HHS Strategic Goals and Objectives - FY 2001

This is a historical document - the current HHS Strategic Plan is available at http://aspe.hhs.gov/hhsplan/

Introduction

The Department

The Department of Health and Human Services (HHS) is one of the largest federal departments, the nation's largest health insurer, and the largest grant-making agency in the United States federal government. The Department promotes and protects the health and well-being of all Americans and provides world leadership in biomedical and public health sciences. HHS accomplishes these objectives through an array of programs in basic and applied science, public health, income support, child development, and the financing and regulation of health and social services. The Department manages this broad range of activities in collaboration with its state, local, tribal, and non-governmental partners, and with the coordination of the staff agencies in the Office of the Secretary. Appendix I provides a brief description of HHS Agencies and staff offices.

Development and Update of the Plan

In 1997, HHS published its first strategic plan in response to the Government Performance and Results Act (GPRA). Since that time, the Department has successfully implemented the remaining GPRA requirements and now is working to continually improve the quality of its GPRA submissions. Part of that quality improvement effort has focused on updating the HHS Strategic Plan to reflect the emergence of new priorities and the experience that has been gained while implementing the initial plan. The result is an expansion and restatement of some of the Strategic Plan goals and objectives. The order of goals and objectives is much the same as in the 1997 plan and does not convey an indication of priority or the importance of one over the other. The discussion of implementation strategies also is expanded and refined. A more thorough discussion of data and management challenges and solutions is provided (Appendices D and H). A more complete analysis of external factors that might affect the goals/objectives and how the Department might mitigate them is included (Appendix B). Possible success indicators are refined and an explanation of how the strategic and annual performance plans are closely linked is now discussed in detail (Appendix C).

Additionally, with the recent release of Healthy People 2010 and the ten Leading Health Indicators, the Department has a clearly articulated set of national health objectives. The ten leading indicators relate to physical activity, overweight and obesity, tobacco use, substance (drug/alcohol) abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care. The HHS Strategic Plan now reflects the priorities set by these national objectives. The eight objectives in Goal 1 parallel eight of the ten leading indicators; Goal 3 parallels the leading indicator on access to health care; and Objective 3.8 parallels the leading indicator on mental health.

Despite these changes, the basic logic of the plan remains the same. The strategic goals and objectives reflect Department-wide priorities that cut across individual HHS agencies and programs. In contrast, our implementation strategies are aligned with the authority and funding of categorical programs. Often, however, individuals and families have needs that go beyond the individual Department programs. For example, the person who is moving from welfare to work may also need access to affordable housing–a program that is within the purview of the Department of Housing and Urban Development (HUD). In this respect, the HHS implementation strategies for helping clients would appear to be constrained by the scope of the programs that we administer.

To overcome this constraint, HHS works with a wide range of federal, state, and local service providers to coordinate the planning and delivery of services in a way that maximizes resources and provides clients with an integrated approach to their needs. The discussion of internal and external coordination has been significantly expanded to provide a clearer sense of where the Department's programs and activities intersect with each other and with organizations outside HHS (see Appendix A).

In addition, Appendix A describes the unique service delivery partnership that we have with state and local governments, tribes, and private organizations that have programs and goals similar to those of HHS. The appendix provides a discussion of how these partnerships work in planning and delivering services and the important role that these organizations play in helping us achieve the objectives we have set in the HHS Strategic Plan.

The Department's objectives and implementation strategies target populations within our program authority (e.g., persons with particular diseases or Native Americans). Where we have discretion and are given finite resources, we target groups with the greatest needs. Beyond this, we cast our objectives and implementation strategies generically and not by particular populations, given the number of separate populations that are eligible for special services.

Planning and Assessment Cycle

Similarly, the Strategic Plan is not a depository of all actions that we might take to achieve an objective. Therefore, implementation strategies under each objective are not inclusive of everything we might do. Rather, they illustrate the general direction we plan to take. For example, a research strategy may be central to achieving one of our objectives. In this case, we would list selected research priorities to provide readers with the major thrust of our agenda and how research relates to achieving the particular objective. Listing every possible research activity would be impossible, given the number of potential research priorities that we might support.

In developing the plan, HHS consulted widely with stakeholders on the proposed revisions. The plan was posted on the web and comments solicited from employees, service delivery partners, and other stakeholders. Letters were sent to nearly 400 stakeholder organizations inviting written comment. We met with tribal and state and local government organization representatives, and held a separate meeting with the HHS Union-Management Partnership Council. We also held a general meeting open to all stakeholder organizations to provide an opportunity for discussion of the plan. The comment period yielded numerous suggestions, with input ranging from editorial to more substantive comments. Many of these were useful, and we made a number of changes to the plan based on the suggestions that we received. For example, we added a new objective on environmental health in response to stakeholder comments.

Our Mission

The mission of the Department of Health and Human Services is to enhance the health and well-being of Americans by providing for effective health and human services and by fostering strong, sustained advances in the sciences underlying medicine, public health, and social services.

Our Vision for a Healthy and Productive America

Healthy and productive individuals, families, and communities are the very foundation of the nation's security and prosperity. Through its leadership in medical sciences and public health, and as guardian of critical components of America's health and safety net programs, HHS seeks to improve the health and well-being of people in this country and throughout the world.

The Department's success should be measured against a yardstick of steady, progressive improvements in the physical and mental health and economic well-being of individuals, families, and communities, and advances in medicine and public health that benefit the entire world. Achieving good health as individuals and as communities is a shared responsibility. To realize its goals, HHS will develop the policies, tools, and resources that are appropriately national in scope. To realize the objectives for improving the nation's health, strengthening the social and economic fabric, and contributing to global health, the Department will form many kinds of partnerships. These include partnerships with other federal departments; state, local, and tribal governments; academic institutions; the business community; nonprofit and volunteer organizations; and our counterparts in other countries and international organizations.

Strategic Goals

In a society that is diverse in culture, language, and ethnicity, HHS manages an array of programs that aim to eliminate disparities in health status and access to health services and that increase opportunities for disadvantaged individuals to work and lead productive lives. These programs have strong foundations in basic and applied science, and are continuously improved through the development of new knowledge and its application. By addressing public health and health needs of vulnerable populations, promoting child and adolescent development, ensuring economic self-sufficiency, and assistance to working families, and financing health and social services, the Department seeks to close the gaps in health status and improve economic opportunities.

Our Core Values

In the Department's ongoing management of its programs, and in our strategic planning process, we have been guided by a set of core values that define the HHS organizational culture. These are:

• To deliver results that are satisfactory and useful both to the people and communities that are directly served by the Department's programs and to the American people who pay for these programs.

• To be an accountable steward of the Department's programs and to enhance the efficiency and quality of the services provided to our customers.

• To focus consistently on the prevention of health and social problems, including the prevention of discrimination in the provision of health and human services.

• To create useful, effective forms of collaboration in regulation, research, service delivery, and management.

• To provide accurate, reliable, understandable, and timely information to our customers, constituents, and stakeholders.

• To seek out and apply the most current scientific knowledge when making decisions that affect the public health or human services.

• To maintain a work environment that encourages creativity, diversity, innovation, teamwork, accountability, continuous learning, a sense of urgency, enthusiasm, celebration of achievement, and the highest ethical standards.

 

Goals, Objectives, and Strategies

Goal 1	Reduce the major threats to the health and productivity of all Americans.
This goal emphasizes Department efforts to improve the health of individuals and families through disease prevention and health promotion.
Goal 2	Improve the economic and social well-being of individuals, families, and communities in the United States.
This goal underscores Department efforts on helping distressed individuals and families become self-sufficient, secure, and independent in safe and economically viable communities.
Goal 3	Improve access to health services and ensure the integrity of the nation's health entitlement and safety net programs.
Goal 4	Improve the quality of health care and human services.
Goal 5	Improve the nation's public health systems.
Goals 3, 4, and 5 focus Department efforts on improving access to, and delivery of, health and human services.
Goal 6	Strengthen the nation's health sciences research enterprise and enhance its productivity.
This goal fosters strong, sustained advances in the systems and sciences underlying medicine and public health.

The HHS Strategic Goals and Objectives

GOAL 1:	Reduce the Major Threats to the Health and Productivity of All Americans
	Objective 1.1	Reduce tobacco use, especially among youth
	Objective 1.2	Reduce the incidence and impact of injuries and violence in American society
	Objective 1.3	Improve the diet and the level of physical activity of Americans
	Objective 1.4	Reduce alcohol abuse and prevent underage drinking>
	Objective 1.5	Reduce the abuse and illicit use of drugs
	Objective 1.6	Reduce unsafe sexual behaviors
	Objective 1.7	Reduce the incidence and impact of infectious diseases
	Objective 1.8	Reduce the impact of environmental factors on human health
GOAL 2:	Improve the Economic and Social Well-Being of Individuals, Families, and Communities in the United States
	Objective 2.1	Improve the economic independence of low income families, including those receiving welfare
	Objective 2.2	Increase the parental involvement and financial support of non-custodial parents in the lives of their children
	Objective 2.3	Improve the healthy development and learning readiness of preschool children
	Objective 2.4	Improve the safety and security of children and youth
	Objective 2.5	Increase the proportion of older Americans who stay active and healthy
	Objective 2.6	Increase independence and quality of life of persons with long-term-care needs
	Objective 2.7	Improve the economic and social development of distressed communities
GOAL 3:	Improve Access to Health Services and Ensure the Integrity of the Nation's Health Entitlement and Safety Net Programs
	Objective 3.1	Increase the percentage of the nation's children and adults who have health insurance coverage
	Objective 3.2	Eliminate disparities in health access and outcomes
	Objective 3.3	Increase the availability of primary health care services for underserved populations
	Objective 3.4	Protect and improve the health and satisfaction of beneficiaries in Medicare and Medicaid
	Objective 3.5	Enhance the fiscal integrity of Health Care Financing Administration (HCFA) programs and purchase the best value health care for beneficiaries
	Objective 3.6	Improve the health status of American Indians and Alaska Natives (AI/AN)
	Objective 3.7	Increase the availability and effectiveness of services for the treatment and management of HIV/AIDS
	Objective 3.8	Increase the availability and effectiveness of mental health care services
	Objective 3.9	Increase the availability and effectiveness of health services for children with special health care needs
GOAL 4:	Improve the Quality of Health Care and Human Services
	Objective 4.1	Enhance the appropriate use of effective health services
	Objective 4.2	Increase consumer and patient use of health care quality information
	Objective 4.3	Improve consumer and patient protection
	Objective 4.4	Develop knowledge that improves the quality and effectiveness of human services practice
GOAL 5:	Improve the Nation's Public Health Systems Objective
	Objective 5.1	Improve the capacity of the public health system to identify and respond to threats to the health of the nation's population
	Objective 5.2	Improve the safety of food, drugs, medical devices, and biological products
GOAL 6:	Strengthen the Nation's Health Science Research Enterprise and Enhance its Productivity
	Objective 6.1	Advance the scientific understanding of normal and abnormal biological functions and behaviors
	Objective 6.2	Improve our understanding of how to prevent, diagnose, and treat disease and disability
	Objective 6.3	Enhance our understanding of how to improve the quality, effectiveness, utilization, financing, and cost-effectiveness of health services
	Objective 6.4	Accelerate private-sector development of new drugs, biologic therapies, and medical technology
	Objective 6.5	Strengthen and diversify the base of well-qualified health researchers
	Objective 6.6	Improve the communication and application of health research results
	Objective 6.7	Strengthen mechanisms for ensuring the protection of human subjects in research and the integrity of the research process

Strategies for Accomplishing Our Goals

In this section we describe our strategies for accomplishing our strategic goals and objectives. In addition, we describe the research-based evidence for the establishment of each HHS strategic goal and the objectives that contribute to its achievement. Legislation and/or regulations required to accomplish objectives are presented as part of the strategies. A discussion of resources that will support these strategies is found in Appendix F, and a matrix relating the Department's strategic objectives to programs is shown in Appendix J.

The design and implementation of the program strategies is a process that is influenced by the lessons learned through program evaluation. Appendix E provides an in-depth discussion of program evaluations and the Department's upcoming plans for program evaluations to look at the effectiveness of the implementation strategies.

Goal 1 - Reduce the Major Threats to the Health and Productivity of All Americans

Research indicates that a significant percentage of premature mortality and morbidity in the United States can be prevented if individuals avoid certain high-risk behaviors (e.g., smoking), adopt healthy ones (e.g., exercise), and reduce exposure to major environmental risks to health (e.g., lead-based paint). The strategic objectives under this goal focus Department efforts on changing behaviors and reducing the risks that are associated with the leading causes of premature mortality and morbidity (e.g., heart disease and stroke) in the United States.

The importance of this goal is evident from the health and economic consequences of the behaviors that are addressed. For example,

• Smoking is estimated to be responsible for more than 400,000 deaths annually (one in every five deaths in the United States is smoking-related), and it is estimated that smoking increases the risk of contracting other diseases, including heart disease and emphysema and other respiratory diseases.

• Unintentional injuries (primarily from fires, falls, drowning, and poisonings) are the leading cause of death in the United States for people between the ages of 1 and 44.

• Violence in intimate relationships is estimated to result in financial losses to women victims of $150 million a year.

• Poor diet and low levels of physical activity are associated with 300,000 deaths each year, second only to tobacco.

• Alcohol abuse exacts a financial toll on the nation, costing over $166 billion annually, of which approximately $58 billion is attributed to underage drinking.

• Drug abuse, estimated to cost society over $100 billion per year, is linked to other public health problems, such as suicide, homicide, motor-vehicle injury, sexually transmitted diseases, and HIV infection.

• Unsafe sexual behavior is related to more than 12 million cases of sexually transmitted diseases, high teen pregnancy rates, and billions of dollars in preventable health care spending each year. While the actual death rates from HIV infection have declined, the number of new infections (estimated at 40,000 annually) and cost of treatment remain high.

• Finally, infectious disease (e.g., pneumonia and influenza) was the sixth leading cause of death in the United States in 1998.

Objective 1.1 - Reduce Tobacco Use, Especially Among Youth

How We Will Accomplish Our Objective

We will provide funding and technical support for education campaigns to deliver the anti-tobacco message. Our efforts will focus on:

• leading a national campaign to educate Americans about the health effects of tobacco use.

• incorporating tobacco education into Department programs and initiatives that target youth such as Project Youth Connect, Teen Parents, Girl Power!, and the Runaway and Homeless Youth program.

• promoting the adoption of tobacco education programs by primary care health care professionals and incorporation of the programs into primary health care services.

• distributing information to health care practitioners and the public on the consequences of tobacco use through the National Clearinghouse on Alcohol and Drug Information.

• disseminating Public Health Service guidelines on smoking cessation to health care practitioners and brochures to consumers.

We will fund state tobacco control programs in all states. These programs will:

1.1 Implementation Strategies

Education Campaigns Tobacco Prevention/Control Programs Enforcing Prohibitions on Sales to Minors Research

• educate young people about the dangers of tobacco use and help them to refuse tobacco use.

• promote cessation of tobacco use among youth and adults.

• protect the public from secondhand smoke.

• identify and eliminate disparities in tobacco use among population subgroups.

• reduce the use of smokeless tobacco.

We will provide assistance to state health departments, schools (in collaboration with the Department of Education), local governments, national anti-tobacco and other organizations to help develop tobacco prevention and control programs. This assistance effort will include a focus on working with states to implement the Synar Amendment.

We will continue to support enforcement of state and local laws and regulations preventing the sale of tobacco to minors through data sharing and technical assistance.

HHS Agencies contributing to this objective (1): ACF CDC FDA HRSA IHS NIH OS SAMHSA

We will undertake research and demonstrations to:

• better understand why people smoke (e.g., the genetic base, environmental interactions, and socioeconomic factors) as a precursor to developing better interventions to prevent or stop tobacco use.

• monitor trends in tobacco use.

• design new ways of preventing or stopping tobacco use and assess the effectiveness of interventions.

• learn how to more effectively translate proven interventions into practice.

(1) All agencies are listed in Appendix I.

Objective 1.2 - Reduce the Incidence and Impact of Injuries and Violence in American Society

How We Will Accomplish Our Objective

We will help develop and improve public and private injury and violence prevention programs. Elements of this strategy include:

• providing information and technical assistance to hospitals and public health agencies on how to standardize and expand the collection of mortality, hospital, and emergency department data to improve surveillance and monitoring.

• directing resources to help tribes develop risk identification and intervention programs.

• directing resources to help states develop the basic capacity for state injury and poison prevention programs.

• providing technical assistance to state and local health departments, state and agency networks on aging, and other organizations serving the elderly to help implement fall prevention programs.

• providing financial and technical assistance to community injury and violence prevention programs, such as programs that focus on preventing suicide, youth/school violence and violence against women, fire safety, and bicycle safety.

We will widely disseminate information on preventing injuries and violence. Particular areas of focus will be:

1.2 Implementation Strategies

Injury/Violence Prevention Programs Information Dissemination Promoting Safety Legislation Research

• children: disseminating information from demonstration programs to safety organizations such as the National Bicycle Safety Network, local bicycle safety programs, and the National Fire Protection Association, on how to prevent childhood injuries.

• the workplace: disseminating information to industry on ways to improve workplace safety.

• the elderly: launching a nationwide campaign to educate older Americans about how to modify their home environment to avoid potentially harmful and debilitating falls.

• youth: in collaboration with the Departments of Education and Justice, disseminating information on school and community youth violence prevention programs.

• communities: in conjunction with the Departments of Education and Justice, providing communities with current information on the incidence of school, street, and gang violence, domestic violence, and substance abuse and violence.

We will foster the development and improvement of state safety legislation by supplying current surveillance data that highlight safety issues; e.g., providing data from our Traumatic Brain Injury surveillance system to help states develop motorcycle helmet, safety belt, and snowmobile legislation.

We will conduct research and demonstrations to:

HHS Agencies contributing to this objective: AHRQ ACF AoA CDC HCFA HRSA IHS NIH OS SAMHSA

• identify the causes and risk factors (e.g., alcohol consumption, workplace hazards, socioeconomic factors) for violence and injuries to help develop more effective prevention programs.

• design better interventions for controlling aggressive behavior and violence in youth.

• design better strategies for preventing injuries in the home, childcare environments, and the workplace.

• understand the pathology and effective treatment of injuries to lessen their impact.

• study the effectiveness of health care interventions for victims of domestic violence.

Objective 1.3 - Improve the Diet and the Level of Physical Activity of Americans

How We Will Accomplish Our Objective

We will carry out education campaigns to encourage the public to improve their diet and exercise habits. Our focus will be on:

• conducting our Five-A-Day education program on the importance of eating vegetables and fruits.

• implementing counseling programs on diet and physically active lifestyles in our primary care programs.

• conducting a national campaign to inform women of childbearing age about the importance of consuming 400 micrograms of folic acid daily, in addition to an appropriate diet, to prevent some types of serious birth defects.

• providing consumers with food content information (food labels) to help them make better diet choices.

1.3 Implementation Strategies

Education Campaigns Supporting Nutrition Programs Research

We will provide financial support and technical assistance to help states develop programs promoting good nutrition and the reduction of excessive consumption of saturated fat and calories, physical inactivity, and obesity among youth.

 

We will provide nutritious meals, nutrition education, and individual nutrition counseling for the elderly in congregate and home-delivered settings.

 

HHS Agencies contributing to this objective: AoA CDC FDA HRSA IHS NIH OS

We will conduct research to:

• learn about and inform the public regarding the effects of diet and exercise on health.

• develop better interventions for the prevention and treatment of obesity.

• evaluate the effectiveness of education in changing diet and exercise behavior.

• develop sound scientific data and expertise to support standards and guidance for evaluating the safety of dietary supplements (e.g., vitamins).

  

Objective 1.4 - Reduce Alcohol Abuse and Prevent Underage Drinking

How We Will Accomplish Our Objective

We will conduct education campaigns directed at high-risk groups to discourage underage drinking and alcohol abuse. These include Girl Power!, Teen Drinking Prevention Campaigns, and others.

We will provide technical assistance to community programs to help develop effective prevention strategies, including public service advertisements and enforcement activities to prevent sales to minors.

1.4 Implementation Strategies

Education Campaigns Enforcing Prohibitions on Sales to Minors Alcohol Abuse Treatment Services Surveillance Research

We will provide financial assistance for screening, residential, and outpatient treatment services.

We will provide technical assistance and financial support to improve surveillance and data systems that provide information to public health officials on trends in alcohol abuse related to youth, domestic abuse, fetal alcohol syndrome, and chronic diseases.

HHS Agencies contributing to this objective: CDC HRSA IHS NIH OS SAMHSA

We will conduct research to:

• understand the causes (e.g., genetic, biological, socioeconomic) of alcohol addiction as a precursor to the development of new prevention and treatment methods.

• design more effective prevention and treatment methods and programs.

• learn more about the health and social costs of underage drinking to guide public policy decisions.

Objective 1.5 - Reduce the Abuse and Illicit Use of Drugs

How We Will Accomplish Our Objective

We will provide science-based information on the effects of drug use and on effective prevention and treatment strategies to health professionals, states, communities, and the public.

We will conduct anti-drug education campaigns targeted at high-risk groups and delivered through networks of community-based organizations and health care providers.

We will help states and communities develop drug prevention and treatment services at the community level, including a targeted capacity expansion strategy to address treatment gaps in communities with serious, emerging drug problems. Other priorities include:

1.5 Implementation Strategies

Information Dissemination Education Campaigns Drug Prevention/Treatment Services Monitoring Trends Research

• community drug abuse prevention programs, especially programs targeted at vulnerable populations.

• community outpatient treatment, methadone programs, and residential treatment services for adolescents and other underserved populations.

• prevention and treatment services to rural and urban Indian communities.

• the Federal Drug-Free Workplace Program.

We will monitor trends in drug use and provide that information to public health and other officials involved in prevention and treatment.

HHS Agencies contributing to this objective: FDA HRSA IHS NIH OS SAMHSA

We will conduct research to:

• learn more about the causes of and risk factors for drug addiction (e.g., genetic, biological, and socioeconomic) and translate that knowledge into prevention and treatment methods.

• design better prevention and treatment strategies and services (e.g., medication for treatment and behavioral modification strategies).

• understand drug use patterns to adapt treatment to community needs.

Objective 1.6 - Reduce Unsafe Sexual Behaviors

How We Will Accomplish Our Objective

We will provide financial and technical assistance to a variety of community prevention services. Our priorities include:

• comprehensive state programs for the prevention of sexually transmitted diseases (STDs).

• state programs to provide abstinence education, including mentoring, counseling, and adult supervision to promote abstinence from sexual activity.

• a variety of prevention and counseling services for high-risk populations served by Department programs such as federally funded health centers, American Indian and Alaska Native (AI/AN) clinics, and mental health and substance abuse providers.

• programs in community organizations that provide HIV prevention services to high-risk individuals (e.g., community health centers that serve gay and lesbian populations).

We will promote the application of privacy/confidentiality policies (through privacy regulations, conferences, posting information on health information surveillance boards, etc.) to encourage individuals to seek testing and counseling.

We will provide technical assistance to help a variety of organizations increase their capacity to provide prevention services. Our efforts will focus on helping:

1.6 Implementation Strategies

STD Prevention Services Promoting Privacy/Confidentiality Developing Service Capacity Research

• cities, states, territories, and selected countries build HIV/AIDS surveillance systems that are capable of tracking the course of HIV and AIDS, targeting prevention programs for population groups or geographic areas, and evaluating the effectiveness of prevention programs.

• states develop curricula and train teachers who can provide youth with the information and skills to avoid HIV infection and reduce unsafe sexual behaviors (in coordination with the Department of Education).

• community-based organizations, medical and public health professionals, HIV community planning groups, and other organizations train their staff in prevention strategies.

HHS Agencies contributing to this objective: ACF CDC HRSA IHS NIH OS SAMHSA

We will fund research to:

• learn more about the spread of sexually transmitted diseases, including the high-risk behaviors associated with spread of the disease, to develop more effective prevention strategies.

• evaluate new tools and techniques for preventing HIV transmission, including promising integration of biomedical and behavioral interventions.

Objective 1.7 - Reduce the Incidence and Impact of Infectious Diseases

How We Will Accomplish Our Objective

We will provide financial and technical assistance to state and local infectious disease control programs. Our priorities will be to:

• develop and implement national data and information system standards for surveillance reporting of infectious diseases.

• provide technical assistance to state and local health departments on how to collect and maintain epidemiological information that can rapidly detect, investigate, and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence.

• provide funding and technical assistance to support screening and treatment for selected diseases at state and local health departments (e.g., sexually transmitted disease, tuberculosis, HIV/AIDS, Hepatitis C Virus, and emerging infections).

• provide funding and technical assistance to state and local health departments and hospitals in the surveillance, prevention, and control of antimicrobial resistance.

1.7 Implementation Strategies

Infectious Disease Control Programs Syphilis Elimination Tuberculosis Reduction Increasing Vaccine Coverage Polio and Measles Eradication Research

We will provide emergency epidemic assistance to domestic and international partners in cases of disease outbreaks that are major public health concerns.

We will provide leadership for planning and implementing a comprehensive initiative for eliminating syphilis in the United States.

We will provide leadership for planning and implementing a comprehensive initiative for reducing tuberculosis (TB). Our strategy includes:

• carrying out a major clinical trial on TB prevention, in conjunction with the Veterans Administration.

• training physicians and other health care providers in tuberculosis diagnosis and treatment.

• implementing cooperative agreements with state and local health departments to maintain a TB prevention and control program in each state.

• continuing collaboration with international partners to advance TB control activities relevant to the United States.

We will implement a strategy to increase vaccine coverage in the United States. Key elements of the strategy will include:

• funding and technical assistance to health departments, health care providers, and other community organizations to administer vaccines against infectious diseases.

• outreach to and education of the public about the efficacy and safety of vaccines, especially through Department and other federal programs.

We will provide technical assistance and support for HIV/AIDS prevention, care, treatment, and infrastructure development to country programs in Africa, Asia, and the Caribbean/Latin America region.

We will maintain a program of technical assistance to other countries to support efforts to eradicate polio and control measles, to prevent the spread of those diseases to the United States.

HHS Agencies contributing to this objective: ACF AoA CDC FDA HCFA HRSA IHS NIH OS SAMHSA

We will fund research to:

• develop new and improved diagnostic tests, drug therapies, vaccines and epidemiologic and laboratory methods for detecting, controlling, and preventing infectious diseases.

• develop new monitoring tools needed to detect emerging infectious diseases.

• study the relationship between drug abuse and the spread of infectious diseases to help develop more effective prevention strategies.

• learn more about negative reactions to vaccines to improve vaccine safety and vaccination coverage levels.

Objective 1.8 - Reduce the Impact of Environmental Factors on Human Health

How We Will Accomplish Our Objective

We will help state and local health agencies develop and implement surveillance and prevention programs that reduce environmental threats. We will focus our efforts on reducing threats to children by helping state and local agencies:

• develop and implement effective environmental interventions to prevent and reduce the onset, suffering, and disproportionate burden of illness related to asthma.

1.8 Implementation Strategies

Surveillance/Prevention Programs Education Research

• identify children at risk for lead poisoning.

We will support the national effort to reduce environmental threats to health by:

• conducting research to better understand the relationship between exposure to toxic substances and human health, develop new and improved biomonitoring methods and prevention strategies, and identify the risk and protective factors for birth defects.

• monitoring the exposure to toxic substances and identifying and reporting health threats.

