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Index
A
Accountability at HHS.
See also Goals and goal setting by HHS
budget allocation, 129 n.2
compact with Congress for, 5, 17, 18, 139, 141-144
creating effective systems, 132-134
current departmental efforts, 127-131
data collection and information system, 10, 16-17, 18-19, 47, 102, 125-126, 134-140
defined, 126-127
flexibility in management and, 5, 33, 139-144
incentives for good performance, 133
leadership terms and, 67
leading health indicators, 129
measuring and evaluating value 74, 97-98, 127, 134-138
performance assessment systems, 127-131, 132
performance improvement plans, 131
program implementation and results, 19, 48, 126, 132, 173
ratings, 130-131
reorganization and, 194-195
reporting systems, 17, 19, 126, 137-139
“State of the Nation’s Health” report to Congress, 17, 19, 126, 137-138
surgeon general’s role, 137-138
systems, 131, 132-134
tenure of secretary and, 133
workforce shortages and, 111
Administration for Children and Families (ACF), 23, 28, 165 166, 216-217
Administration on Aging (AoA), 23, 28, 71, 165, 166, 217, 224, 226, 242
African Americans, 14, 75, 116, 120
Agency for Healthcare Research and Quality (AHRQ)
budget/funding, 8, 10, 28, 29, 35, 57, 77, 89, 96, 152, 172
comparative effectiveness research, 89 n.2, 96, 187, 190, 229-231, 257
data collection and sharing, 8, 11, 51, 187, 190, 228-229
director’s term and selection process, 56
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mission and responsibilities, 8, 77, 166, 229
organizational structure, 26, 89 n.2, 165, 214, 218
origin, 229
statutory requirements and constraints, 89 n.2, 218-219, 228-231
Agency for Toxic Substances and Disease Registry (ATSDR), 26, 29, 165, 166, 223-224, 249-250
Alignment.
See also Organizational structure of HHS;
Structure of HHS
defined, 59
Alzheimer’s disease, 73, 242
American Indians and Alaska Natives, 59, 167, 217.
See also Indian Health Service
Amyotrophic lateral sclerosis, 73
Asian Americans, 14, 116
Assistant secretary for health (ASH), 26, 42, 47, 61, 62, 64, 165, 205, 214, 224, 227, 250
Association of State and Territorial Health Officials, 118
Autism, 73, 237
B
Baby boom generation, 1, 21, 109, 113 n.4, 134, 224
Balanced Scorecard, 132
Beering, Steven, 121
Best Pharmaceuticals for Children Act, 220
Biomedical research, 73, 74
Bioterrorism, 1, 41, 102
Budget for HHS, 1.
See also individual agencies
continuing resolutions, 76
departments compared, 21, 22
discretionary, 3, 30, 46, 143-144
distribution across agencies and programs, 27, 28
predictability across Public Health Service agencies, 48
President’s 2009 requests, 14, 21, 28, 29-30, 76, 117, 129 n.2
research funding, 76-77
splintered appropriations and earmarks, 5, 141
strategic initiative fund, 17, 19, 37, 126, 143, 144, 173
Bureau of Labor Statistics, 120
C
Carmona, Richard, 64, 74-75
Center for Comparative Effectiveness Research, 89 n.2
Center for Faith-Based and Community Initiatives, 60
Center for Food Safety and Applied Nutrition, 78-79
Center for Veterinary Medicine, 76-79
Centers for Disease Control and Prevention
budget allocations, 10, 28, 29, 35, 48, 57, 76, 77, 152, 172
data collection and sharing, 11, 51, 187, 190, 262
director’s term and selection process, 9, 34-35, 56, 62, 66, 68, 94, 171-172
food safety functions, 79-80, 82
mission and responsibilities, 7, 166
organizational structure, 26, 62, 165, 214, 219
origin, 27, 219
science base and scientific credibility, 75
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statutory requirements and constraints, 215-216, 219, 227, 231-240, 247, 256, 261
workforce, 109, 111
Centers for Medicare and Medicaid Services (CMS)
administrator selection and term, 60, 205
budget allocation, 28, 29, 69
data collection and sharing, 11, 94, 135, 187, 190
graduate medical education funding, 115
health care expenditures, 10, 29, 60, 90, 91, 92, 93 n.4, 185 n.14, 189 n.16
mission, 166
organizational structure, 62, 165
oversight, 199
role in evidence-based care and HTA issues, 11, 88-89, 94, 96-97, 135, 141, 187, 190
reimbursement policies, 10, 35, 76, 88, 97, 115, 141 n.9, 185, 186
statutory requirements and restrictions, 141, 213, 217-218, 227
Charge to committee, 24-25, 163-164
assumptions and approach, 3-4
statement of task, 2-3
Children’s Health and Medicare Protection Act, 89 n.2
Chronic disease management, 1, 11, 12, 14, 25, 26, 40, 42, 59, 72, 91, 92, 97, 102, 114, 119, 185, 187, 189
Climate change, 25, 41, 64, 75
Collins, Jim, 105
Commissioned Corps, 8, 34, 55, 64, 66, 171.
