Executive Summary

This Annual Report is organized into five sections corresponding to the HHS department strategic goals, as laid out in our 2018–2022 strategic plan.

Goal 1: Reform, Strengthen, and Modernize the Nation’s Health Care System

HHS aims to improve the quality and reduce the cost of healthcare Americans receive by facilitating patient-centered markets and advancing the direct care provided in our programs. Accomplishments in this section include:

• A decline in the retail prices of prescription drugs, as measured by National Health Expenditure Data, in 2018 for the first time in more than 40 years.
• The first-ever FDA plan for safe importation of prescription drugs from foreign countries, including Canada, to reduce drug costs.
• A record number of generic drug approvals from FDA for the third straight year, with a record number of first generics and record number of biosimilars approved.
• A decrease in average premiums for a benchmark plan on HealthCare.gov, for the second consecutive year since the establishment of the insurance exchanges.
• Protecting and strengthening Medicare, delivering $2.65 billion in savings and more benefits and options to beneficiaries over the last three years.
• The introduction of historic value-based payment models to change how the government pays for emergency services, kidney health, radiation oncology, and primary care.
• Redesigning the ACO program and doubling the number of ACOs taking on downside risk, accelerating Medicare payments tied to value.
• A new requirement that hospitals disclose their standard charges (including gross charges, discounted cash prices, and payer-specific negotiated price) and a proposed rule to provide consumers with anticipated out-of-pocket costs.
• Proposal of historic reforms to Stark Law and Anti-Kickback Statute regulations that may impede value-based and coordinated care arrangements.
• A new proposed rule to give patients access to their electronic health information at no cost, including via smartphone applications.

Goal 2: Protect the Health and Well-Being of Americans Where They Live, Learn, Work, and Play

Our work to protect the health of Americans extends from addressing particular impactable health challenges here in the United States, including the opioid crisis, HIV, and other infectious diseases, all the way to protecting lives around the world from health threats. Covered in this section are accomplishments including:

• Efforts to combat the opioid crisis that led to a 4.1 percent decrease in drug overdose deaths in 2018, the first such decrease in more than two decades.
• Launching the HEALing Communities Initiative to reduce drug overdose mortality by 40 percent in communities in four states, through awarding $350 million to pursue a whole-of-society approach.
• Initiating the President’s historic initiative to end the HIV epidemic in the U.S. by 2030.
• Kicking off the Advancing American Kidney Health Initiative to help prevent kidney disease and deliver better health outcomes for kidney patients.
• Deploying U.S. Public Health Commissioned Corps officers to support 32 missions responding to national emergencies, natural disasters, and other public health crises.
• The first-ever Medicaid demonstrations to expand inpatient treatment options for serious mental illness.
• Working at home and abroad to increase vaccine confidence and responded to measles outbreaks in the U.S., maintaining our country’s elimination status.
• Engaging across HHS in a historic response to the Ebola outbreak in the Democratic Republic of the Congo, including the first approval of a vaccine for Ebola and conducting a clinical trial for therapeutics in a war zone.

Goal 3: Strengthen the Economic and Social Well-Being of Americans across the Lifespan

HHS plays a vital role in supporting independence for all Americans at all stages of life—whether new mothers, youth in foster care, Americans withca disabilities, and older Americans. This section covers items such as:

• An initiative launched to improve availability and quality of treatment and support services for children and families impacted by neonatal abstinence syndrome.
• A nationwide listening tour to develop solutions for expanding access to affordable, high quality child care for working families.
• A record number of foster care adoptions in the U.S. in 2019.
• The first-ever Medicaid demonstrations to expand inpatient treatment options for serious mental illness.
• A new challenge for employers to design models to expand job opportunities for Americans with disabilities, especially intellectual and developmental disabilities.
• Protecting conscience in the foster care space and proposing a rule to protect religious freedom in HHS grants.

Goal 4: Foster Sound, Sustained Advances in the Sciences

HHS works to advance biomedical science to improve the health and well-being of Americans, and everyone around the world, through directly supporting research and working with the private sector to advance promising innovations. This section covers examples of our work at the frontiers of science, including:

• Continued progress of the All of Us long-term research study at the National Institutes of Health with more than 300,000 people enrolled across all 50 states.
• Initiating an effort to provide $500 million over the next decade to improve pediatric cancer research.
• The Cancer Moonshot Initiative that funded over 200 high-impact projects in FY 2019 seeking to advance critical research areas.
• A clinical trial that is testing a promising novel gene replacement therapy in patients with sickle cell disease.
• Issuing a six-year, $226 million contract to retain and increase capacity to produce recombinant influenza vaccine in the United States.

Goal 5: Promote Effective and Efficient Management and Stewardship

In 2019, HHS took major steps forward to be good stewards of taxpayer resources, provide quality customer service to employees and stakeholders, and modernize departmental operations. Included in this section:

• Ending a healthcare fraud scheme that had billed a record $1.3 billion to Medicare and Medicaid in fraudulent claims.
• A decrease in the 2019 Medicare fee-for-service estimated improper payment rate below the threshold for compliance established by law for the third consecutive year.
• HHS ranking as the best place to work among cabinet-level departments for the third straight year.
• Increased participation of staff in the Federal Employee Viewpoint Survey to 71.9 percent, far exceeding the goal set of 60 percent.
• Modernizing and coordinating communications across HHS through a comprehensive digital communications strategy.