• educating health care providers about the consequences of exposure to toxic substances and the availability and value of using existing information systems to prevent and combat environmental health problems.

HHS Agencies contributing to this objective: ATSDR
CDC
HCFA
NIH
OS

Goal 2 - Improve the Economic and Social Well-Being of Individuals, Families, and Communities in the United States

The focus of this goal is to promote and support interventions that help disadvantaged and distressed individuals, families, and communities improve their economic and social well-being. We stress interventions that are related to improving job skills, access to social services, family and community stability, and independent living. We also recognize the importance of health care in achieving many of the objectives under Goal 2 and illustrate this with appropriate strategies in a number of areas such as Head Start. The objectives further prioritize Department efforts by targeting interventions toward low-income families (including those receiving welfare), children, the elderly, persons with disabilities, and distressed communities.

While substantial progress has been made in the past several years in helping welfare recipients move to work, increasing child support payments, and providing childcare and early learning services to low and moderate income families, evidence supports a continued focus on helping those who need help. For example, data (1997) indicate that 19 percent of all children still live in poverty. Preschool enrollment for these children is still at only 40 percent. Affordable childcare for low and moderate income working families is still largely inaccessible. In 1998, only 1.5 million of 9.9 million children eligible for childcare assistance received it. Almost one million children were the victims of substantiated or indicated child abuse or neglect in 1997. Twenty percent of children in foster care remain without permanent placement with a family for as long as three years or more.

As the American population ages, evidence points to the need to extend efforts to help the growing number of elderly persons remain as active and healthy as possible and delay or avoid chronic medical problems. An aging society means that the number of persons needing long-term-care services will increase and the availability of these services in the home and community will be a significant challenge if we are to help these citizens maintain their independence and quality of life. The need for long-term support is not limited to the elderly. As survival rates increase among people who are born with or acquire disabilities, and with more opportunities for them to lead better-quality lives in the community (rather than in institutions), there will be greater need to expand the options for home and community-based support structures for people of all ages.

Objective 2.1 - Improve the Economic Independence of Low Income Families, Including Those Receiving Welfare

How We Will Accomplish Our Objective

 

We will provide technical assistance to promote the adoption of best practices and innovative strategies by states in their welfare to work programs. Our strategy will include:

 

• developing and disseminating best practices and innovative strategies and facilitating peer-to-peer assistance.

• helping to develop performance measurement systems.

• evaluating the impact of Temporary Assistance to Needy Families and other work support strategies on families and children.

• in collaboration with the Department of Education, providing models for integrating work readiness training for welfare clients into adult skills training programs.

• assisting states, communities, and organizations in coordinating transportation resources and services to improve access to employment and training.

We will continue to promote access to quality childcare services to help low-income working parents maintain their jobs and self-sufficiency. Our priorities are to:

2.1 Implementation Strategies

Promoting Best Practices Child Care Services High Performance Bonuses Elimination of Job Barriers Research

• expand the number of low income families receiving childcare subsidies.

• encourage states to increase subsidy payment rates and decrease family co-payments.

• promote collaboration among Head Start, childcare providers, and pre-kindergarten programs to improve service quality and to better meet the full-day needs of low-income working parents, and build the learning skills of their children.

• conduct research to better understand the effects of variations in childcare subsidies on labor force participation and develop models to establish optimal conditions for childcare subsidies to support low income parents who work.

We will work with states to promote access to work supports, such as Medicaid and State Children's Health Insurance Program.

We will provide high performance bonuses to reward states that achieve significant progress in work outcomes and work support indicators under their Temporary Assistance to Needy Families program.

We will eliminate barriers to finding and maintaining jobs for welfare and other low income clients. We will focus on

• identifying barriers to work for welfare recipients who are victims of domestic violence, have developmental and other disabilities, are non-English speaking, reside in economically distressed rural areas, and for others who have serious personal or family problems that interfere with their ability to work.

• developing strategies to overcome identified barriers, including encouraging states to make policy changes, investments, and operational changes to improve the opportunities for recipients who face barriers.

• developing best practices to assist people with mental illness to obtain and maintain employment.

• conducting reviews of state and local welfare agencies and service providers to determine if programs are in compliance with civil rights statutes ensuring equal access.

• providing training and technical assistance to state and local welfare agencies to help them comply with civil rights statutes in the administration of their programs.

HHS Agencies contributing to this objective: ACF HCFA HRSA OCR OS SAMHSA

We will identify alternative strategies for use should caseloads begin to increase or significant numbers of families reach lifetime limits without employment.

We will conduct research to study state implementation of welfare reform; the impact of welfare reform on families, children, and special populations; and broader issues concerning families in poverty.

 

Objective 2.2 - Increase the Parental Involvement and Financial Support of Non-Custodial Parents in the Lives of Their Children

How We Will Accomplish Our Objective

We will implement strategies to increase child support collections from non-custodial parents. These will include:

• providing training and technical assistance to state child support enforcement agencies on the use of the Federal Parent Locator Service, best collection practices, and the use of strategic planning to promote case processing efficiencies.

• implementing an incentive-based funding structure for state child support enforcement agencies.

• conducting effective management of the Federal Parent Locator Service, the Federal Tax Refund Offset Program, the Passport Denial Program, the Multistate Financial Institution Data Match Program and the Child Support Enforcement Network.

• 

  providing oversight to assure certification and implementation of effective automated systems.

• developing guidance to states and providing technical assistance to tribes on how to apply for funding to support the establishment of tribal child support enforcement programs by tribal organizations.

We will eliminate barriers that impede the involvement of non-custodial parents in the lives of their children and implement strategies that increase their involvement. Our strategy will include a "fatherhood" initiative and it will focus on:

• developing and disseminating innovative approaches to resolving access and visitation issues for parents and children who live apart.

2.2 Implementation Strategies

Increasing Child Support Promoting Involvement of Non-Custodial Parents

• providing training and technical assistance to states and communities to help them develop employment, training opportunities, and funding for low-income non-custodial parents.

• identifying and disseminating successful strategies that promote the involvement of non-custodial parents in preparing children to be ready to learn and maximize their educational achievements.

• developing model programs for preventing premature fatherhood and disseminating information on those programs to states and communities.

HHS Agencies contributing to this objective: ACF CDC IHS OS SAMHSA

• conducting research that provides information on the role of men in facilitating child health and well-being and strengthening family formation and functioning.

• promoting greater understanding of the meaning and importance of fatherhood within the diverse ethnic and cultural groups served by the Department's programs through activities such as building public-private partnerships to increase access to information and other resources.

Objective 2.3 - Improve the Healthy Development and Learning Readiness of Preschool Children

How We Will Accomplish Our Objective

To promote learning readiness of preschool children from low income families, we will work to improve access to and the quality of developmental services. The core of this strategy will be:

• expanding Head Start and high quality childcare programs to serve more children.

• promoting service partnerships among Head Start, childcare, pre-kindergarten, and family literacy programs for low-income families and their children.

• conducting research and program evaluation, and developing and implementing performance measures to improve the quality of Head Start and childcare programs.

• identifying strategies that address the need for a trained quality workforce in Head Start and childcare programs.

We will work to increase access to and the effectiveness of health services for preschool children from low-income families. The core of this strategy will involve:

• linking low-income and disadvantaged children in early childhood settings with health care providers (e.g., Maternal and Child Health, Community Health Centers, mental health programs, State Children's Health Insurance Program, and Medicaid).

2.3 Implementation Strategies

Developmental Services Health Services

• providing American Indian and Alaska Native Head Start children with essential health services, including immunizations, dental services, and other well-childcare.

• augmenting programs in early childhood centers to include behavioral health services.

• providing training and technical assistance to Head Start staff and the parents of Head Start children in health promotion and disease prevention.

• conducting research on environmental factors that affect physical and cognitive development of young children (e.g., lead poisoning, violence, and prenatal exposure to drugs and alcohol) and using the results from this research to develop more effective interventions.

HHS Agencies contributing to this objective: ACF CDC HCFA HRSA IHS NIH OS SAMHSA

• providing funding to state and local health departments to identify children at risk for childhood lead poisoning - a significant developmental hazard to children (also see Objective 1.8)

Objective 2.4 - Improve the Safety and Security of Children and Youth

How We Will Accomplish Our Objective

We will promote child safety by incorporating the child safety priority into family preservation programs and providing technical assistance to states, particularly emphasizing the importance of child safety in family preservation and reunification decisions.

We will remove barriers to adoptions by:

• providing technical assistance to states, nonprofit organizations, and local communities on how to identify and remove these barriers, for example, court processes that prevent timely judicial actions to terminate parental rights (Adoption 2002 Initiative).

• implementing an adoption bonus incentives program for states (Adoption 2002 Initiative).

• providing technical assistance to state supreme courts to develop self-assessments and plans to achieve more timely actions on permanency decisions for children.

• conducting reviews of state and local adoption and foster care agencies to determine if their programs are in compliance with the Adoption and Safe Families Act and nondiscrimination laws (Section 1808 of the Small Business Job Protection Act and the family recruitment provisions of the Multi-Ethnic Placement Act).

• providing technical assistance and training for courts, child protection agencies, child welfare agencies and other service providers to help them comply with nondiscrimination laws.

2.4 Implementation Strategies

Promoting Child Safety Removing Barriers to Adoptions Services for Runaway and Homeless Youth Research

We will provide developmental and other services to help runaway and homeless and other high-risk youth return home or live independently.

We will conduct research and demonstrations to:

• better understand how to prevent and treat child abuse and neglect, and family violence (in cooperation with the Department of Justice).

• identify the family preservation and support services that work.

• test more effective child welfare practices.

• assess and improve our technical assistance and training activities under the child welfare, foster care, and adoption assistance programs to improve the effectiveness and relevance of those activities.

HHS Agencies contributing to this objective: ACF CDC OS SAMHSA

• develop better strategies for providing support and family preservation services to families that have incidents of abuse and neglect.

• develop better strategies to help children in families with psychiatric and/or substance use disorders.

Objective 2.5 - Increase the Proportion of Older Americans Who Stay Active and Healthy

How We Will Accomplish Our Objective

We will support an initiative to prevent falls--a leading cause of functional decline in the elderly. Our strategy will focus on:

• supporting a cooperative fall-prevention demonstration program with state and local health departments, our aging network, Medicare PROs, and other partners.

• implementing and evaluating the effectiveness of a national education program to reduce fire and fall-related injuries among older adults (in collaboration with the National Fire Protection Association).

• monitoring incidence and causes of falls in older Americans and responding with appropriate interventions.

• developing and disseminating information on physical activities that increase muscular strength, endurance, and flexibility, which will improve individuals' ability to perform the tasks of daily living and improve overall balance.

We will promote expansion of health care services that contribute to the prevention of functional decline in the elderly. Our strategy includes:

2.5 Implementation Strategies

Fall Prevention Programs Health Care Services Aging Services Research

• providing health care providers with information about the preventive and primary health care and chronic disease management needs of the elderly.

• disseminating "Put Prevention Into Practice," a national campaign targeted at people over age 50, to improve the delivery of clinical preventive services such as screening tests, immunizations, and counseling for life style and behavior changes.

• developing and implementing new arthritis awareness programs.

We will fund and provide technical assistance for basic services, such as meals and transportation, that combat factors that lead to functional decline in the elderly (e.g., poor nutrition, social isolation, and poverty).

We will support a program of biomedical, behavioral, and health services research to:

• better understand the aging process and the factors (social, health, and services) that contribute to healthy aging and prolonged independent functioning.

• increase understanding of the behaviors that lead beneficiaries to utilize preventative services covered by the Medicare program.

  HHS Agencies contributing to this objective: AHRQ AoA CDC FDA HCFA HRSA IHS NIH OS SAMHSA

• create an evidence-based center on healthy aging using the best available science to identify what works to promote health and prevent functional decline in the Medicare population.

• develop effective strategies for preventing substance abuse by older Americans, specifically focusing on common problems such as medication misuse/abuse, alcohol abuse, and alcohol in combination with medications.

• determine the occupational safety and health risks of older workers and the impact of these risks on their safety, health, disability, and employment; and develop effective interventions to reduce these risks and promote a healthy work experience.

 

Objective 2.6 - Increase Independence and Quality of Life of Persons with Long-Term-Care Needs

How We Will Accomplish Our Objective

We will promote policies that empower individuals needing long-term-care services to be involved in the planning and directing of their services.

To prevent institutionalization, we will help communities develop and finance integrated, comprehensive community services for persons with long-term-care needs. Our priorities will be on:

• continuing our financing of community-based long-term-care services through Medicaid and the aging network.

• developing innovative policies, programs, and protection and advocacy systems for persons with developmental disabilities in each state.

• funding technical assistance centers and consumer and family network development grants to help persons with mental illness and their families develop and access comprehensive, community-based treatment services.

• implementing a program of support for family caregivers who delay or prevent the need for institutionalization of family members.

We will facilitate employment for persons with disabilities, including those with more severe disabilities. Our strategy will include:

2.6 Implementation Strategies

Empowering Disabled Individuals Community-Based Services Employment Enforcing Non-Discrimination Statutes Improving Nursing Home Quality Research

• advocacy and financial assistance for the development of programs that contribute to the employment of persons with developmental disabilities.

• development of better rehabilitation and employment models for recovering adults with mental illness, including those with serious mental illness and/or substance abuse problems.

• reduced health and long-term-care coverage barriers for employment, through promotion of state buy-in to Medicaid for certain people with disabilities under the Ticket to Work and Work Incentives Improvement Act of 1999.

We will enforce nondiscrimination laws to ensure access to services. Our focus will be on:

• civil rights reviews, investigations, and outreach activities directed at home health and other community providers of long-term-care services to protect against discrimination on the basis of race, gender, national origin, disability, and age.

• enforcement of the Olmstead decision and Americans with Disabilities Act to ensure that states have comprehensive effective working plans for providing services to all qualified individuals with disabilities in the most integrated setting and moving people off waiting lists at a reasonable pace.

We will foster improved quality of care in nursing homes and other long-term-care facilities. We will:

• implement policies to prevent, identify, and stop physical or verbal abuse, neglect, and misappropriation of resident belongings.

• implement policies to minimize the incidence of pressure sores.

• enhance policies to encourage optimum nutrition and hydration standards of care for nursing home residents.

• develop and disseminate financing and service delivery models that improve the coordination and integration of home health, rehabilitation, and nursing facility services.

We will carry out research and demonstrations to improve the effectiveness of long-term-care services. On-going priorities will include:

• examining the effectiveness of consumer-operated, self-help programs for persons with mental illness as an alternative to traditional programs or institutionalization.

• demonstrating effective ways to support families who need assistance in caring for family members with Alzheimer's disease, focusing on minority, low-income and rural families.

• examining the effectiveness of models that address unique needs of children and families who need home and community-based long-term-care resources.

HHS Agencies contributing to this objective: ACF AHRQ AoA FDA HCFA NIH OCR OS SAMHSA

• conducting demonstrations and research related to models that enable consumer direction of personal assistance services.

• developing a network to assist states in expanding community-based services.

• developing best practices and models of community service networks for persons with developmental disabilities.

• conducting demonstrations of effective ways to integrate acute and long-term-care services.

Objective 2.7 - Improve the Economic and Social Development of Distressed Communities

How We Will Accomplish Our Objective

We will promote active involvement of HHS grantees in support of comprehensive community development networks. Our strategy will include:

• continuing investment in community-based organizations, such as Community Action Agencies, that plan, coordinate, and link a range of categorical federal, state, local, and private assistance in a manner responsive to local needs.

• offering priority funding to Empowerment Zones, Enterprise Communities, Native American communities, and other distressed communities pursuing comprehensive strategic plans for revitalization, through grant criteria in various HHS programs.

• encouraging health and human service programs to play a lead role in comprehensive community development efforts, such as Healthy Start involvement in community development programs.

We will strengthen the economic infrastructure within distressed communities to establish the foundation for a stable environment. Our strategy will include:

• encouraging participation in interagency "new market" initiatives to spur private investment in distressed communities through financial assistance to programs that target job creation for low-income individuals (e.g., financial and technical assistance to private employers, self-employment/ microenterprise programs, and business development programs).

  2.7 implementation strategies

  Supporting Community Development Networks Economic Infrastructure Development Developing Community Institutions/Civic Capital

• leveraging HHS-funded programs (such as federally funded health centers, which generated nearly $3 billion in economic activity within distressed communities in FY 1999) to serve as catalysts for community economic development through job creation and utilization of local markets.

We will enhance the capacity of community-based institutions and development of civic capital to enable communities to collaborate more effectively, amass sufficient resources, and create synergies in addressing mutual difficulties and challenges. Our focus will include:

• providing training, technical assistance, and related instructional materials to community-based organizations, to support planning, program development, resource identification and coordination.

• sponsoring programs that develop community leadership and empower residents to participate in the design and implementation of programs that best meet local needs, such as in the areas of substance abuse prevention and treatment, mental health, HIV/AIDS services and treatment, and child development.

HHS Agencies contributing to this objective: ACF AoA CDC HRSA IHS OS SAMHSA

• establishing performance measurement scales and systems that assess and correlate family, organizational, and community well-being.

• providing technical assistance and funding to low income communities and provider organizations in the communities to develop health care delivery systems and priority primary care services.

• providing financial incentives to encourage low-income individuals to save for purchasing homes and starting businesses.

Goal 3 - Improve Access to Health Services and Ensure the Integrity of the Nation's Health Entitlement and Safety Net Programs

In addition to changing behavior and reducing environmental health risks, improving health in the United States involves assuring that everyone has access to health care. The focus of Goal 3 is to promote increased access to health care, especially for persons who are uninsured, underserved, or otherwise have health care needs that are not adequately addressed by the private health care system.

The access challenges are substantial, particularly for some groups. Overall, approximately 45 million Americans lack health insurance. Although recent efforts to cover the nation's children are beginning to show success, many children still lack coverage. Over 2,000 counties in the United States are designated health profession shortage areas where access to primary health care for 45 million residents would be limited without HHS community programs. A 1998 Harvard School of Public Health/CDC study found that the lowest life expectancies in the country (including inner city ghettos) for both men and women exist in American Indian communities, and mortality disparities for American Indian/Native American people are worsening. Access to treatment for persons with HIV/AIDS, estimated to cost as much as $20,000 per year, would be severely limited without support for the cost of drug therapies and associated services. Less than one-third of the adults with diagnosable mental disorders receive treatment in a given year. Many families cannot afford the cost of care for children with special health care needs.

Minorities have particular problems with access and they face a range of disparities in health care. Approximately 38 percent of Hispanic and 24 percent of African-American adults are without health insurance, compared with 14 percent of white adults. Infant mortality rates are higher for minority groups, as are the incidence of illness and deaths associated with certain chronic diseases such as cancer, cardiovascular disease, and diabetes.

The major source of health insurance coverage for older Americans is Medicare. Ensuring the fiscal integrity of the program is critical to continued access to care. Significant accomplishments in reducing the financial drain from fraud, waste, and abuse have been recorded. Still, we can do more to reduce improper payments, which in fiscal year 1999 were estimated at $13.5 billion.

In addition to Medicare, the Department addresses the access challenge through a variety of entitlement and safety net programs, such as Medicaid, the State Children's Health Insurance Program, and Community Health Centers, that provide access to health care for uninsured and low income individuals.

Objective 3.1 - Increase the Percentage of the Nation's Children and Adults Who Have Health Insurance Coverage

How We Will Accomplish Our Objective

We will continue to assist states in their efforts to promote and publicize the opportunity for eligible children and adults to enroll in Medicaid. Our strategy includes asking states to review their computer systems and eligibility processes to ensure that all families that are eligible for Medicaid benefits keep them, and asking states to reinstate anyone who may have been improperly terminated from the program.

We will continue to identify and enroll eligible children and adults in the State Children's Health Insurance Program (SCHIP) and the Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary programs and ensure that enrolled beneficiaries have access to comprehensive health care.

We will support ongoing implementation of the State Children's Health Insurance Program by:

• continuing ongoing discussions with Congress, advocates, and other interested parties to ensure that the needs of children are being addressed by SCHIP.

• continuing to work with states to further expand and refine state programs through the approval of state plan amendments, the provision of technical assistance, and the dissemination of best practices.

3.1 Implementation Strategies

Medicaid/SCHIP Enrollment HIPAA Enforcement Promoting Legislation to Expand Coverage Enforcing Non-Discrimination Research

We will implement the Health Insurance Portability and Accountability Act (HIPAA) by carrying out enforcement activities in states which fail to substantially enforce HIPAA and for nonfederal governmental plans that are self-funded and insured, and by issuing implementing regulations for HIPAA and related amendments.

We will promote adoption of legislation to:

• allow Medicare buy-in for certain people below age 65.

• allow access to all Medigap options if a beneficiary is in a Health Maintenance Organization (HMO) that withdraws from Medicare.

• expand the initial six-month open-enrollment period in Medigap to newly disabled individuals and beneficiaries with End Stage Renal Disease.

• expand insurance coverage to parents of children in the State Children's Health Insurance Program and certain other targeted groups.

• develop lower cost options for Medigap supplemental health insurance (in coordination with the National Association for Insurance Commissioners).

We will enforce nondiscrimination in the State Children's Health Insurance Programs, Medicare, and Medicaid through reviews and technical assistance on civil rights compliance.

We will conduct research to:

• study the most effective ways to enroll children.

• evaluate the effectiveness of programs designed to provide insurance coverage for children, including the impact of the programs on child access to appropriate health services.

HHS Agencies contributing to this objective: ACF AHRQ ASPE CDC HCFA HRSA OCR OS SAMHSA

• better understand the factors that impede or enhance access to health care insurance and access to health care for those who are insured.

• track state-level changes in health insurance coverage, access to care, health status, and use of health services.

• study the reasons people make the decisions they do (beyond affordability) regarding whether to purchase health insurance.

 

Objective 3.2 - Eliminate Disparities in Health Access and Outcomes

How We Will Accomplish Our Objective

We will work with state governments to reduce the disparity in health insurance coverage through improved outreach and enrollment efforts to minority groups in our Medicaid and State Children's Health Insurance Program.

We will implement quality improvement interventions through Medicare Peer Review Organizations (PROs) to reduce disparities in health care between minority beneficiaries and others.

3.2 Implementation Strategies

Health Insurance Coverage Improving Quality of Care Enforcing Non-Discrimination Promoting Culturally Appropriate Health Services Research

We will enforce nondiscrimination in treatment under Title VI of the Civil Rights Act through compliance reviews and investigations.

We will provide technical assistance and outreach and develop partnerships with providers; medical, dental, and public health schools; advocacy organizations; and health professions organizations to develop nondiscriminatory policies and practices in access and treatment.

We will promote the availability and use of culturally and linguistically appropriate health services, practice, and communication strategies in our health programs.

We will conduct research and demonstrations to learn:

• the underlying causes of racial and ethnic health disparities (such as discrimination, socioeconomic factors, and epidemiology) in access to and delivery of medical and dental services.

HHS Agencies contributing to this objective: AHRQ AoA CDC HCFA HRSA IHS NIH OCR OS SAMHSA

• how disparities in access affect health outcomes.

• in what types of organizations, providers, conditions, or setting disparities exist.

• how to eliminate disparities in a set of priority areas that include infant mortality, cancer screening and management, diabetes, immunizations, and cardiovascular disease.

• what factors are associated with oral health disparities among children and their families to develop effective interventions to reduce the disparities.

Objective 3.3 - Increase the Availability of Primary Health Care Services for Underserved Population

How We Will Accomplish Our Objective

We will increase the supply of health care providers, including under-represented minorities, who are likely to locate and remain in underserved communities most in need of primary health care services. Our efforts will focus on financial support for:

• additional National Health Service Corps personnel and application of best practices for the retention of personnel in underserved communities.

• scholarships and grants to tribal college health professions programs, special pay authorities, and loan repayment to promote the recruitment and retention of health care providers to serve in American Indian and Alaska Native (AI/AN) communities.

• training programs for minority students designed to enhance their professional capacity and encourage them to pursue graduate level careers in public health.

• increasing the number of nurses that provide and support primary care in underserved communities.

We will expand primary health care services to underserved populations by:

• providing financial assistance to additional federally funded health centers.

3.3 Implementation Strategies

Increasing Provider Supply Primary Care Services Service Integration Research

• conducting outreach and reduction of barriers to the participation of American Indians and Alaska Natives in a variety of programs, including Medicaid, the State Children's Health Insurance Program, and the Maternal and Child Health Block Grant.

• supporting the development of comprehensive systems of care in communities through implementation of the new Community Access Program.

• providing technical assistance and funding to help low-income communities and provider organizations in the communities develop culturally competent primary health care, including priorities for oral health, diabetes, substance abuse, and mental health treatment services.

• providing technical assistance to states, communities, and organizations to improve the coordination of transportation resources and services.

• supporting the establishment of telehealth programs in urban and rural communities, which are designed to overcome barriers to health care access for underserved individuals. We will improve the integration of mental health and substance abuse services with primary care by:

• testing and disseminating innovative models for integrating mental health and substance abuse services with primary and early childhood care, such as the models in the "Starting Early-Starting Smart" program.

• providing technical assistance, training, and funding for the development of community-based integrated systems of care that serve children with serious emotional disturbances.

As called for by the Surgeon General's Report on Oral Health, we will improve the integration of oral health services into primary care by:

• testing and disseminating innovative models for integrating oral health services into primary and early childhood care.

HHS Agencies contributing to this objective: AHRQ CDC HRSA IHS NIH OS SAMHSA

• providing technical assistance, training, and funding for the development of community-based integrated systems of care that serve children with special oral health needs.

We will fund research on primary care services, especially for underserved to identify gaps in access, quality, and outcomes and to develop strategies, tools and programs that will improve access and quality and train minority providers.

Objective 3.4 - Protect and Improve the Health and Satisfaction of Beneficiaries in Medicare and Medicaid

How We Will Accomplish Our Objective

We will promote the use of preventive services for our beneficiaries. Our efforts will focus on:

• launching a two year, nationwide education campaign (beginning in 2001) to promote the use of preventive health services by older Americans and people with disabilities.
• implementing strategies, based on research findings, to increase the utilization of clinical prevention and screening services; for example, implementing quality improvement projects to increase the rate of influenza and pneumococcal vaccinations, mammography screening, and retinal eye exams for diabetics.

We will educate our beneficiaries on how to seek high-quality, cost-effective health care. Our focus will be on:

• developing improved tools for measuring health plan and provider health care quality.

3.4 Implementation Strategies

Preventive Services Beneficiary Education Quality Oversight Improving Services

• developing and providing information that is consistent, accurate, understandable, convenient and accessible; able to assist beneficiaries in communicating with their health care providers and making informed choices among alternatives for supplemental insurance coverage, health plans and providers, treatment options, and healthy behaviors; and produced in a variety of formats that are culturally competent and recognize the needs of the diverse populations we serve.

• providing information on health plan options to beneficiaries through multiple channels, including print, Internet, toll-free telephone service, in-person counseling, and health fairs. We will improve our Medicare services by:

We will improve our Medicare services by:

• making decisions about service coverage on the basis of the best evidence available on the quality and effectiveness of the service.

• assessing and understanding the health care and benefit needs of beneficiaries through focus groups, surveys, and questionnaires.

• providing choices to Medicare beneficiaries similar to those available through other purchasers of health care.

• educating Medicare beneficiaries and their caregivers to help them make sound health care decisions.

• modernizing Medicare benefits by pursuing enactment of a voluntary Medicare prescription drug benefit and the elimination of cost sharing for preventive services.