See also Surgeon general
Communicable Disease Center, 27, 219.
See also Centers for Disease Control and Prevention
Community health centers
utilization, 50
workforce shortages, 114
Comparative Effectiveness Advisory Board, 89 n.2
Comparative effectiveness research
by AHRQ, 89 n.2, 96, 187, 190, 229-231, 257
and clinical decision making, 94
data collection and sharing, 11, 12, 87, 93, 175, 186, 190
defined, 178 n.5
evaluative framework, 179-183
evolution of the field, 182-183
foreign models, 176, 177-178, 185-186
health information technology and, 101-103
holistic approach, 179, 182-183
impact on cost of care, 184-185
objections to cost-effectiveness analysis, 183-190
separation of costs from, 183
Comparative Effectiveness Research Act of 2008, 89 n.2
Comprehensive Environmental Response, Compensation, and Liability Act, 223
Congress.
See also Recommendations to Congress
appointment process for key officials, 9, 34, 35, 56, 67 n.3, 68, 171-172, 205, 220, 242-243
appropriations and earmarks, 5, 141
compact with HHS, 5, 17, 141-144
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fragmentation of oversight and appropriations, 3, 5, 17, 24, 41, 43
participation in priority setting, 41, 139
Congressional Budget Office, 50, 177 n.3, 184, 189
Cost-effectiveness analysis
for accountability, 19, 37
defined, 178-179 n.5
economic vs. social perspective, 182
evolution of the field, 182-183
health information technology, 102
patient and insurance characteristics and, 184, 188-189
price changes and technological obsolescence, 181-182
QALY limitations and thresholds, 179 n.7, 180, 181, 186
timing issue, 180-181
Costs. See Health care costs/spending
Council for Excellence in Government, 109, 130 n.5
Council of Teaching Hospitals and Health Systems, 91, 92
Council on Graduate Medical Education, 115
D
Data collection and information systems.
See also Health information technology
for accountability, 10, 16-17, 18-19, 47, 134-139
AHRQ, 8, 11, 51, 187, 190, 228-229
CMS, 11, 51, 187, 190, 262
department-wide for decision making and program assessment, 3, 10, 18-19, 36, 47, 134-140, 173
FDA, 11, 51, 94, 135, 187, 190
HRSA, 51
NIH, 11, 17, 94, 187, 190, 243, 244, 245, 246, 261
Sentinel Initiative, 135
uses, 137-139
Davis, Tom, 2, 24, 163, 187, 190
Decision making. See Accountability at HHS;
Management and decision making;
Secretary of HHS
Defense Advanced Research Projects Agency (DARPA), 17, 143
Demos Center for the Public Sector, 109
Department of Education Organization Act, 192
Disraeli, Benjamin, 125
E
Economy, health care cost and, 50
Egg Products Inspection Act, 226
Eisenhower, Dwight D., 55, 192, 210
Elders, Joycelyn, 64
Embryonic stem cell research, 64, 74
Emerging infections, 1, 25, 41, 102
Emerging Leaders Program, 110
Employee Retirement Income Security Act, 42
Enhanced Health Care Value for All Act, 89 n.2
Evidence-based practices.
