How to improve the efficiency and performance of government programs

by Neil Hoosier

Founder and CEO, Neil Hoosier & Associates

In his recent budget request, President Biden highlighted his goals to improve the performance and efficiency of government programs in order to deliver a better experience to the end user, and also to ensure that the vast amount of federal relief money being distributed is spent wisely and free from fraud, waste and abuse.

Specifically, the budget request notes the following:

“Delivering Government Services Effectively and Efficiently. The Federal Government administers a wide array of programs on behalf of the American people, but implementation efforts often fail to adopt a human, customer-focused mindset—preventing these programs from reaching all those they are intended to benefit and serve. The Administration is implementing a comprehensive approach to improving the access, equity, and overall delivery of Federal services, which includes improving customer experience management. The Budget supports the Nation’s highest impact service providers across a variety of agencies to deliver on their annual Customer Experience Action Plans. This includes, for example: increasing the use of remote inspection capabilities to enable families to send the Federal Emergency Management Agency digital video and images of disaster property damage for verification and validation; making it possible for individuals to request a call back, rather than waiting on the phone, for more Internal Revenue Service functions; collecting customer feedback on interactions with the Transportation Security Administration from passengers that experience secondary screening; and adapting the design of new “journey to discharge” approaches at the Veterans Health Administration for patient information to reduce preventable adverse events within three weeks of discharge.

Ensuring Effective Implementation of COVID-19 Pandemic Relief Funds and Stewardship of Taxpayer Resources. The Administration will administer pandemic relief funding—including funding provided through the American Rescue Plan Act of 2021 (the American Rescue Plan)—with maximum accountability and transparency and a focus on achieving results. This requires designing programs and service delivery models that achieve equitable results while promoting transparency and supporting long-term outcomes that benefit the American people. These goals can be achieved while minimizing burden to agencies and recipients through sound financial management, a focus on program integrity, and accurate and timely reporting on data about the use of taxpayer funds.”

A recent story from the Wall Street Journal describing issues facing the SBA during the pandemic provides a vivid example of the kind of problems President Biden is trying to improve. The article describes an agency charged with the massive task of distributing COVID relief to struggling small businesses during the pandemic and the delays, mix-ups, confusion and fraud that resulted.

Public health agencies are staring down similar issues as they try to ensure they are effectively spending more than $300 billion in federal funds after years of budget cuts. And the issue is not limited to the federal government. State and local governments are dealing with a similar story as they too are staring at an influx of federal aid and seeking to ensure that they allocate the money wisely [link to article].

The pandemic and recovery have made clear the need for good, effective, efficient government. For more than 20 years, NHA has helped through management, oversight and training to improve the efficiency and performance of one of the largest, most complex and consequential government programs: Medicare. Our experience has revealed a few key lessons that can be applied to other areas of the government to help achieve similar improvements in efficiency and performance:

1. Ensure that all the different players and pieces are working in concert.

Government programs involve large, complex bureaucracies with tasks divided among disparate units, agencies, jurisdictions and organizations. The potential for inefficiencies, delays and mistakes is clear. To mitigate this problem, government programs should take steps to ensure that the different pieces are functioning together. In our role as an integration contractor for one of the Medicare programs, NHA helps to ensure that multiple different contractors work in concert with each other as well as with the federal government through document sharing, meeting coordination, software maintenance, training and other steps. This helps to ensure that a large, complex program with many different players functions efficiently and effectively.

2. Engage the end user through outreach and education.

Understanding how to navigate the complicated requirements and procedures of a government program can greatly improve the experience of the end user. NHA helps to educate and engage the different Medicare program end users — including beneficiaries, providers, insurance companies and contractors – through trainings, webinars, user guides, website content management and other methods. The result is a better experience for all the stakeholders.

3. Establish a robust program integrity infrastructure.

Ensuring that government funds are spent wisely and free from fraud, waste and abuse is an essential task, particularly with the large amounts of federal relief money being distributed to entities not used to dealing with such large sums. The first step is to ensure that an appropriate program integrity infrastructure is in place. This is similar to the work NHA provided to CMS to help refine its Medicare-Medicaid program integrity infrastructure by identifying a set of best practices and recommendations. The program integrity operations must be appropriately robust and tailored to ensure that instances of fraud, waste and abuse are detected and prevented.

These steps, and others, can help to ensure that with the scope and importance of government programs at an all-time high, these programs can function as efficiently and effectively as possible.

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