• developing the capacity of our staff and service delivery partners to continuously improve consumer service to beneficiaries.

• supporting projects by Medicare Peer Review Organizations (PROs) to increase the number of beneficiaries who receive the most optimal care available in the clinical priority areas, including acute myocardial infarction, heart failure, pneumonia, stroke/transient ischemic attack/atrial fibrillation, diabetes, and breast cancer.

• using Health Outcomes Survey data to target improvements in care of Medicare beneficiaries.
• testing flexible delivery, payment, and coverage approaches through program demonstrations to better meet beneficiary needs.

We will use surveillance, research, and oversight to protect our beneficiaries from substandard care and discriminatory care. Our focus will be on:

• establishing minimum quality performance standards for plans and providers, assessing performance, and rapidly excluding substandard care providers from our programs.
• providing performance information, guidelines, benchmarks, and improvement strategies to providers, plans, states, and beneficiaries and their advocates.
• developing, testing and employing surveillance tools, such as the Medicare Quality of Care Surveillance System, to identify potential difficulties with services.

HHS Agencies contributing to this objective: AHRQ HCFA OCR OS

• conducting research on how to solve service problems.

• monitoring health plan and provider treatment of protected populations as changes in Medicare and Medicaid unfold, to ensure that these people are treated fairly (for example, working with state and local agencies to ensure that health care providers communicate effectively with sensory-impaired individuals and people with limited proficiency in English).

Objective 3.5 - Enhance the Fiscal Integrity of HCFA Programs and Purchase the Best Value Health Care for Beneficiaries

How We Will Accomplish Our Objective

We will use value-based purchasing for Medicare and Medicaid. Our strategy includes:

• pursuing enactment of private sector purchasing and quality improvement tools for Medicare; for example, care coordination, disease management, and a "competitive defined benefit" program to inject price and quality competition among health plans in Medicare.

• developing and disseminating guidelines and a checklist for our regional offices to use in reviewing State Medicaid managed care contracts.

• implementing policies designed to better align payments to market price and levels of care to patient needs and to provide a range of plan choices to beneficiaries.

• conducting research on developing new payment systems, and evaluating the effectiveness of value-based purchasing techniques, such as competitive bidding.

We will protect Medicare's financing by supporting the dedication of a portion of future budget surpluses to Medicare.

We will carry out an intensive fraud and abuse control effort where we will try to ensure that we pay the right amount to a legitimate provider for an eligible beneficiary. Our strategy will include:

• educating the provider billing community on payment policy, documentation, and fraudulent practices to increase this community's participation in reducing fraud and billing errors.

3.5 Implementation Strategies

Value-Based Purchasing Protecting Medicare Financing Controlling Fraud and Abuse Modernizing Accounting Practices

• improving the methodology (e.g., rigor, consistency) for evaluating the performance of Medicare fee-for-service contractors.

• increasing the effectiveness of Medicare claims reviews and look-behind reviews of medical documentation.

• using the best available computer software and data systems to detect aberrant patterns and trends in Medicare billing.

• evaluating the Health Care Fraud and Abuse Control Program and using the results to improve performance and better direct resources.

• developing and demonstrating effective models for reducing errors and preventing health care fraud, waste, and abuse.

• implementing a Payment Error Prevention Program through the Peer Review Organizations (PROs) to identify specific payment error problems in acute care hospitals and help the hospitals to establish payment compliance programs.

• working with State Medicaid Agencies to develop national program safeguard models.

• helping states to identify and resolve crosscutting issues between the Medicare and Medicaid programs that can result in vulnerability to fraud (e.g., crossover claims and duplicate payments by Medicaid and Medicare).

• developing and implementing a method to inform state agencies about fraudulent activities that are currently occurring around the country.

• educating beneficiaries to identify and report instances of fraud.

• implementing the Comprehensive Error Rate Testing program to produce contractor, benefit specific, and national error rates.

We will continue to modernize Medicare's accounting practices to ensure a clean audit opinion. Our strategy will include:

• analyzing Medicare's accounts receivable and pursuing delinquent debt.

HHS Agencies contributing to this objective: AoA HCFA OIG OS

• hiring a national contractor to coordinate benefits to ensure that Medicare does not pay claims that private insurance companies should pay.

• validating the financial management systems of all of Medicare's claims processing contractors.

• evaluating commercial off-the-shelf software for implementation of an integrated general ledger system to standardize the accounting systems used by all contractors.

Objective 3.6 - Improve the Health Status of American Indians and Alaska Natives

How We Will Accomplish Our Objective

We will improve the quality of and access to health services for American Indian and Alaska Native people by:

• ensuring a supply of qualified, culturally competent health professionals with adequate facilities, equipment, supplies, and training.

• supporting the integration of traditional healing practices into health care in a manner that is appropriate and acceptable to each tribal setting.

• improving the collection and management of payment from third-party health insurance providers (including Medicare, Medicaid, State Children's Health Insurance Program, and private insurers) on behalf of eligible American Indian and Alaska Native people served at Indian Health Service facilities.

• facilitating ongoing tribal consultation with components of HHS and other federal and state agencies to assure that American Indian and Alaska Native people have equitable access to benefits and services provided by these agencies.

• promoting partnerships with tribes and urban programs, including tribal self- determination and community empowerment, to solve local health difficulties by engaging communities in budget and policy development and expanding local control over use of resources.

• maintaining accreditation of health care facilities.

• monitoring health status and evaluating program effectiveness through adequately staffed tribal epidemiology centers.

3.6 Implementation Strategies

Improving Service Access/Quality Nutrition Programs Applying Public Health Practices

• allocating technical and financial resources to services that address health conditions that disproportionately affect American Indian and Alaska Native people; these conditions include diabetes, obesity, injuries, alcohol and drug abuse, oral diseases, cancer, family abuse and violence, suicide, mental disorders, and diseases and conditions related to poor living environments.

We will work to prevent malnutrition among Native American elderly by providing meals, counseling, and nutrition education.

We will apply public health practices to:

HHS Agencies contributing to this objective: AoA CDC HCFA HRSA IHS NIH OS SAMHSA

• improve the collection of standardized data to correctly identify American Indian and Alaska Native populations and tribes and monitor the effectiveness of health interventions.

• improve the understanding of the relationships among health status, different American Indian and Alaska Native tribes, tribal-specific health risks, and effective preventive and clinical services.

• identify and disseminate best practices in health care.

Objective 3.7 - Increase the Availability and Effectiveness of Services for the Treatment and Management of HIV/AID

How We Will Accomplish Our Objective

We will support expanding financial resources for:

• Ryan White CARE Act programs, including grants to states which provide for appropriate pharmaceuticals; to eligible metropolitan areas with high case loads; and to community-based organizations which focus on early intervention services, particularly targeted to communities of color.

• a targeted capacity expansion program that integrates substance abuse treatment and HIV/AIDS services in African American, Hispanic/Latino, and other racial/ethnic minority communities.

3.7 Implementation Strategies

Expanding Prevention/Treatment Services Information Dissemination

• early identification and intervention to prevent maternal transmissions of HIV/AIDS.

• early medical intervention and treatment of American Indians and Alaska Natives with HIV/AIDS.

We will promote access to treatment services through dissemination of HIV treatment guidelines to Medicaid providers and beneficiaries.

HHS Agencies contributing to this objective: AHRQ HCFA HRSA IHS OS SAMHSA

We will provide timely and relevant information to decision-makers about the treatments and resources utilized to treat persons with HIV disease.

 

Objective 3.8 - Increase the Availability and Effectiveness of Mental Health Care Services

How We Will Accomplish Our Objective

We will improve the capacity of community mental health service providers to deliver comprehensive, integrated, culturally competent mental health services. Our strategy will focus on capacity building related to priority population groups and providers, and it will include:

• providing seed money to communities to identify exemplary practices, build consensus for adoption of a specific practice, and provide technical assistance for adoption and implementation.

• increasing block grant funds that respond to the mental health and other service needs of those with serious emotional disturbances.

• promoting the use of culturally appropriate mental health services for underserved populations, such as ethnic and racial groups.

• providing funding to communities to develop comprehensive, family-driven systems of care for children and their families in which mental health services are coordinated with other services such as education, juvenile justice, substance abuse, and other health services.

• educating primary care providers on the identification and referral of patients with mental health problems.

• educating personnel from state and area agencies on aging about how to recognize and make available appropriate services for depression and other mental health problems among older Americans.

3.8 Implementation Strategies

Capacity Building Anti-Stigma Campaign Knowledge Development

• developing and implementing strategies and providing technical assistance to states and health plans on how to improve the recognition and treatment of mental disorders among Medicaid and dually eligible (Medicaid/ Medicare) beneficiaries.

• supporting centers and state collaboration efforts to provide mental health services to youth at risk for becoming runaway and homeless.

We will launch an anti-stigma campaign, based on the Surgeon General's mental health report, to increase the likelihood that people will seek mental health services.

We will develop knowledge to improve the effectiveness of mental health services. Our efforts will focus on:

• gathering state-of-the-art information on the current status of our nation's cognitive and emotional health to set improvement goals (the Healthy Brain Project).

HHS Agencies contributing to this objective: ACF AoA FDA HCFA HRSA NIH OS SAMHSA

• assessing the outcomes and effectiveness of treatments for mental disorders among various target populations, such as treatment outcomes among different groups of women, and the interaction and impact of race, culture, and socioeconomic status in terms of patient preferences, treatments, and health outcomes.

• developing better preventive interventions, diagnostic tools, medication, behavioral, and combined medication-behavioral interventions, and rehabilitation models.

 

Objective 3.9 - Increase the Availability and Effectiveness of Health Services for Children with Special Health Care Needs

How We Will Accomplish Our Objective

We will provide technical assistance to help states build community health service systems for children and families.

We will work with states and other stakeholders in efforts to educate special needs populations about systems of care and the benefits of coordinated services.

We will develop performance measures in conjunction with states and providers to increase standards for ensuring appropriate, quality care for special needs populations.

3.9 Implementation Strategies

Developing Community Health Systems Capacity Education Performance Measurement Research

We will utilize the information from the nationwide survey on access and utilization of services to fill gaps in services for children with special health care needs.

We will sponsor research on strategies to increase the availability and effectiveness of health care services for children with special needs. Research efforts will include:

HHS Agencies contributing to this objective: AHRQ HCFA HRSA OS SAMHSA

• a nationwide survey on access and utilization.

• development of better payment and funding methods.

• development of improved and screening tools for identifying special needs children.

 

Goal 4 - Improve the Quality of Health Care and Human Services

Improving quality of life and health in the United States also involves improving the quality of human services and health care that persons receive. The focus of this goal and supporting objectives is on the implementation of a variety of strategies to improve service quality. In this respect, several of the objectives parallel the goals in the Department's health care quality initiative. (Other elements of the initiative are included elsewhere in the strategic plan.) On the human services side, quality improvement focuses on the generation of knowledge that can be translated into the improvement of human services.

While many Americans receive quality health care, there is disturbing evidence that quality is a problem in a number of areas. The Institute of Medicine of the National Academy of Sciences estimates that as many as 98,000 persons die each year from medical errors (To Err is Human: Building a Safer Health System. National Academy Press. Linda T. Kohn, Janet M. Corrigan and Molla S. Donaldson, editors. 2000). Under-use of services is an ongoing challenge. For example, one study found that 30 percent of women age 52 to 69 in surveyed managed care plans had not received a mammogram in the previous two years. On the other hand, some services are used unnecessarily. One study indicated that half of all patients diagnosed with a cold and two-thirds of the patients diagnosed with acute bronchitis received antibiotics which offer little or no benefit for these conditions. Screening tests are sometimes misread. One study found that anywhere from 10 to 30 percent of Pap smear test results were incorrectly classified as normal. Finally, improving health care quality must involve consumers and purchasers of health care who are knowledgeable about quality choices. Yet when considering and selecting their health care options, the majority of Americans do not use quality-related information comparing the quality of health care plans, doctors, or hospitals to make their choices.

With respect to the quality of human services, the Department has been engaged in the development of a research strategy to better understand the transformations in human services programs. This strategy identifies the requisite knowledge base, data, performance measures, and program evaluations and research needs for national leadership. The movement toward devolution of responsibility for human services to state and local organizations and the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 offer tremendous opportunities and unprecedented challenges in the redefinition and implementation of services to families. Documenting, understanding, interpreting, and facilitating the exchange of information and experiences among states is essential for encouraging sound decisions that promote the well-being of families and children.

Objective 4.1 - Enhance the Appropriate Use of Effective Health Services

How We Will Accomplish Our Objective

We will disseminate knowledge about effective health services through multiple mechanisms and partnerships, including health networks and health care provider organizations. We will focus these activities on:

• disseminating protocols/guidelines for prevention and treatment of mental health and substance abuse, particularly for challenging patient populations such as homeless persons with dual diagnoses.

• promoting the use of patient care guidelines on effective methods of care for treatable diseases such as diabetes, arthritis, and tuberculosis.

• use of web sites and electronic clearinghouses to facilitate easy and wide-spread access to information.

• establish a national partnership with the Department of Defense, the Veterans Administration, state health agencies, hospitals, and health care organizations, to develop and disseminate information on the best ways of preventing medical errors.

  4.1 Implementation Strategies

  Information Dissemination Quality Monitoring Research

  This will be done through benchmarking, providing grants for additional research on causes of medical errors, and developing a data clearinghouse.

We will monitor the quality of care to ensure effective services are used. We will do this through projects carried out by Medicare Peer Review Organizations to assess whether beneficiary care meets professionally recognized standards in six clinical areas: acute myocardial infarction, heart failure, pneumonia, stroke/transient ischemic attack/atrial fibrillation, diabetes, and breast cancer.

HHS Agencies contributing to this objective: AHRQ CDC FDA HCFA HRSA NIH OS SAMHSA

We will carry out research and evaluation activities to develop knowledge about effective health services and how best to promote their use. We will focus on:

• understanding the relationship between health care services and health outcomes and developing mechanisms to measure and monitor the quality of these services.

• developing tools to help individual practitioners and health systems apply the latest information on preferred treatment.

Objective 4.2 - Increase Consumer and Patient Use of Health Care Quality Information

How We Will Accomplish Our Objective

We will disseminate and publicize culturally and linguistically appropriate health care quality information to consumers and patients through provider networks and other partners. Some key elements of our strategy will be to:

• develop an annual report on national trends in the quality of health care and provide it to the American people beginning in FY 2003.

• disseminate consumer-oriented report cards for patients receiving mental health services and their families.

• disseminate culturally and linguistically appropriate health care quality information.

• develop,

  4.2 Implementation Strategies

  Disseminating Health Care Quality Information Research

  test, and disseminate web-based patient education tools and materials, such as information on health care quality, on the HHS web site.

We will support research and evaluation activities to establish scientific and public health information that will enable individuals to make informed health service choices. We will focus on:

• developing, testing, and disseminating quality measures that are effective and useful to consumers and patients for making choices about treatment and health plan selection.

• developing and testing better methods of presenting information on quality to both general and specialized audiences.

HHS Agencies contributing to this objective: AHRQ CDC FDA HCFA HRSA OCR OS SAMHSA

 

Objective 4.3 - Improve Consumer and Patient Protection

How We Will Accomplish Our Objective

We will implement the Consumers' Bill of Rights and Responsibilities in HHS health care programs and advocate for passage of a National Patients' Bill of Rights.

We will evaluate and monitor the effectiveness of provider grievance and complaint procedures in HHS health care programs. This will include:

• providing patients with information on how to exercise their grievance and appeal rights.

4.3 Implementation Strategies

Consumer Bill of Rights Monitoring Grievances/Complaints Protection and Advocacy Promoting Privacy Survey and Certification Encouraging Culturally Appropriate Services

• investigating allegations of discrimination.

• developing clear and easy to understand informed consent documents.

• requiring organizations coming into our provider networks (e.g., Medicare+Choice organizations and other organizations with which we contract) to meet prescribed standards for grievance and appeal processes.

We will provide training and technical assistance to improve protection and advocacy programs for the elderly, mentally ill, and developmentally disabled individuals.

We will issue and enforce privacy regulations authorized under HIPAA medical records privacy provisions and promote the adoption of comprehensive privacy legislation.

HHS Agencies contributing to this objective: ACF AoA HCFA HRSA IHS NIH OCR OS SAMHSA

We will continue to establish standards and conduct survey and certification activities for participation in Medicare and Medicaid by health care providers, including clinical laboratories.

We will encourage provision of culturally and linguistically appropriate health care services using incentives, such as awards to grantees/service delivery partners who model excellence in culturally competent practice.

 

Objective 4.4 - Develop Knowledge That Improves the Quality and Effectiveness of Human Services Practice

How We Will Accomplish Our Objective

We will support research and evaluation activities to develop knowledge about effective human services, and we will promote the exchange of information and experiences among service providers by:

• making investments in our research infrastructure to improve our statistical modeling capacity, databases, and other tools necessary for research and evaluation.

4.4 Implementation Strategies

Infrastructure Development Understanding Key Programs Demonstrations and Evaluations Application of Results

• building on existing federal investments through partnerships with public and private researchers to create a strong understanding of key programs, including Temporary Assistance for Needy Families (TANF), childcare, child support enforcement, and child welfare.

• continuing to improve data reporting and performance measurement in federal human services programs, including programs that provide flexible funds to states.

• fostering improvements in the quality of human services through demonstration waivers, rigorous evaluations, carefully designed impact evaluations, and testing innovations in a variety of programs.

• maximizing the opportunities to base policy and program design on reliable information through technical assistance that translates knowledge gained about outcomes and best practices into practice.

HHS Agencies contributing to this objective: ACF AoA OS

 

Goal 5 - Improve the Nation's Public Health Systems

In addition to behavior, access, and quality, the vitality of the public health system in the United States is essential to ensuring and improving the health of Americans. Therefore, Goal 5 is concerned with making sure the infrastructure of the public health system is sound.

Weaknesses in the public health infrastructure have been documented since the 1988 report from the Institute of Medicine, The Future of Public Health (National Academy of Sciences, IOM, Committee for the Study of the Future of Public Health; Division of Health Care Services, 1988). Most recently (February 1999), a General Accounting Office study reported that over half of state public health laboratories do not conduct tests for surveillance of hepatitis C and penicillin-resistant S. pneumoniae. According to the study, just over half of the state public health laboratories have access to advanced molecular technology. The study reported that public health directors believe that there are not enough laboratory staff who can perform tests and that there are insufficient numbers of epidemiology staff who can analyze data and translate surveillance information into disease prevention and control activities. The laboratories at the Centers for Disease Control and Prevention and the Food and Drug Administration are overcrowded. Other data indicate that state and local public health staff have limited access to technology. For example, only 48 percent of local health department directors have continuous high speed Internet access.

Objective 5.1 - Improve the Capacity of the Public Health System to Identify and Respond to Threats to the Health of the Nation's Population

How We Will Accomplish Our Objective

We will upgrade the surveillance, risk assessment, and response capacity of the public health system. Our priorities will focus on investments in infrastructure to improve responses to specific priority needs. These include:

• developing a National Electronic Disease Surveillance System (NEDSS) to monitor the emergence or re-emergence of a variety of infectious diseases.

• allocating resources to state health departments to expand their capacity to identify variations of E. coli and Salmonella and other pathogenic microorganisms, and to more rapidly exchange information.

• increasing the number of health care facilities that conduct surveillance of occupational exposures and infections using the National Surveillance System for Health Care Workers.

• providing funding to increase surveillance for influenza in state and local health departments and global sites.

• provide support to rebuild state and local health departments' core tuberculosis prevention and control activities, including reporting of surveillance data describing the epidemiology of tuberculosis.

• providing training, technical assistance, and funding to improve capacity of state and local health departments to conduct Hepatitis C Virus counseling, testing, and maintain referral demonstration sites.

• providing resources for sentinel networks capable of identifying early victims of bioterrorism and responding to attacks, such as the National Pharmaceutical Stockpile Program and Rapid Toxic Screen.

• providing assistance in the planning and implementation of the Federal Response Plan to natural disasters and other humanitarian emergencies, including assistance in expanding the scientific body of knowledge for responding to these crises.

• allocating resources to state/local health departments and hospitals for better surveillance, prevention, and control of microbial resistance.

• developing national data standards for surveillance to enable easier transfer and sharing of information.

• providing resources to four tribal epidemiology centers to expand their capacity for surveillance of disease and health status of Native Americans.

• developing a surveillance mechanism to assess needs of people with disabilities.

• allocating resources to expand the number of states with diabetes programs that will have the core capacities for surveillance, communication, and assessment of quality of care.

5.1 Implementation Strategies

Infrastructure Investments Public Health Communications Workforce Development

• expanding the ability of states to track the performance and outcomes of their health programs through electronic reporting mechanisms.

• making electronic hardware available to state and local public health agencies to support electronic surveillance networks.

We will improve the public health data infrastructure by providing training and funding to state health statistics centers on the collection and interpretation of statistics for state-level decision making and cross-state comparisons.

We will improve public health communications by:

• funding cooperative agreements with states to support the Health Alert Network for electronic communications at all levels of government.

• developing prevention information systems to provide substance abuse prevention practitioners with direct access to a wide range of scientifically sound prevention-related information resources.

• producing and releasing public health data in clearer formats to better disseminate information on public health trends, issues, and difficulties/challenges. We will improve the supply and skills of the public health workforce. Our focus will be on training:

• public health specialists, preventive medicine residents, nurses, and public health dentists to serve in medically underserved areas.

• public health leadership personnel capable of developing, managing, and evaluating scientifically sound public health programs.

HHS Agencies contributing to this objective: CDC FDA HRSA IHS NIH OS SAMHSA

• epidemiologists and laboratory specialists in applied epidemiology.

• prevention researchers.

• public health information specialists to address the increasingly sophisticated information needs of public health programs.

• a more racially and ethnically diverse public health workforce.

Objective 5.2 - Improve the Safety of Food, Drugs, Medical Devices, and Biological Products

How We Will Accomplish Our Objective

We will access state-of-the-art science necessary for timely and credible regulatory decisions by:

• recruiting top scientists.

• engaging in continuous training of the professional work force.

• maintaining up-to-date laboratories and equipment.

• participating in exchange programs with academia, public, and private sector organizations.

• engaging in collaborative, targeted research with the greater scientific community to address critical public health and safety issues.

We will improve food safety by:

• expanding and providing technical assistance to the foodborne diseases surveillance network (FoodNet) to increase its capacity to identify sources of foodborne pathogens.

5.2 Implementation Strategies

Science Capacity Food Safety Drug Safety Medical Device Safety Biological Products Safety

• developing new methods for fingerprinting bacterial, viral, and parasitic foodborne pathogens.

• evaluating risk factors that contribute to foodborne illness and implementing control measures to minimize the impact of these factors.

• providing training and education for consumers and state and local public health professionals on preventing and detecting foodborne illness.

• promoting adoption of the 1999 model food code through educational campaigns and training programs.

• increasing international collaboration with and technical assistance to other countries to improve surveillance systems and expand the global sharing of surveillance information.

• developing, disseminating, and conducting training on Good Agricultural and Manufacturing Practices for domestic fresh produce growers, packers, and shippers.

We will improve drug safety by:

• processing and responding quickly to reports of adverse drug events through the Adverse Events Reporting System.

• inspecting drug manufacturing and repackaging establishments to ensure conformance with good manufacturing practices.

• making more easily understandable information about choosing and taking prescription and over-the-counter drugs available to consumers and health professionals to prevent misuse.

• developing safer vaccines.

We will improve the safety of medical devices by:

• inspecting mammography facilities annually and taking enforcement action against those that do not meet acceptable standards for safety and quality.

• inspecting medical device manufacturing establishments and reinspecting those showing serious deficiencies to ensure that they have complied with established standards.

• expanding the national network of hospitals and clinics that recognize and report adverse events relating to medical devices.

We will improve the safety of biological products by:

• processing and responding quickly to reports of adverse biological events through the Adverse Events Reporting System.

HHS Agencies contributing to this objective: AHRQ CDC FDA NIH OS

• inspecting (and reinspecting) biological manufacturing, repackaging, and blood bank establishments for conformance with safety and purity standards.

 

Goal 6 - Strengthen the Nation's Health Science Research Enterprise and Enhance its Productivity

The "health research" goal recognizes the prominence of health research in HHS and its importance in furthering the overall mission of improving the nation's health. Many strategies under other goals and objectives are also research based, so there is overlap among the goals and objectives. The objectives under Goal 6 deal with creating knowledge that ultimately is useful in addressing health challenges. In this respect, the objectives address the need to maintain and improve the research infrastructure that produces scientific advances.

Objective 6.1 - Advance the Scientific Understanding of Normal and Abnormal Biological Functions and Behaviors

How We Will Accomplish Our Objective

We will advance our scientific knowledge by:

• expanding our investments in basic research.

• applying stringent peer review for scientific quality on all research proposals to return the maximum possible on the public's investment in medical research.

• ensuring the medical research is responsive to public health needs, scientific opportunities, and advances in technology using effective research priority setting processes.

6.1 Implementation Strategies

Investments Peer Review Priority Setting Technology Transfer

• promoting technology transfer through such mechanisms as interagency collaborations and partnerships with academia and industry to facilitate the wide and rapid diffusion of new knowledge.

HHS Agencies contributing to this objective: CDC FDA NIH OS

 

Objective 6.2 - Improve Our Understanding of How to Prevent, Diagnose, and Treat Disease and Disability

How We Will Accomplish Our Objective

We will improve our understanding of how to prevent, diagnose and treat disease and disability by:

• expanding the nation's investments in research to translate new fundamental knowledge into new or improved diagnostics, prevention strategies, and treatments.

• using population-based, behavioral, and social science research to assess risks and behaviors associated with diseases, injuries, disabilities, and premature death.

• continuing to promote the inclusion of women and minorities and their sub- populations in human subject research though recruitment outreach and monitoring of participation.

• applying stringent peer review for scientific quality on all research proposals to ensure the maximum possible return on the public's investment in medical research.

• sustaining processes for research priority setting that ensure medical research is responsive to public health needs, scientific opportunities, and advances in technology.

6.2 Implementation Strategies

Investments Risk and Behavior Assessment Human Subject Recruitment Peer Review Priority Setting Technology Transfer

• promoting technology transfer through such mechanisms as interagency collaborations and partnerships with academia and industry to facilitate the rapid commercialization of new drugs, biologic therapies, and medical devices.

HHS Agencies contributing to this objective: AHRQ CDC FDA NIH OS

 

Objective 6.3 - Enhance Our Understanding of How to Improve the Quality, Effectiveness, Utilization, Financing, and Cost-Effectiveness of Health Services

How We Will Accomplish Our Objective

We will improve our understanding of how best to deliver health services in the United States by:

• increasing our investment in health services research.

• identifying key research questions and selecting the highest quality research proposals.

• creating research partnerships with states and private sector organizations.

6.3 Implementation Strategies

Investments Improving Project Quality Research Partnerships Focusing Research

• focusing our research on understanding how to improve health services for unserved and underserved populations (e.g., minorities and populations in rural areas); how to improve financing; and how to improve services that present significant challenges in terms of access and effectiveness (e.g., primary care, emergency care, long-term-care, mental health, and substance abuse).

HHS Agencies contributing to this objective: AHRQ CDC HCFA HRSA NIH OS SAMHSA

 

Objective 6.4 - Accelerate Private-Sector Development of New Drugs, Biologic Therapies, and Medical Technology

How We Will Accomplish Our Objective

We will accelerate development by:

• applying state-of-the-art science knowledge to ensure timely review of important new medical products.

