Goal 4: Increase Efficiency, Transparency, and Accountability of HHS Programs
As the largest grant-awarding agency in the Federal Government and the Nation’s largest health insurer, HHS places a high priority on ensuring the integrity of its investments. HHS manages several hundred programs in basic and applied science, public health, income support, child development, and health and social services, awarding approximately 90,000 grants annually. Its responsibilities are driven by complex scientific and technologic issues that require sophisticated analyses of exponentially growing amounts of information. Robust and secure information technology infrastructure and information management systems are required to support mission-critical activities, such as personalized medicine applicants and analysis of product marketing applications.
Promoting program integrity and increasing transparency of HHS’s efforts requires the expertise of staff across HHS, working both independently and in close collaboration. HHS provides ongoing training and guidance for staff who oversee grants and contracts, and uses established internal administrative procedures. HHS uses its grants management information system to report all grant award data across agencies, review program announcements, and review audits and resolution of grants audit findings.
HHS financial management systems work to ensure effective internal controls, timely and reliable financial and performance data for reporting, and system integration. As part of this effort, HHS maintains management systems, processes, and controls that ensure financial accountability; provide useful management information; and meet requirements of Federal laws, regulations, and guidance.
HHS also embraces the power of Open Government, recognizing that with openness comes responsibility and accountability for results. Through Open Government, HHS is promoting transparency, participation, and collaboration—vital enablers of success in the HHS mission to improve the health and well-being of all Americans.
HHS’s Open Government efforts will break new ground in enabling the public to give feedback to HHS programs. HHS can help stakeholders contribute knowledge and experience to help it do jobs better, and HHS can support new kinds of collaborative teamwork that will deliver better results for our citizens. HHS will move forward toward new strategies, new tools, and a new culture of public participation and collaboration in its affairs.
Planned evaluations of HHS activities in this goal include program integrity reviews of states’ Medicaid programs to ensure compliance with Federal program integrity regulations, provide technical assistance to state’s program integrity operations, and identify areas to improve effectiveness and efficiency. Further, HHS will continue to enter into contracts that support Medicaid integrity efforts and provide support and assistance to states through training and other educational programs. These evaluations will help to ensure that HHS knows how its program dollars are spent and that HHS regularly shares the findings with its partners, stakeholders, and the public.
HHS works to increase its efficiency, transparency, and accountability through the effort of every agency and office, including CMS, the Office of the Inspector General (OIG), and ASFR.
Managing more than $900 billion in public investments is an enormous responsibility—and an opportunity. Stewardship of Federal funds is more than just ensuring that resources are allocated and expended responsibly. If Federal investments are managed with integrity and vigilance, the benefit to the public is improved health and enhanced well-being.
Responsible stewardship of new resources involves allocating these resources in an effective way—and for activities that generate the highest benefits.
HHS has placed a strong emphasis on protecting program integrity and the well-being of program beneficiaries by identifying opportunities to improve program efficiency and effectiveness. HHS is making every effort to ensure that when it makes payments to individuals and businesses as program beneficiaries, grantees, or contractors, or on behalf of program beneficiaries, that the right recipient is receiving the right payment for the right reason at the right time. Internal controls and risk assessment activities are evolving and being strengthened across programs, including Medicare, Medicaid, Head Start, TANF, Low Income Home Energy Assistance Program (LIHEAP), foster care, and child care, to strengthen the integrity and accountability of payments.
The Secretary has identified program integrity, transparency, and accountability as key Strategic Initiatives.
All agencies and offices in HHS, including ACF, ASFR, CMS, HRSA, OMHA, and OIG are focused on ensuring the integrity of HHS programs, and is employing the following key strategies.
- Ensure that individuals and entities that seek to participate as providers and suppliers in federal healthcare programs understand, and agree to comply with, financial integrity standards before enrolling in those healthcare programs;
- Establish payment methodologies that are reasonable and responsive to changes in the marketplace;
- Assist healthcare providers and suppliers in adopting practices that promote compliance with program requirements, including quality and safety standards;
- Increase the identification and dissemination of best practices in internal controls to ensure that funds disbursed for health and human service programs are used for their intended purposes; and
- Work with states, localities, and grantees to strengthen the integrity and accountability of payments to health care and human service programs.
- Ensure continuous improvement through the collection and evaluation of public/stakeholder feedback.
