Since 2002, the Office of Management and Budget (OMB) has systematically rated the management and performance of federal programs using a standard assessment instrument. Assessments, along with accompanying explanation and evidence, are publicly available. This analysis draws on that information for insights into management challenges facing the largest federal health care programs and identifies opportunities for improving their performance. The exercise is, in turn, a test of the OMB assessments’ value in guiding management-improvement strategies for federal health care programs. When a new administration takes office in January 2009, this overview might provide valuable guidance in building management and performance capacity into reformed or new health care programs.