See also Value-based health care system
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management and decision making, 11, 74, 88-89, 94, 96-97, 135, 141, 187, 190
medicine, 1, 94-98
F
Family planning, 64, 74
Federal Advisory Committee Act, 216
Federal Communications Commission, 67 n.3, 119
Federal Emergency Management Agency, 193
Federal Employees Health Benefits Program, 42, 184 n.13, 189 n.15
Federal Meat Inspection Act, 226
Federal Security Agency, 210, 220
Food and Drug Administration (FDA).
See also Food safety regulations
accountability, 62, 197
budget allocation, 10, 17, 28, 29, 35, 48, 57, 77, 83 n.10, 152, 172
commissioner’s term and selection process, 9, 34-35, 56, 66, 67 n.3, 68, 171-172, 204, 205
congressional oversight, 17, 43, 142
data collection and sharing, 11, 51, 94, 135, 187, 190
food safety regulation, 78-83
health technology assessment, 180-181
integration and coordination with other agencies, 10, 35, 57, 78, 80-82, 83, 151, 172, 212
mission and responsibilities, 7, 8, 79-80, 167
organizational structure, 26, 62, 165, 197, 198, 199, 212, 220
origin, 37
science base and infrastructure, 78-80, 82, 110
statutory requirements and constraints, 17, 27, 81, 135 n.8, 141-142, 220, 241-242, 247
workforce, 62, 78-79, 110, 203
Food-borne diseases, 10, 25, 35, 57, 80, 81, 83, 172
Food, Drug, and Cosmetic Act, 220
Food Safety and Inspection Service (FSIS)
mission and responsibilities, 8, 10, 80-83
statutory requirements, 225-226
unification of FDA and, 10, 35, 57, 83, 172
Food safety regulation, 78-83
accountability, 81
globalization and, 80
oversight, 8, 80-81
unification of FDA and FSIS activities, 10, 35, 57, 78-79, 81-83, 172
weaknesses in, 8, 78-81
Foundation for the National Institutes of Health, 248
G
Gerberding, Julie, 75
Goals and goal setting by HHS, 4, 6
and accountability, 5, 16, 45, 127, 128, 129
data collection based on, 135
department-wide objectives, 128
five-year strategic plan, 16 n.3, 73-74, 128, 129, 130, 131, 134
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Governance of HHS, 3.
See also Management and decision making;
Secretary of HHS
Government Accountability Office, 32, 67, 80, 109
Government Performance and Results Act, 16 n.3, 127, 128, 129, 130, 131, 206
health challenges, 46
Healthy People 2010, 3, 16 n.3, 45, 47, 127-128
internal challenges, 46-47
long-term vs. short-term, 133
and mission statement, 46
narrow priorities, 130
President’s Management Agenda, 16 n.3, 127, 128, 131, 197
Program Assessment Rating Tool, 16 n.3, 127, 128, 130, 134
public service employment, 109
required characteristics, 45-46
secretary’s 500-day plan, 128, 130
and vision for health, 40, 46
Gross domestic product, 10, 50
H
Head Start, 23, 59, 71
Health Care Comparative Effectiveness Research Institute, 89 n.2
Health care costs/spending.
See also Health reform
CMS expenditures, 10, 29, 60, 90, 91, 92, 93 n.4, 185 n.14, 189 n.16
CMS reimbursement strategies and, 88, 185, 187, 189
comparative effectiveness and, 185, 189
as context for health challenges, 1, 25, 49
contributing factors, 11, 185, 187, 189
GDP and, 10, 50
HHS expenditures, 10, 40
impacts, 50
and outcomes and longevity, 2, 50, 90-91
physician and hospital practice patterns and, 90
Health Care Financing Administration, 213, 218
Health care system.
See also Health information technology;
Health workforce;
Value-based health care system
deficiencies in, 11
geographic variation in care patterns, 11, 14, 89-90, 97, 177 n.3
Health challenges.
See also specific challenges
cross-department collaboration, 41, 42
goal setting, 46
greatest, 49
identifying and prioritizing, 40- 43
overview, 1-2, 25, 40-41
public health, 69
Health information technology
and accountability, 102-103
and comparative effectiveness research, 101-103
electronic medical records, 11, 12, 100-103
food safety-related, 78-79
incentives for adopting, 102
public health benefits, 101-102
public information, 11, 12, 98-100
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Health insurance.