HHS strives to allocate resources in the most efficient manner possible by minimizing inappropriate payments, targeting emerging fraud schemes by provider and type of service, and establishing safeguards to correct programmatic vulnerabilities. Reducing fraud, waste, and abuse in HHS program spending for health care, social services, and scientific research is a top priority for the Department. These activities are not one-time efforts to reduce fraud and improper payments; rather, the activities reflect our long-term commitment to continuously reduce system waste and inefficiencies.
HHS is strengthening efforts to identify and eliminate improper payments. Internal controls and other risk assessment activities are focused on identifying and eliminating systemic weaknesses that lead to erroneous payments. HHS investments in cutting-edge technology and data mining technologies will allow for the analysis of potential fraud with unprecedented speed and efficiency. HHS will receive snapshots of fraudulent claims activity in real time, and complete in a matter of days analyses that previously took months or years.
HHS efforts to combat healthcare fraud, waste, and abuse include provider education, data analysis, audits, investigations, and enforcement. In addition, HHS is working in collaboration with the Department of Justice through the establishment and operation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) task force. CMS works with OIG and the U.S. Department of Justice on this joint effort. To date, the HEAT task force has conducted concentrated investigations in Baton Rouge, Brooklyn, Detroit, Houston, Los Angeles, Tampa, and Miami.
HHS is monitoring and assisting the efforts of states, territories, and tribes to prevent and control error and improper payments in Head Start, TANF, LIHEAP, foster care, and child care. For example, TANF agencies use employment data from the National Directory of New Hires (NDNH) to identify unreported and underreported income, thereby reducing improper assistance payments. In addition, ACF uses Title IV-E Foster Care Eligibility Reviews to ensure that children for whom Federal foster care payments are claimed are program eligible and are placed with eligible foster care providers. In addition to CMS and ACF, every agency and office in the Department is focused on fighting fraud and eliminating abuse and improper payments through a number of key strategies described below.
- Monitor programs vigilantly, pursue prosecution and punishment for those who commit fraud, and remedy program vulnerabilities;
- Monitor grantees and contractors vigilantly, using existing flexibilities to remedy performance risk, ensuring federal funds are awarded only to responsible entities and taking action to exclude those known to commit fraud;
- Require designated providers and suppliers to implement compliance programs and to undergo screening, including advanced screening for certain types of high-risk providers and suppliers;
- Use data to develop better predictive indicators, restructure automated edits, and enhance medical record review efforts in Medicare to help stop known schemes before payment is made;
- Increase coordination among federal departments, including increased health-related data sharing among agencies;
- Hold states accountable for producing results and implementing controls to address risks and errors, and help and enable states to become more effective in ensuring the integrity of their programs; and
- Disseminate best practices in preventing, measuring, or reducing improper payments.
Transparency and data sharing are of fundamental importance to HHS and its ability to achieve its mission. HHS’s vast stores of data are a remarkable national resource that can be used to help citizens better understand what the Department does and hold the public and private sectors accountable. HHS data and information is used to increase awareness of health and human service issues and generate insights into how to improve health and well-being. By making data and information more useful and more available, HHS promotes public and private sector innovation and action and provides the basis for new products and services that can benefit the Americans.
Several core principles guide HHS’s plan for leveraging its data, including publishing more Government information online in ways that are easily accessible and usable; developing and disseminating accurate, high-quality, and timely information; fostering the public’s use of the information HHS provides; and advancing a culture of data sharing at HHS.
HHS is strongly committed to data security and the protection of personal privacy and confidentiality as a fundamental principle governing the collection and use of data. HHS protects the confidentiality of individually identifiable information in all public data releases, including publication of datasets on the Web. As new approaches evolve, HHS will incorporate them into its data release policies.
By employing these processes for data prioritization, release, and monitoring, HHS intends to increase the value derived from its information resources in several ways. Consumers will be able to access information and benefit directly from using it personally. Public administrators may use information resources to inform service delivery and improve customer satisfaction.
Information resources also will bring new transparency to health care to help spark action to improve performance; help those discovering and applying scientific knowledge to locate, combine, and share potentially relevant information across disciplines to accelerate progress; and enhance entrepreneurial value, catalyzing the development of innovative products and services that benefit the public and, in the process of doing so, fuel the private sector’s economic growth.
One particularly innovative project, launched by HHS in 2010, is the Community Health Data Initiative. The project will develop an integrated Web-based, user-friendly, relational database and a query system of national-, state-, and local-level health indicators, including health outcomes and health determinants, along with evidence-based public health or policy interventions. Database users will be able to compare their indicators, as data permit, with those of other groups of interest, either by geography or by population characteristics, such as age, income, sex, race, and ethnicity. Users will access multiple options for selecting and viewing data. Moreover, the database will grant the public open access with feature sets designed and optimized for distinct user populations.