• streamlining the review processes for approval of new drugs, therapies, and technology.

• increasing communications and collaboration (e.g., cooperative research and development agreements) with sponsors both before and during the review process.

• harmonizing regulatory standards with those of other industrial nations.

6.4 Implementation Strategies

Science Capacity Streamlining Review Process Communication Harmonizing Standards Priority Setting

• prioritizing the review of new drugs and medical devices, paying special attention to drugs and devices that offer the greatest potential for treating serious or life-threatening diseases.

HHS Agencies contributing to this objective: FDA NIH OS

 

Objective 6.5 - Strengthen and Diversify the Base of Well-Qualified Health Researchers

How We Will Accomplish Our Objective

We will strengthen and diversify the base of researchers by:

• investing in research training and career development programs.

• supporting training programs in minority institutions and in those that serve minorities.

• recruiting under-represented segments of society into research training and career development programs.

6.5 Implementation Strategies

Training Recruitment Geographic Distribution

• implementing a program to broaden the geographic distribution of health services research funding and enhance the competitiveness of institutions located in states that have a low success rate for grant applications.

HHS Agencies contributing to this objective: AHRQ CDC HCFA NIH OS

 

Objective 6.6 - Improve the Communication and Application of Health Research Results

How We Will Accomplish Our Objective

We will increase our use of technology to expand our dissemination capacity and reduce the time it takes to provide information to stakeholders, including the use of multiple media channels (such as print, television, radio, and the interactive World Wide Web) and the electronic gathering and transfer of information.

We will use new information technology to facilitate the wide and rapid dissemination of new research findings across research disciplines to bridge the practice gaps among clinical and public health disciplines.

We will establish partnerships with health professional associations, industry groups, patient representatives, and purchasers of care to more widely disseminate research findings.

6.6 Implementation Strategies

Technology Partnerships HHS Website Development Research

We will improve linkages and organization of HHS web sites that disseminate research results to improve the reach and effectiveness of our communications.

We will support research and other activities designed to develop better information dissemination models and communication programs.

HHS Agencies contributing to this objective: AHRQ CDC FDA HCFA HRSA NIH OS SAMHSA

 

Objective 6.7 - Strengthen Mechanisms for Ensuring the Protection of Human Subjects in Research and the Integrity of the Research Process.

We will strengthen mechanisms for ensuring protection of human subjects by:

• increasing and enhancing the educational opportunities for clinical investigators and Institutional Review Board (IRB) members and staff to facilitate their understanding and application of federal requirements for the protection of human subjects.

• issuing specific guidance on informed consent.

• promoting the use of accreditation of human-subject-protection programs and certification of IRB staff and members, as part of the NIH grant award process and the assurance process.

• clarifying existing conflict of interest regulations and developing new conflict of interest policies for the biomedical research community.

• pursuing legislation to enable FDA to levy the civil monetary penalties for violations of informed consent and other requirements.

6.7 Implementation Strategies

Training/Staffing Improving Procedures Accreditation Monetary Penalties Research

• We will strengthen the integrity of the research process by:

• increasing staffing and, where appropriate, improving our review procedures for ensuring research integrity, and applying these improvements to enhance the monitoring of research institutions.

• enhancing the way we address and resolve allegations of research misconduct; for example, adopting a standardized definition of research misconduct and consistent policy for resolving allegations across the various federal research agencies.

• in collaboration with the scientific community, providing and facilitating required expanded training in the responsible conduct of research for our partner institutions.

HHS Agencies contributing to this objective: AHRQ CDC FDA NIH OS

• expanding efforts to conduct research on issues affecting research integrity, including methods to maximize effective training in responsible research, types of federal regulations that are effective and efficacious, and identification of institutional systems and processes that can be adopted to ensure responsible research.

 

Appendix A - Coordination

Many programs within the Department have goals, objectives, and target populations that appear similar. Likewise, many Department programs appear to duplicate or overlap programs in other Federal agencies. Many state, local, and private sector programs also have goals, objectives, and target populations in common with Department programs. Because programs appear to have overlapping goals and constituencies, it is often assumed that a high degree of waste and duplication is occurring. In fact, although many programs work to achieve similar goals and objectives, the specific activities that they undertake to accomplish the goals are often decisively different and represent complementary, not duplicative, approaches to addressing a common problem.

For example, a number of Department programs spend resources to reduce the use of tobacco (Objective 1.1). The same is true of state and local health departments and other public and private health organizations. While working to achieve the same goal, the various agencies and organizations actually play quite different roles. CDC's Chronic Disease Prevention and Health Promotion program provides funds to states for the development of tobacco prevention programs. Substance Abuse and Mental Health Services Administration (SAMHSA) is charged with implementing the Synar Amendment and provides funds to states for compliance activities to prevent the sale of tobacco to minors. The National Institutes of Health (NIH) supports research on ways to reduce nicotine addiction and how to provide better prevention and treatment interventions. The Office of Public Health and Science (OPHS) works with Smoke-Free Kids, US Soccer, and other community coalitions to develop and incorporate prevention programs into their activities.

The example is illustrative of how programs with overlapping goals and objectives can be complementary. The way we make sure programs complement each other is by using a variety of internal and external coordination mechanisms, such as coordinating committees and joint program planning. These mechanisms are thoroughly described in the sections on internal and external coordination that follow.

INTERNAL COORDINATION

Over 300 Department programs make up the resource base that HHS deploys to implement the goals and objectives in the strategic plan. Appendix J shows that deployment by program (or aggregated program categories). It is evident from the table that a significant number of programs are deployed to achieve each goal and objective.

The table illustrates the Department's challenge: making sure that each program contributes to the achievement of Department goals and objectives in a way that is complementary and that HHS resources are used efficiently. How the challenge is met and how coordination is achieved are critical. In fact, it is achieved in a number of ways:

PLANNING SYSTEMS

The Department maintains a number of planning systems that enable coordination of program operations across the operating divisions. In this respect, strategic planning, annual performance planning, and the annual budget process are primary tools for reviewing program priorities and harmonizing program activities. For example, the strategy sections of strategic and annual performance plans are used to plan and delineate the complementary roles of the various programs for achieving a particular goal. Additionally, the budget process gives Department staff the chance to review resource allocations each year and eliminate overlap and duplication.

In addition to these major planning systems, the Department manages a process for coordinating development of legislative proposals and regulation. More broadly, the Department engages in an annual planning process for research, demonstration, and evaluation activities. This planning involves representatives from all HHS agencies.

JOINT INITIATIVES

Both to advance important areas of policy interest and to promote program coordination, HHS routinely designates special initiatives and assigns management responsibility to two or more operating divisions. The Department's health disparity and bioterrorism initiatives are representative of these initiatives. The Initiative to Improve Health Care Quality is another example, through which representatives from all HHS agencies collaborate to make information on quality easier for consumers to use (Objective 4.2), strengthen value-based purchasing by the Department (Objective 3.5), improve the quality of health care services delivered directly by Department programs (Goal 4), expand research that improves quality (Goals 4 and 6), and measure national health care quality (Goals 4 and 5). Joint management works well to coalesce program activities and allocate resources in a way that promotes efficiency and coordination. These special initiatives are subsequently incorporated into the strategic and performance plans.

COORDINATING COMMITTEES/ACTIVITIES

On a more permanent basis, HHS establishes coordinating committees as a way to integrate a variety of internal activities. These established coordinating bodies include, for example:

• The Public Health Council (consisting of Agency heads or deputies) meets quarterly to ensure coordination and communication across public health and other HHS agencies for the purpose of sustaining and improving the nation's public health infrastructure.

• The Data Council advises the Secretary on data policy and serves as a forum for consideration of those issues. The council also coordinates the Department's data collection and analysis and ensures effective long-range planning for surveys and other investments in major data collection.

• The Oral Health Coordinating Committee examines issues of oral health that cut across all HHS agencies, such as oral health information needed for decision making and efforts related to reducing disparities and promoting multi-agency oral health initiatives.

• The Interagency Narcotic Treatment Policy Review board coordinates federal policy regarding the use of methadone. The board helps ensure that agencies responsible for regulatory and oversight activities, funding, technical assistance, and policy development meet, deliberate, and review and comment on pertinent agency/departmental issues. Membership includes representatives from the Food and Drug Administration (FDA), SAMHSA, National Institute on Drug Abuse (NIDA), Health Care Financing Administration (HCFA), Office of the Secretary (OS), Department of Veterans Affairs, Drug Enforcement Administration (DEA), and Office of National Drug Control Policy (ONDCP).

• The Fetal Alcohol Interagency Coordinating Committee plans and reviews research work on fetal alcohol syndrome among NIH, the Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the Indian Health Services (IHS).

• The Healthy People 2010 steering committee includes all HHS Operating Divisions/Agencies, and the Healthy People Consortium is comprised of 650 national and state organizations. Together, these bodies coordinate, advise, and plan activities for measuring and implementing health and social services throughout the Department.

• The Secretary's Council on National Health Promotion and Disease Prevention serves to further advise the Department with regard to the development, monitoring, measurement, and implementation of Healthy People 2010.

• The Minority Initiatives Steering Committee and Minority Initiatives Coordinating Committee coordinate efforts to improve the health of racial and ethnic groups across the Department.

• The HHS Chief Financial Officers Council ensures that HHS's financial management policy and reporting support program missions by providing accurate, timely, and useful information for decision making. The council is also responsible for reporting financial information to the Congress, Office of Management and Budget (OMB), General Accounting Office (GAO), the Department of the Treasury, and the public.

• The HHS Chief Information Officer (CIO) Advisory Council includes membership from each of the HHS agencies. The council advises the Chief Information Officer on the promotion of Department-wide Information Resources Management (IRM) goals, strategic policies and initiatives, and enhanced communications among the agencies. In addition, CIO Advisory Council members serve on the HHS Information Technology Investment Review Board.

EXTERNAL COORDINATION

Almost all health and human service programs entrusted to the Department intersect in some manner with programs of other federal agencies and the public and private sector. This diversity compounds the challenge of coordinating HHS programs with those outside the Department. In addition, Department programs are organized and delivered in a variety of ways, ranging from the direct provision of services where the Department supports most of the costs, to block grants to states where the Department supports a fraction of the costs. This diversity means that the mechanisms for achieving coordination are necessarily as varied as the programs. Coordinating mechanisms can be imbedded in service delivery partnerships. They can be formal mechanisms such as coordinating councils. They can be ad hoc mechanisms such as meetings or workgroups. Department staff are also directly responsible for coordination. For example, the HHS Regional Directors help ensure that Department programs and activities are coordinated with state, local, tribal, and private organizations in their regions. A discussion of two of these coordination mechanisms follows.

SERVICE DELIVERY PARTNERSHIPS

Although the Department delivers services directly under several programs-most notably the Food and Drug Administration and the Indian Health Service-HHS relies on a large network of state, local, and tribal government organizations, contractors, and private entities to help develop,

HHS relies on a large network of state, local, and tribal government organizations, contractors, and private entities to help develop, finance, and carry out the goals, objectives, and programs that we share in common.

finance, and carry out the goals, objectives, and programs that we share in common. Program services delivered by these organizations range from financing and providing health services (Medicaid, community health services) to services that help families, communities, and individuals improve their well-being (Temporary Assistance to Needy Families, Head Start, refugee assistance).

Several aspects of coordination are essential to these service delivery partnerships. First, the role of each partner must be well defined. Second, there must be a mutual understanding of the goals and objectives of the partnership. Finally, there must be a continuing dialogue between the partners to address ongoing policy and operational issues. Coordination is achieved in a variety of ways. Some of the most common mechanisms are:

• Consultation with partners in the development of the program goals and objectives that we have in common.

• Cooperative partnership agreements (grants, contracts, memoranda of understanding).

• Partnership meetings.

• Advisory councils.

OTHER FEDERAL AGENCIES

A number of federal agencies have goals and objectives and run programs that are parallel to or intersect with those of the Department. Often the people being served are the same or similar. For example, the Department's Food and Drug Administration shares food safety and inspection responsibilities with the Department of Agriculture. When responsibilities are shared, it is

important to ensure that efforts are harmonized, not duplicated. This is done in a number of ways, such as joint planning, coordinating councils and workgroups, and cooperative agreements. Several examples illustrate the priority placed on effective coordination between federal agencies and how coordination is accomplished:

• The Interagency Task Force on Children's Health Outreach is responsible for bringing approximately 11 federal departments together to develop ways to educate families about and enroll children in Medicaid and the State Children's Health Insurance Program. This involves developing outreach materials and coordinating outreach activities of the participating agencies.

• The White House Council on Youth Violence is responsible for coordinating the development of Federal policy, research agendas, and program activities dealing with youth violence. It includes the Departments of Health and Human Services, Education, Labor, and Justice.

• Approximately 11 federal agencies are part of the Interagency Committee on School Health. The committee is tasked with jointly identifying needs and facilitating the planning of strategies to improve federal leadership in addressing school health needs.

• Drug control efforts are coordinated by the Office of National Drug Control Policy through a comprehensive strategic plan that outlines the distinct roles and responsibilities of various federal agencies in the war on drugs.

• The Quality Interagency Coordination Task Force (QuIC) ensures that all federal agencies involved in purchasing, providing, studying, or regulating health care services are working in a coordinated way toward the common goal of improving quality of care.

In addition to the examples of external coordination provided above, the following table (Table A) provides a more comprehensive list of HHS program activities that intersect with the programs and activities of organizations outside the Department and where coordination is important. The table also shows how coordination is achieved.

 

TABLE A
EXTERNAL COORDINATION

GOAL 1: Reduce the Major Threats to the Health and Productivity of All Americans

Objective	Crosscutting Activity	HHS Agencies	External Organizations	Coordination Means
Objective 1.1
Reduce tobacco use, especially among youth	Media campaigns and education programs to prevent tobacco use	CDC, NIH, SAMHSA, HIS	State and local health departments, health promotion and research organizations	Cooperative agreements, HHS Interagency Working Group on Tobacco
	Surveillance - support for national longitudinal study of adolescent health	NIH, CDC	Robert Wood Johnson Foundation	Joint planning and funding
Objective 1.2
Reduce the incidence and impact of injuries and violence in American society	Development of strategies and dissemination of information for reducing youth violence	CDC, NIH, SAMHSA	Departments of Education, Justice, and Labor	White House Council on Youth Violence
	Surveillance/research on the causes of injury and violence and development of prevention strategies	CDC, HIS, Administration for Children and Families (ACF), SAMHSA	Departments of Justice, Labor, and Transportation; state and local health departments; Consumer Product Safety Commission; consumer product safety organizations	Cooperative agreements and contracts
	Media campaigns and education programs to prevent violence and injury	CDC, HIS, ACF, SAMHSA, HRSA, Administration on Aging (AoA)	Departments of Justice, Labor Transportation; Consumer Product Safety Commission; consumer product safety organizations; multiple state, tribal, and local government agencies; community organizations	Cooperative agreements, joint planning
	Research on violence and injury to children	NIH, CDC, ACF, HRSA	Departments of Education and Justice, Brain Injury Association, American Academy of Physical Medicine and Rehabilitation, World Health Organization	Cooperative agreements
	Research on elder abuse and neglect	NIH, AoA, CDC	Census Bureau	Interagency agreements
Objective 1.3
Improve the diet and the level of physical activity of Americans	Development of national dietary guidelines and nutrition research	CDC, OPHS, NIH, ACF, AoA, FDA, HRSA, IHS, SAMHSA	Departments of Agriculture, Defense, Veterans Affairs, and Commerce; NSF, AID, NASA, and Office of Science and Technology Policy (OSTP); American Public Health Association	Cooperative agreements and contracts
	Physical activity/fitness and healthy diet promotion/education	CDC, HRSA, OPHS, AoA, IHS, President s Council on Physical Fitness and Sports	Department of Agriculture; state and local health departments; tribes; other national, state and local organization promoting healthy behaviors	Cooperative agreements, contracts, joint planning
Objective 1.4
Reduce alcohol abuse and prevent under age drinking	Alcohol addiction treatment services	SAMHSA, HIS	State, tribal, and local health departments; community treatment organizations	Joint planning
	Alcohol abuse prevention campaigns	SAMHSA, HRSA	Departments of Transportation, Education and Justice; state and local health departments, community organizations	Joint planning
Objective 1.5
Reduce the abuse and illicit use of drugs	Development and Implementation of National Drug Control Policy	SAMHSA, CDC, NIH, FDA	ONDCP; Departments of Education, Justice, Treasury, Housing and Urban Development and Transportation	ONDCP National Drug Control Strategic Plan
	Drug addiction treatment services	SAMHSA, HIS	State, tribal, and local health departments; correctional institutions; community drug treatment organizations	Joint national and regional meetings
	Implementation of the federal drug free workplace program	SAMHSA	All federal agencies	Central policy guidance and oversight of federal agency programs
	Research on prevention and treatment of drug abuse	HRSA, NIH, SAMHSA, CDC	Departments of Energy, Labor, Justice and Veterans Affairs; National Science Foundation; Uniformed Services University of the Health Sciences; institutions of higher education	Cooperative agreements; Attorney General s Methamphetamine Task Force; Interagency Narcotic Treatment Policy Review Board
Objective 1.6
Reduce unsafe sexual behaviors	Prevention programs (domestic)	OPHS, CDC, HRSA, IHS, SAMHSA	State and local departments of education and health, community prevention programs	HIV/AIDS Prevention Community Planning Process
	Prevention programs (international)	NIH, CDC	USAID, World Health Organization, UNAIDS, European Union, Medical Research Council of the United Kingdom, Rockefeller Foundation	International working group on Microbicides, Sexually Transmitted Disease Diagnostics Initiative, Syphilis Research Initiative
	Surveillance	CDC	State and local health departments, other national and community organizations	Cooperative agreements
Objective 1.7
Reduce the incidence and impact of infectious diseases	Surveillance	CDC, FDA, NIH	Department of Agriculture, state and local health departments, international health organizations	Cooperative agreements
	Prevention/control (immunization) programs	CDC, FDA, IHS, HCFA, HRSA	State and local health departments, state Medicaid agencies, health care providers, voluntary health organizations	Joint planning, cooperative agreements
	Research	NIH, FDA, CDC, AHRQ, HRSA	Environmental Protection Agency, Departments of Defense, Veterans Affairs, and Agriculture	Interagency Task Force on Antimicrobial Resistance
Objective 1.8
Reduce the impact of environmental factors on human health	Biomonitoring	NIH, CDC, Agency for Toxic Substances and Diseases Registry (ATSDR)	Association of Public Health Laboratories State and local health agencies	Joint projects, cooperative agreements

 

GOAL 2: Improve the Economic and Social Well-being of Individuals, Families, and Communities in the United States
 

Objective	Crosscutting Activity	HHS Agencies	External Organizations	Coordination Means
Objective 2.1
Improve the economic independence of low income families, including those receiving welfare	Education/Job Skills/ Training for welfare and low income persons	ACF	Departments of Labor and Education	Interagency Unified Planning Workgroup
	Development of ongoing guidance for Public Housing Authorities and local welfare agencies to target services and assistance to families receiving welfare and housing assistance.	ACF	Department of Housing and Urban Development	Cooperative agreements; joint planning
Objective 2.2
Increase the parental involvement and financial support of noncustodial parents in the lives of their children	Locating delinquent parents and enforcing child support orders	ACF	Departments of Justice, State, and Treasury; state child enforcement agencies	Expanded federal Parent Locator Service
Objective 2.3
Improve the healthy development and learning readiness of preschool children	Delivery of early childhood health, education, and developmental services	ACF, HRSA, HCFA, IHS, OPHS, SAMHSA	Department of Education; other federal agencies; state, tribal, and local education agencies; state and local health departments; state Medicaid agencies; health care providers; Head Start providers; day care providers	Joint planning, interagency agreements, cooperative agreements, Interagency Children s Health Outreach Task Force
	Early childhood research	ACF, NIH	Department of Education and other federal departments and agencies	Early Childhood Research Working Group
	Early education of children with disabilities	ACF	Departments of Education, Labor, and other federal departments and agencies	Federal Interagency Coordinating Council
Objective 2.4
Improve the safety and security of children and youth	Child abuse prevention, child welfare and independent living support services	ACF, SAMHSA	Departments of Justice and Labor	Joint planning, committees
Objective 2.5
Increase the proportion of older Americans who stay active and healthy	Research	NIH, AoA, CDC, President s Council for Physical Fitness and Sports	National Academy of Sciences, NASA	Interagency agreements
Objective 2.6
Increase independence and quality of life of persons with long-term-care needs	Long-term-care services	HCFA, AoA, Office for Civil Rights (OCR), SAMHSA, NIH	State developmental disability agencies, long-term-care providers, state and local agencies on aging, state Medicaid agencies	Joint planning
	Employment of adults with disabilities	AoA, ACF	Departments of Labor and Education and other federal agencies	Presidential Task Force on Employment of Adults with Disabilities
Objective 2.7
Improve the economic and social development of distressed communities	Community development/social services	ACF, HRSA	Department of Housing and Urban Development, local community development and social service organizations	Joint planning

 

GOAL 3: Improve Access to Health Services and Ensure the Integrity of the Nation's Health Entitlement and Safety Net Programs

Objective	Crosscutting Activity	HHS Agencies	External Organizations	Coordination Means
Objective 3.1
Increase the percentage of the nation s children and adults who have health insurance coverage	Oversight of HIPAA	HCFA	Departments of Labor and Treasury	Joint Regulatory Development
	Enrollment outreach	HCFA, ACF, HRSA	Departments of Agriculture and Education, child care providers, early education providers, state and local health departments, state Medicaid agencies	Partnership agreements, joint planning
	Resolution of consumer issues	HCFA	DOL, state departments of insurance, National Association of Insurance Commissioners	Ad-hoc meetings, joint planning, participation in quarterly meetings
Objective 3.2
Eliminate disparities in health access and outcomes	Nondiscrimination in access to quality health care	OCR, AHRQ, HCFA, CDC, HRSA, OPHS	State and local health departments, state Medicaid agencies, health care providers, state and local provider organizations, medical societies, universities, faith communities, civil rights advocacy and community-based organizations	Local coalitions
Objective 3.3
Increase the availability of primary health care services for underserved populations	Financing and delivery of health care services for underserved populations	HCFA, HRSA, IHS, SAMHSA	State and local health departments, state Medicaid agencies, health care providers	Joint planning
Objective 3.4
Protect and improve the health and satisfaction of beneficiaries in Medicare and Medicaid	National Medicare Education Program	HCFA	Employers, unions, major trade and professional societies, consumer and senior advocacy groups	Joint planning with Medicare "Alliance Network" of over 130 national groups
	Standardized data collection, measurement, analysis, and intervention strategies	HCFA, AHRQ	Departments of Labor and Defense and Veterans Administration	Joint planning through the Quality Improvement Interagency Coordinating Task Force (QuIC)
Objective 3.5
Enhance the fiscal integrity of HCFA programs and purchase the best value health care for beneficiaries	Anti-fraud and abuse programs	HCFA, OIG, AoA	Department of Justice	Interagency agreements
Objective 3.6
Improve the health status of American Indians and Alaska Natives (AI/AN)	Expanding health care services, community development, child protection services; targeted health improvement initiatives	IHS,  HCFA ACF/ Administration for Native Americans (ANA)	Departments of Interior, Housing and Urban Development, Transportation, and Justice	Interagency agreements, and joint planning
Objective 3.7
Increase the availability and effectiveness of services for the treatment and management of HIV/AIDS	Financing of HIV/AIDS treatment services	HRSA, HCFA, IHS	State and local health departments, state Medicaid agencies, community health providers, AI/AN tribes	Joint planning, interagency agreements
Objective 3.8
Increase the availability and effectiveness of mental health care services	Building community-based systems of care	SAMHSA, HRSA, ACF	Departments of Education and Justice, state and community mental health service providers, substance abuse service providers, homeless service providers	Joint planning
	Financing of mental health services	SAMHSA HCFA, HRSA	State and community mental health service providers, state Medicaid agencies	Joint planning
	Integrating persons with severe mental disabilities into the community.	HCFA, SAMHSA	Departments of Housing and Urban Development, Labor, Agriculture	Joint planning
Objective 3.9
Increase the availability and effectiveness of health services for children with special health care needs	Delivering health care services to children with special health care needs	HRSA, HCFA	Departments of Education and Labor, state and local health departments, state Medicaid agencies, President s Council on Disabilities	Joint planning
	Provision of information and education on health care resources for children with special health care needs	HRSA	State and local health departments, health care providers, American Academy of Pediatrics, community organizations	Joint planning

 

GOAL 4: Improve the Quality of Health Care and Human Services

Objective	Crosscutting Activity	HHS Agencies	External Organizations	Coordination Means
Objective 4.1
Enhance the appropriate use of effective health services	Evaluating and disseminating the results of effectiveness research	AHRQ, HCFA, HRSA, NIH, CDC	Institutions of higher education, public and private health care and medical societies	Clearinghouse
	Quality improvement initiatives	AHRQ, HCFA, HRSA	Department of Labor, and all federal departments with health care responsibility	Joint planning through the Quality Improvement Interagency Coordinating Task Force
Objective 4.2
Increase consumer and patient use of health care quality information	Development and dissemination of health care quality information	HCFA, HRSA, AHRQ, IHS	Departments of Labor, Defense, and Veterans Affairs; and other federal departments with health care responsibility	Joint planning, Quality Improvement Interagency Coordinating Task Force, interagency agreements
Objective 4.3
Improve consumer and patient protection	Implementation of consumer protections	AHRQ, HCFA, HRSA, NIH	Department of Labor, and other federal departments with health care responsibility	Joint planning through the Quality Improvement Interagency Coordinating Task Force
	Focus on improving quality of care and elimination of abuse in long-term-care facilities	HCFA, AoA, SAMHSA	Department of Justice, Nursing Home Medical Directors Association, American Dietetic Association, State survey agencies	Cooperative agreements
Objective 4.4
Develop knowledge that improves the quality and effectiveness of human services practice	Research	ACF, Assistant Secretary for Planning and Evaluation (ASPE)	Institutions of higher education, foundations, state human service agencies	Inter-agency work group, annual conferences

 

GOAL 5: Improve the Nation's Public Health Systems

Objective	Crosscutting Activity	HHS Agencies	External Organizations	Coordination Means
Objective 5.1
Improve the capacity of the public health system to identify and respond to threats to the health of the Nation s population	Development of bioterrorism and other surveillance and response networks	CDC, OPHS, HRSA, SAMHSA, NIH, FDA	Departments of Agriculture, Defense, Justice, and Transportation; Federal Emergency Management Agency; state and local health departments	Cooperative agreements, Federal Interagency Workgroup
	Upgrading the public health information infrastructure	CDC, HRSA, SAMHSA	State and local health and substance abuse prevention and treatment agencies	Cooperative agreements
Objective 5.2
Improve the safety of food, drugs, medical devices, and biological products	Food inspection and outbreak surveillance	FDA, CDC	Department of Agriculture, Environmental Protection Agency, state and local health departments	Federal Council on Food Safety, Foodborne Outbreak Coordinating Group, cooperative agreements, integrated surveillance networks (e.g., FoodNet)
	Food safety research, education and information dissemination to regulated industries	FDA	Department of Agriculture, institutions of higher education, National Center for Food Safety and Technology, Joint Institute for Food Safety Research and Applied Nutrition, Food and Drug Law Institute, Drug Information Association	Advisory Councils, cooperative agreements, Memoranda of Understanding
	Inspection of imports	FDA	U.S. Customs Service	Cooperative development of processes
	Blood products and vaccine safety	FDA, NIH, CDC	American Red Cross, state health departments, blood banks, WHO, American Academy of Pediatrics	Collaborative standard setting

 

GOAL 6: Strengthen the Nation's Health Science Research Enterprise and Enhance its Productivity

Objective	Crosscutting Activity	HHS Agencies	External Organizations	Coordination Means
Objective 6.1
Advance the scientific understanding of normal and abnormal biological functions and behaviors	Scientific research	NIH, CDC, FDA, AQHR	Extramural research community: universities, hospitals, other research centers Other federal agencies: NASA, Department of Education, and Environmental Protection Agency, etc.	Research partnerships Joint program/project planning and coordination
			Private industry	Technology transfer agreements
Objective 6.2
Improve our understanding of how to prevent, diagnose, and treat disease and disability	See Objective 6.1
Objective 6.3
Enhance our understanding of how to improve the quality, effectiveness, utilization, financing, and cost-effectiveness of health services	Health services research	AHRQ, NIH, CDC, HCFA, HRSA, SAMHSA	Institutions of higher education, research foundations, voluntary health organizations	Cooperative agreements, grants, contracts, research conferences
Objective 6.4
Accelerate private-sector development of new drugs, biologic therapies, and medical technology	Harmonizing regulatory standards	FDA	Foreign governments and organizations	International committees and organizations
Objective 6.5
Strengthen and diversify the base of well-qualified health researchers	Training and career development programs	NIH, HCFA, HRSA, AHRQ, CDC	Institutions of higher education	Advisory committees, joint grant announcements
Objective 6.6
Improve the communication and application of health research results	Health communication and education	NIH, CDC, FDA, AHRQ, HRSA, HCFA, President s Council for Physical Fitness and Sports	Institutions of higher education, voluntary health-related organizations, community organizations, state and local health departments, private sector organizations	Memoranda of understanding, partnership agreements, joint conferences and meetings
Objective 6.7
Strengthen mechanisms for ensuring the protection of human subjects in research and the integrity of the research process	Strengthening institutional review boards	NIH, OPHS, FDA	Institutions of higher education, foundations	Meetings, conferences, technical assistance

Appendix B - External Factors

In some cases, achieving our strategic goals and objectives may be impeded by factors that are beyond the control of the Department of Health and Human Services (HHS). For example, national or local economic conditions can influence whether we are successful in helping families on welfare become economically independent. In some cases, there may be ways to ameliorate the impact of these conditions on our strategies and objectives. In other cases, there may not. The following table (Table B) provides a list of the significant external factors (economic, human, environmental, etc.) that could present challenges for management and could affect whether or how well we achieve our strategic goals and objectives. The table also provides an indication of actions that might be taken to ameliorate these factors, should they arise.