See also Uninsured Americans
expenditures, 50
Health of the public, defined, 26
Health outcomes, in United States., 2, 10
integrated care and, 92-93
intensity of services and, 90, 177 n.2
programs and reimbursement based on, 12
rationing of care and, 177 n.2
Health reform
data sources for, 51-52
comprehensive approach, 49, 150
and HHS organizational success, 31, 51, 59
HHS role, 6, 51, 59, 61, 140, 150, 152, 154, 156-157
pressures for, 40, 49
process, 52
reimbursement policies, 49-50, 51
Health Resources and Services Administration (HRSA)
budget allocation, 28, 29
data collection and sharing, 51
mission, 167
organizational structure, 26, 165, 222, 226-227
statutory requirements and constraints, 222, 235, 236, 256-262
workforce training programs, 116, 117, 256
Health technology assessment, 101-103.
See also Comparative effectiveness research
Health workforce
advanced practice nurses and physician assistants, 14, 115- 116
clinical care, 113-117
community health centers, 114
dental practitioners, 14, 113, 117
geriatrics professionals, 14, 114- 115
HRSA educational programs, 116-117, 256
mental health practitioners, 114
minority professionals, 14, 107, 116-117, 118-119
nurses, 114
and patient outcomes, 114, 115
primary care physicians, 14, 107, 113, 114, 115
public health, 13, 15, 107, 114, 117-119
science preparation, 118
shortages, 14, 15, 25, 41, 113-114, 117
telemedicine and telehealth, 14, 119
training programs, 14, 15-16, 106, 107, 115, 120
Healthy People 2010, 3, 16 n.3, 45, 47, 127-128
HHS workforce
assessment strategy, 106, 119-120
hiring practices, 111, 140
information technology personnel, 111
leadership and management training, 110 n.3
leadership selection and term length, 9, 34-35, 56, 61, 66-68, 72, 171-172, 202-205
minority representation, 14
organizations promoting public-service careers, 109
performance rewards, 15, 105-106, 112-113, 134
recruitment strategies, 14, 15, 65, 105, 108, 110, 111-113, 140, 204
retirement rates, 108-109
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scientific expertise, 14, 15, 16, 17, 73-75, 106, 110, 120-121
senior leadership losses, 3, 13, 14, 62, 106, 108-112
shortages, 13, 46, 47, 52, 106-107, 140
size, 21, 108-109
state and local public health services, 106
subcabinet-level positions, 61
telecommuting and flexible schedules, 14, 112, 140
Hispanic Americans, 14, 116, 120
HIV/AIDS, 47, 63, 64, 74, 182 n.10, 218, 240, 249, 262
I
Indian Health Care Improvement Act of 1988, 224
Indian Health Service, 26, 28, 29, 165, 167, 214, 234, 240, 250-251, 262
Information technology.
See also Data collection and information systems;
Health information technology
workforce shortages, 111
Institute of Medicine, 2, 24, 49, 69 n.4, 70, 81, 88, 106, 110, 187
Intermountain Healthcare, 90
K
Kaplan, Robert, 132
King, Martin Luther, Jr., 44
Koop, C. Everett, 63, 64
L
Leavitt, Michael, 31-32, 72, 96, 128, 169
M
Management and decision making.
See also Accountability at HHS;
Secretary of HHS;
Strategic planning
congressional involvement, 17
cross-department collaboration, 41, 119
department-wide information system for decision making and program assessment, 3, 10, 18-19, 36, 47, 134-138, 173
essential elements, 32-33, 47-49, 63
evidence-based practices, 11, 74, 88-89, 94, 96-97, 135, 141, 187, 190
flexibility in, 5, 17, 18, 33, 37, 41, 46, 111, 112, 125, 126, 139-144, 150, 171, 173
foreign models for HTA, 177-178
general principles, 156-157
political pressure and interference, 64, 72, 74-47, 60-63
political pressure and interference, 64, 72, 74-75
positions reporting to the secretary of HHS, 7, 8-9, 46-47, 60-63
public health agenda, 69-72
Marine Hospital Service, 27
Mayo Clinic, 90
McKinsey Global Institute, 179 n.6
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Medicaid.
