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2019 State of the Department Address

Alex M. Azar II
HHS employees
February 22, 2019
Washington, D.C.

We already know that, in 2018, the results of our work were remarkable. This year, if we continue to focus on results, together we have even greater successes ahead of us.

Good morning everyone, and thank you so much for joining me here in the Humphrey Building or tuning in from around the country, or even around the world.

That’s right: Members of our HHS team are stationed all around the world. So at CDC Vietnam, it’s 10 PM, but I’m sure they’re tuning in!

I know it can be hard to step away from the day-to-day bustle here at the department, but it’s a useful exercise to pause every once in a while, and take stock of what we’ve accomplished together in the past year.

So first, I want to congratulate everyone on the remarkable accomplishments of this team over the past year—let’s give the whole HHS team a round of applause.

Certainly, we can’t be totally comprehensive today, but reviewing the results of our work is an important exercise for any team.

I’ll mention the four priorities I’ve laid out as secretary: lowering prescription drug prices, combating the opioid crisis, reforming the individual insurance market, and transforming our healthcare system to one that pays for value.

But I want to lay out our work together in the context of HHS’s five strategic goals from our 2018 strategic plan, organized and assembled by ASPE.

Those five goals also organize the HHS annual report we released today. Our five goals are:

Reforming, strengthening, and modernizing our healthcare system;

Protecting the health of Americans where they live, learn, work, and play;

Strengthening the economic and social well-being of Americans across their lifespan;

Fostering sound, sustained advances in the sciences, and

Promoting effective and efficient management and stewardship of the department.

It’s a mouthful, I realize—but it’s worth always remembering that the work of every single employee here at HHS advances one of those vital goals, and, in all likelihood, several of them at once.

I want to run through some greatest hits on each goal, every one of which has seen aggressive action and impressive results in 2018.

I’ll begin with our efforts to reform our healthcare system by bringing down the high price of prescription drugs. We took a historic amount of action in this area in 2018—and we saw historic results.

Last May, we released President Trump’s drug-pricing blueprint. It is a tremendous testament to the whole HHS team how much of that blueprint we marched through in just the first seven months following its release.

One goal of the blueprint was to increase competition. The past two years, FDA has been setting records for the number of low-cost generic drugs available, through relentless process improvements and new efforts under their Drug Competition Action Plan.

They set a fiscal-year record for most generics ever approved in FY 2017, and then they set another record in FY 2018.

We also saw competition supported by historic levels of new brand drugs, with a record 59 novel drugs or biologics approved.

These are remarkable achievements. Let’s have a hand for everyone on the HHS team who’s helped make it possible.

Take just one example of these new generics: This month, we approved a new complex generic inhaler that the manufacturer has indicated will come in at 70 percent less than the current brand-drug price. That is a remarkable achievement, with real impact on people’s lives, and our team here at HHS helped make it happen.

We’ve also taken historic steps to improve negotiation. The Center for Medicare and Medicaid Innovation put forth a model to save billions of dollars by securing for American patients a share of the discounts given to other countries for drugs covered by Medicare Part B, where we don’t negotiate today.

That was such a bold step that President Trump came here to the Humphrey Building to announce it—the President of the United States, at HHS, announcing a CMMI model. Then he went ahead and mentioned that work in the State of the Union. Not bad!

We also proposed the first-ever requirement to disclose drugs’ list prices in TV ads.

Two weeks ago, one major drug company announced it was going being including these prices voluntarily, before we’d even finalized the rule.

That’s just one example of how our policies are already beginning to change industry behavior. In 2018, for the first time in almost 50 years, the consumer inflation measure for prescription drug prices actually went negative.

We saw drug companies take substantially fewer price increases on brand drugs, and more price cuts on all kinds of drugs, after the release of the blueprint than in previous years.

Our vision for more affordable healthcare reaches well beyond prescription drugs.

Last year, we also rolled out a vision for value-based healthcare, a challenge that so many of us at the department have been working on for a long time.

We started with a particular focus on empowering patients as consumers, which requires transparency about price and quality. One first step, which took effect last month, was our requirement for hospitals to post machine-readable price lists on their websites.

Meanwhile, the Agency for Healthcare Research and Quality launched a competition to encourage the standardization of patient-reported outcomes, to help give patients a greater voice in their care.

