Top 10 challenges facing HHS

Overview:

One of the top challenges facing HHS in 2015 will be the management of the health insurance exchanges erected under the Affordable Care Act, according to an Office of Inspector Generals report. The annual summary highlights the most significant management and performance challenges HHS has faced in 2014 and will continue to address in 2015. These are the top 10 challenges identified by OIG:

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10) Ensuring the safety of food, drugs and medical devices

OIG has revealed weaknesses in FDA's ability to adequately oversee the safety of drugs, biologics, medical devices, and food. It has also revealed failures by industry participants to follow processes designed to ensure the safety and efficacy of these FDA-regulated products. Challenges that continue to face HHS and FDA include the safety of imported drugs, the distribution of unapproved drugs, off-label use and promotion of drug and devices, and the safety and efficacy of compounded drugs.

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9) Protecting HHS grants and contract funds from fraud, waste and abuse

HHS is the largest grant-making organization in the federal government and the third largest contracting agency in the federal government. The Government Accountability Office and OIG both have identified weaknesses in HHS contracting processes and contract management throughout the Department. For example, the OIG report suggests HHS could greatly improve its contractor performance monitoring and needs to implement a program to actively pursue fraud under the Program Fraud Civil Remedies Act.

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8) Ensuring effective financial and administrative management

Responsible stewardship of HHS programs is a challenge in and of itself. Underpinning such stewardship, the OIG says, should be a financial management and administrative infrastructure that employs appropriate internal controls to minimize risk to the programs and safeguard resources. HHs has been taking steps to address outstanding financial management challenges, including financial audits. It has also scheduled an upgrade of its accounting systems, expected to be completed in 2016.

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7) Effectively operating public health and human services programs to best serve program beneficiaries

HHS funds and operates public health and human services programs that promote health and economic and social well-being. Many of these programs target vulnerable populations. Effective management of these programs is essential to ensure that they achieve their goals and best serve the programs' intended beneficiaries, the OIG report says. Key challenges include (1) ensuring effective preparedness and response to current and future public health emergencies, (2) protecting the health and safety of vulnerable populations, and (3) ensuring access for intended beneficiaries and delivery of quality services.

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6) The meaningful and secure exchange and use of electronic health information

The health care system increasingly relies on health information technology and the electronic exchange and use of health information, including electronic health records. While these new technologies offer opportunities for improved patient care, more efficient practice management and improved overall public health, the OIG says challenges also exist. They include ensuring the health data is accurate, reliable and protected from misuse.

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5) Ensuring quality in nursing home, hospice and home- and community-based care

As the median age of Americans continues to rise and as more Americans live with chronic medical conditions, HHS faces challenges in ensuring that beneficiaries who require nursing home, hospice, or home- and community-based services (HCBS) receive high quality care, the OIG says. HHS should continue to prioritize quality of nursing home, hospice, and HCBS, OIG says, adding recommendations such as monitoring how often nursing home residents are hospitalized and developing resources to help nursing home staff reduce the incidence of adverse events.

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4) Fighting waste and fraud and promoting value in Medicare parts A and B

Waste in health care programs is a multi-dimensional problem. Key areas of focus for reducing waste in Medicare Parts A and B include reducing improper payments, fighting fraud, fostering economical payment policies and transitioning from volume to value in health care, the OIG report says. HHS faces challenges and opportunities in each of these areas, it adds.

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3) Protecting an expanding Medicaid program from fraud, waste and abuse

As of August 2014, CMS reported that enrollment in Medicaid and the Children's Health Insurance Program had increased by 8.7 million people since individuals became eligible to apply under the ACAs expanded eligibility criteria in October 2013. In addition to facing the challenges in implementing expanded eligibility, Medicaid programs face long-standing program integrity challenges, including improving the effectiveness of Medicaid data; preventing and addressing fraud, waste and abuse; ensuring access to care; and curbing state Medicaid policies that inflate federal costs.

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2) Ensuring appropriate use of prescription drugs in Medicare and Medicaid

CMS provides prescription drug coverage for 37.4 million Medicare beneficiaries through Part D and 59.4 million Medicaid beneficiaries. Maintaining the integrity of these two programs is critical to ensuring patient safety; safeguarding the quality of care; protecting the programs from fraud, waste and abuse; and protecting taxpayer dollars, the OIG report says. In both programs, OIG has uncovered improper and potentially harmful prescribing practices, pharmacies billing for drugs not dispensed and diversion of prescription drugs.

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1) Insurance exchanges

The marketplaces erected under the ACA were among the most significant challenges for HHS in fiscal year 2014 and will continue to present a top management and performance challenge in fiscal year 2015, OIG says. Key among the challenges will be ensuring accurate eligibility determinations; processing enrollments, re-enrollments and qualifying life change events; and communicating timely and accurate information to health insurance issuers and consumers.

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