Implementing Health Care Reform

Implementing the Recovery Act has been a major challenge.  But it pales in comparison to the complexity facing those implementing the health care reform bill.  Office of Personnel Management director John Berry says implementing this new law will be equivalent to being “the moon shot of our generation.”  Last week, Senator Mark Warner reinforced Berry’s observation, calling it “the mother of all implementation challenges.”

The Obama Administration is gearing up to meet the many deadlines in the bill.  In fact, it’s created a separate website to provide information on this: HealthReform.Gov.

However, there is also a major public management challenge involved as well.  As a result, the IBM Center is sponsoring a separate, new blog (with an optimistic title) – Implementing Health Care Reform — to provide insights into the implementation of this effort.  It is being co-authored by Professor Don Kettl, one of the preeminent academics in the field of public administration, and dean of the University of Maryland’s School of Public Policy; and Jack Meyer, who holds a joint appointment in both the School of Public Policy and the School of Public Health at the University of Maryland.

Be sure to visit the site, and book mark it!


Data-Driven Performance: The Hearing

Senator Mark Warner chaired another hearing of his Taskforce on Government Performance, on “Data-Driven Performance:  Using Technology to Deliver Results.”

The Obama Administration’s chief technology officer, Aneesh Chopra, testified.  Here are some interesting excerpts from his statement:

. . . .I’ve focused my government performance efforts in three areas in which technology can spur rapid innovation and drive results:

  • R&D: Moving Research into Development and Deployment
  • Open Standards:  Enabling “Government as a Platform”
  • Prizes and Competitions:  Aligning Innovation toward National Priorities.

When combined, these three pillars can drive high-performance government.  By “platform,” I mean a government that uses low-cost information technologies to do what it uniquely can—make high-quality data available, coordinating standards activities across may disparate actors, moving federally-funded research into development and deployment, hosting prizes and competitions – while leaving it to citizens, companies, non-profits, and academic institutions to build innovative tools and services on top of the platform.

His testimony gives examples of how agencies are moving forward on each of these pillars already.

Chopra was accompanied by Vivek Kundra, the federal government’s chief information officer, who talked about using technology to drive performance via the use of dashboards.  He described the use of the Obama Administration’s IT Dashboard to reduce wasteful tech spending, and doing it with a lower reporting burden on agencies.

Sen. Warner noted that the Executive Branch probably needs to focus on other areas of reporting burdens, such as the overlap between the reporting requirements for,, and GSA’s contract database, the Federal Procurement Data System.  Organizations have to report to each, with different timeframes, different data elements, and using different standards.  Kundra agreed.

Post Script:  Toward the end of the hearing, Senator Warner mentioned that both Chopra and Kundra were featured on a segment of the Jon Stewart show the night before, where Stewart poked fun at their announcement of the Open Government Directive, calling Chopra the “Indian George Clooney.”  It’s worth watching!

OMB’s New Performance Principles

OMB Chief Performance Office Jeff Zients testified today before the Senate Budget Committee’s new Task Force on Government Performance.  He laid out a set of five key principles OMB will follow in developing a governmentwide performance management system.

He prefaced his remarks noting: “The test of a performance management system is whether it is used. . . the current approach fails this test.  Congress doesn’t use it.  Agencies don’t use it.  And it doesn’t produce meaningful information for the public.  There’s too much emphasis on process and not enough on outcomes.”

He went on to say: “This must change.  Federal managers and employees at all levels must use performance goals and measures to set priorities, monitor progress, and diagnose problems.”  He said that OMB wanted to build on lessons best practices from states, localities, other countries, and federal agencies.  He wants to use the best of what works to create a new performance management system based on the following five principles:

  • Senior leader ownership of performance management process.  Secretaries and Deputies will be charged with the setting of agency goals and will be responsible for performance against those goals
  • Cascading goals and measurements.  A clear line must link agency strategic goals and measures to unit-level, program-level, and ultimately individual targets.
  • Outcome-oriented, cross-agency goals and measurements.  Current goals and measures connect agencies to their missions, but broad government outcomes often require contributions from multiple actors across different agencies as well as outside the government.  Goals and measures must support coordination across these boundaries, with a clear sense as to who the “goal owner” is and what various organizations must contribute.
  • Relentless review and accountability.  Reviews must be performed at all levels of government on progress, at least quarterly. “Only this kind of relentless review process will result in performance management becoming ingrained into the culture of government.”
  • Transparent process.  Transparency plays a critical role in engaging the public, Congress, and the overall government workforce.  It promotes understanding, innovation, involvement, and accountability.

Zients noted some progress already.  Agencies have developed three to eight “ambitious, outcome-oriented high priority goals which they intend to achieve in the next 12 to 24 months” and this list will be released as part of the fiscal year 2011 budget process.  He also noted the use of management dashboards, such as the IT Dashboard, and said “We plan similar dashboards for other common government functions, including procurement, financial management, and personnel management.”   He also said OMB will look for ways to make agency Performance and Accountability Reports more useful.  The Department of the Interior’s report may be a useful model.

He said he looked forward to working with the Senate Budget Committee.  He said to the Senate task force, “we believe you have a unique perspective for examining how the government can more effectively achieve broad goals through multiple programs that cut across agency and appropriation boundaries.”

Chairman Mark Warner noted that his task force would be examining two to three policy goals and mapping out the programs, agencies, and committee jurisdictions involved, along with potential broad goals and outcome measures that might be developed.