See also Centers for Medicare and Medicaid Services
defined, 21 n.1
expenditures, 21
Medical homes, 11, 97, 176
Medicare.
See also Centers for Medicare and Medicaid Services
baby boom generation, 1, 21, 113 n.4, 134
defined, 21 n.1
expenditures, 21, 90, 91, 92
quality of care, 90, 91
Medicare Improvements for Patients and Providers Act of 2008, 103
Mental health services, 14, 28, 63, 64, 73, 101, 114, 117, 129, 254, 255.
See also Substance Abuse and Mental Health Services Administration
Mission, 47-48
agencies of HHS, 3
HHS, 2, 4, 27, 40, 45
and vision for health, 40
N
National Academy of Sciences, 67
National Aeronautics and Space Administration, 22, 45, 194
National Association of County and City Health Officials, 118
National Board of Public Health Examiners, 118
National Center for Health Statistics, 17, 215, 228
National Institute for Clinical Excellence (UK), 176, 177 n.2, 186
National Institutes of Health (NIH)
budget/funding, 10, 27, 28, 29, 30, 35, 48, 57, 76, 77, 143-144, 152, 172
common fund, 17, 143-144
data collection and sharing, 11, 17, 94, 187, 190, 243, 244, 245, 246, 261
director’s authority, 22, 223
Director’s New Innovator Award, 144
Director’s Pioneer Award Program, 144
Director’s term and selection process, 9, 34, 35, 56, 67 n.3, 68, 171-172, 205, 220, 242-243
integration and coordination with other agencies, 71, 94
mission and responsibilities, 7, 167, 220, 243-244, 245-249, 253
organizational structure, 26, 62, 165, 212, 214, 220, 221, 249
origin, 27
and public health emergencies, 247
Scientific Management Review Board, 222
statutory requirements and constraints, 220-222, 236, 242-249
trans-institute initiatives, 143-144, 246
workforce, 62, 66, 243, 247, 248
National Institutes of Health Reform Act of 2006, 222
National Marine Fisheries Service, 80
National Science Board, 121
National Science Foundation, 22, 67 n.3
Natural disasters, 41, 64 n.1
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O
Obesity, 42, 47, 129, 206, 236
Office for Civil Rights (OCR), 28, 165, 214
Office of Education, 210
Office of Management and Budget, 128, 130, 131, 133, 134, 150, 244
Office of Medicare Hearings and Appeals (OMHA), 28, 165
Office of Personnel Management (OPM), 15, 36, 42, 105, 109 n.1, 110, 111, 112, 140, 155, 173
Office of Regulatory Affairs, 79
Office of the Inspector General, 28
Office of the National Coordinator for Health Information Technology, 28, 165
Older Americans Act, 212
Organizational structure of HHS.
See also Management and decision making;
Reorganization of HHS;
Secretary of HHS;
Structure of HHS;
individual agencies
alignment of agency activities, 3, 7-10, 23, 47-48, 59-60, 171- 172, 197, 202
ASH’s authority, 26, 42, 47, 61-62, 64, 165, 205, 214, 224, 227, 250
business-line approach, 61-62
“ideal,” 2, 30
organizational chart and missions, 165-167
piecemeal accretion of programs, 2, 23, 25, 27
positions reporting to the secretary, 7, 8-9, 46-47, 60-63
subcabinet-level positions, 61-62
successful elements of, 4, 32-33
Outcomes. See Health outcomes
P
Pancreatic cancer, 73
Pandemics, 1, 41, 150 n.3, 220
Partnership for Public Service, 109, 111
Perkins, Frances, 147
Planning. See Strategic planning
Population health.
See also Public health
determinants, 69
model, 70
Post-Katrina Emergency Management Reform Act, 31
Poultry Products Inspection Act, 226
Poverty, 40, 50
President’s Management Agenda (PMA), 16 n.3, 127, 128, 131, 197
Presidential Management Fellows program, 110
Private sector
partnering with HHS, 3, 15, 46, 72
strategic planning role, 42
Program Assessment Rating Tool (PART), 16 n.3, 127, 128, 130, 134
Public health.
