feedback on question, Should you put more political capital in Open Government? Dear Secretary Sebelius, President Obama's Open Government Initiative stands as the most important government reform and most important public agenda item of our times. Unequivocally, investing much more political capital to advance Open Government would undercut Washington partisanship, restore the people’s business and trust, increase the Obama Administration's popularity and advance the President's public policy agenda. Fact: The U.S. Congress and federal agencies share unprecedented challenges in the effective development and efficient implementation of policy. As you know, political gamesmanship, disproportionate political influence, misaligned technology and ingrained procedures hinder at the root the ability to govern—to serve the public interest. Therefore, I invite you or your team to discuss 4 recommendations guided by a strategy: 1. Most publicly, urge President Obama to encourage all Americans to participate in the Initiative, using the Internet and national television. 2. In next budget, urge the President to recommend substantial federal dollars toward Open Government to both support technological and human resources. 3. Urge the President to establish a quarterly schedule of professionally facilitated meetings for increasing congressional comity and collaboration informed by the public’s consensus. 4. Mobilize civil society to clarify public will through deliberative and collaborative democracy in web 2.0, which includes urging the President to empower 'Organizing for America' with community organizers in every community to connect the public’s values, preferences (in policy trade-offs) to political will per policy initiative. No steps could be more critical to strengthen national representation, governance, justice or security. Our generation seeks not the fight of political messaging, but rather the right action of servant leadership that empowers the public in a partnership of governance. To remake American government, we must first remake Washington. It’s possible; I can prove it. Yours respectfully, Alexander Moll cc. Mr. Todd Park, CTO HHS