tem should coordinate and integrate existing data collection efforts—such as those of the National Center for Health Statistics—and minimize creation of new ones. It should provide actionable feedback that would guide management decisions and facilitate preparation of an annual “State of the Nation’s Health” report to Congress.

The committee determined that increased congressional involvement in HHS management and operations has hindered the department’s flexibility. For example, during the past two decades, Congress has acted 125 times to give FDA increased regulatory responsibilities, but without providing the additional resources needed to meet them. Congressional responsibility and oversight for HHS are scattered across 12 Senate and House committees and six subcommittees, which hampers the department’s coherence.

Greater management flexibility for the secretary is essential to improving the value obtained from HHS programs. With increased flexibility, the secretary could, for example, do the following:

  • Rationalize Medicare and Medicaid reimbursement, in order to improve outcomes of care and produce savings.

  • Combat fraud and abuse more effectively and recoup billions of dollars in improper payments.

  • Make HHS programs more transparent and consistent across federal regions.

One way to provide greater flexibility would be to create a strategic initiative fund, drawn from the budgets of HHS agencies. Similar to the Department of Defense’s Defense Advanced Research Projects Agency (DARPA) and the NIH common fund, this fund would allow the development of cross-agency and cross-departmental initiatives, as well as facilitate timely responses to public health threats.

Underlying the development of all of the committee’s preceding recommendations is the recognition that an updated and streamlined relationship is needed between Congress and the department. Under this “new compact,” HHS would provide greater accountability in exchange for more flexibility. The new compact would allow HHS and its future secretaries to achieve higher performance and provide more value to Americans, while improving Congress’s ability to monitor the department’s progress. In this way, a revitalized Department of Health and Human Services would be much better positioned to meet the nation’s twenty-first century health care challenges.

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