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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Index A Accountability at HHS. See also reorganization and, 194-195 Goals and goal setting by reporting systems, 17, 19, 126, HHS 137-139 budget allocation, 129 n.2 “State of the Nation’s Health” compact with Congress for, 5, report to Congress, 17, 19, 17, 18, 139, 141-144 126, 137-138 creating effective systems, surgeon general’s role, 137-138 132-134 systems, 131, 132-134 current departmental efforts, tenure of secretary and, 133 127-131 workforce shortages and, 111 data collection and information Administration for Children and system, 10, 16-17, 18-19, 47, Families (ACF), 23, 28, 165 102, 125-126, 134-140 166, 216-217 defined, 126-127 Administration on Aging (AoA), flexibility in management and, 5, 23, 28, 71, 165, 166, 217, 224, 33, 139-144 226, 242 incentives for good performance, African Americans, 14, 75, 116, 133 120 leadership terms and, 67 Agency for Healthcare Research leading health indicators, 129 and Quality (AHRQ) measuring and evaluating value budget/funding, 8, 10, 28, 29, 35, 74, 97-98, 127, 134-138 57, 77, 89, 96, 152, 172 performance assessment comparative effectiveness systems, 127-131, 132 research, 89 n.2, 96, 187, 190, performance improvement plans, 229-231, 257 131 data collection and sharing, 8, program implementation and 11, 51, 187, 190, 228-229 results, 19, 48, 126, 132, 173 director’s term and selection ratings, 130-131 process, 56 275

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276 HHS IN THE 21ST CENTURY mission and responsibilities, 8, discretionary, 3, 30, 46, 143-144 77, 166, 229 distribution across agencies and organizational structure, 26, 89 programs, 27, 28 n.2, 165, 214, 218 predictability across Public origin, 229 Health Service agencies, 48 statutory requirements and President’s 2009 requests, 14, constraints, 89 n.2, 218-219, 21, 28, 29-30, 76, 117, 129 228-231 n.2 Agency for Toxic Substances and research funding, 76-77 Disease Registry (ATSDR), splintered appropriations and 26, 29, 165, 166, 223-224, earmarks, 5, 141 249-250 strategic initiative fund, 17, 19, Alignment. See also 37, 126, 143, 144, 173 Organizational structure of Bureau of Labor Statistics, 120 HHS; Structure of HHS defined, 59 Alzheimer’s disease, 73, 242 C American Indians and Alaska Natives, 59, 167, 217. See also Carmona, Richard, 64, 74-75 Indian Health Service Center for Comparative Amyotrophic lateral sclerosis, 73 Effectiveness Research, 89 n.2 Asian Americans, 14, 116 Center for Faith-Based and Assistant secretary for health Community Initiatives, 60 (ASH), 26, 42, 47, 61, 62, 64, Center for Food Safety and Applied 165, 205, 214, 224, 227, 250 Nutrition, 78-79 Association of State and Territorial Center for Veterinary Medicine, Health Officials, 118 76-79 Autism, 73, 237 Centers for Disease Control and Prevention budget allocations, 10, 28, 29, B 35, 48, 57, 76, 77, 152, 172 data collection and sharing, 11, Baby boom generation, 1, 21, 109, 51, 187, 190, 262 113 n.4, 134, 224 director’s term and selection Balanced Scorecard, 132 process, 9, 34-35, 56, 62, 66, Beering, Steven, 121 68, 94, 171-172 Best Pharmaceuticals for Children food safety functions, 79-80, 82 Act, 220 mission and responsibilities, 7, Biomedical research, 73, 74 166 Bioterrorism, 1, 41, 102 organizational structure, 26, 62, Budget for HHS, 1. See also 165, 214, 219 individual agencies origin, 27, 219 continuing resolutions, 76 science base and scientific departments compared, 21, 22 credibility, 75

