HHS chief lays out 500-day management plan

Health and Human Services Secretary Mike Leavitt is, quite literally, a man with a plan.

A 500-day plan actually, a management tool that he says he uses to schedule his time, focus the attention of the department, and provide his staff with a road map for understanding the boss's vision.

The 500-day plan, which Leavitt rolled out in May and posted on an HHS Web site, describes the secretary's long-term vision for the future of American health care, as well as about two dozen steps the department must take to get started. It includes a set of underlying principles that Leavitt has been repeating from various podiums for years, ideas that he says form "a prism through which those who work with me can look to determine how I will view a problem."

Leavitt's penchant for plans and principles gives him a useful way of establishing clear goals for a large public bureaucracy, management experts say. But whether the plans offer a meaningful yardstick for measuring the performance of the man or his department is an open question.

Leavitt was in his third term as the Republican governor of Utah when President Bush tapped him in August 2003 to succeed Christine Todd Whitman as the head of the Environmental Protection Agency. After Bush won re-election in November, he asked Leavitt to move from the EPA to HHS, which has three times the employees and 50 times the budget.

During his 447-day tenure at the EPA, Leavitt issued a 500-day plan that promised to "increase the velocity of environmental progress by implementing 'a better way.' " The wording of many of the plan's elements makes it difficult to render a judgment on Leavitt's success or failure in his former post.

The EPA plan included, for example, promises to "restore watersheds and coastal waters" and to "apply consistent and certain enforcement to motivate compliance." Neither goal included measurable benchmarks. Some of Leavitt's specific legislative commitments -- including elevating the EPA to Cabinet status and passing broad Clean Air legislation known as "Clear Skies" -- remain unfulfilled. Leavitt did make headway on some of his regulatory initiatives, such as signing a proposed rule to regulate mercury emissions from power plants. New EPA Administrator Steve Johnson is expected to unveil his own list of priorities in the next few weeks.

Leavitt's 500-day plan for HHS has two parts: visionary goals that the secretary posits for the nation over the next 5,000 days (that is, by 2019), and concrete strategies that he will concentrate on for his first 500 days. The "visions" include establishing an electronic system for managing individual health records, in place of today's paperwork. The "strategies" in this area include convening a "national collaboration" to develop standards for the data and technology that would handle such a system.

HHS has already taken some of the short-term steps in the 500-day plan; in some cases, work had begun before Leavitt arrived. For instance, in May, the Government Accountability Office reported that the department is "taking initial steps toward developing a national strategy for health IT." But the biggest success that the GAO pointed to was the July 2004 (pre-Leavitt) release of a three-phase framework for action on the national strategy. The GAO said that Health and Human Services had begun taking steps to implement the first phase of the strategy, but "has not established milestones for completion of phase I activities, nor has it made detailed plans or set milestones" for the second and third phases.

Former House Speaker Newt Gingrich, R-Ga., who has been promoting the potential of medical technology to save lives and money, has criticized HHS for a slow start, spending tens of millions of dollars when, he says, billions will be required. Leavitt counters that it is necessary to get standards in place before investing huge sums of money.

Leavitt says he plans to spend the majority of his time working on items in the 500-day plan, but he cautions, "It is not even a full list of all the things that would be considered a priority in the department. There are many other things that others have been tasked with responsibility for."

Underlying both the EPA and HHS plans is a set of nearly identical slogans that shape Leavitt's prism: "National standards, neighborhood solutions.... Markets before mandates.... Collaboration, not polarization.... Change a heart, change a nation."

Leavitt enumerated the same principles in the late 1990s as part of the Western Governors' Association's vision for collaborative decision-making on environmental issues, a plan called "Enlibra." In 1999, when Leavitt became the National Governors Association chair, the same principles became part of its standing environmental policies.

Joseph Newhouse, professor of health policy and management at Harvard University, said that the department's 500-day plan seems to be mostly a recitation of the administration's existing priorities. "I would have thought there was something underlying this that was substantially more detailed," Newhouse said.