See also U.S. Public Health Service
defined, 7, 26
education and credentialing, 118-119
emergencies, 46
globalization and, 58
information technology and, 12
infrastructure deficiencies, 2, 25, 41, 129
integrated agenda, 69-72
reach and relationships of HHS throughout, 58-59
state and local departments, 3, 42, 46, 118
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systems research, 135-136
threats, 1, 40
workforce shortages, 117-119
Public Health and Social Services Emergency Fund, 28
Public Health Service Act, 209, 211, 212-213, 214-216, 218, 219, 220-221, 222, 223, 227, 232, 249, 256, 257
Public information
campaigns, 42
and patient involvement in decisionmaking, 99-100
reliable sources, 98-99
Pure Food and Drugs Act of 1906, 27
Q
Quality of health care, 10, 50, 89-90, 91.
See also Health outcomes
R
RAND Corp., 184
Rationing of care, 177, 179, 183, 185
Recommendations to Congress
accountability and decision making (5, 5b), 18, 19, 37, 125, 126, 137, 173
comparative value assessment of health care (3a), 12, 35, 37 n.a, 87, 172, 175-190
dissenting opinions on recommendation 3a, 37 n.a, 175-190
food safety regulation (2i), 10, 35, 57, 83, 172
fostering adaptability and alignment (2c, 2d, 2e, 2h, 2i), 4, 9, 10, 34-35, 55-56, 57, 171-172
funding for NIH, CDC, FDA, and AHRQ (2h), 10, 35, 57, 77, 172
leadership appointments and confirmations (2d, 2e), 9, 34-35, 56, 68, 171-172
outcome-based programs and reimbursement policies (3b), 12-13, 35, 88, 98, 172
strategic initiative fund (5g), 17, 19, 37, 126, 143, 144, 173
surgeon general’s selection (2c), 9, 34, 55-56, 66, 171
workforce strengthening (4b, 4c, 4f), 15, 36, 105-106, 112, 113, 173
Recommendations to HHS
accountability and decision making (5e, 5f), 19, 37, 125-126, 136-137, 138-139, 144
alignment of activities and operations (2a), 8, 34, 55, 60
collaboration with state, local, and community-based health care organization (3c), 13, 35, 88, 98
compact with Congress (5), 5, 36-37, 125-126, 173
to Congress, see Recommendations to Congress
define a vision (1), 4, 6-7, 34, 39-40, 49
department-wide data collection and information system (5a, 5c, 5d), 10, 18-19, 36, 88, 125, 136, 173
electronic information capabilities in health care (3e), 13, 36, 88, 103
evidence-based decision making (2g), 10, 35, 56-57, 76
general principles, 156-157
health reform (1d), 7, 34, 40, 53
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overarching themes, 4-5, 33
positions reporting to the secretary (2b), 8-9, 34, 55, 63
prioritize health challenges (1a), 6, 34, 39, 43-44
public health programs and reimbursement policies (2f), 9-10, 12, 13, 35, 56, 72
public information on prevention and treatment options (3d), 11, 13, 36, 88, 100
surgeon general’s empowerment (2c), 9, 34, 55-56, 66
value-based health care system (3), 4-5, 12, 35-36, 87-88
workforce strengthening (4a, 4d, 4e), 5, 15-16, 36, 105, 106, 112, 113, 119-120, 121
Reorganization of HHS
advice to next secretary, 206-207
alternatives to, 201-206
committee position on, 3-4, 31, 78
costs of, 196-197
efforts, 30-37
examples and rationale for other departments, 192-195
impact of change, 197-201
and organizational culture, 198-199
Secretaries’ views of, 31-32, 195-207
statutory authority, 210-226
time frame for, 31-32, 78
Research and development biomedical, 73-74
Richmond, Julius B., 63
Roosevelt, Franklin D., 44, 193
S
Satcher, David, 64, 75
Schizophrenia, 73
Schweiker, Richard, 169, 201
Science-based professions, 106
international students and scholars, 120
lack of interest in, 15, 16
minority underrepresentation, 120
workforce shortages, 13, 14, 107, 120-121
Secretary of HHS.
See also Transition to new secretary
flexibility in management of HHS, 5, 17, 18, 33, 37, 41, 46, 111, 112, 125, 126, 139-144, 150, 171, 173
former, by tenure and administration, 169
management demands, 7, 8-9, 46-47, 48, 60-63, 142, 200-201
positions reporting to, 7, 8-9, 46-47, 60-63
reorganization authority, 210-226
role, 61, 136
tenures, 31, 133
views of former secretaries on reorganization, 31-32, 142, 195-207
Senior Executive Service Candidate Program, 110 n.3
Senior Presidential Management Fellows program, 110
Shalala, Donna, 169, 196
Social and Rehabilitation Services, 212
Social Security Act, 211, 217, 218, 227, 228
Social Security Administration (SSA), 21, 22, 27, 41, 67 n.3, 192, 196, 198, 210
Social Security Independence and Improvement Act, 192
Social Security program, 27
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State and local governments
partnerships with HHS, 3, 46, 72
public health role, 42
strategic planning role, 42
State Children’s Health Insurance Program (SCHIP), 28, 29, n.3, 30
State of the USA, Inc., 129 n.1
Statutory requirements and constraints
Administration for Children and Families, 216-217, 227-228
Administration on Aging, 217
Agency for Toxic Substances and Disease Registry, 223-224, 249-250
AHRQ, 218-219, 228-2
barriers to reorganization, 226-227
CDC, 219, 231-240
CMS, 217-218
constraints on HHS organization, 227-262
Department of Veterans Affairs undersecretary for health, 225
FDA, 220, 241-242
health functions of other federal offices, 225-226
Health Resources and Services Administration, 222, 256-262
history of secretary’s exercise of reorganization authority, 213-226
Indian health Service, 224, 250-251
NIH, 220-222, 242-249
regional offices, 224
reorganization authority, 215-216
Reorganization Plan No. 1 of 1953, 210-211
Reorganization Plan No. 3 of 1966, 211-213
Secretary’s authority to organize, 210-213
Substance Abuse and Mental Health Services, 223, 251-256
USDA Food Safety Inspection Service, 225-226
Strategic planning
goal setting, 40, 45-47
health reform, 6, 7, 40
mission statement, 40, 45
prioritizing health challenges, 6, 34, 40-44
team, 6, 39, 41, 42
vision, 6-7, 39-40, 44
Structure of HHS.
See also Organizational structure of HHS;
Reorganization of HHS
challenges, 3, 57-59
food safety regulation, 8, 58, 78-83
internal challenges, 46-47
leadership selection process and terms of office, 7, 66-68
opportunities for change, 32-33
origins, 23, 25-27
and performance, 30, 44, 191
planning, see Strategic planning
public health agenda, 7-8, 69-72
research funding, 8, 76-77
scientific expertise, 7, 8, 73-76
Substance Abuse and Mental Health Services Administration (SAMHSA)
budget allocation, 28, 29
mission, 167
organizational structure, 26, 165, 214, 223
origin, 223
statutory requirements and constraints, 215, 223, 251-256
Surgeon general
accomplishments and controversies, 63, 64
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empowerment, 63-66
reporting to the secretary, 60-61, 210
responsibilities, 7, 8, 64, 137
selection process and term, 9, 64, 65
Surgeon General Independence Act, 65 n.2
Surgeon General Restoration Authority Act, 65 n.2
T
Taylor, Frederick, 207
Temporary Assistance for Needy Families, 23, 216, 217
Terry, Luther L., 63
Thompson, Tommy, 169, 196, 197
Tobacco control programs, 26, 42, 63, 129
Transition to new secretary
continuity throughout tenure, 153-155
first 90 days, 150-151
first year in office, 151-153
general principles, 19-20, 156-157
and restructuring, 31
scenario, 148
steps, 149-155
Truman, Harry S., 21
U
Uninsured Americans, 1, 50, 70
U.S. Department of Agriculture (USDA), 22, 27, 71 n.5, 80-81, 82, 83, 220, 226.