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277 INDEX statutory requirements and Communicable Disease Center, 27, constraints, 215-216, 219, 219. See also Centers for 227, 231-240, 247, 256, 261 Disease Control and workforce, 109, 111 Prevention Centers for Medicare and Medicaid Community health centers Services (CMS) utilization, 50 administrator selection and term, workforce shortages, 114 60, 205 Comparative Effectiveness budget allocation, 28, 29, 69 Advisory Board, 89 n.2 data collection and sharing, 11, Comparative effectiveness research 94, 135, 187, 190 by AHRQ, 89 n.2, 96, 187, 190, graduate medical education 229-231, 257 funding, 115 and clinical decision making, 94 health care expenditures, 10, 29, data collection and sharing, 11, 60, 90, 91, 92, 93 n.4, 185 12, 87, 93, 175, 186, 190 n.14, 189 n.16 defined, 178 n.5 mission, 166 evaluative framework, 179-183 organizational structure, 62, 165 evolution of the field, 182-183 oversight, 199 foreign models, 176, 177-178, role in evidence-based care and 185-186 HTA issues, 11, 88-89, 94, health information technology 96-97, 135, 141, 187, 190 and, 101-103 reimbursement policies, 10, 35, holistic approach, 179, 182-183 76, 88, 97, 115, 141 n.9, 185, impact on cost of care, 184-185 186 objections to cost-effectiveness statutory requirements and analysis, 183-190 restrictions, 141, 213, 217- separation of costs from, 183 218, 227 Comparative Effectiveness Charge to committee, 24-25, 163- Research Act of 2008, 89 n.2 164 Comprehensive Environmental assumptions and approach, 3-4 Response, Compensation, and statement of task, 2-3 Liability Act, 223 Children’s Health and Medicare Congress. See also Protection Act, 89 n.2 Recommendations to Chronic disease management, 1, Congress 11, 12, 14, 25, 26, 40, 42, 59, appointment process for key 72, 91, 92, 97, 102, 114, 119, officials, 9, 34, 35, 56, 67 n.3, 185, 187, 189 68, 171-172, 205, 220, 242- Climate change, 25, 41, 64, 75 243 Collins, Jim, 105 appropriations and earmarks, 5, Commissioned Corps, 8, 34, 55, 64, 141 66, 171. See also Surgeon compact with HHS, 5, 17, 141- general 144

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278 HHS IN THE 21ST CENTURY fragmentation of oversight and department-wide for decision appropriations, 3, 5, 17, 24, making and program 41, 43 assessment, 3, 10, 18-19, 36, participation in priority setting, 47, 134-140, 173 41, 139 FDA, 11, 51, 94, 135, 187, 190 Congressional Budget Office, 50, HRSA, 51 177 n.3, 184, 189 NIH, 11, 17, 94, 187, 190, 243, Cost-effectiveness analysis 244, 245, 246, 261 for accountability, 19, 37 Sentinel Initiative, 135 defined, 178-179 n.5 uses, 137-139 economic vs. social perspective, Davis, Tom, 2, 24, 163, 187, 190 182 Decision making. See evolution of the field, 182-183 Accountability at HHS; health information technology, Management and decision 102 making; Secretary of HHS patient and insurance Defense Advanced Research characteristics and, 184, 188- Projects Agency (DARPA), 189 17, 143 price changes and technological Demos Center for the Public obsolescence, 181-182 Sector, 109 QALY limitations and Department of Education thresholds, 179 n.7, 180, 181, Organization Act, 192 186 Disraeli, Benjamin, 125 timing issue, 180-181 Costs. See Health care costs/ E spending Council for Excellence in Economy, health care cost and, 50 Government, 109, 130 n.5 Egg Products Inspection Act, 226 Council of Teaching Hospitals and Eisenhower, Dwight D., 55, 192, Health Systems, 91, 92 210 Council on Graduate Medical Elders, Joycelyn, 64 Education, 115 Embryonic stem cell research, 64, 74 D Emerging infections, 1, 25, 41, 102 Emerging Leaders Program, 110 Data collection and information Employee Retirement Income systems. See also Health Security Act, 42 information technology Enhanced Health Care Value for for accountability, 10, 16-17, 18- All Act, 89 n.2 19, 47, 134-139 Evidence-based practices. See also AHRQ, 8, 11, 51, 187, 190, 228- Value-based health care 229 system CMS, 11, 51, 187, 190, 262