- Coordinate HHS data collection and analysis activities, and ensure effective long-range planning for surveys and other investments in major data collection;
- Proactively identify opportunities for transparency, data sharing, and dissemination through electronic posting of datasets on http://www.data.gov;
- Include staff with data expertise on Strategic Initiatives and cross-departmental priorities to provide knowledge of HHS data; assess data needs, gaps, and opportunities; improve data quality; develop plans and recommendations for evaluation and performance information; and identify ways to share existing and new data with the public and key audiences in ways that adhere to transparency principles and advance the initiative;
- Explore effective ways to gather, share, and analyze data from numerically smaller populations, such as American Indian and Alaska Native(AI/AN), Asian and Pacific Islander groups, and others, while maintaining the highest standards of data confidentiality;
- Engage in a proactive new program of monitoring, stimulating, and incorporating innovative and beneficial uses of HHS data through systematic dialogue with key stakeholder groups;
- Expand the focus of CMS’s data environment from claims processing to state-of-the-art data analysis and information sharing;
- Establish governance within Freedom of Information Act (FOIA) operations to promote the proactive publishing of information and include FOIA officers across the Department in transparency and data-sharing planning activities;
- Implement the Community Health Data Initiative to provide multiple methods for selecting and viewing data and to allow open, fully accessible public access; and
- Use Data 2020 to track progress toward achieving the Nation’s health objectives contained in Healthy People 2020.
Executive Order 13514, “Federal Leadership in Environmental, Energy, and Economic Performance,” promotes sustainability in the Federal Government and sets priorities for the reduction of greenhouse gas emissions. Sustainability is integral to the HHS mission. Conducting our activities in a sustainable manner will benefit Americans today as well as secure the health and well-being of future generations of Americans. In carrying out the Executive Order, HHS will be a leader in promoting the co-benefits of sustainability to health and well-being.
HHS efforts to reduce greenhouse gas emissions will protect our environment and the public’s health. Our operations produce greenhouse gases that are associated with negative health impacts resulting from alterations of our climate, ecosystems, food and water supplies, and other aspects of the physical environment. These gases and other air, water, and land contaminants are generated from energy production and use, employee travel and commuting, facility construction and maintenance, and mission activities, such as patient care and laboratory research.
By helping to control greenhouse gas emissions, HHS will reduce other releases that directly impact health. For example, mercury released with greenhouse gases from the combustion of fossil fuels in power plants may contribute to the reduced cognitive ability of children in surrounding areas. Research findings have also shown that air pollution is associated with higher rates of asthma and other allergic responses, morbidity from cardiopulmonary and respiratory disease, and other adverse health outcomes.
By conserving resources through sustainable purchasing operations, management of real property and recapitalization of building infrastructure and waste management positions, HHS can meet its mission while managing costs. Operational efficiencies, such as reductions in paper, water, and energy use, allow more resources to be devoted to mission-specific purposes. Managing waste reduces the level of toxins that enter water sources and food chains. Reuse and recycling efforts can reduce the amount of land devoted to landfills and raw material extraction. Protecting plant and animal species ensures biodiversity, maintains delicate ecosystems, and offers the potential to use these as sources of new medical treatments.
Sustainable facilities improve the health of our staff, patients, and other building occupants. Worker absenteeism, acute disease, and chronic diseases are associated with stressors and pollutants in the indoor environment. Ventilation improvements and green cleaning and pest management practices can reduce the adverse health effects of toxic chemicals in the environment.
The Senior Sustainability Officer in the Office of the Secretary helps ensure that HHS operations promote sustainability and comply with Executive Order 13514. However, meeting our sustainability goals is a shared responsibility, underpinning the functions of agencies and offices throughout HHS. It is also the responsibility of the individuals directly employed by HHS as well as its grantees and contractors.
To integrate sustainability into the HHS mission and to implement Executive Order 13514, HHS agencies and offices will employ the following key strategies.
- Reduce energy consumption and greenhouse gas emissions through sustainable management of energy use and other activities;
- Conserve resources through sustainable purchasing, operations, and waste management;
- Promote and protect human and environmental health through sustainability planning and operations;
- Lead, communicate, and engage the community on the benefits of sustainability in all policies and actions; and
- Support research on the relationship between sustainability and human health and well-being.
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