TABLE B
EXTERNAL FACTORS

Goal/ Objective	External Factor	Effect on Strategies/ Goal/Objective	HHS Response to Mitigate Factor
GOAL 1: Reduce the Major Threats to the Health and Productivity of All Americans
Objective 1.1
Reduce tobacco use, especially among youth	States use of tobacco settlement funds, to conduct campaigns to encourage youth and adults not to smoke	State use of settlement money for anti-smoking purposes would assist HHS efforts/strategies	Work with our state partners to foster effective use of settlement money
	Federal cigarette tax rate	Higher rates would discourage smoking among youth	Work toward Congressional action
Objective 1.2
Reduce the incidence and impact of injuries and violence in American society	Demographic and economic trends	Higher rates of violence are associated with economic distress and the size of the population below age 25	Expand effective youth development programs; maintain safety net programs
	Increases or decreases of violence in the media	Violent behaviors influenced by media exposure may increase or decrease with level of violence shown in the media	Encourage media to reduce display/ presentation of violence
	Trends in requirements for the use of occupational and recreational safety equipment (e.g., safety helmets)	Safety equipment reduces amount and extent of injuries	Promote increased collaboration and sharing of information between public safety interest groups and all levels of government to strengthen safety requirements
Objective 1.3
Improve the diet and the level of physical activity of Americans	Decreases in availability of public facilities, such as biking and walking trails, to promote physical activity	Decreasing availability of, proximity to, and access to local recreational facilities can influence amount of physical exercise	Promote studies of excellent facilities and provide communities with tools to assess their own community facilities
	Availability of time and other resources available to adopt and maintain a healthy diet and exercise program	Many Americans (e.g., single working mothers) are too pressed by daily schedules or finances to exercise regularly or eat nutritious meals	Promote adoption of family-friendly workplaces; work with Department of Education to encourage schools to further increase proportion of schools that provide access to physical activity spaces and facilities for people, outside of normal school hours
Objective 1.4
Reduce alcohol abuse and prevent underage drinking	Reluctance of states and local governments to develop community policies that limit the accessibility of alcohol, impose low blood alcohol concentration levels, and impose swift and severe penalties for drunk driving	The presence of these community policies is linked to decreases in alcohol abuse	Promote increased collaboration with and sharing of information between public interest groups and all levels of government to strengthen alcohol policies
Objective 1.5
Reduce the abuse and illicit use of drugs	Unforeseen emergence of new "designer" drugs that are initially seen as benign	New epidemics could emerge and increase the level of drug use	Maintain surveillance systems and react quickly to proscribe and publicize dangers and consequences of new drugs
	Increase in size of the 12 to 20 population cohort	Increase in number of people in most vulnerable age group for initiation of drug use	Intensify prevention efforts for 12 to 20 age group
Objective 1.6
Reduce unsafe sexual behaviors	No major external factors identified
Objective 1.7
Reduce the incidence and impact of infectious diseases	Periodic outbreaks as a result of emerging and re-emerging drug-resistant bacteria and viruses, imported food products, and immigration	These factors may result in fluctuations in the rates of infectious diseases in the U.S.; prevention efforts may not be entirely successful in areas such as illegal immigration and drug-resistant microbes	Continue directing medical research toward difficulties such as drug-resistant microbes; cooperate with other countries on control and eradication of infectious diseases and food importation standards
Objective 1.8
Reduce the impact of environmental factors on human health	Successful lawsuits weakening environmental laws and regulations	May result in worsening conditions despite efforts to link environmental factors to health and increase public awareness	Continue providing good science to educate policy makers of the health consequences of environmental conditions
GOAL 2: Improve the Economic and Social Well-being of Individuals, Families, and Communities in the United States
Objective 2.1
Improve the economic independence of low income families, including those receiving welfare	Economic conditions	Historically, welfare recipients, low income minorities and persons with disabilities are more vulnerable to unemployment during recessions; this may offset efforts in job training and placement	Prioritize activities and focus funding, technical, and other resources on the most cost-effective program elements: emphasize job skill acquisition, education, and job placement targeted to higher end, more skilled employment in areas less volatile under changing economic conditions Continue ensuring the provision of safety net services for transition during economic downturns
Objective 2.2
Increase the parental involvement and financial support of non-custodial parents in the lives of their children	Economic conditions	Non-custodial parents may lose jobs/income resulting in fluctuations in income support ability	Increase efforts to achieve more emotional involvement of non-custodial parents with their children to encourage job retention or greater efforts to find employment during economic downturns
	Work/time demands on parents	Work stress and parental difficulty in finding time for involvement with children may result in high levels of family conflict and family discord; children may grow up without parental role models	See Objective 1.3
Objective 2.3
Improve the healthy development and learning readiness of preschool children	No major external factors identified
Objective 2.4
Improve the safety and security of children and youth	Economic conditions	Family stress is greater as economic situations deteriorate leading to increased potential for violence and family breakup	Maintain integrity of safety net programs
	Impact of welfare reform	The success or failure of programs for low-income families as part of welfare reform will have an unknown impact on the child welfare system over the next several years	Provide states with training and technical assistance to demonstrate how they might effectively make use of Temporary Assistance to Needy Families (TANF) technical and financial resources to combat any negative impact of welfare reform that might emerge
Objective 2.5
Increase the proportion of older Americans who stay active and healthy	See factors identified for Objective 1.3
Objective 2.6
Increase independence and quality of life of persons with long-term-care needs	Economic conditions	Putting qualified working-age adults with disabilities to work calls for job availability; decreases in state and local budgets could result in a reduction in funding for home and community-based placements for individuals with disabilities	See Objective 2.1
	Success of efforts to make medical insurance available to disabled persons who work	Disabled individuals rely on continuing medical insurance to maintain employment; the success of efforts to protect access to affordable insurance will affect decisions of disabled persons to move from dependency to work	Monitor recent changes in access to medical insurance to see if further modification to existing legislation is needed
Objective 2.7
Improve the economic and social development of distressed communities	Overall economic conditions as well that of particular geographic regions	Economic decline is correlated with fewer jobs and lack of economic development	Focus technical and financial resources in the most depressed/ vulnerable geographic areas
GOAL 3: Improve Access to Health Services and Ensure the Integrity of the Nation s Health
Objective 3.1
Increase the percentage of the nation s children and adults who have health insurance coverage	Economic conditions	Economic variables affect business decisions to provide employee health insurance and decreasing family income and job loss cause increases in the uninsured; decisions by state insurance regulators also affect insurance coverage	Focus on outreach to enroll eligible persons in insurance programs; monitor trends in coverage and propose legislative or regulatory changes where needed
Objective 3.2
Eliminate disparities in health access and outcome	Economic conditions	An increase in the number of uninsured persons affects minorities disproportionately, decreasing their access to quality care	See Objective 3.1
Objective 3.3
Increase the availability of primary health care services for under-served populations	Economic conditions	See Objectives 3.1 and 3.2	See Objectives 3.1 and 3.2
Objective 3.4
Protect and improve the health and satisfaction of beneficiaries in Medicare and Medicaid	Instability due to structural and financial changes in the health care industry, the changing nature and complexity of health care, and rapid changes in health care technology	Possible decline in beneficiary satisfaction with access to and quality of services	Utilize data sources to understand health care needs of beneficiaries and develop proposals for improving services where possible; use improved evidence-based processes for addressing Medicare coverage issues
Objective 3.5
Enhance the fiscal integrity of HCFA programs and purchase the best value health care for beneficiaries	Increasing amounts and emergence of new types of fraud and abuse	Changes in health care delivery, such as increasing managed care enrollment and new coverage (e.g., new preventive benefits) and payment policies (e.g., new prospective payment systems for skilled nursing facilities and home health agencies) introduce new program designs which may bring shifting incentives for waste, fraud, and abuse	Conduct continual analysis of patterns of fraud, waste, and abuse; conduct ongoing training of investigators to recognize and deal with new types of fraud that emerge; develop partnerships with public interest groups and health industry organizations to intensify and broaden the fight against fraud
	Demographic changes/aging of the population	Variation in birth rates and improvement in life expectancy, are expected to result in major increases in the number of older persons relative to those of working age beginning in 2010; current analyses based on that projection predict that, with the expected drop in the ratio of active workers to retirees, payroll tax revenues will not keep pace with expected Medicare expenditures; a larger number of elderly beneficiaries has implications for Medicaid as well as Medicare, in part because of Medicaid's role in financing long-term-care services	Work with the Executive Branch and the Congress for a bipartisan commitment to address the long-term financial challenges
Objective 3.6
Improve the health status of American Indians and Alaska Natives	Continued poor economic conditions in American Indian/Alaska Native (AI/AN) communities	Because poverty is correlated with poor health status, making significant progress in improving the health status of AI/AN people is likely to be limited in the face of extreme and persistent poverty	Expand efforts to collaborate with agencies and organizations that have the potential to increase economic development in AI/AN communities; expand the development of preventive technologies that are less dependent on individual compliance and refractory to the negative effects of poverty
Objective 3.7
Increase the availability and effectiveness of services for the treatment and management of HIV/AIDS	Cost of anti-retroviral therapies and treatment may increase and/or insurance companies may drop coverage	Access to therapies and treatment could be restricted if costs escalate	Develop better purchasing agreements with drug manufactures; support for program expansions to subsidize purchases and monitoring of Medicaid coverage
	Shifting demographics of disease and populations	Populations become harder to reach and serve, or longer life expectancy greatly increases the number of persons being treated	Develop improved surveillance and outreach strategies; provide assistance to service providers in planning and capacity building to meet sudden demographic shifts
Objective 3.8
Increase the availability and effectiveness of mental health care services	No major external factors identified
Objective 3.9
Increase the availability and effectiveness of health services for children with special health care needs	No major external factors identified
GOAL 4: Improve the Quality of Health Care and Human Services Entitlement and Safety Net Programs
Objective 4.1
Enhance the appropriate use of effective health services	Increasing complexity of health care system; ongoing development of new technologies and pharmaceuticals; lack of access to health care by many Americans	Increased need for research and the dissemination and implementation of research findings in the outcomes, quality, cost, access, and use of health care	Continue building evidence base for the delivery of health care and focus on fostering the implementation of evidence-based research findings into health care practice and making information available to consumers
Objective 4.2
Increase consumer and patient use of health care quality information	Increasing complexity of health care system	Consumers have had little experience with making choices in health care	Promote public/private educational efforts; continue conducting research and evaluation to determine effective strategies
Objective 4.3
Improve consumer and patient protection	Congressional passage of the Patient Bill of Rights	Patient Bill of Rights will increase the protections legally available	Continue implementation of rights and privacy protections within existing authority
Objective 4.4
Develop knowledge that improves the quality and effectiveness of human services practice	No major external factors identified
GOAL 5: Improve the Nation s Public Health Systems
Objective 5.1
Improve the capacity of the public health system to identify and respond to threats to the health of the nation s population	New threats emerge that outpace capacity	Inadequate preparation for all threats	Attempt to improve capacity to identify new strains of pathogenic microorganisms
Objective 5.2
Improve the safety of food, drugs, medical devices, and biological products	Increasing age of population	The coming "aging" bulge in the U.S. population means that a higher percent of the population may be more susceptible (compromised immune systems) to food-borne illness, which may offset reasonable efforts to reduce illness from this cause	Intensify education programs on food safety
	Increasing importation of foods and products from around the world	There is an increased risk of food-borne illness appearing or unsafe products being marketed, due to varying foreign standards	Develop increased international cooperation and standards
	Technological advances create greater product complexity and diversity	Increasingly more complex products may slow review process and delay market approvals; health professionals may have insufficient skills and resources to maintain safety at current levels	Improve skills and training and early involvement and communications with scientific community in development of new products
GOAL 6: Strengthen the Nation s Health Science Research Enterprise and Enhance its Productivity
Objective 6.1
Advance the scientific understanding of normal and abnormal biological functions and behaviors	The uncertainties and risks intrinsic to the process of research	The pace of progress in scientific research is intrinsically uneven and difficult to accurately forecast; history demonstrates the benefits of sustained research effort, but at any given time it is difficult to predict how/from where the next important advance will emerge	Broaden the research portfolio; carry out sound management of the research enterprise; encourage the flexibility to respond to changing scientific opportunities and willingness to take risks
	The pace of technological advance	Improvements in existing technologies or the availability of radically new capabilities can significantly affect the current array of scientific opportunities; as with research progress, these important developments can be difficult to predict in advance	See above
	Level of resources available (size of appropriations), other factors (e.g., rates for indirect cost and inflation) which influence purchasing power of research dollars	The year-to-year level of budget authority directly affects the agency s abilities to maintain the existing research effort and to expand to address new opportunities	Carry out sound management of the research enterprise; maintain strong support for biomedical research in Congress, the Executive branch, and other public organizations, and in the private sector
	Public acceptance and support	The public s willingness to continue to broadly support the biomedical research enterprise is an important factor to the extent to which the frontier of knowledge can be pushed forward in biology and related sciences; among other issues, advances in medical technology and breakthroughs in medical research have created a new set of challenges regarding ethical and moral considerations that are associated with the pursuit of these scientific advances and their incorporation into medical practice	Make a strong effort to communicate with the public about new scientific achievements and their important implications for health; institute processes to involve the public in dialogue about these important issues
Objective 6.2
Improve our understanding of how to prevent, diagnose, and treat disease and disability	Nature of and rate at which basic research yields new insights about the fundamentals of biological functions and behavior	While developing new approaches for prevention, diagnosis, and treatment can be a demanding scientific exercise, the availability of new insights about fundamental processes is often a precondition for development to become feasible	Managing for a successful and productive basic research enterprise (see Objective 6.1)
	Various business considerations (e.g., intellectual property issues, technical capabilities, competing opportunities, and other business considerations)	The efforts of many different actors are involved in the successful development and commercialization of new approaches; high degrees of concern among researchers from private and public interests and others may hinder cooperation among research entities, thus inhibiting creative and successful development of new approaches	Encourage programs that provide for the rapid and widespread dissemination of new scientific findings; support public policies that strengthen technology transfer and encourage the development of innovative products and services
	Level of public acceptance and support for research See also Objective 6.1 for additional external factors and responses	Same as for basic research (see Objective 6.1)	Same as for basic research (see Objective 6.1)
Objective 6.3
Enhance our understanding of how to improve the quality, effectiveness, utilization, financing, and cost-effectiveness of health services	No major external factors identified
Objective 6.4
Accelerate private-sector development of new drugs, biologic therapies, and medical technology	Developmental and liability costs of new drugs can be prohibitive to private organizations developing new therapies	New treatment for diseases may not be forthcoming	Create public/private partnerships to share the cost of developing new drug therapies
Objective 6.5
Strengthen and diversify the base of well-qualified health researchers	Strength of job market for research scientists; extent of opportunities for both new and seasoned researchers; remuneration	Realities and the perceptions about potential candidates, as well as candidates' perceptions of job opportunities, salary levels, etc. affect recruitment	Encourage successful basic and applied research programs, which continue to yield new scientific knowledge and opportunities, and continuing public support for the biomedical research enterprise provide the greatest leverage in sustaining demand for well qualified and creative researchers; promote career messages
	Level of resources available to support agency programs for training and career development	The year-to-year level of budget authority directly affects an agency s ability to maintain existing programs and to expand to address new needs	Maintain strong support for training and career development programs with public budget decision makers, with relevant sectors of private industry, and with the general public
Objective 6.6
Improve the communication and application of health research results	Degree of public acceptance and support	The public s willingness to continue to broadly support the biomedical research enterprise is a critical factor in the progress of the biomedical sciences	Strengthen efforts to communicate with the public about the progress of medical research and its impact on their lives; institute processes to better involve the public in addressing important issues on the research agenda
Objective 6.7
Strengthen mechanisms for ensuring the protection of human subjects in research and the integrity of the research process	Expansion of private research and pressure to move research from the laboratory to market more quickly to recoup costs	Patient protections may erode as competition for volunteers increases; quality of study may decrease under time pressures	Expand oversight where authority exists

Appendix C - Performance Plan Linkage and Success Indicators

LINKAGE

The Department of Health and Human Services (HHS) Annual Performance Plan is the primary mechanism for implementing the Department's Strategic Plan. The relationship between the two is intertwined. The HHS Strategic Plan sets broad, long-term objectives for the Department; for example: Improve the Diet and the Level of Physical Activity of Americans (Objective 1.3). It also describes the principal implementation strategies for achieving the strategic objective; for example: 1) provide nutritious meals for the elderly; 2) educate women about the benefits of folic acid consumption to prevent birth defects; or 3) provide consumers with food content information (labels) to help them make better diet choices. In turn, the Department's Annual Performance Plan sets annual performance goals for HHS programs and relates these goals to the task of carrying out the strategies and long-term objectives in the Department's Strategic Plan. In so doing, the link between annual program activities and goals and the strategic plan is established. The link can occur in various ways.

In many cases, annual performance goals may be identical to the strategic objective or the principal implementation strategies contained in the strategic plan. In these cases, the performance plan provides more detail and often sets annual targets for the strategic objective or implementation strategy. For example, the FY 2001 annual performance goal for the Administration on Aging's (AoA) Home-Delivered Nutrition Service program is to increase the number of nutritious meals provided to the elderly by 11 million. An FY 2001 annual performance goal for the Centers for Disease Control and Prevention's (CDC) Environmental Disease Prevention program is to increase the number of women of reproductive age who consume the recommended amount of folic acid to 45 percent. An FY 2001 annual performance goal of the Food and Drug Administration (FDA) Food program is to increase the proportion of adults who report changing their decisions to buy or use a food product because they read food labels to 55 percent. The relationship with the Department's Strategic Plan strategies cited in the preceding paragraph is evident.

In other cases, annual performance goals may not be identical to a strategic objective or strategy in the strategic plan. Nonetheless, there is still a direct relationship. To illustrate, the following program activities and attendant FY 2001 performance goals are related to achieving Objective 1.3 (although there is no corollary strategy for these specific activities in the strategic plan): 1) the Indian Health Service (IHS) will establish model fitness programs at 10 IHS sites; and 2) CDC's Chronic Disease Prevention program will help states develop health promotion programs as a way to increase the percent of people, ages 18 to 74, who engage in light to moderate physical activity.

Cumulatively, therefore, the HHS Annual Performance Plan outlines-in the form of annual performance goals for HHS programs-the incremental steps the Department will take each year to achieve its strategic objectives. Likewise, the annual performance data generated to report on annual performance goals can be useful in assessing progress toward achieving the strategic objectives. First, the performance plans and reports provide an extensive body of information on programs, performance measures, and program strategies that are relevant to the objectives in the strategic plan. Second, the performance plans and reports will provide annual performance data that allow HHS to analyze progress toward the achievement of the Departments goals and objectives on a continuous basis. Finally, the performance plans and reports provide a mix of measures, particularly process, output, and outcome measures, that provide for a richer assessment of progress than can be provided by long-term outcome measures alone.

In summary, the HHS performance plans and reports will continue to identify an extensive set of strategies, initiatives, programs, and performance goals that will support all of the strategic objectives and serve as the primary mechanism for tracking progress toward achievement of the HHS Strategic Plan's goals and objectives.

SUCCESS INDICATORS

Table C provides examples of indicators that can be used to gauge whether we are making progress toward achieving strategic plan objectives. Data sources for the indicators are varied, and some representative sources are listed within the table. However, it should be noted that responsibility for accomplishment of the indicators is not necessarily linked to the entity collecting the data. For example, CDC's National Center for Health Statistics (NCHS) serves a unique role within the Department, providing data support for a myriad of programs not necessarily carried out by CDC.

As stated, performance data from the HHS Annual Performance Plan is relevant in demonstrating progress toward achieving the Department's Strategic Plan objectives. We have incorporated an illustrative set of measures from FY 2001 performance plan into the table to demonstrate this linkage(1). In addition, we have coordinated the indicators with other performance measurement activities. For example, where objectives in the strategic plan parallel the objectives in the Healthy People 2010 initiative(2), we have incorporated the indicators from Healthy People into the table.

HHS will continue to assess progress toward achievement of the Department's strategic goals and objectives in the HHS Annual Performance Plan and Report Summary (HHS Summary) which accompanies the detailed performance plans and reports submitted to the Congress each year with the HHS Budget. For example, in the HHS Summary submitted to the Congress in February 2000, the Department described how selected results for measures in the annual performance plans provided substantive evidence of HHS progress toward the achievement of its strategic goals.

 