See also Food Safety and Inspection Service
U.S. Department of Commerce, 22, 80
U.S. Department of Defense (DoD), 17, 21, 22, 42, 59-60, 119, 135, 192, 194
U.S. Department of Education, 22, 27, 71 n.5, 169, 192, 193, 195, 196, 198, 209
U.S. Department of Energy, 22, 194
U.S. Department of Health and Human Services (HHS). See Accountability at HHS;
individual agencies, offices, and programs
activities and programs, 1, 22-23
alignment of agencies and programs, see Organizational structure of HHS;
Structure of HHS
budget, see Budget for HHS
decision making, see Accountability at HHS;
Management and decision making;
Secretary of HHS goals, see Goals and goal setting by HHS
international relationships, 23-24
leadership, see Assistant secretary for health;
HHS workforce;
Secretary of HHS
mission, 2, 4, 27, 40, 45, 69
organization, see Organizational structure of HHS;
Reorganization of HHS;
Structure of HHS
oversight, 132
performance, 44
planning, see Strategic planning
private-sector partnerships, 3, 15, 46
recommendations, see
Recommendations to HHS state and local government partnerships with, 3, 46
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vision, 4, 6-7, 34, 39-40, 44, 47-48
U.S. Department of Health, Education, and Welfare, 27, 169, 192, 195, 196, 209, 210, 219
U.S. Department of Homeland Security (DHS), 22, 23, 31, 41, 42, 71 n.5, 78, 80, 143, 193, 196
U.S. Department of Housing and Urban Development (HUD), 22, 194, 228
U.S. Department of Justice, 22, 142
U.S. Department of Labor, 22, 42, 71 n.5
U.S. Department of State, 22
U.S. Department of the Interior, 22, 71 n.5, 251
U.S. Department of the Treasury, 22, 71 n.5
U.S. Department of Transportation, 22, 71 n.5, 194
U.S. Department of Veterans Affairs, 22, 42, 63, 71 n.5, 119, 135, 225
U.S. Environmental Protection Agency, 22, 41, 71 n.5, 80, 194
U.S. Public Health Service.
See also specific offices and agencies
accountability, 70
alignment and flexibility in, 69-70, 71-72
attributes of integrated agenda, 71-72
Commissioned Corps, 8, 34, 55, 64, 66, 171;
see also Surgeon general
communicable disease control, 27
emergency response funding, 46, 64
evidence-based decisionmaking, 70, 71, 72, 73-75
financial resources of agencies under, 27, 29, 69
infrastructure, 2, 70, 108
integration of state and local agencies and community-based organizations, 13, 72
organizational structure, 26, 27, 210, 212, 214
oversight, 26, 42, 47, 61, 62, 64, 165, 205, 214, 224, 227, 250
population health approach, 70, 71
reorganization, 26
valuation of services, 71
workforce, 72, 73-75, 106, 107, 108, 117-119
V
Value-based health care system
CMS role, 11, 88-89, 94, 96-97, 135, 141, 187, 190
collaboration with state, local, and community-based health care organizations, 13, 35, 88, 98
comparative effectiveness research, 67, 89-93, 101-103, 175-190
data collection and sharing, 87, 101-103
electronic information capabilities, 98, 100-103
evidence-based care, 1, 11, 13, 94-98
home care technologies, 99
and innovation, 178 n.4, 181-182 n.10, 186
integrated care, 11, 92-93, 97, 101, 176
legislation, 89 n.2
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primary vs. specialist care, 11, 14, 93, 97, 107, 114, 115, 119
public information, 98-100
role of HHS, 88-89
Veterans Administration, 193
Vision, 4, 6-7, 34, 39-40, 44, 47-48.
See also Strategic planning
Vulnerable populations
access to care, 7, 9-10, 35, 40, 41, 56, 58, 71, 72, 107, 117, 181 n.9
programs for, 216-217
W
Waxman, Henry A., 2, 24, 163, 187, 190
WebMD, 99
Workforce. See Health workforce;
HHS workforce;
Science-base professions
World Health Organization, 41
