Sunday, December 14, 2008

A Crisis-Driven Reorganization of Health and Human Services?

Remember when, in response to a large crisis, the Federal government reorganized over 20 separate agencies into a new Department called ‘Homeland Security?’ How about the recent meltdown-driven foray of the U.S. government into banking and insurance? Now that there is growing consensus that there is a healthcare crisis, think the Department of Health and Human Services (HHS) will go unchanged? How can Congress resist?

And here's its cover for it to do something. The Institute of Medicine has released a report to Congress at the request of the House Committee on Oversight and Government Reform. Recall that HHS is a cabinet level Department that includes not only Medicare and Medicaid, but the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control, the Indian Health Service, the Agency for Healthcare Research and Quality (AHRQ) and a host of others. It occupies about a quarter of the entire Federal budget. Think the one-time $700 billion bailout is a lot of money? That’s HHS’ yearly budget. Given the coming Administration’s appetite for ‘change’ and the leading role of HHS in leading that change, the IOM report could catalyze crisis-style reorganization the Department.

You can access a ‘brief’ of the IOM report here. That’s free. For a full report, you’ll need to go here. That's not free, but the DMCB suspects members of Congress won’t need to pay for it.

Here’s a quick summary of the brief for you.

HHS needs to define a modern ‘vision, mission and goals’ to help persons inside and outside of the Department to understand its work. The IOM recommends the number of individual department heads within HHS be reduced and that the remainder be ‘re-aligned’ to fulfill the new mission and goals. In addition, the office of the Surgeon General needs to be revitalized and AHRQ needs more dependable budgeting. When there is overlap with outside Federal agencies (an example being food safety), it should be brought entirely within HHS. HHS also needs to begin studying and reporting on the comparative effectiveness of medical interventions and procedures. It should also invest in its own workforce recruitment and professional development. Congress should increase HHS’ accountability by getting regular reports but allow greater flexibility to fulfill a ‘new compact.’

The Disease Management Care Blog likes what it’s reading. If that sprawling bureaucracy known as HHS can be even slightly more efficient, mission driven, attentive to outcomes and modeled after entities in the private sector, patients and their providers might be better off for it. Of course, the devil is in the details of the enabling legislation. Let’s hope that Congress follows through on the IOM Report.

No comments: