1.) Finally, the department  engages in some coordinated planning, but lacks comprehensive  planning and oversight to ensure that its many workforce efforts address  identified national needs. HHS’s Strategic Plan Lacks Specific Strategies for Its Health Care Workforce Programs Related to Their Effect on Access and Quality

HHS’s strategic plan includes broad strategies to which the department’s  health care workforce efforts relate, but these strategies do not focus  specifically on workforce issues. For  example, as part of one strategy, HHS seeks to improve access to  comprehensive primary and preventative medical services in historically  underserved areas and to support federally funded health centers. While it is important to  have specific performance measures that assess individual programs,  health care workforce is an issue that straddles many different programs  and HHS agencies, and therefore it is also important to have broader  measures that assess how these individual programs contribute to the  department’s overall effectiveness in developing the health care  workforce to improve access to care. According to HHS, over three-quarters of the 72 health care workforce  programs had performance measures tracked by the relevant HHS  agency. HHS Coordinates Some Health Care Workforce Planning, but Lacks Comprehensive and Ongoing Oversight to Ensure Needs Are Fully Addressed

HHS does not have a consistent and ongoing effort to coordinate all of  the workforce planning efforts and resources that are distributed across  the department’s various offices and agencies. Recently, multiple stakeholders reported that a more coordinated federal  effort—possibly managed at the department level—could help to ensure a  more adequate supply and distribution of the health care workforce,  especially given changes in the delivery of care. For example, in  examining federal GME funding, IOM and COGME each stated that the  GME program lacks the oversight and infrastructure to track outcomes,  reward performance, and respond to emerging workforce challenges. HHS’s Largest Health Care Workforce Programs Do Not Target Areas of Identified Need, Although Smaller Programs Do

Our review showed that although HHS’s health care workforce programs  support education and training for multiple professions, the biggest  programs do not specifically target areas of workforce need. The two  CMS Medicare GME programs, which accounted for 77 percent of HHS’s  fiscal year 2014 obligations for health care workforce development,  support hospital-based training of the many different types of physician  specialties. However, HHS cannot specifically target existing Medicare  GME program funds to projected workforce needs—such as primary care  and rural areas— because the disbursement of these funds is governed  by requirements unrelated to workforce shortages. HHS Has Limited Authority to Target Health Care Workforce Programs to Areas of Need and Has Taken Some Steps To Do So

According to HHS officials, the department generally has limited authority  to better target workforce programs to address projected health care  workforce needs. According to these officials, the agency has used demonstration  authorities to test new payment models for the Medicaid GME program. Because the responsibilities for HHS’s workforce efforts, programs, and  resources are dispersed among many agencies, it is important that HHS  have a department-wide approach regarding its strategies and the actions  needed to ensure an adequate supply and distribution of the nation’s  workforce. HHS has proposed additional authorities in the past, but these have not  been enacted, and HHS officials acknowledge that these additional  authorities may not be sufficient to fully address the existing program  limitations identified by stakeholders. Without a comprehensive and  coordinated approach to program planning, HHS cannot fully identify the  gaps between existing programs and national needs, identify actions  needed to address these gaps, or determine whether additional legislative  proposals are needed to ensure that its programs fully meet workforce  needs. Recommendation for Executive Action

To ensure that HHS workforce efforts meet national needs, we  recommend that the Secretary of Health and Human Services develop a  comprehensive and coordinated planning approach to guide HHS’s health  care workforce development programs—including education, training, and  payment programs—that  includes performance measures to more clearly determine the extent  to which these programs are meeting the department’s strategic goal  of strengthening health care;  identifies and communicates to stakeholders any gaps between  existing programs and future health care workforce needs identified in  HRSA’s workforce projection reports;  identifies actions needed to address identified gaps; and  identifies and communicates to Congress the legislative authority, if  any, the Department needs to implement the identified actions. HHS also provided technical comments, which we incorporated as  appropriate.
Why GAO Did This Study

An adequate, well-trained, and diverse health care workforce is essential for providing access to quality health care services. The federal government—largely through HHS—funds programs to help ensure a sufficient supply and distribution of health care professionals. Some experts suggest that maintaining access to care could require an increase in the supply of providers, while others suggest access can be maintained by, among other things, greater use of technology.
GAO was asked to review HHS's workforce efforts. In this report, GAO examines (1) HHS's planning efforts for ensuring an adequate supply and distribution of the nation's health care workforce and (2) the extent to which individual HHS health care workforce programs contribute to meeting national needs. GAO reviewed strategic planning documents, workforce projection reports, and other related documents obtained from HHS agencies; interviewed HHS officials; and analyzed performance measures for the largest health care workforce programs operated by HHS.

What GAO Found

The Department of Health and Human Services (HHS) engages in some planning for the 72 health care workforce programs administered by its agencies, but lacks comprehensive planning and oversight to ensure that these efforts meet national health care workforce needs. HHS's current strategic plan includes broad strategies—such as improving access to comprehensive primary and preventive medical services in historically underserved areas and supporting federally funded health centers—to which department officials said the health care workforce programs relate. However, these strategies do not explicitly reference workforce issues or specify how these programs contribute towards HHS's current strategic goals and performance targets. The health care workforce performance measures tracked by HHS and its agencies are specific to individual workforce programs and do not fully assess the overall adequacy of the department's workforce efforts. The Office of the Secretary leads workforce planning efforts, but it does not have an ongoing formal effort to ensure that the workforce programs distributed across its different agencies are aligned with national needs. Multiple external stakeholders, such as the Institute of Medicine and the Council on Graduate Medical Education, have reported that graduate medical education (GME) funding lacks the oversight and infrastructure to track outcomes, reward performance, and respond to emerging workforce challenges and that a more coordinated effort could help to ensure an adequate supply and distribution of the health care workforce. Consistent with leading practices, a coordinated department-wide planning effort is important to ensure that these efforts are aligned and managed effectively to meet workforce needs.
While HHS's workforce programs support education and training for multiple health professions, its largest programs do not specifically target areas of workforce need, such as for primary care and rural providers. For example, its two Medicare GME programs accounted for about three-quarters of HHS's fiscal year 2014 obligations for health care workforce development. However, HHS cannot target existing Medicare GME program funds to projected workforce shortage areas because the programs were established by statute and funds are disbursed based on a statutory formula that is unrelated to projected workforce needs. HHS has limited legal authority to target certain existing programs to areas of emerging needs and has taken steps to do so within its existing authorities, such as the approval of certain demonstration projects to test new payment models for Medicaid GME funds. Further, the President's budget has proposed additional authorities that would allow HHS to implement new education and training programs and payment reforms intended to support primary care providers, but these authorities have not been enacted and officials did not know the extent to which they would be sufficient to address identified needs. External stakeholders have recommended additional reforms that would allow these programs to better targets areas of need. Without a comprehensive and coordinated planning approach, HHS cannot fully identify gaps and actions to address those gaps, including determining whether additional legislative proposals are needed to ensure that its programs fully meet workforce needs.

What GAO Recommends

GAO recommends that HHS develop a comprehensive and coordinated planning approach that includes performance measures, identifies any gaps between its workforce programs and national needs, and identifies actions to close these gaps. HHS concurred with GAO's recommendations and provided technical comments, which GAO incorporated as appropriate.