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279 INDEX management and decision organizational structure, 26, 62, making, 11, 74, 88-89, 94, 96- 165, 197, 198, 199, 212, 220 97, 135, 141, 187, 190 origin, 37 medicine, 1, 94-98 science base and infrastructure, 78-80, 82, 110 statutory requirements and F constraints, 17, 27, 81, 135 n.8, 141-142, 220, 241-242, Family planning, 64, 74 247 Federal Advisory Committee Act, workforce, 62, 78-79, 110, 203 216 Food-borne diseases, 10, 25, 35, Federal Communications 57, 80, 81, 83, 172 Commission, 67 n.3, 119 Food, Drug, and Cosmetic Act, 220 Federal Emergency Management Food Safety and Inspection Service Agency, 193 (FSIS) Federal Employees Health Benefits mission and responsibilities, 8, Program, 42, 184 n.13, 189 10, 80-83 n.15 statutory requirements, 225-226 Federal Meat Inspection Act, 226 unification of FDA and, 10, 35, Federal Security Agency, 210, 220 57, 83, 172 Food and Drug Administration Food safety regulation, 78-83 (FDA). See also Food safety accountability, 81 regulations globalization and, 80 accountability, 62, 197 oversight, 8, 80-81 budget allocation, 10, 17, 28, 29, unification of FDA and FSIS 35, 48, 57, 77, 83 n.10, 152, activities, 10, 35, 57, 78-79, 172 81-83, 172 commissioner’s term and weaknesses in, 8, 78-81 selection process, 9, 34-35, 56, Foundation for the National 66, 67 n.3, 68, 171-172, 204, Institutes of Health, 248 205 congressional oversight, 17, 43, 142 G data collection and sharing, 11, 51, 94, 135, 187, 190 Gerberding, Julie, 75 food safety regulation, 78-83 Goals and goal setting by HHS, 4, health technology assessment, 6 180-181 and accountability, 5, 16, 45, integration and coordination with 127, 128, 129 other agencies, 10, 35, 57, 78, data collection based on, 135 80-82, 83, 151, 172, 212 department-wide objectives, 128 mission and responsibilities, 7, 8, five-year strategic plan, 16 n.3, 79-80, 167 73-74, 128, 129, 130, 131, 134

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280 HHS IN THE 21ST CENTURY Governance of HHS, 3. See also as context for health challenges, Management and decision 1, 25, 49 making; Secretary of HHS contributing factors, 11, 185, Government Accountability Office, 187, 189 32, 67, 80, 109 GDP and, 10, 50 Government Performance and HHS expenditures, 10, 40 Results Act, 16 n.3, 127, 128, impacts, 50 129, 130, 131, 206 and outcomes and longevity, 2, health challenges, 46 50, 90-91 Healthy People 2010, 3, 16 n.3, physician and hospital practice 45, 47, 127-128 patterns and, 90 internal challenges, 46-47 Health Care Financing long-term vs. short-term, 133 Administration, 213, 218 and mission statement, 46 Health care system. See also Health narrow priorities, 130 information technology; President’s Management Health workforce; Value- Agenda, 16 n.3, 127, 128, 131, based health care system 197 deficiencies in, 11 Program Assessment Rating geographic variation in care Tool, 16 n.3, 127, 128, 130, patterns, 11, 14, 89-90, 97, 134 177 n.3 public service employment, 109 Health challenges. See also specific required characteristics, 45-46 challenges secretary’s 500-day plan, 128, cross-department collaboration, 130 41, 42 and vision for health, 40, 46 goal setting, 46 Gross domestic product, 10, 50 greatest, 49 identifying and prioritizing, 40- 43 H overview, 1-2, 25, 40-41 public health, 69 Head Start, 23, 59, 71 Health information technology Health Care Comparative and accountability, 102-103 Effectiveness Research and comparative effectiveness Institute, 89 n.2 research, 101-103 Health care costs/spending. See electronic medical records, 11, also Health reform 12, 100-103 CMS expenditures, 10, 29, 60, food safety-related, 78-79 90, 91, 92, 93 n.4, 185 n.14, incentives for adopting, 102 189 n.16 public health benefits, 101-102 CMS reimbursement strategies public information, 11, 12, 98- and, 88, 185, 187, 189 100 comparative effectiveness and, 185, 189

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281 INDEX Health insurance. See also community health centers, 114 Uninsured Americans dental practitioners, 14, 113, 117 expenditures, 50 geriatrics professionals, 14, 114- Health of the public, defined, 26 115 Health outcomes, in United States., HRSA educational programs, 2, 10 116-117, 256 integrated care and, 92-93 mental health practitioners, 114 intensity of services and, 90, 177 minority professionals, 14, 107, n.2 116-117, 118-119 programs and reimbursement nurses, 114 based on, 12 and patient outcomes, 114, 115 rationing of care and, 177 n.2 primary care physicians, 14, 107, Health reform 113, 114, 115 data sources for, 51-52 public health, 13, 15, 107, 114, comprehensive approach, 49, 117-119 150 science preparation, 118 and HHS organizational success, shortages, 14, 15, 25, 41, 113- 31, 51, 59 114, 117 HHS role, 6, 51, 59, 61, 140, telemedicine and telehealth, 14, 150, 152, 154, 156-157 119 pressures for, 40, 49 training programs, 14, 15-16, process, 52 106, 107, 115, 120 reimbursement policies, 49-50, Healthy People 2010, 3, 16 n.3, 45, 51 47, 127-128 Health Resources and Services HHS workforce Administration (HRSA) assessment strategy, 106, 119- budget allocation, 28, 29 120 data collection and sharing, 51 hiring practices, 111, 140 mission, 167 information technology organizational structure, 26, 165, personnel, 111 222, 226-227 leadership and management statutory requirements and training, 110 n.3 constraints, 222, 235, 236, leadership selection and term 256-262 length, 9, 34-35, 56, 61, 66- workforce training programs, 68, 72, 171-172, 202-205 116, 117, 256 minority representation, 14 Health technology assessment, 101- organizations promoting public- 103. See also Comparative service careers, 109 effectiveness research performance rewards, 15, 105- Health workforce 106, 112-113, 134 advanced practice nurses and recruitment strategies, 14, 15, 65, physician assistants, 14, 115- 105, 108, 110, 111-113, 140, 116 204 clinical care, 113-117 retirement rates, 108-109

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282 HHS IN THE 21ST CENTURY scientific expertise, 14, 15, 16, L 17, 73-75, 106, 110, 120-121 senior leadership losses, 3, 13, Leavitt, Michael, 31-32, 72, 96, 14, 62, 106, 108-112 128, 169 shortages, 13, 46, 47, 52, 106- 107, 140 size, 21, 108-109 M state and local public health services, 106 Management and decision making. subcabinet-level positions, 61 See also Accountability at telecommuting and flexible HHS; Secretary of HHS; schedules, 14, 112, 140 Strategic planning Hispanic Americans, 14, 116, 120 congressional involvement, 17 HIV/AIDS, 47, 63, 64, 74, 182 cross-department collaboration, n.10, 218, 240, 249, 262 41, 119 department-wide information system for decision making I and program assessment, 3, 10, 18-19, 36, 47, 134-138, Indian Health Care Improvement 173 Act of 1988, 224 essential elements, 32-33, 47-49, Indian Health Service, 26, 28, 29, 63 165, 167, 214, 234, 240, 250- evidence-based practices, 11, 74, 251, 262 88-89, 94, 96-97, 135, 141, Information technology. See also 187, 190 Data collection and flexibility in, 5, 17, 18, 33, 37, information systems; Health 41, 46, 111, 112, 125, 126, information technology 139-144, 150, 171, 173 workforce shortages, 111 foreign models for HTA, 177- Institute of Medicine, 2, 24, 49, 69 178 n.4, 70, 81, 88, 106, 110, 187 general principles, 156-157 Intermountain Healthcare, 90 political pressure and interference, 64, 72, 74-47, 60-63 K political pressure and interference, 64, 72, 74-75 Kaplan, Robert, 132 positions reporting to the King, Martin Luther, Jr., 44 secretary of HHS, 7, 8-9, 46- Koop, C. Everett, 63, 64 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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283 INDEX Medicaid. See also Centers for National Institutes of Health (NIH) Medicare and Medicaid budget/funding, 10, 27, 28, 29, Services 30, 35, 48, 57, 76, 77, 143- defined, 21 n.1 144, 152, 172 expenditures, 21 common fund, 17, 143-144 Medical homes, 11, 97, 176 data collection and sharing, 11, Medicare. See also Centers for 17, 94, 187, 190, 243, 244, Medicare and Medicaid 245, 246, 261 Services director’s authority, 22, 223 baby boom generation, 1, 21, Director’s New Innovator 113 n.4, 134 Award, 144 defined, 21 n.1 Director’s Pioneer Award expenditures, 21, 90, 91, 92 Program, 144 quality of care, 90, 91 Director’s term and selection Medicare Improvements for process, 9, 34, 35, 56, 67 n.3, Patients and Providers Act of 68, 171-172, 205, 220, 242- 2008, 103 243 Mental health services, 14, 28, 63, integration and coordination with 64, 73, 101, 114, 117, 129, other agencies, 71, 94 254, 255. See also Substance mission and responsibilities, 7, Abuse and Mental Health 167, 220, 243-244, 245-249, Services Administration 253 Mission, 47-48 organizational structure, 26, 62, agencies of HHS, 3 165, 212, 214, 220, 221, 249 HHS, 2, 4, 27, 40, 45 origin, 27 and vision for health, 40 and public health emergencies, 247 Scientific Management Review N Board, 222 statutory requirements and National Academy of Sciences, 67 constraints, 220-222, 236, National Aeronautics and Space 242-249 Administration, 22, 45, 194 trans-institute initiatives, 143- National Association of County and 144, 246 City Health Officials, 118 workforce, 62, 66, 243, 247, 248 National Board of Public Health National Institutes of Health Examiners, 118 Reform Act of 2006, 222 National Center for Health National Marine Fisheries Service, Statistics, 17, 215, 228 80 National Institute for Clinical National Science Board, 121 Excellence (UK), 176, 177 National Science Foundation, 22, n.2,186 67 n.3 Natural disasters, 41, 64 n.1

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284 HHS IN THE 21ST CENTURY O P Obesity, 42, 47, 129, 206, 236 Pancreatic cancer, 73 Office for Civil Rights (OCR), 28, Pandemics, 1, 41, 150 n.3, 220 165, 214 Partnership for Public Service, 109, Office of Education, 210 111 Office of Management and Budget, Perkins, Frances, 147 128, 130, 131, 133, 134, 150, Planning. See Strategic planning 244 Population health. See also Public Office of Medicare Hearings and health Appeals (OMHA), 28, 165 determinants, 69 Office of Personnel Management model, 70 (OPM), 15, 36, 42, 105, 109 Post-Katrina Emergency n.1, 110, 111, 112, 140, 155, Management Reform Act, 31 173 Poultry Products Inspection Act, Office of Regulatory Affairs, 79 226 Office of the Inspector General, 28 Poverty, 40, 50 Office of the National Coordinator President’s Management Agenda for Health Information (PMA), 16 n.3, 127, 128, 131, Technology, 28, 165 197 Older Americans Act, 212 Presidential Management Fellows Organizational structure of HHS. program, 110 See also Management and Private sector decision making; partnering with HHS, 3, 15, 46, Reorganization of HHS; 72 Secretary of HHS; Structure of strategic planning role, 42 HHS; individual agencies Program Assessment Rating Tool alignment of agency activities, 3, (PART), 16 n.3, 127, 128, 7-10, 23, 47-48, 59-60, 171- 130, 134 172, 197, 202 Public health. See also U.S. Public ASH’s authority, 26, 42, 47, 61- Health Service 62, 64, 165, 205, 214, 224, defined, 7, 26 227, 250 education and credentialing, 118- business-line approach, 61-62 119 “ideal,” 2, 30 emergencies, 46 organizational chart and globalization and, 58 missions, 165-167 information technology and, 12 piecemeal accretion of programs, infrastructure deficiencies, 2, 25, 2, 23, 25, 27 41, 129 positions reporting to the integrated agenda, 69-72 secretary, 7, 8-9, 46-47, 60-63 reach and relationships of HHS subcabinet-level positions, 61-62 throughout, 58-59 successful elements of, 4, 32-33 state and local departments, 3, Outcomes. See Health outcomes 42, 46, 118

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285 INDEX systems research, 135-136 funding for NIH, CDC, FDA, threats, 1, 40 and AHRQ (2h), 10, 35, 57, workforce shortages, 117-119 77, 172 Public Health and Social Services leadership appointments and Emergency Fund, 28 confirmations (2d, 2e), 9, 34- Public Health Service Act, 209, 35, 56, 68, 171-172 211, 212-213, 214-216, 218, outcome-based programs and 219, 220-221, 222, 223, 227, reimbursement policies (3b), 232, 249, 256, 257 12-13, 35, 88, 98, 172 Public information strategic initiative fund (5g), 17, campaigns, 42 19, 37, 126, 143, 144, 173 and patient involvement in surgeon general’s selection (2c), decisionmaking, 99-100 9, 34, 55-56, 66, 171 reliable sources, 98-99 workforce strengthening (4b, 4c, Pure Food and Drugs Act of 1906, 4f), 15, 36, 105-106, 112, 113, 27 173 Recommendations to HHS Q accountability and decision making (5e, 5f), 19, 37, 125- Quality of health care, 10, 50, 89- 126, 136-137, 138-139, 144 90, 91. See also Health alignment of activities and outcomes operations (2a), 8, 34, 55, 60 collaboration with state, local, R and community-based health care organization (3c), 13, 35, RAND Corp., 184 88, 98 Rationing of care, 177, 179, 183, compact with Congress (5), 5, 185 36-37, 125-126, 173 Recommendations to Congress to Congress, see accountability and decision Recommendations to making (5, 5b), 18, 19, 37, Congress 125, 126, 137, 173 define a vision (1), 4, 6-7, 34, comparative value assessment of 39-40, 49 health care (3a), 12, 35, 37 department-wide data collection n.a, 87, 172, 175-190 and information system (5a, dissenting opinions on 5c, 5d), 10, 18-19, 36, 88, 125, recommendation 3a, 37 n.a, 136, 173 175-190 electronic information food safety regulation (2i), 10, capabilities in health care (3e), 35, 57, 83, 172 13, 36, 88, 103 fostering adaptability and evidence-based decision making alignment (2c, 2d, 2e, 2h, 2i), (2g), 10, 35, 56-57, 76 4, 9, 10, 34-35, 55-56, 57, general principles, 156-157 171-172 health reform (1d), 7, 34, 40, 53

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286 HHS IN THE 21ST CENTURY overarching themes, 4-5, 33 Schweiker, Richard, 169, 201 positions reporting to the Science-based professions, 106 secretary (2b), 8-9, 34, 55, 63 international students and prioritize health challenges (1a), scholars, 120 6, 34, 39, 43-44 lack of interest in, 15, 16 public health programs and minority underrepresentation, reimbursement policies (2f), 120 9-10, 12, 13, 35, 56, 72 workforce shortages, 13, 14, 107, public information on prevention 120-121 and treatment options (3d), 11, Secretary of HHS. See also 13, 36, 88, 100 Transition to new secretary surgeon general’s empowerment flexibility in management of (2c), 9, 34, 55-56, 66 HHS, 5, 17, 18, 33, 37, 41, 46, value-based health care system 111, 112, 125, 126, 139-144, (3), 4-5, 12, 35-36, 87-88 150, 171, 173 workforce strengthening (4a, 4d, former, by tenure and 4e), 5, 15-16, 36, 105, 106, administration, 169 112, 113, 119-120, 121 management demands, 7, 8-9, Reorganization of HHS 46-47, 48, 60-63, 142, 200- advice to next secretary, 206-207 201 alternatives to, 201-206 positions reporting to, 7, 8-9, 46- committee position on, 3-4, 31, 47, 60-63 78 reorganization authority, 210- costs of, 196-197 226 efforts, 30-37 role, 61, 136 examples and rationale for other tenures, 31, 133 departments, 192-195 views of former secretaries on impact of change, 197-201 reorganization, 31-32, 142, and organizational culture, 198- 195-207 199 Senior Executive Service Secretaries’ views of, 31-32, Candidate Program, 110 n.3 195-207 Senior Presidential Management statutory authority, 210-226 Fellows program, 110 time frame for, 31-32, 78 Shalala, Donna, 169, 196 Research and development Social and Rehabilitation Services, biomedical, 73-74 212 Richmond, Julius B., 63 Social Security Act, 211, 217, 218, Roosevelt, Franklin D., 44, 193 227, 228 Social Security Administration (SSA), 21, 22, 27, 41, 67 n.3, S 192, 196, 198, 210 Social Security Independence and Satcher, David, 64, 75 Improvement Act, 192 Schizophrenia, 73 Social Security program, 27

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287 INDEX State and local governments Secretary’s authority to organize, partnerships with HHS, 3, 46, 72 210-213 public health role, 42 Substance Abuse and Mental strategic planning role, 42 Health Services, 223, 251-256 State Children’s Health Insurance USDA Food Safety Inspection Program (SCHIP), 28, 29, n.3, Service, 225-226 30 Strategic planning State of the USA, Inc., 129 n.1 goal setting, 40, 45-47 Statutory requirements and health reform, 6, 7, 40 constraints mission statement, 40, 45 Administration for Children and prioritizing health challenges, 6, Families, 216-217, 227-228 34, 40-44 Administration on Aging, 217 team, 6, 39, 41, 42 Agency for Toxic Substances vision, 6-7, 39-40, 44 and Disease Registry, 223- Structure of HHS. See also 224, 249-250 Organizational structure of AHRQ, 218-219, 228-2 HHS; Reorganization of HHS barriers to reorganization, 226- challenges, 3, 57-59 227 food safety regulation, 8, 58, 78- CDC, 219, 231-240 83 CMS, 217-218 internal challenges, 46-47 constraints on HHS organization, leadership selection process and 227-262 terms of office, 7, 66-68 Department of Veterans Affairs opportunities for change, 32-33 undersecretary for health, 225 origins, 23, 25-27 FDA, 220, 241-242 and performance, 30, 44, 191 health functions of other federal planning, see Strategic planning offices, 225-226 public health agenda, 7-8, 69-72 Health Resources and Services research funding, 8, 76-77 Administration, 222, 256-262 scientific expertise, 7, 8, 73-76 history of secretary’s exercise of Substance Abuse and Mental reorganization authority, 213- Health Services 226 Administration (SAMHSA) Indian health Service, 224, 250- budget allocation, 28, 29 251 mission, 167 NIH, 220-222, 242-249 organizational structure, 26, 165, regional offices, 224 214, 223 reorganization authority, 215- origin, 223 216 statutory requirements and Reorganization Plan No. 1 of constraints, 215, 223, 251-256 1953, 210-211 Surgeon general Reorganization Plan No. 3 of accomplishments and 1966, 211-213 controversies, 63, 64