TABLE C
STRATEGIC OBJECTIVE INDICATORS

Strategic Objective	Indicator(s) for Objective	Data Source(3) (APP = Annual Performance Plan; HP2010 = Healthy People 2010)
Objective 1.1
Reduce tobacco abuse, especially among youth	Proportion of adolescents, age 12 to 17 years, who have used cigarettes in the past month	National Household Survey on Drug Abuse (Substance Abuse and Mental Health Services Administration SAMHSA) APP
	Percentage of persons age 18 and over currently smoking	National Health Interview Survey (CDC) HP2010
	Proportion of mothers who smoke during pregnancy	National Health Interview Survey (CDC) APP
	Number of states whose rate of tobacco sales to minors violations is at or below 20 percent	Synar Reports (a component of Substance Abuse, Prevention, and Treatment Block Grant Application) (SAMHSA) APP
Objective 1.2
Reduce the incidence and impact of injuries and violence in American society	Death rate from unintentional injuries resulting from falls, fire, drowning, firearms, or car crash (per 100,000 population)	National Vital Statistics System (CDC) HP2010
	Percentage of adolescents in grades 9 to 12 engaged in physical fighting in previous 12 months	Youth Risk Behavior Survey (CDC) HP2010
	Rate of physical assault by current or former intimate partners (per 1,000 population)	National Crime Victimization Survey (Department of Justice DOJ) APP/HP2010
Objective 1.3
Improve the diet and level of physical activity of Americans	Proportion of Americans age 18 and over reporting engaging in physical activity five times a week for at least 30 minutes per time	National Health Interview Survey (CDC) HP2010
	Proportion of Americans defined as obese (by age group)	National Health and Nutrition Examination Survey (CDC) HP2010
	Percentage of persons consuming fruits/vegetables five times per day	Behavioral Risk Factor Surveillance System (CDC) HP2010
	Proportion of adults who report changes in their decisions to buy or use a food product because they read the food label	Consumers Surveys and Reports (Food and Drug Administration FDA) APP
	Number of home-delivered meals	State Data Report (AoA) APP
Objective 1.4
Reduce alcohol abuse and prevent underage drinking	Percentage of adolescents and adults engaged in binge drinking in past 30 days	National Household Survey on Drug Abuse (SAMHSA) HP2010
	Percentage of adolescents age 12 to 17 who have used alcohol in the past 30 days	National Household Survey on Drug Abuse (SAMHSA) APP/HP2010
	Rates and intensity of follow-up for adolescents discharged from IHS-supported Regional Treatment Centers	Resource and Patient Management System and Regional Treatment Center Evaluation System (IHS) APP
Objective 1.5
Reduce the abuse and illicit use of drugs	Percentage of adolescents age 12 to 17 who have used illicit drugs in past 30 days	National Household Survey on Drug Abuse (SAMHSA) APP/HP2010
	Percentage of adults age 18 years and over who have used illicit drugs in past 30 days	National Household Survey on Drug Abuse (SAMHSA) APP/HP2010
	Proportion of adults receiving substance abuse services who are currently employed or engaged in productive activities, have a permanent place to live in the community, and have no, or reduced, involvement with the criminal justice system.	Substance Abuse, Prevention, and Treatment Grant Applications (SAMHSA) APP
Objective 1.6
Reduce unsafe sexual behaviors	Cases of gonorrhea and syphilis among teens and young adults (per 100,000 persons)	Sexually Transmitted Diseases Surveillance System (CDC) APP/HP2010
	Proportion of adolescents who abstain from sexual intercourse or use condoms if currently sexually active	Youth Risk Behavior Survey (CDC) APP/HP2010
	Percentage of high school students who have been taught about HIV/AIDS prevention in school	Youth Risk Behavior Survey (CDC) APP
Objective 1.7
Reduce the incidence and impact of infectious diseases	Vaccination coverage for universally recommended vaccines for children age 19 to 35 months (percent)	National Immunization Survey (CDC) APP/HP2010
	New tuberculosis (TB) cases (rates per 100,000 population)	TB Surveillance Reports (CDC) HP2010
	Hepatitis C cases (Rate per 100,000 population)	National Notifiable Disease Surveillance System (CDC) HP2010
	Proportion of adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal pneumonia	(1) National Health Interview Survey (non-institutionalized population) (CDC) APP/HP2010 (2) National Nursing Home Survey (institutionalized population) (CDC) APP/HP2010
	Percentage of Medicare Beneficiaries age 65 and older who receive an annual vaccination for influenza and a lifetime vaccination for pneumococcal pneumonia	Medicare Current Beneficiary Survey (MCBS) (Health Care Financing Administration HCFA) APP
Objective 1.8
Reduce the impact of environmental factors on human health	Proportion of children age 1 to 5 years old with elevated lead levels in their blood	National Health and Nutrition Examination Survey (CDC) HP2010
	Number of states that monitor diseases and conditions that can be caused by exposure to environmental hazards	Periodic surveys HP2010
	Number of new methods to measure human exposure to toxic substances developed	National Health and Nutrition Examination Survey and Clinical Laboratory Improvement Act (CLIA) data systems (CDC) APP
	Number of states that implement core asthma programs	Administrative data (CDC) APP
Objective 2.1
Improve the economic independence of low income families, including those receiving welfare	Temporary Assistance for Needy Families (TANF) workforce participation rates (by race/ethnicity/gender) Percentage rate of earnings gained by employed adult TANF recipients and former recipients (by available race/ethnicity/gender)	TANF data (ACF)APP State administrative data and Unemployment Insurance wage data (ACF) APP
	Percentage of adult TANF recipients and former recipients employed in one quarter of the year who continue to be employed in the subsequent quarter	TANF administrative data (ACF) APP
	Percentage of refugees entering employment through Administration on Children and Families (ACF)-funded refugee employment services	ACF administrative data (ACF) APP
Objective 2.2
Increase the parental involvement and financial support of non-custodial parents in the lives of their children	IV-D Collection Rate for Current Support (IV-D cases with support orders) Percentage of paternity established for children born out of wedlock	State data from Child Support Enforcement data system (ACF) APP State data from Child Support Enforcement data system (ACF) APP
Objective 2.3
Improve the healthy development and learning readiness of pre-school children	Physical health status (Head Start Children) Average gain in word knowledge (Head Start Children)	Head Start Program Information Report (ACF) APP Family and Child Experience Survey (FACES) (ACF) APP
	Average gain in letter identification (Head Start Children)	FACES (ACF) APP
	Percentage of parents who read to child three times per week or more (Head Start Children)	FACES (ACF) APP
Objective 2.4
Improve the safety and security of children and youth	Rate of substantiated cases of maltreatment Number and percentage of children who exit foster care via adoption or reunification within one or two years of placement (by race/ethnicity)	National Child Abuse and Neglect data system (ACF) APP Adoption and Foster Care Analysis and Reporting System (AFCARS) (ACF) APP
Objective 2.5
Increase the proportion of older Americans who stay active and healthy	Proportion of persons age 65 and over unable to perform one or more Activities of Daily Living Number of meals provided to seniors	National Health Interview Survey (CDC) CDC data State Data Report (AoA) APP
Objective 2.6
Increase independence and quality of life of persons with long-term-care needs	Proportion of adults with disabilities reporting satisfaction with life Prevalence of physical restraints in nursing homes	Behavioral Risk Factor Surveillance System (CDC) HP2010 Online Survey and Certification Reporting (OSCAR) database; Minimum Data Set (MDS) database (HCFA) APP
	Prevalence of pressure ulcers (bed sores) among patients in nursing homes	MDS database (HCFA) APP
Objective 2.7
Improve the economic and social development of distressed communities	Amount of non-federal resources brought into low-income communities by the Community Services Network	Community Services Block Grant Information System (ACF) APP
Objective 3.1
Increase the percentage of the nation's children and adults who have health insurance coverage	Proportion of persons with health insurance Number of children enrolled in State Children's Health Insurance Program (SCHIP), and Medicaid	(1) National Health Interview Survey (NHIS) (CDC) (2) Health Insurance Coverage (U.S. Census Bureau) HP2010 Statistical Enrollment Systems (SEDS)
Objective 3.2
Eliminate disparities in health access and outcomes	Proportion of persons with health insurance (by available race/ethnicity)	(1) NHIS (CDC) (2) Health Insurance Coverage (U.S. Census Bureau) HP2010
	Infant (under the age of 1 year) deaths (per 1,000 live births), collected by available race/ethnicity	National Vital Statistics System (CDC) APP/HP2010
	Life expectancy, collected by available race/ethnicity	National Vital Statistics System (CDC) APP/HP2010
	New AIDS cases (per 100,000 population, collected by available race/ethnicity)	HIV/AIDS Surveillance Systems (multiple data sources) (CDC) APP/HP2010
	Vaccination coverage for universally recommended vaccines for children, age 19 to 35 months (collected by available race/ethnicity)	National Immunization Survey (CDC) APP/HP2010
	New cases of diabetes (rate per 1,000 population, collected by available race/ethnicity)	National Health Interview Survey (CDC) HP2010
Objective 3.3
Increase the availability of primary health care services for under-served populations	Number of uninsured and under-served persons served by Health Centers Current field strength of the National Health Service Corp (NHSC) Percentage of NHSC providers remaining at their NHSC placement site	Program data /Uniform Data System (Health Resources and Services Administration HRSA) APP Program data /Uniform Data System (HRSA) APP Program data / Uniform Data System (HRSA) APP
Objective 3.4
Protect and improve the health and satisfaction of beneficiaries in Medicare and Medicaid	Survival of Medicare beneficiaries one year following hospitalization for heart attack. Medicare beneficiaries'; (managed care and fee-for-service after 2000) satisfaction with the health care services they receive through the Medicare program	Medicare Part A hospital claims and Medicare Enrollment Database (HCFA) APP Medicare Consumer Assessment of Health Plans Study (CAHPS) and CAHPS survey modified for Fee For Service Medicare (HCFA) APP
Objective 3.5
Enhance the fiscal integrity of HCFA programs and purchase the best value health care for beneficiaries	Percentage of improper payments under the Medicare fee-for-service programs (post-payment claims) CPA's rating of the Health Care Financing Administration's (HCFA) financial statement	HHS, Office of Inspector General Reports on theFinancial Statement Audit of the Health Care Financing Administration(OIG) APP CPA audit report of HCFA financial statement on Web. (HCFA)
Objective 3.6
Improve the health status of American Indians and Alaska Natives (AI/AN)	Diabetes prevalence rates for AI/AN population	IHS automated record system (Resource and Patient Management System/Patient Care Component RPMS/PCC) data (IHS) APP/HP2010
	Cancer death rates for AI/AN population	National Vital Statistics System (with miscoding adjustments) (CDC) HP2010
	Percentage of AI/AN hospitalizations related to alcohol abuse	Periodic cross-sectional surveys of IHS hospitals (IHS)
	Injury-related hospitalization rate for AI/AN people	Automated Patient Record System (IHS) APP
	Rate of family abuse, neglect, and violence in AI/AN population	Mental Health and Social Services Component of Automated Patient Record System (IHS) IHS data
	Infant mortality rates for AI/AN population	National Vital Statistics System (with miscoding adjustments) (CDC) HP2010
	Life expectancy for AI/AN population	National Vital Statistics System (with miscoding adjustments) (CDC) HP2010
Objective 3.7
Increase the availability and effectiveness of services for the treatment and management of HIV/AIDS	Number of visits for health-related care annually through HIV Emergency Relief Grants and HIV Care Grants to States Number of people receiving appropriate anti-retroviral HIV therapy (during at least one month of the year) through State AIDS Drug Assistance Programs Proportion of HIV-infected adolescents and adults who receive testing, treatment, and prophylaxis consistent with current Public Health Service (PHS) treatment guidelines	AIDS Annual Administrative Report (HRSA) APP AIDS Drug Assistance Program Annual Administrative Report (HRSA) APP Adult Spectrum of Disease Surveillance Project (CDC) HP2010
Objective 3.8
Increase the availability and effectiveness of mental health care services	Suicide rate (per 100,000 population) Proportion of children with mental health problems who receive treatment Proportion of adults 18 years and older with mental disorders who receive treatment Proportion of persons with serious mental illness who are employed Number of children receiving mental health services who attend school most of the time and who have no/reduced contact with law enforcement.	National Vital Statistics System (CDC) APP/HP2010 National Household Survey on Drug Abuse (SAMHSA) HP2010 (1) National Household Survey on Drug Abuse (SAMHSA) HP2010 (2) Epidemiologic Catchment Area Program (National Institute of Mental Health NIMH) HP2010 National Health Interview Survey (CDC) HP2010 SAMHSA administrative data and site visits (SAMHSA) APP
Objective 3.9
Increase the availability and effectiveness of health services for children with special health care needs	Number of children with special health care needs with a medical/health home (i.e., who have regular sources of primary and specialty care) Number of children served by Title V	State block grant (Title V) reports (HRSA) APP/HP2010 State block grant reports (HRSA) APP
Objective 4.1
Enhance the appropriate use of effective health services	Mammograms : Percentage of women aged 40 and over who have received a mammogram and clinical breast exam within the preceding two years	National Health Interview Survey (CDC) HP2010
	Women receiving breast exams at HRSA health centers	Uniform Data System (HRSA) APP
	Women receiving mammography at IHS facilities	Data system (IHS) APP
	Medicare beneficiaries age 65 and older receiving a mammogram every two years	Medicare claims data (HCFA) APP
	Papanicolaou (Pap) test: Percentage of women age 18 and over having a Pap test within the past three years	National Health Interview Survey (CDC) HP2010
	Women receiving Pap exams in HRSA Health Centers	Uniform Data System (HRSA) APP
	Women receiving Pap screening at Indian Health Service facilities	Data Systems (IHS) APP
	Proportion of HRSA Health Center users who are hospitalized for potentially avoidable conditions	HRSA Community Health Center Effectiveness Study APP
	Percentage of people age 50 or over who have had a fecal occult blood test in the past two years (for colorectal cancer screening) Percentage of mothers receiving prenatal care in the first trimester of pregnancy (by available race/ethnicity)	National Health Interview Survey (CDC) HP2010 National Vital Statistics System (CDC) HP2010
	Survival of Medicare beneficiaries one year following hospitalization for heart attack Proportion of IHS clients with diagnosed diabetes that have improved control Proportion of IHS clients with diagnosed diabetes and hypertension that have achieved diabetic blood pressure control standards	Medicare Part A hospital claims and Medicare Enrollment Database (HCFA) APP Diabetes Audit (IHS) APP Diabetes Audit (IHS) APP
Objective 4.2
Increase consumer and patient use of health care quality information	Percentage of Medicare beneficiaries who report satisfaction with the availability of program information Beneficiary understanding of the basic features of Medicare program	Medicare Current Beneficiaries Survey (HCFA) APP Medicare Current Beneficiaries Survey (available in 2001) (HCFA) APP
Objective 4.3
Improve consumer and patient protection	Medicare + Choice Organization (M+CO) appeals indicators Prevalence of physical restraints in nursing homes	Appeals data reported from the Health Plan Management System (HPMS) APP Online Survey and Certification Reporting database (OSCAR); MDS database (HCFA) APP
	Prevalence of pressure ulcers (bed sores) in nursing homes	MDS database (HCFA) APP
	Level of accuracy for diagnostic laboratory tests regulated under CLIA	OSCAR (HCFA) APP
	Passage of consumer protection legislation	Not Applicable
	Number of substantiated incidents of abuse, neglect, or rights violations reported to State Protection and Advocacy systems which are favorably resolved	State Protection and Advocacy Annual Program Performance Reports (ACF) APP
Objective 4.4
Develop knowledge that improves the quality and effectiveness of human services practice	New knowledge that results in changes to how human services are delivered and improved outcomes for clients	Qualitative descriptions of new knowledge and the impact of the knowledge on systems and clients (ACF) Qualitative data
Objective 5.1
Improve the capacity of the public health system to identify and respond to threats to the health of the Nation s population	Proportion of states and local public health agencies that met national performance standards for essential public health services Number of states and major metropolitan areas with epidemiological and surveillance capacity to investigate and mitigate bioterrorism threats Time lag of release of national survey and surveillance data Implementation of the national electronic disease and surveillance system Proportion of population-based Healthy People 2010 objectives for which national data are available for all population groups	National Public Health Performance Standards Program (future) (CDC) HP2010 Administrative report data (CDC) APP Administrative report data (CDC) APP Office of Public Health Service (OPHS) Data Systems (CDC) HP2010 National Center for Health Statistics (CDC) HP2010
Objective 5.2
Improve the safety of food, drug, medical devices, and biological products	Infections caused by key foodborne pathogens (cases/100,000 population) Percentage of high-risk domestic food establishments inspected once every year Proportion of reported foodborne outbreak investigations in which the causative organism or toxin is identified Percentage of domestic seafood industry operating with preventative controls for safety as evidenced by functioning Hazard Analysis Critical Control Points (HACCP) systems Number of states adopting the Food Code	Foodborne Disease Active Surveillance Network (CDC/FDA) APP/HP2010 Field Activities Tracking System (FDA) APP FoodNet/PulseNet (CDC) APP Field Activities Tracking System; National Seafood HACCP Compliance Database (FDA) APP FDA National Health and Diet Surveys (FDA) APP
Objective 6.1
Advance the scientific understanding of normal and abnormal biological functions and behaviors	New findings related to biological functions and behavior, which are published and/or disseminated and which may include:   Discoveries resulting in significant new understanding of a particular biologic or behavioral process such new understanding may open up new avenues of research, or it might be applicable to other disciplines, other areas of research, or other diseases   Research yielding answers to long-standing, important biological and behavioral questions, or providing novel investigative approaches for addressing such questions	Science advances, science capsules, and stories of discovery (with relevant citations as appropriate) APP
	Genomic information about humans, model organisms, and/or disease-causing agents that is translated into new understanding of the role of genes and/or the environment in human health, disease, and behavior
	Discoveries that have potential for translation into new or improved technologies, diagnostics, treatment, and preventive strategies
Objective 6.2
Improve our understanding of how to prevent, diagnose, and treat disease and disability	New findings related to the prevention, diagnosis, and treatment of disease and disability and which may include:   Findings demonstrating the potential to lead/contribute to the development of preventive measures or strategies for delaying the onset/progression of disease and disability	Science advances, science capsules, and stories of discovery (with relevant citations as appropriate) APP
	Research-based advances and public health campaigns resulting in broad health impacts-such as reductions in morbidity and mortality, changes in health-related behavior, amelioration of health disparities   Prevention strategies that are applicable to other disciplines, areas of research, or diseases and conditions
	Discoveries that improve the quality of life by preventing or delaying the onset/progression of symptoms, suffering, loss of function, and/or injury
	New findings that demonstrate the potential to lead/contribute to the development of new and improved diagnostics
	Diagnostics that improve health care and/or quality of life, including new or improved diagnostic methods that are more sensitive and accurate; allow diagnosis or detection at an early/earlier stage; enable early/earlier treatment or preventive interventions; predict future susceptibility to disease/disability; and/or are less invasive, painful, and/or than current techniques
	Diagnostic methods that are applicable to other disciplines, areas of research, or diseases
	New findings that demonstrate the potential to lead/contribute to the development of new and improved treatments
	New or improved treatments that improve health care and/or quality of life, including treatments that are more effective or have fewer side effects; relieve suffering; are more cost-effective; are less invasive, painful, and/or costly than current methods; effect a cure or remission of disease; and/or restore/increase physical function/activity
	Treatment approaches that are applicable to other disciplines, areas or research, or diseases
	Number of new innovative mechanisms for improving public prevention efforts that have been identified through population-based research	Qualitative description
Objective 6.3
Enhance our understanding of how to improve the quality, effectiveness, utilization, financing, and cost-effectiveness of health services	Evidence that Department-sponsored or conducted research contributes to: availability of knowledge about how to improve health care services and the health care system in the U.S. availability of new tools and performance measures useful for assessing the quality of care provided in a range of health care settings	Qualitative description based on:   evidence of publications research in professional peer reviewed journals evidence of use in policy making, establishing coverage decisions, measuring quality results of impact evaluations
Objective 6.4
Accelerate private-sector development of new drugs, biologic therapies, and medical technology	Percentage of standard original new drug application submissions reviewed and acted upon with one year of receipt Percentage of standard original product license applications, biologic license applications, and new drug applications reviewed and acted upon within 12 months of receipt (six months for priority applications)	Center-wide Oracle Management Information System (COMIS); New Drug Evaluation/Management Information System (FDA) APP Biologics Regulatory Management System (FDA) APP
	Percentage of "On-time Premarket Approval Application and Humanitarian Device Exemption first actions complete medical device pre-market approval applications" reviewed within six months after submission date	Center for Devices and Radiological Health Premarket Tracking System and Receipt Cohorts (FDA) APP
Objective 6.5
Strengthen and diversify the base of well-qualified health researchers	Number of incidents of successful scientific careers among students and trainees supported by HHS training and career development programs Available gender and racial/ethnic characteristics of new doctorates granted in the biomedical sciences; available gender and racial/ethnic characteristics of the U.S. biomedical sciences workforce	Evaluations of career development programs (e.g., NIH s forthcoming report on NRSA recipients) Survey data collected by National Research Council and National Science Foundation (NSF) NSF data
Objective 6.6
Improve the communication and application of health research results	Proportion of Health People 2010 objectives for which national data are released within one year of end of data collection Evidence of awareness of research results among health care providers; high-risk, under-served, and/or affected publics; and the general public	NCHS (CDC) HP2010 Customer surveys; data on use of agency information systems and websites; effectiveness evaluations; project tracking and measurement systems (AHRQ) APP
	Research advances translated into improved healthcare practices	Evaluations
Objective 6.7
Strengthen mechanisms for ensuring the protection of human subjects in research and the integrity of the research process	Number of collaborative activities (workshops, publications, and other resource materials) that assist institutions to promote integrity and develop administrative processes that respond to allegations of scientific misconduct	Administrative files (Office of Public Health Service OPHS) APP
	Percentage of institutional policies for responding to allegations of scientific misconduct that have been reviewed for compliance with federal regulations	Administrative files (OPHS) APP
	Rate of completing Office of Research Integrity oversight of scientific misconduct cases within eight months of receiving final decisions from institution	Administrative files (OPHS) APP

Notes:
1. FY 2001 performance goals and data presented here may change depending on the FY 2001 appropriation.
2. Healthy People 2010 contains health-related objectives for the nation (see introduction for a more comprehensive discussion of Healthy People). Though objectives are set in 10-year increments, data for the objectives are usually reported annually.
3. The HHS Agency listed indicates that it is the source of the data, not that it is necessarily responsible for achieving the objective or for improvements in the measure.

Appendix D - Data Challenges and Responses

OVERVIEW

Sound information is essential to the Department of Health and Human Services' (HHS) mission of enhancing the health and well-being of the population. For virtually every HHS strategic goal, whether providing for effective health and human services or fostering sustained advances in medicine and public health, reliable and readily available information is necessary for planning and decision making. In addition, the growing emphasis on program accountability requires that we maintain significant amounts of performance information to determine whether our programs are succeeding in their mission.

The Department plays an essential role in creating data and information for decision-making, both as a direct producer and user of data and as a partner with other health and human service entities and governmental agencies. A number of significant improvements have been made in HHS data systems. However, new needs are arising and a number of critical data gaps remain. As a result, the Department has taken a number of steps designed to address key data needs, develop a coordinated HHS wide strategy on data issues, and strengthened the Department's ability to work in collaboration with state and local governments, health and human service organizations, and the research and public health communities.

A STRATEGIC PERSPECTIVE

The HHS Data Council is the principal internal advisory body to the Secretary of Health and Human Services on health and human services data policy. The Council serves as a department-wide forum for data issues and undertakes activities to close current information gaps and build information systems for the future.

To facilitate its work, the Council has established a Data Strategy Work Group to identify current and emerging needs for data, assess current HHS data capabilities to address these needs, and develop recommendations for a multi-year data strategy. In addition to program-specific data, the Work Group has identified a number of crosscutting data needs and is including these in the development of the HHS data strategy. The Work Group identified six critical data needs:

• better data on populations and sub-populations, including data on race and ethnic groups, persons with disabilities, and data by gender and other special populations.

• data for assessing the impact of policies and programs on the health and well-being of families and individuals at the state level.

• data for measuring and improving the safety, quality, and effectiveness of health care.

• data for understanding the changes occurring in the delivery and organization of health care.

• data for monitoring the health and well-being of the population and assessing progress toward national health objectives identified in Healthy People 2010.

• data for measuring program performance.

IMPROVING DATA ON POPULATIONS AND SUB-POPULATIONS

Despite major advances in health care in the United States, significant disparities persist in key health indicators across all racial and ethnic groups. Similar disproportionate health risks may exist for other populations, such as gay, lesbian, and bisexual youths and adults. The elimination of these disparities is a major focus of HHS initiatives.

The Department's ability to identify disparities, understand their causes, and measure progress toward their elimination is limited because of data availability. With few exceptions, existing surveys do not provide adequate information at the national level on minority and other special populations in the Unites States. Information on minority sub-populations is extremely limited. Consequently, even when information is available on minority populations, such as Hispanics or Asians, it often masks significant variations in health and well-being among specific subgroups, such as Mexican American versus Cuban populations.

HHS is taking steps to improve data on minority and ethnic populations and sub-populations. On the recommendation of the Data Council, the Secretary has issued a policy requiring the inclusion of standardized information on race and ethnicity in Department-sponsored data collection efforts. A number of HHS surveys now over-sample some minority populations. A Working Group on Race and Ethnicity Data completed a review of race and ethnicity data needs and developed a set of recommendations for moving forward that are under consideration by the Data Council. Also, HHS is in the process of assessing the current capabilities of Department surveys to provide data on minority populations and sub-populations, including innovative analytical approaches. HHS will be encouraging the collection, appropriate use, and reporting of racial, ethnic, primary language, and gender data by recipients of HHS funding.

In addition, HHS is supporting a review and synthesis of the literature on measures of race discrimination in health care, with recommendations for improving both the measures themselves and the resulting data collected. The Department is supporting a similar research review and syntheses relating to information on sexual orientation in HHS health and social surveys and research.

STATE-LEVEL DATA TO ASSESS THE IMPACT OF POLICIES AND PROGRAMS ON THE HEALTH AND WELL-BEING OF FAMILIES AND INDIVIDUALS

While a number of political, market and technological forces continue to transform the nation's health and human services systems, the Department's ability to describe and assess the impact of those changes on families and individuals is limited. Many of the changes in the health and human services systems have their impact at the state level and in local and regional markets, yet HHS has limited capacity to assess their effects. Current surveys are not able to identify and monitor key trends in health and well-being, health insurance coverage, access, utilization, welfare participation, and other issues at the state level, where key health and human services policies and decisions are made. The Data Council is currently considering how to address the need for state-level data as part of the development of the Department's data strategy.

DATA TO UNDERSTAND CHANGES IN THE DELIVERY AND ORGANIZATION OF HEALTH CARE

Major changes in the health care system are occurring more quickly than the Department is able to either describe or assess their impact. In addition, because of proprietary concerns, traditional sources of data on the health system are disappearing. To address these issues, HHS has established an interagency working group. The working group is identifying health care data needs, including the needs for data related to health plans, providers, and supply and demand. The group is evaluating current data availability and opportunities for improvement. This effort is part of the Data Council's data strategy development process.

DATA TO MEASURE AND IMPROVE THE SAFETY, QUALITY, AND EFFECTIVENESS OF HEALTH CARE

The policy and market mechanisms that helped control health care costs are now causing concern about the quality of care that may have resulted. Assuring the quality and safety of health care is a major concern and objective of the Department. While significant progress has been made to collect and improve quality data, additional improvements are needed. Therefore, a number of data enhancements currently are under consideration within the Department to ensure that HHS can fulfill its leadership role.

DATA TO MONITOR HEALTH AND WELL-BEING AND ASSESS PROGRESS TOWARD NATIONAL HEALTH OBJECTIVES

A variety of information is needed to monitor health status, identify threats to health, and assess progress toward Healthy People 2010, the health objectives for the United States. These measures have become basic building blocks in the assessment of the nation's health and well-being. Healthy People 2010, the health agenda for the nation, is an established national program that is widely used by the public health community. The Healthy People 2010 initiative reflects national consensus about the important measures of health behaviors, health risks, and health services. HHS uses the initiative to guide some of its data development efforts and address the health needs of the country. Healthy People 2010 builds on the data investments made in the 1990s (e.g., an expanded National Health Information System and new surveys such as the Centers for Disease Control and Prevention School Health Program and Practices Survey). The initiative uses this information for national baselines from which ten-year targets have been established.

However, critical gaps in existing health data systems are evident and are mirrored in the Healthy People 2010 framework. These include reliable data for some of the nation's most vulnerable population groups (e.g., people with low income, Native Americans, Native Hawaiians and other Pacific Islanders, and persons with disabilities). Planning and activities are underway in the Department to identify and evaluate approaches for addressing these data gaps.

DATA TO MEASURE PROGRAM PERFORMANCE

The advent of the Government Performance and Results Act (GPRA) has focused attention on the need for data to measure whether HHS programs and activities are achieving intended results. This is a reflection of a broader shift in thinking toward accountability, results, outcomes, and evidence-based decisions for public programs. Accordingly, HHS agencies are in the process of assessing their current capacity for program performance data and identifying future needs. In addition, agencies are working with their service delivery partners to promote and help develop data systems for measuring program results. Strategies for a more systematic and coordinated approach to data needs across HHS are under consideration, including the potential for sharing common data resources to enhance performance measurement.

PRIVACY

The Data Council (discussed above) has a Privacy Committee which serves as a focus for the Council's activities, analyses, and decisions with respect to privacy.

The Department carries out its collection and use of data with privacy as a fundamental consideration. HHS participates in the development and use of data and information to carry out its programs and functions with a focus on protecting the confidentiality of that information. Indeed, HHS has a long tradition and commitment to the fair, respectful, and confidential treatment of the information that is entrusted to it in the performance of its functions.

Identifiable information that the Department and its contractors receive is protected by legal controls, most particularly the Privacy Act of 1974, and additionally in some instances by special Federal research and statistical confidentiality statutes similar to the Census Bureau statutes for protecting information. Additionally, the Department is currently preparing a major health information confidentiality regulation. Under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, HHS was directed to issue a final regulation with national standards to protect the privacy and security of individually-identifiable health information. A notice of proposed rulemaking was issued in November 1999, and work is proceeding on a final rule. The regulation will apply to health care providers that transmit data electronically, health plans, and health care information clearinghouses. It will give individuals rights with respect to their records, will constrain record holders in their use and disclosure of personal health information, and will require record holders to have safeguards for the information.

NEXT STEPS

Having identified the six critical data needs outlined above, the next step is to identify and prioritize specific data gaps and develop strategies to address those gaps. We expect recommendations on a strategy for the six data areas to be completed in the fall, 2000, and they will be presented to the Data Council. The Council subsequently will evaluate the recommendations and formulate an implementation plan. The plan may involve, as appropriate, meetings with states and other partners to forge implementation partnerships, technical assistance to a variety of organizations involved in data collection, development of new data standards, budget requests for data enhancements, modifications to administrative, regulatory, and programmatic data reporting systems, and improvements to data analysis and dissemination activities.

Appendix E - Program Evaluations

Program evaluations can play an important role in formulating goals, objectives, and implementation strategies for a variety of planning activities throughout the Department of Health and Human Services (HHS). Program evaluations also tell us whether our efforts are successful. While there are still gaps in what we know, we now are beginning to assemble a body of evaluative information that supports the way we craft our various goals and objectives and substantiates the effectiveness of strategies to achieve those goals and objectives. To illustrate this, we provide a discussion of the evaluative information that contributed to setting our goals and objectives. We also discuss program evaluations that demonstrate the effectiveness of implementation strategies that we will use. Finally, we provide a list of future evaluations that will provide additional insight into the effectiveness of our strategies and cumulative impact of our efforts (1). A goal by goal discussion follows.

GOAL 1: REDUCE THE MAJOR THREATS TO THE HEALTH AND PRODUCTIVITY OF ALL AMERICANS

SETTING THE GOAL/OBJECTIVES

A variety of statistical data on health trends in the United States contributed to the creation of Goal 1. For example, information from the National Vital Statistics Report provided the basis for establishing strategic objectives that address major causes of premature mortality and morbidity in the United States. Also useful was a wide variety of information on specific behavioral trends and incidences of disease available from national surveys and public health surveillance systems, such as the Behavioral Risk Factor Surveillance System, the Total Diet Survey (Food and Drug Administration) and the National Household Survey on Drug Abuse (2).

EFFECTIVENESS OF OUR IMPLEMENTATION STRATEGIES

Available evaluation studies underline the effectiveness of a number of the strategies that the Department will use to achieve its objectives. For example, a key element in our strategy to reduce tobacco use among youth is the support of tobacco education programs. A recent evaluation of a major anti-tobacco media campaign in Florida demonstrated the effectiveness of education programs in preventing tobacco use, especially when targeted to younger persons. As a deterrent to tobacco sales to minors, the effectiveness of strategies to enforce the prohibition on sales to minors (Synar) is supported by recent evaluations; e.g., a 1998 Battelle study.

Similarly, evaluations, such as the review of the Child and Adolescent Trial for Cardiovascular Health (CATCH) program, point to the effectiveness of education programs in changing behaviors and attitudes toward diet and physical activity (Objective 1.3). Also, findings from Food and Drug Administration's (FDA) Food Label and Nutrition Tracking System indicate that consumers are reading, understanding, and changing their minds about food products as a result of FDA food labeling activities. The positive impact of consumer education on diets is also supported by the study The Effects of Education and Information Source on Consumer Awareness of Diet-Disease Relationships.

Examples of other evaluations that underline the effectiveness of our strategies in Goal 1 include: preliminary results from the National Cross-site Evaluation of High Risk Youth substance abuse prevention programs (Objectives 1.4 and 1.5); results from the National Treatment Improvement Evaluation Studies (NTIES) evaluation showing that treatment works (Objective 1.5); and evaluations of behavior counseling programs such as Project RESPECT (Objective 1.6).

FUTURE EVALUATIONS

Objective	Subject	Methodology	End Date	Agency
Objective 1.1
Reduce tobacco use, especially among youth	Evaluation of the effectiveness of population-based tobacco prevention and control programs	National/state prevalence surveys and demand models based on tobacco pricing and state policies	Ongoing with annual updates	Centers for Disease Control and Prevention (CDC)
Objective 1.2
Reduce the incidence and impact of injuries and violence in American society	Evaluation of state and local school-based programs designed to prevent chronic disease, including dietary patterns, physical activity, and overweight/obesity	Quasi experimental school-based studies	Ongoing	CDC
	Evaluation of multi-faceted interventions for community-dwelling elderly	To be developed	Being developed	CDC
	Evaluation of multi-faceted youth violence prevention interventions	To be developed	Being developed	CDC
	Evaluation of interventions to increase proper restraint use for children	To be developed	Being developed	CDC
	Evaluation of the effect of state and local residential smoke alarm legislation on smoke alarm use and reductions in injuries and fire related deaths	To be developed	Being developed	CDC
Objective 1.3
Improve the diet and level of physical activity of Americans	Evaluation of consumer knowledge of relationship between diet and health and dietary supplement labels	National Sample (telephone survey)	2002	FDA
Objective 1.4
Reduce alcohol abuse and prevent underage drinking	Evaluation of the effectiveness of the Hispanic/Latino media campaign to encourage dialogue between parents and children about substance abuse	Survey	2001	Substance Abuse and Mental Health Services Administration (SAMHSA)
Objective 1.6
Reduce unsafe sexual behaviors	Evaluation of state and local school-based programs designed to improve adolescent reproductive health, including prevention of HIV, other sexually transmitted diseases (STDs), and teenage pregnancy	Quasi- experimental school-based studies	Ongoing	CDC
Objective 1.7
Reduce the incidence and impact of infectious diseases	Analysis of influenza and pneumoccocal reports/data	Claims Database analysis	2002	Health Care Financing Administration (HCFA)

 

GOAL 2: IMPROVE THE ECONOMIC AND SOCIAL WELL-BEING OF INDIVIDUALS, FAMILIES, AND COMMUNITIES IN THE UNITED STATES

SETTING THE GOAL/OBJECTIVES

Data from a variety of national, state and program-specific sources provided valuable insights and information useful for the development of Goal 2, including development of the objectives and implementation strategies. For example, the national evaluation of welfare-to-work activities provided information on the effectiveness of the JOBS program in seven sites and was the basis for many of the reforms in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Additionally, state and program administrative data were particularly useful in assessing trends and establishing the objectives for child welfare, abuse and neglect, early learning (Head Start) and child care. The Department's third annual report, America's Children: Key National Indicators of Well-Being, provided a secondary source of trend data for these objectives. Projections by the Department's micro simulation model, the Transfer Income Model (TRIM), were useful in testing alternative approaches and strategies for human services programs. Census data and data from surveys of the National Center for Health Statistics (CDC) contributed to the development of objectives that address trends in aging and long term care.

EFFECTIVENESS OF OUR IMPLEMENTATION STRATEGIES

In Goal 2, there are a number of implementation strategies that focus on identifying effective program practices and disseminating these to states and other service providers through Federal technical assistance and capacity development activities. Evaluative assessments of these efforts point to their value and argue for continuing to help identify and disseminate best practices as a key strategy to achieve our objectives in Goal 2. For example, there is substantial evidence that many welfare-to-work experiments supported by the Department have been adopted by states. Many elements of successful demonstrations were adopted in the welfare reform provisions of Temporary Assistance to Needy Families (TANF).

In other areas, we point to the success of bonus payments and technical assistance to help states reduce barriers to adoption (Objective 2.4). Recent evaluative data indicate substantial increases in adoptions in FY 1997 and FY 1998, indicating the success of these strategies. Also, the Government Accounting Office (GAO) recently found that the use of adoption incentives increases the likelihood of adoption of older and minority children and is cost effective (GAO/HEHS-97-73).

There is evaluative evidence going back a number of years that demonstrates the success of working through programs such as Head Start to link children to health care. These include A Descriptive Study of Head Start Health Services (a 1996 study of a representative sample of 1,200 children in 40 Head Start programs), current Head Start Program Information Report data, and Child Care State plans. Similarly, evaluations are beginning to show that providing access to quality childcare is effective in promoting healthy childhood development. (See the 1999 study, Access to Child Care for Low-Income working Families, and a National Institute of Child Health and Human Development study examining outcomes for children attending centers that meet professional standards.) Finally, results from the Family and Child Experiences Survey are beginning to show the positive impact of Head Start on child performance in cognitive and social skills, indicating learning readiness for kindergarten (Objective 2.3).

FUTURE EVALUATIONS

Objective	Subject	Methodology	End Date	Agency
Objective 2.1
Improve the economic independence of low income families including those receiving welfare	Evaluation of employment retention and advancement strategies; impact of welfare reform on child outcome measures; rural welfare to work strategies; and the effectiveness of serving special populations	Experimental and non-experimental	Variable 2001-2005	Administration on Children and Families (ACF)
Objective 2.3
Improve the healthy development and learning readiness of preschool children	Continuing evaluation of the impact of Head Start (FACES) on the social and cognitive progress of children	Surveys, observations, childhood assessments	Ongoing	ACF
	Continuation ofA National Study of Child Care for Low-Income Families	Analysis of administrative data, surveys, interviews	2002	ACF
Objective 2.4
Improve the safety and security of children and youth	Continuation of a national longitudinal study of child welfare that looks at the effectiveness of services provided for families and children	Surveys, interviews	Ongoing in three to five year cycles	ACF
	Assessment of child welfare outcomes in areas of safety, permanency, and child and family well-being	Surveys, interviews	Ongoing	ACF
	Evaluation of the impact of family preservation and support services	Surveys, interviews	Date-phased	ACF
Objective 2.5
Increase the proportion of older Americans who stay active and healthy	Evaluation of multi-faceted fall-prevention programs for community-dwelling elderly	To be decided	Being developed	CDC
Objective 2.6
Increase independence and quality of life of persons with long-term-care needs	Evaluation of the home and community-based services waiver program Evaluation of multi-state demonstrations for integrating acute and long-term-care services	Descriptive analysis and consumer survey Quasi-experimental using surveys, case studies and database analysis	2002 2002	Health Care Financing Administration (HCFA) HCFA
	Multi-state evaluation of dual eligibles demonstrations (cash and counseling demonstrations for making individuals more involved in planning and directing their community-based long-term-care services)	Control group	2003	HCFA
Objective 2.7
Improve the economic and social development of distressed communities	Evaluation of impact of Individual Development Accounts	To be determined	2005	ACF

 

GOAL 3: IMPROVE ACCESS TO HEALTH SERVICES AND ENSURE THE INTEGRITY OF THE NATION'S HEALTH ENTITLEMENT AND SAFETY NET PROGRAMS

SETTING THE GOAL/OBJECTIVES

Data from a number of health related surveys, such as the U.S. Census and Current Population Survey, were instrumental in helping set Goal 3 objectives that address problems such as the lack of access to health care insurance and services and health disparities. Examples include the Medical Expenditure Panel Survey (Agency for Healthcare Research and Quality), the National Survey of Health Insurance (Kaiser/Commonwealth), the National Vital Statistics System (CDC), policy briefs of the National Center for Cultural Competence, and the report of the Surgeon General on Mental Health. Also useful were program data from the Health Resources and Services Administration on medical shortage areas and cost data from the Agency for Healthcare Research and Quality (AHRQ) on the cost of services to persons with HIV/AIDS, (see AHRQ Publication No. 99-RO28). Information from the Department's Office of the Inspector General (OIG) contributed to the development of our objective on the integrity of the Medicare and Medicaid programs. Data from the Medicare Current Beneficiary Survey were useful for assessing issues related to the effectiveness of and access to Medicare services.

EFFECTIVENESS OF OUR IMPLEMENTATION STRATEGIES

A number of evaluative studies and other evidence illustrate the effectiveness of Goal 3 implementation strategies in increasing access to and effectiveness of health care services. For example, increasing the supply of physicians in under-served areas is a successful strategy for improving access to health care services. In addition, there is a similar impact where community health centers are located, and considerable evidence supports the success of Ryan White programs in increasing access to health care services for persons with HIV/AIDS. Finally, a continuing national evaluation of the strategy to support comprehensive community mental health services for children and their families shows improvements in a range of child outcome indicators (e.g., school attendance and behavior).

FUTURE EVALUATIONS

Objective	Subject	Methodology	End Date	Agency
Objective 3.1
Increase the percentage of the nation's children and adults who have health insurance coverage	Assessment of the impact of welfare reform on Medicaid Evaluation of the State Children s Health Insurance Program	Analysis of claim and eligibility files National analysis of enrollment and service use files and meta-analysis of state evaluations	2001 2004	HCFA HCFA
	Cost-benefit analysis of the Health Insurance Portability and Accountability Act (HIPAA) and related provisions	Modified cost-benefit analysis	2001	HCFA
	Evaluation of the use of High Risk Pools	Case study	2001	HCFA
	Evaluation of the treatment of associations under HIPAA reform to determine their effectiveness in extending health insurance coverage	Case study	2001	HCFA
	Evaluation of the Qualified Medicare Beneficiary (QMB) and Special Low Income Medicare Beneficiary (SLMB) programs	National sample survey, focus groups, case studies	2002	HCFA
Objective 3.2
Eliminate disparities in health access and outcomes	Evaluation of Racial and Ethnic Approaches to Community Health (REACH) demonstrations to eliminate health disparities	Comparison of standardized scores with and across communities and Behavioral Risk Factors Surveillance System (BRFSS)-matched demographic comparison	Ongoing	CDC
Objective 3.3
Increase the availability of primary health care services for under-served populations	Evaluation of Health Center Performance	User visit survey	2001	HRSA
	Evaluation of Critical Access Hospitals program	Rural Research Center case studies and analyses	2002	HRSA
Objective 3.4
Protect and improve the health and satisfaction of beneficiaries in Medicare and Medicaid	Evaluation of the Medicare+Choice Program, including beneficiary access to managed care options, the cost and quality of services and beneficiary satisfaction	Analysis of beneficiary encounter data	2001	HCFA
Objective 3.5
Enhance the fiscal integrity of HCFA programs and purchase best value health care for beneficiaries	Evaluation of coordinated care and disease management demonstrations to determine their effectiveness in promoting value-based purchasing for Medicare	Claims and cross-site analysis	2005	HCFA
Objective 3.6
Improve the health status of American Indians and Alaska Natives (AI/AN)	Evaluation of obesity at diabetes prevention pilot sites to determine effectiveness of prevention approaches in decreasing overweight and obesity in young children	Clinical assessments and behavioral surveys	2004	Indian Health Service (IHS)/ACF
Objective 3.7
Increase the availability and effectiveness of services for the treatment and management of HIV/AIDS	Evaluation of Ryan White HIV/AIDS programs	Analysis of grantee data	2001	HRSA
Objective 3.8
Increase the availability and effectiveness of mental health care services	Evaluation of whether target audiences are adopting Treatment Improvement Protocols	Mail survey	2001	SAMHSA
Objective 3.9
Increase the availability and effectiveness of health services for children with special health care needs	Study on Children with Special Health Care Needs	State and Local Area Integrated Telephone Survey (SLAITS) interview mechanism	2002	HRSA, CDC

 

GOAL 4: IMPROVE THE QUALITY OF HEALTH CARE AND HUMAN SERVICES

SETTING THE GOAL/OBJECTIVES

Goal 4 development was substantially influenced by recent findings of the Advisory Commission on Consumer Protection and Quality in the Health Care Industry and the Institute of Medicine's report on medical errors. The Commission found that medical errors occur in hospitals, nursing homes, pharmacies, urgent care centers, and home care, and that all medical errors cost the nation approximately $37.6 billion annually. Also, the challenge to improve health care quality in the United States is well outlined in the Department's report, The Challenge and Potential for Assuring Quality Health Care for the 21st Century. In developing Goal 4, we also considered the continuing need to improve the quality of human services based on widely available trend data on the well-being of children and families in the United States.

EFFECTIVENESS OF OUR IMPLEMENTATION STRATEGIES

Although much of the initiative to improve care quality is new and evaluations of programs and activities are just beginning, some evidence of effectiveness has emerged. This is linked to the design of our strategies. For example, a key component of our quality improvement strategies is to develop evidence-based findings on effective health services and promote use of the findings. Evaluation findings of the Agency for Healthcare Research and Quality in 1999 (Publication No. 99-R043) and evidence from other studies (Publication No. 95-N012) support the conclusion that evidence-based research is making its way into practice and, in turn, is contributing to improvements in patient outcomes. Similarly, GAO testified in 1995 (GAO/T-HEHS-95-221) that AHRQ practice guidelines seemed to have a positive impact on patient outcomes.

Efforts to increase consumer and patient use of health care information are the focus of an ongoing evaluation of the Health Care Financing Administration education program-Medicare & You-which is designed to help beneficiaries make the best use of new benefits and program flexibility. This evaluation will continue to provide feedback on the program and guide future directions. Finally, ongoing assessments of the impact and effectiveness of the Mammography Quality Standards Act has shown the value of certification and inspection strategies as an effective means of addressing patient protections.

A key implementation strategy for improving the quality of human services programs is the development of a broad framework that includes quality data, performance measurement systems, and program evaluations. As policy and program design devolve to state and local levels, it is vital that these levels of government have reliable information on which to base their decisions and that the effects of different policy and program choices on quality and accessibility is understood. Documenting, understanding, interpreting, and facilitating the exchange of information and experiences among states is essential to providing high quality services that promote the well-being of families and children.

FUTURE EVALUATIONS

Objective	Subject	Methodology	End Date	Agency
Objective 4.1
Enhance the appropriate use of effective health services	Evaluation of Centers for Education and Research on Therapeutics to assess their effectiveness in translating and disseminating objective information on the appropriate and safe use of therapeutics	Citation analysis; other methodologies under development evaluation to commence in FY 2001	FY 2002 (first quarter)	AHRQ
	Assessment of State Rules and Practice Regarding Collection and Reporting of Racial and Ethnic Data by Health Insurers and Managed Care Plans	Database analyses and selected site visits	9/2001	Office of Public Health Service (OPHS)
Objective 4.2
Increase consumer and patient use of health care quality information	Expanded evaluation of Medicare & You Handbook: 2000 (the national education campaign to help Medicare beneficiaries make choices among health benefits and plans)	Survey	Ongoing	HCFA
	Evaluation of the use of web sites as an effective means of disseminating health care quality information	Analysis of consumer feedback data	2001	HCFA
Objective 4.3
Improve consumer and patient protection	Evaluation of the use of a quality indicator format in the end stage renal disease survey process National Assessment of Culturally and Linguistically Appropriate Services in Managed Care Organizations (MCOs) Serving Racially and Ethnically Diverse Communities	Expert assessment Survey of random sample of MCOs	2003 9/2001	HCFA OPHS
Objective 4.4
Develop knowledge that improves the quality and effectiveness of human services practice	See Goal 2 evaluations	See Goal 2	See Goal 2	See Goal 2

 

GOAL 5: IMPROVE THE NATION'S PUBLIC HEALTH SYSTEMS

SETTING THE GOAL/OBJECTIVES

A variety of assessments of the capacity of the Public Health Service to identify and respond to health problems in the United States are available and support the need to strengthen the public health infrastructure. For example, a 1999 GAO study (GAO/HEHS-99-26) documented problems with laboratory capacity. This is supported by a Department assessment (1997), Public Health Workforce: An Agenda for the 21st Century, which singles out laboratory capacity as a pressing problem. Healthy People 2010 documents the need for better information technology. The Institute of Medicine (1988) published perhaps the most comprehensive view of the challenge, The Future of Public Health.

EFFECTIVENESS OF OUR IMPLEMENTATION STRATEGIES

Achievement of Goal 5 rests largely on the dual strategies of improving the surveillance and response capacity of federal, state, and local health agencies and improving the effectiveness and timeliness of communications throughout the public health system. Our adoption of these strategies is supported by assessments that are beginning to show successes in several areas. For example, assessments of efforts in the National Center for Health Statistics (NCHS) to improve the timely release of surveillance and survey data have been positive. Also, an assessment of the CDC Assessment Initiative to enhance the ability of state and local health departments to use data for policy making has been positive.

In the area of medical device safety, evidence suggests that FDA information dissemination about faulty medical products, transmitted through advisories, has a positive impact on product safety, although further review is indicated. There is evidence that the implementation of FDA Adverse Event Reporting System for Biologics has resulted in improved products through changes in product labeling. Betaseron is one example. The success of food safety consumer education strategies is supported by analytic findings in Background Research and Recommendations for the Food Safety Campaign. Finally, strategies to make drug prescription information more easily available and understandable seem to be successful, according to information obtained through our biennial National Survey of Prescription Medicine Information Received by Consumers.

FUTURE EVALUATIONS

Objective	Subject	Methodology	End Date	Agency
Objective 5.1
Improve the capacity of the public health system to identify and respond to threats to the health of the nation's population	Evaluation of how the public health infrastructure affects the performance of public health programs and interventions Evaluation of the impact of new information systems, technology, and informatics training on public health practice Evaluation of the impact of public health workforce development (training) on public health organization performance and the public health Evaluation of the effectiveness of safety and public health advisory issuances	Survey Survey Survey Survey	FY 2001 FY 2001 FY 2002 Ongoing	CDC CDC CDC FDA
Objective 5.2
Improve the safety of food, drugs, medical devices, and biological products	National Survey of Prescription Medicine Information Received by Consumers Evaluation of consumer knowledge of food safety issues	Survey Survey	Ongoing Biennial 2002	FDA FDA

 

GOAL 6: STRENGTHEN THE NATION'S HEALTH SCIENCES RESEARCH ENTERPRISE AND ENHANCE ITS PRODUCTIVITY

SETTING THE GOALS/OBJECTIVES

Almost every day, the American health science research community announces new discoveries that hold tremendous potential for the prevention and treatment of disease and injury. The promise of these discoveries argues for the nurture of the research infrastructure that produces the discoveries. As a result of this productivity, strengthening this country's health sciences enterprise has become and remains one of the strategic goals of the Department.

EFFECTIVENESS OF OUR IMPLEMENTATION STRATEGIES

Success in achieving Goal 6 will rely on how effectively our strategies nourish health research. One element is to facilitate the conduct of research and to move successful research into practice and products. Evaluative information supporting our direction is continuing to emerge. For example, attempts to accelerate the development of new medical products through streamlining the product application and review process has led to shorter review times and we are seeing new products approved under Fast Track processes. (Two such products for the treatment of HIV were approved in 1999.) Overall, streamlining efforts in response to the Prescription Drug User Fee Act (PDUFA) and the Food and Drug Administration Modernization Act (FDAMA) efforts are working to decrease product approval times, as reported in the FY 1999 Performance Report to Congress.

FUTURE EVALUATIONS

Objective	Subject	Methodology	End Date	Agency
Objective 6.1
Advance the scientific understanding of normal and abnormal biological functions and behaviors	Review and assessment of results achieved from funded research, conducted as a normal part of scientific planning and priority setting	Various mechanisms, involving numerous internal and external groups	Continuous	NIH
Objective 6.2
Improve our understanding of how to prevent, diagnose, and treat disease and disability	Review and assessment of results achieved from funded research, conducted as a normal part of scientific planning and priority setting	Various mechanisms, involving numerous internal and external groups	Continuous	NIH
Objective 6.4
Accelerate private sector development of new drugs, biologic therapies, and medical technology	Evaluation of statutory performance under PDUFA and FDAMA	Administrative Data Analysis	Ongoing	FDA
Objective 6.5
Strengthen and diversify the base of well-qualified health researchers	Evaluation of Minority Institution Research Development Programs awarded as cooperative agreements NRSA Postdoctoral Evaluation Study Survey of graduate science student support Survey of doctorate recipients	Modified case study approach Longitudinal survey with comparison groups Survey Survey	2001 2001 Biennial (2002) Biennial (2002)	NIH NIH NIH NIH
Objective 6.6
Improve the communication and application of health research results	Evaluation of Internet-based tools to improve cancer clinical trials	Comparison groups	2002	NIH

Notes:
1. Program evaluation information is displayed only for those objectives for which future evaluations are planned.
2. This includes information tracking major health risks in America (e.g., the percentage of adults who are obese), behavioral risk factors among adults for cardiovascular disease (Centers for Disease Control and Prevention), and information tracking other trends.
 

Appendix F - Resources Supporting the HHS Strategic Plan

The United States federal government, through the Department of Health and Human Services (HHS), remains committed to investing resources to improve the health and well-being of all Americans. The Department does not anticipate increased spending across the board, but expects stable funding for programs and for the management and administration of these programs. HHS and its partners will continue to enhance the nation's investment through wise program and resource utilization decisions that get the most for the funds available.

To support the strategies described in the HHS Strategic Plan, and to ensure that HHS and its partners have the capacity to implement them effectively, the Department will pursue resources that are compatible with the demands of the plan's program strategies. The discussion that follows describes the approaches HHS will employ to coordinate resources for two resource categories that are critical to program success at this time: human and information resources. In addition, we highlight many of the resources that the Department and its partners will employ to achieve the strategic goals in the HHS Strategic Plan.

The highly coordinated HHS budget formulation processes ensure that the resources for both programmatic and management strategies are identified to support the HHS Strategic Plan. The HHS Budget Review Board, which consists of Department leaders representing broad policy and functional interests, will continue to conduct hearings on the budget requests of all HHS components and make recommendations regarding cross-cutting Departmental budget initiatives that improve HHS programs. In recent years, for example, HHS budget coordination resulted in budgets that supported critical resource challenges associated with Y2K compliance.

HUMAN RESOURCES

Over the last several years, workforce planning has emerged as a significant resource challenge for HHS. The Department is responding with coordinated planning efforts that are linked to the HHS budget process. Multiple factors contribute to the workforce planning challenge faced by HHS and other federal agencies. The Department's agencies are confronted with an aging workforce that will be subject to high levels of retirement beginning within the next few years. Unprecedented advances in information technology and the legitimate expectations of the Congress that federal agencies better manage technology have significantly altered the skill requirements of positions throughout federal agencies and programs. Advances in medical science and the reform of human service programs have had a similar effect on federal, state, and community organizations and their employees who must adapt rapidly and continuously to changing demands.

To ensure coordinated planning in the budget context, HHS requires program components to submit a workforce plan with each fiscal year budget. This workforce plan must address the strategies and costs of addressing these critical issues. HHS workforce plans are developed following Departmental guidance presented in Building Successful Organizations-Workforce Planning in HHS, November 1999. This guidance presents a flexible Departmental model of planning that addresses the analysis of several common fundamental elements of workforce planning: workforce analysis, competency assessment, gap and solution analysis, workforce transition analysis, and evaluation.

INFORMATION RESOURCES

Sound information and competent information management are essential to the core mission of HHS. Although the Department and its partners have significant data collection systems in place, long-term commitments are underway to close data gaps, build the next generation of information systems, and deliver useful and accessible information to customers. Following on its success in addressing the challenge of Y2K compliance, HHS will apply lessons learned to equally important information technology challenges that remain and are emerging. The improvements that the Department seeks in information technology and systems are far-reaching, focusing not only on program data and information systems, but also on financial, grants, and property management information and systems, and on the consistency and security of information systems and technologies across HHS.

Program Data and Information Systems. The Department plays an essential role in creating health and human services information for decision-making, as producer and user of data, and as a partner with other information entities. Through coordination under the HHS Data Council and the HHS budget process, the Department will create essential cross-cutting investments that build on and amplify data resource objectives for individual programs and agencies, and ensure that the wealth of information resources are coordinated and prioritized. Through planning coordinated by the Department, multiple HHS components will contribute to the pursuit of broad-based improvements in data on:

• United States populations and subgroups

• The health care delivery system

• Health and human service outcomes, effectiveness and quality

• Methods and tools for data collection

Similar coordination will continue to occur for program information systems planning in areas such as:

• Data standards

• Security of Internet transmission

• Capacity of federal, state, community, and private partners to accommodate emerging systems and technologies

• Electronic data interchange with the health care system

HHS and partner data and information infrastructures must accommodate and include dissemination and translation into information that is useful for decision-making needs, including:

• Easy and consistent access

• User enabling through training and technical assistance

• Expertise to ensure the translation of data into knowledge

• Improved analytical methods and tools

Information Technology Management. The Department is employing a systems-life cycle (SLC) approach to information technology (IT) management, using industry standards and HHS best practices. Under this approach, HHS will conduct planning, analysis, design and performance measurement, using Commercial-Off-The-Shelf (COTS) solutions and adhering to Government directives. The Department will continue to focus its efforts in four key IT infrastructure management initiatives, including:

• Clinger-Cohen Act compliance (including five-year IT plans)

• IT/cyber security

• Internet/Intranet strategy

• Telecommunications strategy

Financial, Grants and Logistics Management. Attention to information resources is critical to maintaining clean and unqualified financial opinions and in improving financial and property management. HHS will strengthen the financial statement reporting process with the development of automated processes for consolidating the Operating Divisions' (OPDIV) financial statement for Departmental reporting and will improve processes for the reconciliation of the financial records for all HHS financial offices. An electronic logistics training and support network will be developed to deliver competency-based electronic learning and online certification to the desktop via an electronic performance support network. In addition, the network will enable the Department to establish a professional certification program in logistics.