Patients have also been the focus of the steps on health IT that CMS and our Office of the National Coordinator took in 2018. That work culminated in this month’s proposal to offer patients and providers new seamless, interoperable access to their health data.

A final piece of affordable healthcare is access to affordable insurance options. This past year, the national average benchmark premium on HealthCare.gov actually dropped for the first time, while the number of insurers on the exchange rose for the first time since 2015.

These results are thanks to hard work by everyone at CMS, and CCIIO in particular, who ran a virtually seamless customer experience and worked closely with states to bring down premiums.

At the same time the ACA market has stabilized, we have rolled out new options for consumers who may be priced out of ACA plans.

That included expanded access to short-term, limited duration insurance plans, Association Health Plans, and health reimbursement arrangements.

There are already at least 28 Association Health Plans on the market under our new rules, some covering tens or hundreds of thousands of Americans.

HHS also plays a more direct role in healthcare than just payments and insurance, supporting the provision of care through the Indian Health Service and HRSA’s community health centers.

In 2018, IHS created its first-ever Office of Quality, which reflects the need for a culture of continuous quality and safety improvement in our tribal health facilities. The Office of Quality will help address issues raised by CMS oversight and build the most productive, collaborative relationship possible between IHS and CMS.

HRSA’s community health centers play a key role not just in providing high-quality, affordable care to millions of Americans, but also in fighting infectious disease.

That’s a part of our second strategic goal: protecting the health and well-being of Americans.

HRSA and many of its health centers are home to the Ryan White HIV/AIDS program.

The share of Ryan White patients who have achieved viral suppression, meaning they can live long, healthy lives and pose virtually no risk of transmitting the disease, has now reached 85.9 percent—an all-time record.

The plan that President Trump has announced to end America’s HIV epidemic in ten years would simply not be possible without the achievements of the programs we already run, like Ryan White, and the scientific advances made at NIH, CDC, and FDA.

Every year, HHS also plays a role in fighting infectious disease abroad. This past year, CDC worked closely with the Democratic Republic of the Congo and the World Health Organization to respond to one of the most dangerous Ebola outbreaks in history. In fact, the work of many at CDC over the years has already strengthened the ability of the Congolese government to respond to outbreaks on its own.

HHS also responds to infectious diseases and other public health challenges when disaster strikes.

This past year, the U.S. Public Health Service Commissioned Corps deployed more than 1,000 officers, alongside personnel from the National Disaster Medical System and across HHS, to respond to hurricanes, wildfires, typhoons—even a volcanic eruption!

This past fall, some of these same Commissioned Corps officers and staff from the Assistant Secretary for Preparedness and Response received a historic honor for their response to 2017’s large hurricanes: the Department of Defense’s Humanitarian Service Medal, the first time HHS personnel have ever received this award for a large-scale deployment.

It’s not just infectious diseases or natural disasters that threaten our health and well-being, though. Sadly, substance abuse, and opioid abuse in particular, is one of the greatest health challenges we face.

President Trump has brought a new focus to this issue across the entire federal government, and we’ve seen results from that leadership.

One of the First Lady’s guests at the State of the Union a couple weeks ago was a young woman named Ashley, from Dayton, Ohio.

I met her last year when we visited Brigid’s Path, a clinic in Dayton that works with young mothers struggling with opioid addiction.

Her story is bracing. Late in her pregnancy, she got in a car crash on her way to buy drugs from a dealer. The crash sent her to the hospital, where her baby was born—alive, but dependent on opioids.

If Ashley hadn’t gone to the hospital that day, her doctors said, her baby probably would not have lived.

Today, she’s not just a State of the Union guest—she’s working, celebrating one year in recovery, and about to take custody of her child again. Our goal is to make sure every American struggling with addiction can become the next Ashley.

Think about all the ways we can help make this happen.

First, we need to connect people like Ashley to treatment.

In 2018, HHS put out historic levels of grant funding, more than $2 billion, to connect people struggling with addiction to high quality treatment options—with SAMHSA helping to put a special focus on medication-assisted treatment.

CMS also approved Substance Use Disorder demonstrations for Medicaid programs in 14 states, bringing the total number of states with demonstrations to 21.

