Improve Care, Provide Continuity, and Eliminate Fraud

In the United States, the Department of Health and Human Services (HHS) is the federal agency responsible for protecting the health of all Americans. The agency oversees and regulates providers of essential human services, while acting as somewhat of a “watch-dog” agency for those who are least able to help themselves.

The Department of Health and Human Services manages both Medicare and Medicaid health care insurance. As stated here previously, HHS represents almost a quarter of the entire federal budget expenditures. The Medicare program is the nation’s largest health insurer, handling more than 1 billion claims per year. Medicare and Medicaid together provide healthcare insurance for one in four Americans.

High Cost and Low Relative Efficiency

Healthcare costs consume an ever-increasing amount of our nation’s resources, putting a financial strain on families, businesses, and government budgets. When costs go up, which are generally reflected in rising health insurance premiums, it erodes a worker’s take-home pay while simultaneously effecting the competitiveness of American businesses. Healthcare costs take up a growing share of federal, state, and family budgets. In the United States, one of the sources of inefficiency that is leading to rising healthcare costs is a payment/reimbursement system that rewards medical inputs rather than patient outcomes. As most of us realize, the current “system” contains high administrative costs. Also lacking is a focus on disease prevention.

The intent of the Affordable Care Act is to bring down costs for families, elders, businesses, and government with the broadest package of healthcare cost-cutting measures that has ever been enacted. As part of health reform implementation, HHS is attempting to lower costs for families, our elderly parents, and individuals through insurance market reforms that ensure access to preventive care.

HHS is attempting to shift the healthcare landscape. Medicare is a system that rewards volume of service. The new vision is to create a healthcare system that 1.) will reward efficiency and effective care; 2.) that reduces delivery system fragmentation and now combines continual care services; and 3.) better aligns reimbursement rates with provider costs. Efforts are being made to strengthen program integrity in Medicare and Medicaid, and to encourage widespread adoption and meaningful use of health information technology to help reduce the growth of healthcare costs.

The Department of Health and Human Services, in conjunction with the Department of Justice, is also trying to crack down on fraud and systemic abuse involving healthcare. During Fiscal Year 2012, the government won or negotiated over $3 billion in healthcare fraud judgments and settlements. For FY 2012 the Federal government actually collected $4.2 billion from current and prior year settlements.