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288 HHS IN THE 21ST CENTURY empowerment, 63-66 U.S. Department of Defense reporting to the secretary, 60-61, (DoD), 17, 21, 22, 42, 59-60, 210 119, 135, 192, 194 responsibilities, 7, 8, 64, 137 U.S. Department of Education, 22, selection process and term, 9, 64, 27, 71 n.5, 169, 192, 193, 195, 65 196, 198, 209 Surgeon General Independence U.S. Department of Energy, 22, Act, 65 n.2 194 Surgeon General Restoration U.S. Department of Health and Authority Act, 65 n.2 Human Services (HHS). See Accountability at HHS; individual agencies, offices, T and programs activities and programs, 1, 22-23 Taylor, Frederick, 207 alignment of agencies and Temporary Assistance for Needy programs, see Organizational Families, 23, 216, 217 structure of HHS; Structure of Terry, Luther L., 63 HHS Thompson, Tommy, 169, 196, 197 budget, see Budget for HHS Tobacco control programs, 26, 42, decision making, see 63, 129 Accountability at HHS; Transition to new secretary Management and decision continuity throughout tenure, making; Secretary of HHS 153-155 goals, see Goals and goal first 90 days, 150-151 setting by HHS first year in office, 151-153 international relationships, 23-24 general principles, 19-20, 156- leadership, see Assistant 157 secretary for health; HHS and restructuring, 31 workforce; Secretary of HHS scenario, 148 mission, 2, 4, 27, 40, 45, 69 steps, 149-155 organization, see Organizational Truman, Harry S., 21 structure of HHS; Reorganization of HHS; Structure of HHS U oversight, 132 performance, 44 Uninsured Americans, 1, 50, 70 planning, see Strategic planning U.S. Department of Agriculture private-sector partnerships, 3, 15, (USDA), 22, 27, 71 n.5, 80- 46 81, 82, 83, 220, 226. See also recommendations, see Food Safety and Inspection Recommendations to HHS Service state and local government U.S. Department of Commerce, 22, partnerships with, 3, 46 80

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289 INDEX vision, 4, 6-7, 34, 39-40, 44, 47- evidence-based decisionmaking, 48 70, 71, 72, 73-75 U.S. Department of Health, financial resources of agencies Education, and Welfare, 27, under, 27, 29, 69 169, 192, 195, 196, 209, 210, infrastructure, 2, 70, 108 219 integration of state and local U.S. Department of Homeland agencies and community- Security (DHS), 22, 23, 31, based organizations, 13, 72 41, 42, 71 n.5, 78, 80, 143, organizational structure, 26, 27, 193, 196 210, 212, 214 U.S. Department of Housing and oversight, 26, 42, 47, 61, 62, 64, Urban Development (HUD), 165, 205, 214, 224, 227, 250 22, 194, 228 population health approach, 70, U.S. Department of Justice, 22, 142 71 U.S. Department of Labor, 22, 42, reorganization, 26 71 n.5 valuation of services, 71 U.S. Department of State, 22 workforce, 72, 73-75, 106, 107, U.S. Department of the Interior, 22, 108, 117-119 71 n.5, 251 U.S. Department of the Treasury, 22, 71 n.5 V U.S. Department of Transportation, 22, 71 n.5, 194 Value-based health care system U.S. Department of Veterans CMS role, 11, 88-89, 94, 96-97, Affairs, 22, 42, 63, 71 n.5, 135, 141, 187, 190 119, 135, 225 collaboration with state, local, U.S. Environmental Protection and community-based health Agency, 22, 41, 71 n.5, 80, care organizations, 13, 35, 88, 194 98 U.S. Public Health Service. See comparative effectiveness also specific offices and research, 67, 89-93, 101-103, agencies 175-190 accountability, 70 data collection and sharing, 87, alignment and flexibility in, 69- 101-103 70, 71-72 electronic information attributes of integrated agenda, capabilities, 98, 100-103 71-72 evidence-based care, 1, 11, 13, Commissioned Corps, 8, 34, 55, 94-98 64, 66, 171; see also Surgeon home care technologies, 99 general and innovation, 178 n.4, 181-182 communicable disease control, n.10, 186 27 integrated care, 11, 92-93, 97, emergency response funding, 46, 101, 176 64 legislation, 89 n.2

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290 HHS IN THE 21ST CENTURY 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