These efforts to expand treatment are having results: Since January 2017, the number of patients receiving buprenorphine, one form of medication-assisted treatment, increased by 21 percent, while the number of prescriptions for naltrexone, another form of MAT, has increased by 47 percent.

Another key way to save lives is access to the overdose-reversing drug, naloxone. In the week following the Surgeon General’s April 2018 advisory on naloxone, we saw a record number of retail prescriptions for the drug. Overall since January 2017, the number of naloxone prescriptions dispensed monthly has increased by 338 percent.

We also have to think about how we got into the opioid crisis in the first place. When I was in Ohio, I heard from some young people whose addiction began with legal opioid prescriptions, for something like a sports injury.

The CDC is working with the Assistant Secretary for Health to update and expand our prescribing guidelines, which inform the everyday decisions clinicians make.

These guidelines and efforts to expand non-opioid pain treatment options are having a dramatic effect: Total opioid prescribing nationally is down 22 percent since January 2017.

The final result I’ll mention of our national effort on opioids is the most important.

In 2018, provisional drug overdose death counts provided by the CDC began to flatten and decline for the first time.

For years, all of the indicators in the opioid crisis were headed in the wrong direction.

Now, thanks not just to HHS but to so many Americans working on the ground, in their own communities, we are finally seeing the tide of this crisis begin to turn.

Tackling the opioid epidemic requires better integration of our efforts in both health and human services. That mindset is useful on a number of other challenges, too, and informs our third strategic goal, to strengthen the economic and social-wellbeing of Americans.

In 2018, CMS approved the first-ever state demonstrations to incentivize work and community engagement among certain adult Medicaid beneficiaries.

We know there is a strong connection between finding work and improving physical and mental health, and we want to pursue these goals in all our health and human services programs.

Last year, the Office of Child Support Enforcement at ACF issued guidance to states encouraging them to use grant funds to promote employment programs for noncustodial parents—an outcome that will be good for the parents paying child support, and good for the children and parents relying on that support.

ACF also plays an important role in taking care of unaccompanied alien children who arrive in the United States each year. We saw the number of these minors arriving nearly double from 29,000 in 2017 to 51,000 in 2018.

We are proud of the work that ACF’s Office of Refugee Resettlement does to ensure that we have high-quality facilities and high-quality care for these children—even when we see a large surge in arrivals.

Another key piece of HHS’s work is respecting the innate dignity and first freedoms of every American.

In 2018, our Office for Civil Rights launched a Conscience and Religious Freedom Division, the first time a federal office for civil rights has established such a division. There is no reason we cannot promote science and expand access to healthcare and human services while also protecting our first freedom, the right of conscience.

That brings me to our fourth strategic goal, advancing science and research. Our work here occurs at both a practical, translational level, and on the level of basic biomedical science.

On the practical level, 2018 saw the FDA establish a framework for collaboration with the Department of Defense to help better meet the unique health needs of America’s military personnel.

As just one example, FDA approved an auto-injector for the military as a countermeasure for nerve agent exposure—and they did it six months ahead of DoD’s product development schedule!

On the biomedical side, we’ve seen NIH make huge strides in our understanding of cancer. In 2018, as part of the Cancer Moonshot, we invested an additional $300 million to accelerate cancer research.

This builds on longstanding investments that are producing real discoveries. Last year saw results from an NIH study, the largest breast cancer treatment trial ever conducted, that can spare more than 65,000 women per year from undergoing unnecessary, toxic chemotherapy.

Further, as the President mentioned in the State of the Union address, the National Cancer Institute is now building a childhood cancer initiative that will gather as much data as we can to learn from the experience of every child who suffers from cancer.

In the same vein, this past May, NIH launched one of the most ambitious research efforts in American history, the All of Us Research Program. All of Us aims to engage 1 million volunteers in building a national database that accelerates health research and personalized medicine, while shining a special light on populations underrepresented in biomedical research. Over 186,000 individuals have already signed up.

We hope All of Us will transform the research landscape, but we’re also working to maximize the utility of the data we already have. In 2018, HHS took major strides toward the creation of a department-wide data strategy, an idea that came out of ReImagine HHS, the effort started in 2017 to improve departmental management. It is no exaggeration to say that, today, HHS is leading the federal government in our data efforts.

Individual Op Divs have upped their data game too: In 2018, for the first time, all 50 states contributed data to ACL’s National Adult Maltreatment Reporting System, which collects data on elder abuse and abuse of people with disabilities to inform policy that addresses and prevents these horrific crimes.

One key piece of departmental management is our work to update and reform our regulations.

In 2018, HHS generated more than $12 billion in savings from regulatory reform—more than half of the administration’s total reg reform savings. We’re a big agency—but we’re not more than half the government! That is truly an impressive result.

We also need to be good stewards of taxpayer dollars.

In 2018, HHS’s Office of Inspector General—and I—participated in the largest national Healthcare Fraud Takedown Day in history, charging over 600 individuals with participating in fraud schemes involving about $2 billion in losses to Medicare and Medicaid.

This complements the progress made at CMS, where the agency cut improper payments in Medicare and Medicaid by an estimated $4.6 billion in the last year.

We also saw advances in the management of the legal branches of HHS. The Office of Medicare Hearings and Appeals removed more than 224,000 appeals from its backlog in FY 2018, while the Departmental Appeals Board reduced its backlog by more than half.

HHS has stepped up its IT work as well, measured by what’s called the Federal IT Acquisition Reform Act, or FITARA. We’re now tied for the top agency in the FITARA rankings, getting a B+ grade in 2018.

There’s no grade inflation here, I assure you. We could do better, but this is a real B+, like we used to get in school. We had a D just a few years ago.

Last but not least, for the second straight year, HHS was ranked the best cabinet agency at which to work.

That is a credit to the work of so many in human resources and management to increase employee engagement.

We win plenty of awards, as the Deputy Secretary mentioned.

This year, HHS employees won three of the eight individual Service to America awards, or Sammies, given for exceptional accomplishments in federal service. The Sammies are often known as the Oscars for federal employees—or, alternatively, the Oscars for people who wear ID-card lanyards.

In closing, I want to mention a couple new initiatives that are aimed at making HHS a better place to work—part of a slew of ideas being worked on across the department.

I know there’s a lot of reporting done within HHS, including to the Office of the Secretary. A top-to-bottom review found that hundreds of pages of reports are being generated for the Office of the Secretary every week, often siloed off and containing the same information.

In conjunction with HHS’s Chief Technology Officer, we developed a new system, to be rolled out in the coming weeks, that will replace two of these reports that currently involve 7,500 hours of work a year. In the future, we plan to integrate even more reporting into this new system, freeing up staff from duplicative work and improving the flow of information across the department.

This winter, we’re also in the process of rolling out a new HHS Intranet for the Staff Divisions, which will be completed soon.

In May, we plan to roll out this Intranet to all of HHS, as a complement to the existing Op Div Intranets, eventually offering new internal communications tools as part a department-wide digital strategy.

We want to do everything we can to make HHS the best place to work. But the single best reason to work here is our mission: improving the health and well-being of every American.

I hope every accomplishment that I’ve shared today is a reminder of how important that mission is, and how all of us play a role in it.

This year, we have exciting possibilities on the horizon.

We will take major steps in transforming our health system to pay for value, rolling out new models that empower patients and pay for outcomes. We will continue to be vigilant about infectious disease threats abroad, including through addressing the massive humanitarian crisis in Venezuela, where HHS has already led efforts to gather international support.

We’ll be active on public health at home, which means redoubling our efforts on the opioid crisis and beginning the President’s plan to end the HIV epidemic, but also focusing on vaccine-preventable diseases like measles.

We’ll push ahead with research efforts like All of Us, and we’ll continue working toward making HHS the best managed department and best place to work in the federal government.

Together, as a team, we have plenty of challenges to tackle in 2019. It can sometimes be easy, in business, government, or anywhere else, to focus on the processes we perform, rather than on the results we generate.

I want to emphasize that this is a lesson straight from the top: President Trump is deeply appreciative of the work this department does, and supportive of our priorities.

He really cares about the work we do, and, like me, he cares about us delivering results for the American people.

We already know that, in 2018, the results of our work were remarkable. This year, if we continue to focus on results, together we have even greater successes ahead of us.

I look forward to working with all of you this year and in the years to come. Thank you for tuning in today, thank you for what you’ve done for the American people this year, and thank you for making HHS such a wonderful place to work.

Content created by Speechwriting and Editorial Division 
Content last reviewed on February 22, 2019