RESOURCE SUPPORT BY STRATEGIC GOAL

The following summary of resource specifications in support of the Department's strategic goals reflect the importance of human, information, and other resources in years to come. The resource specifications and these two resource categories in particular also reflect the demands that are being imposed on American society and the federal government by tremendous advances in knowledge in medical and information technology science and in human service program design and delivery.

GOAL 1: REDUCE THE MAJOR THREATS TO THE HEALTH AND PRODUCTIVITY OF ALL AMERICANS

The Department will continue to pursue approaches to reducing health threats that reflect a balanced resource portfolio. For HHS, the portfolio begins with support of the nation's investment in Healthy People 2010, which focuses on the development and use of leading health indicators as a measure of well-being for Americans. Eight of the ten leading health indicators are directly associated with health threats that compromise our health and productivity. The following are examples of resource objectives that will support this goal:

• Resources for information supporting the measurement of health indicators.

• Investments in existing capacity (e.g., in community health centers) to enhance community interventions against health threats, particularly in under-served areas.

• Resource input for continued research into increasingly effective interventions.

• Support to improve measurement of the quality of clinical preventive care.

• Investments in education to promote healthy behaviors, especially through established educational and communication infrastructures.

• Partnership support to coordinate and facilitate prevention activities, measure health indicators, and ensure maximum utilization of existing infrastructures.

This kind of balanced resource portfolio will enhance current programs that address the threats identified under Goal 1, such as smoking, substance abuse, sexually transmitted disease and domestic violence.

GOAL 2: IMPROVE THE ECONOMIC AND SOCIAL WELL-BEING OF INDIVIDUALS, FAMILIES, AND COMMUNITIES IN THE UNITED STATES

HHS is committed to identifying necessary resources to support programs that improve the well-being of Americans, particularly the most vulnerable: children, the elderly, the disabled, the poor, and the disadvantaged. A significant element of the Department's resource strategy for human service programs includes support of new and advanced information technology resources in states and communities across the nation. The resources necessary to continue the advancement of human service programs include:

• Technical assistance to state, community, and other program grantees, will focus on best practices and high-performance characteristics.

• Information sharing and dissemination methodologies (for subjects such as employment retention and advancement interventions) available to programs administered by states and communities.<</li>br>

• Investments in national databases, directories, operations, and systems (e.g., child support), shared among state and other grantees, will be supported and enhanced through matching and incentive funding programs.

• Research and evaluation resources will be conformed to support the advancement of knowledge about the design and implementation of human service programs.

• Program partnership resources will foster information sharing, program coordination, and performance management throughout and across programs for children, the elderly, and the disadvantaged.

• HHS will leverage the resources of government, non-profit, and private entities for the advancement of federal and state programs for vulnerable populations.

• Identification of resource requirements to develop core competencies of human service employees and grantees and identify new crosscutting program paradigms to ensure the consistency of human resource objectives.

Investments concentrated on improvements to data and information systems, combined with other traditional resource mechanisms, will support an array of program advancements for children, the elderly and the disadvantaged. These include moving families to work and job retention, child care, child support, fathering and child well-being, early childhood development, children's health, adoption and foster care, the safety and security of youth, and programs for the elderly.

GOAL 3: IMPROVE ACCESS TO HEALTH SERVICES AND ENSURE THE INTEGRITY OF THE NATION'S HEALTH ENTITLEMENT AND SAFETY NET PROGRAMS

There is similar consistency in the resource areas that HHS agencies and programs believe will produce improved results activities that focus on access to health care. The resource mechanisms include the following:

• Access strategies throughout HHS will focus on enhancing investments in existing, community-based infrastructures that our target populations use (e.g., school-based care for children).

• Employ guidance, assistance, and knowledge advancement resources to leverage the resources and activities of partners to enhance the success of outreach strategies that are crucial to improving access to care.

• Resources that enhance data and information technology will remain an important element for identifying populations that require access improvements.

• Investments in physical infrastructure development, supporting health and sanitation facilities, will remain a significant resource objective for Native American and other rural populations.

• Pursuing improved third-party reimbursement, particularly for safety net providers, will help health services dollars go further to serve those in need.

• Resources will foster innovations such as joint purchasing of pharmaceutical supplies to provide for discounts and reduction of operating costs.

• Sizeable reductions in Medicare payment errors have demonstrated the value of devoting resources to improving the financial integrity of entitlement programs. HHS is committed to devoting additional resources toward this end for Medicare, Medicaid, and other entitlement programs. To improve program integrity and the access of Americans to health services, HHS will focus on coordinated activities within the Department and with program partners. For program integrity improvements, HHS and its partners will utilize a variety of resource mechanisms, including the following:

• Systems investments, technical assistance, and other communication mechanisms will support continued improvement of law enforcement coordination nationwide.

• Input for more sophisticated methods of analyzing and using administrative data to profile abuse and target audits and investigations will be pursued.

• Resources supporting team approaches to the conduct of anti-fraud and abuse activities will be applied across wider geographical areas.

• Resources will be employed to identify improvements in policies and procedures that reduce fraud and abuse.

• Investments in existing review and inspection infrastructures will be enhanced to focus on the assessment of program integrity and quality factors.

• Input into public education and training will be pursued to utilize the community to participate in the fight against fraud and abuse.

• Resources for partnership with industry and provider groups will foster voluntary compliance with policies and enhance government knowledge of areas vulnerable to fraud and abuse.

Partnership and the coordination of resources within HHS and among its program partners are central to success of the Department's strategies to improve access to health care and to ensure the integrity of the service programs administered through the Department.

GOAL 4: IMPROVE THE QUALITY OF HEALTH CARE AND HUMAN SERVICES

HHS participates in many activities that significantly influence the delivery of health and human services in the United States, including consumer advocacy, information dissemination, the purchase and provision of health care, and research that identifies what care can and cannot do. The Department has a responsibility to protect consumers by ensuring that care is accessible, safe, fair, effective, and accountable. To support HHS's quality of care objectives, planning, coordination, and crosscutting resources will continue to be employed, as indicated below:

• Investments in communication will facilitate consumer access to information about the quality of health and human services.

• Resource input to develop and utilize purchasing models will strengthen value-based purchasing.

• Peer review and performance measurement resources will support quality improvement in direct service programs.

• Resources for research and evaluation that begin and end with consumer assessment will promote quality improvement throughout the health care industry.

• Support of intergovernmental coordination and partnership will allow the development of cross-government consumer protections.

The application of coordinated resources associated with knowledge development, converting knowledge to applicable design, information dissemination, and peer review will support the Department strategies to improve the quality of care that HHS program beneficiaries receive.

GOAL 5: IMPROVE THE NATION'S PUBLIC HEALTH SYSTEMS

The nation's public health infrastructure is the underlying and often-invisible framework that protects the safety of our food and water, controls outbreaks of deadly contagion, lessens the burden of chronic disease, and prevents injury. Like all infrastructures, the public health infrastructure requires deliberate, regular maintenance and conscious, periodic renovation. In addition, preparing the nation for the health and medical consequences of a bioterrorist event has significant implications for supporting and adapting the public health infrastructure. The resources that will support public health systems are associated with the essential components of the public health infrastructure, as defined by Healthy People 2010. These include:

• Throughout the federal, state, and community infrastructure, we will apply resources to pursue strong science, including epidemiology, behavioral and biomedical prevention research, and health systems research to direct public health action.

• We will support the continued development of a skilled and highly effective workforce that is able to put that science to the best use.

• We will contribute to the development of integrated information and surveillance systems to ensure that state-of-the-art science is not squandered and that interventions are evaluated for effectiveness.

• Resources to address the threat of bioterrorist attack will include strengthening the nation's public health response capability, creating and maintaining a stockpile of pharmaceuticals and other materials, and enhancing the design, development, and approval of diagnostics, antibiotics/antivirals, and vaccines.

GOAL 6: STRENGTHEN THE NATION'S HEALTH SCIENCE RESEARCH ENTERPRISE AND ENHANCE ITS PRODUCTIVITY

Even as the health research enterprise in the United States enjoys enormous success, it possesses the opportunities and the national support to exceed that success. At a time when health research enjoys significant bipartisan support, the demands of demographic and social changes, the transforming health care system, and the focus of the medical industry on prevention offer opportunities and research challenges for health research to vastly improve the health and well-being of Americans. HHS will continue to organize and coordinate its research capacity toward effectively responding to these challenges. The Department will continue to pursue the management and administration of the research enterprise with multiple resource mechanisms and objectives. For example:

• Health research resources will focus on the continuum of the sciences and will encompass laboratory, clinical, epidemiological, behavioral, social, health services, and outcomes research.

• Physical infrastructure support will be provided that is widely accessible to allow sharing of capacity and knowledge in the health and public health research arenas.

• To support the changing frontiers of science with a continuing supply of personnel prepared to understand the implications of current discoveries, HHS will pursue varied and innovative forms of training and recruitment that attract and retain the best minds to medical science.

• Research today is multi-disciplinary and requires extensive input to support the use of research teams armed with a breadth of knowledge and variety of skills.

• Investments in state-of-the-art instrumentation and information technology will be key to HHS's comprehensive research strategy.

• Resource input for health data will address multiple aspects of the health continuum, including population-based characteristics, consumer assessment, the health care delivery system, and outcomes, effectiveness, and health care quality.

• Multi-faceted resource mechanisms for research information dissemination and technology transfer will be pursued and applied for biomedical, public health, and health-care systems research.

The rate of improvement in the practice of medicine and public health is strongly influenced by the rate and application of new discovery. To ensure preparation to take advantage of the opportunities for and from discovery, our health research portfolio must be diverse, encompassing many scientific disciplines and a wide range of diseases and conditions. Given the remarkable rate of discovery and the ever-diminishing time between a finding in basic research and changes in clinical and public health practice, America cannot afford to slow this vital work.

Appendix G - Schedule for Initiating Significant Actions

A sampling of some significant actions to be undertaken as part of the strategies articulated in the Department of Health and Human Services (HHS) Strategic Plan to accomplish the strategic objectives is listed below:

• Providing Targeted Capacity Expansion support to enhance both alcohol and drug treatment availability and accessibility in the nation's cities by encouraging the development of creative and comprehensive alcohol and drug early intervention and treatment systems for adolescents and adults. (Scheduled for 2001) (Objectives 1.4 and 1.5)

• Using the National Registry of Effective Prevention Programs, identify 100 model substance abuse prevention programs that are well implemented and thoroughly evaluated and have produced consistently positive and replicable results for dissemination to health professionals, states, communities, and the public. (Scheduled for 2002) (Objectives 1.4 and 1.5)

• Releasing the Healthy People 2010 Midcourse Review, identifying mid-decade updates and revisions. (Scheduled for 2005) (Goals 1 and 3)

• Providing high performance bonuses to reward states that achieve significant progress in work outcomes and work support indicators under their Temporary Assistance to Needy Families program. (FY 2002 - 2003) (Objective 2.1)

• Instituting annual implementation of an adoption bonus incentives program to states (Adoption 2002 initiative). (Begun in FY 2000, and ongoing) (Objective 2.4)

• Implementing the Community Access Program, designed to increase the capacity and effectiveness of the nation's health care safety net and to promote improved access to services for the uninsured. (Scheduled for 2001-2004) (Objectives 3.1 and 3.3)

• Launching a two-year, nationwide education campaign (beginning in 2001) to promote the use of preventive health services by older Americans and people with disabilities. (Objective 3.4)

• Implementing the new program of graduate medical education payments to freestanding children's teaching hospitals which train resident physicians, including nearly 30 percent of the country's pediatricians and nearly 50 percent of all pediatric specialists. (Scheduled for 2001) (Objectives 3.3 and 3.9)

• Conducting a nationwide technical assistance/education campaign to inform health plans, HMOs, physician groups, human service providers, advocates, and other stakeholders regarding policy guidance on the Title VI prohibition against national origin discrimination as it affects persons with limited English proficiency. (Beginning FY 2001, and ongoing) (Objectives 3.2 and 4.2)

• Issuing a regulation revising current conditions for coverage for end stage renal disease (ESRD) facilities approved to provide ESRD service under Medicare. The new rules will update the conditions to reflect developments in technology and equipment and develop performance expectations for the facility that result in quality, comprehensive care for the dialysis patient. (FY 2001) (Objective 4.3)

• Issuing a regulation on reporting research misconduct, which would require sponsors to submit information indicating that research misconduct may have been committed by a person involved in reporting on human subject trials. (FY 2001) (Objective 6.7)

Appendix H - Using Management Tools in Support of Program Goals

This section discusses several "management tools" such as workforce planning and training, information technology (IT), and customer service. All of these tools help the Department of Health and Human Services (HHS) achieve its strategic goals and objectives. For example, building on IT tools to build greater consistency and efficiency into information technology management across the Department, and reducing threats to computer security contributes directly to Objective 5.1. In addition, it contributes to all the strategic objectives in direct or indirect ways.

The Department has committed itself to achieve results that improve the lives of Americans. Thus, all of the strategic goals of HHS are programmatic goals. At the same time, the Department recognizes that these goals will not be achieved without paying attention to the means or management methods that are employed to carry them out. Just as the Congress is instrumental in the development of strategies that support the achievement of programmatic goals, in the last ten years, the Congress has worked with the Executive Branch to provide an extensive array of management tools to help federal agencies improve program performance.

HHS resolved long ago to take full advantage of the tools that the Congress, the Executive Branch, and others have provided to improve the management and administration of our program responsibilities. In this appendix, we have summarized the HHS efforts to make use of a variety of management tools to support the improvement of program results. It is important to the Department that this strategic plan identifies in a broad way how these functional management tools can and will influence program improvement over the term of the plan. The Congressional and Executive Branch oversight staff who have contributed significantly to the development and utilization of these tools are important stakeholders and partners of the Department in our efforts to improve program results. The information that follows illustrates that their efforts will continue to influence the performance of HHS programs.

• The Government Performance and Results Act (GPRA) is the principal tool that compels Federal programs to focus on results. In addition to this Strategic Plan, HHS will continue to use performance measures from its Annual GPRA Performance Plans and Reports to inform its decision making processes.

• The financial management tools provided by the Chief Financial Officers (CFO) Act and the Federal Financial Management Improvement Act (FFMIA), in conjunction with the Federal Managers Financial Integrity Act (FMFIA) and the Debt Collection Improvement Act (DCIA), will continue to produce greater financial accountability across HHS for years to come.

• The Clinger-Cohen Act has provided a solid and consistent basis for the planning and management of technology resources and policy issues. Presidential Decision Directive 63 (PDD63): Critical Infrastructure Development is a tool that recognizes that addressing computer-based risks to the nation's critical infrastructures requires an approach that involves coordination and cooperation across federal agencies and among public and private-sector entities and other nations.

• The Executive Branch also provides for the development and sharing of best management practices and tools through the President's Management Council (PMC), the President's Council for Integrity and Efficiency (PCIE), and the Chief Financial Officers' Council.

• The Office of Federal Procurement Policy Act and Executive Order 12931 seek to improve procurement efficiency in support of the mission accomplishments of federal agencies, and instruct agencies to establish clear lines of contracting authority and accountability. The Act promotes electronic commerce in the administration of procurement systems. The Presidential Directive on Electronic Commerce states that government must adopt a market-oriented approach to electronic commerce, one that facilitates the emergence of a global, transparent, and predictable environment to support business and commerce.

• The Federal Acquisition Streamlining Act (FASA) broke new ground in acquisition methodology and embodies key principles of acquisition reform. FASA was designed to simplify and streamline the federal procurement process, offering reforms for more cost-effective government and the ability of businesses to compete for government contracts.

• The private sector has offered tools, such as the Balanced Scorecard, that provide innovative methods for federal agencies to improve the accountability of their management functions.

• Formal, ongoing measurement of employee satisfaction is the basis for continuous improvement under the Quality of Worklife Initiative. The programmatic goals and objectives that have been set forth in this HHS Strategic Plan cannot be achieved without attention to management. The Department uses the tools that the Congress and others have provided to improve management in support of our program policy goals.

• Through the ongoing development of Major Management Challenges, the General Accounting Office (GAO) and the HHS Office of Inspector General (OIG) offer the Department an additional tool, through their reports, that assist us in identifying and defining management challenges which can affect the ability of HHS components to effectively achieve important program objectives.

LEADERSHIP AND COORDINATION

HHS will continue to employ management strategies that support and coordinate program activities across the Department.

In line with the structure and diversity of the Department and its program activities, HHS management strategies have reflected a move away from a "command and control" leadership structure. Program legislation has compelled HHS components to operate as large, independent, and distinct agencies. They have their own history, needs, and approaches to program administration, often legislatively delineated. To attempt to constrain the Department's large agencies into a homogeneous unit-even for planning purposes-would dilute their strengths and their unique values. As a result, program components will remain the core of the organizational focus of HHS. Staff units should remain small and engaged in activities that facilitate program coordination, prevent duplication of effort, and ensure consistent attention to the mission, goals, and objectives of the Department and the priorities of the Administration and the Secretary.

Consistent with HHS's organizational philosophy, the focus of management issues within the Department will be on substantive, policy issues rather than on formal, organizational management processes. Methods of decision making in HHS will be consensual and will engage high levels of interaction among program and staff executives. In the Department's budget process, for example, the Secretary and senior executives throughout HHS will develop the budget based on themes that reflect Departmental priorities. Each year, the HHS leadership will establish a manageable number of initiatives that call for collaborative efforts across separate Operating Divisions (OPDIVs) and the Office of the Secretary (OS). Collaborative management does not preclude regular high-level Departmental interest and guidance in the management of HHS components. To ensure and foster the kind of performance-based management that GPRA has prompted, the Deputy Secretary, along with the Chief of Staff, the Assistant Secretary for Management and Budget, and other senior executives of the Office of the Secretary, will continue to meet quarterly with the head and senior staff of each HHS Operating Division to address management issues.

PERFORMANCE MEASUREMENT

As performance measures mature and performance trends emerge, HHS GPRA performance data will inform and support budget decisionmaking in HHS.

The GPRA is a valuable tool that will enhance the Department's efforts to improve programs that serve the American people. With the continued development of performance goals and measures for approximately 300 programs, HHS will compile an extensive body of information that will be informative across programs and agencies. Such data will become increasingly important to HHS's leadership and program coordination efforts. Although the Department consists of large agencies with many and disparate functions, HHS coordinates the focus and direction of its program activities through Departmental initiatives developed in the annual HHS budget decision-making processes. Performance measurement will steadily strengthen these processes as data on program performance trends become available and serve as indicators to support the persistent cultivation of strategies and objectives to improve programs across the Department. In particular, performance measurement will inform the following:

• The budget process in which HHS develops coordinated Departmental initiatives and uses the annual performance plans to improve programs and support the achievement of HHS's long-term goals.

• Program evaluation, to assist HHS in providing programs with a deeper assessment of program effectiveness than can be provided by performance data, and to inform the development of improvements in ongoing performance measurement.

• The Strategic Plan, in which HHS sets out long-term goals and objectives for its program components and the external entities that engage in the day-to-day administration of HHS programs across the country.

Budget decision-making in HHS will be key to Departmental coordination of program activity and performance measurement in HHS. In recent years, HHS modified its Departmental budget formulation processes specifically to better bring together information and leaders from throughout the Department to define the program initiatives that will move HHS toward the accomplishment of its mission. Anticipating that GPRA information will enhance this decision-making process, HHS combined GPRA annual planning and reporting with the budget formulation process and into the HHS budget documents. The Department is an entity that is focused on concerted progress toward the achievement of the mission, goals, and objectives of this Strategic Plan through its Departmental initiatives. As GPRA implementation continues to mature, program executives and managers throughout HHS will use trend data on performance results to seek the coordinated improvement of HHS programs on an ongoing basis, specifically by: 1) assessing performance activity and results, 2) engaging in program evaluation activity where deeper assessment is required, 3) redefining program strategies to produce improved results, and 4) modifying future performance targets to be consistent with available resources and up-to-date priorities and policy decisions.

PROGRAM EVALUATION

HHS is committed to ensuring that its evaluations yield valuable knowledge, and that this knowledge is used to complement annual performance planning and reporting.

In the era of results-oriented management, evaluations are playing an increasingly important role in strategic planning, performance management, and program improvement. Evaluations conducted by HHS agencies generally serve one or more of the following purposes: to evaluate program effectiveness, develop performance measurements, assess environmental impacts on health and human services (i.e., external factors affecting program performance), and improve program management.

The results of these evaluations are increasingly being used by HHS program managers to inform the annual performance planning process and the interpretation and reporting of annual performance data. Program effectiveness provides a way to determine the impact of HHS programs on achieving intended goals and objectives. Performance measurement is the primary mechanism used to monitor annual progress in achieving departmental strategic and annual performance goals. To support performance measurement, we are investing evaluation funds to develop and improve performance measurement systems and improve the quality of the data that support those systems. We use environmental assessment monitor and forecast changes in the health and human services environment that will influence the success of our programs and the achievement of our goals and objectives. In turn, this understanding allows us to adjust our strategies and continue to deliver effective health and human services. Program management evaluations program managers with the necessary information or data helpful for effectively designing and managing a program. These evaluations generally focus on developmental or operational aspects of program activities and provide understanding of services delivered and populations served.

FINANCIAL MANAGEMENT

All HHS resources are used appropriately, efficiently, and effectively. Decision makers should have timely, accurate, and useful program and financial information.

The HHS CFO Financial Management Status Report and Five Year Plan highlights the functions that will affect the financial condition and resources of HHS programs until 2005. This financial planning document, updated, and published every year, puts forth two strategic financial management goals for the Department (highlighted immediately above) that are focused on a vision where managers at all levels work with program partners to provide services to the American people.

Under the auspices of the Government Management Reform Act (GMRA), HHS continues to improve the financial management of its programs and supporting activities. Individual OPDIV and HHS financial statements and audits are key tools for determining how well the Department manages taxpayer funds. It is important that we continue to maintain our efforts to receive unqualified "clean" audit opinions from auditors for its accounts. The financial integrity of the Medicare program is an important Department objective. Although the Department as achieved a "clean" audit opinion for the program, we are continuing to improve the financial management system underlying the program. This includes validating the financial management systems of all Medicare claims processing contractors and evaluating commercial off-the-shelf software for development of an integrated general ledger system to standardize the accounting systems used by contractors (see Objective 3.6).

The annual HHS Accountability Report integrates financial information with key GPRA program performance results and other management reports. The report provides HHS managers, the Congress, and the public with information that will become increasingly important for decision making and will show the costs of the programs of HHS.

One of the management reports included in the HHS Accountability Report delineates the results of the HHS CFO Financial Management Status Report and Five Year Plan. This plan covers the many functions that affect the financial condition and resources of HHS and support the Department's financial management goals.

Six management priorities have been identified to achieve these goals:

• Improve financial accountability.

• Improve financial management systems.

• Develop human resources and CFO organizations.

• Improve management of receivables.

• Use electronic commerce to improve financial management.

• Improve administration of Federal grant programs.

BUSINESS MANAGEMENT FOR GRANTS AND ACQUISITION

HHS will better focus grant and contract resources toward achieving the Department's program objectives. We will support the Administration's goal of developing and utilizing the nation's small business capacity.

Another vital component of the Department's corporate strategy involves intense management of its relationships with the external contractor and grantee communities. These relationships play a crucial role in the delivery of HHS's mission objectives and account for the spending of over $155 billion annually. Our objectives, summarized immediately above, seek to focus grant and contract resources toward achieving the Department's program objectives and to support the Administration's goal of developing and utilizing the nation's small business capacity.

Prominent among the Department's strategies are the HHS Scorecards for acquisition and grants that strive to achieve balance among various perspectives and goals, such as efficient business processes, innovative leadership, empowered employees, satisfied customers, and dedicated grantees and vendors. This cost-effective grants and acquisition performance management approach will help HHS to:

• Gauge the overall health of its grants and acquisition systems.

• Target opportunities for organizational improvement.

• Achieve its program missions.

• Give grants and acquisition executives a useful risk management and decision-making tool.

• Promote the sharing of successful practices.

• Gauge our progress in implementing grants and acquisition reform initiatives.

The balanced scorecard strategies that have been devised by the Office of Grants and Acquisition Management in the Office of the Assistant Secretary for Management and Budget are being implemented by HHS Operating Divisions.

To further improve results through the objectives of the HHS grants and acquisition management enterprise, the Department will employ additional implementation strategies, such as:

• Departmental business managers will team with OPDIV counterparts to develop creative policy guidance, techniques, and best practices.
  Departmental training programs will develop and certify business managers throughout the OPDIVs.

• A knowledge management system called the Knowledge Exchange Network (KEN) uses the Internet to automate training courses and provide operational business managers easy access to the guidance and latest techniques.

• Participatory balanced scorecard improvement systems will allow OPDIV business offices to oversee and continually benchmark operations.

• HHS corporate business managers team with the Office of Management and Budget (OMB) and counterparts in sister agencies to improve policies and develop new initiatives to manage and improve the government's business processes.

• HHS leadership in the Inter-Agency Electronic Grants Committee will result in a "Federal Commons" designed to provide all types of grantee organizations, with a common "face" for conducting grants business electronically. As the largest grant-making component in the federal government, HHS plays a key role in the federal grants management arena.

• HHS has developed systems to streamline, target, and improve the accountability of its partners consistent with Single Audit Act Amendments and various legislative initiatives. Systems will ensure that all grantees that are required to submit federal Single Audits do so.

• For Electronic Government/Electronic Commerce (E-Gov/EC), HHS has set forth three goals to meet a Departmental E-Gov/EC vision. HHS's vision is for an enterprise-wide electronic environment where best business practices and enabling technologies are used to facilitate the most efficient exchange of business information resulting in streamlined and rapid response to the customer and supporting the HHS mission. The E-Gov/EC goals supporting this vision are:

• Achieve flexibility, increased productivity, and a dynamic working environment through the application of E-Gov/EC.

• Achieve efficient and effective responses to changing environments by the introduction of business process improvements or reengineering and the exploitation of E-Gov/EC technologies.

• Achieve cultural changes from the current business practices through guidance and the attainment of necessary skills for the implementation of E-Gov/EC.

HUMAN RESOURCES MANAGEMENT

Mission accomplishment in HHS--as everywhere--means having the right people with the right skills doing the right jobs at the right time.

Workforce Planning. Making full use of the contributions of the work force requires analysis to know what skills are needed and planning to make sure that employees have those skills. Effective workforce planning supports budget requests, provides a solid basis for staffing requests, and documents our human resource needs. The workforce planning model that will serve the Department in meeting these objectives is based on a business model that analyzes the present workforce, identifies organizational objectives and the workforce competencies needed to achieve them, compares present workforce competencies to those needed in the future, and develops plans to transition from the present workforce to the future workforce. The definitive HHS workforce planning document, Building Successful Organizations, has been developed by the Office of Human Resources of the Office of the Assistant Secretary for Management and Budget. It outlines the Department's expectations for workforce planning over the next few years and provides a consistent model that program units throughout HHS can use to ensure that budget requests reflect and present the workforce conditions and needs of the agencies.

Workforce Improvement. HHS will collaborate with the President's Management Council as it generates Government-wide tools to elevate the principles upon which we evaluate the federal workforce. With renewed emphasis that workforce performance evaluation must rest on program results and feedback from customers and employees, the Department will direct its efforts to communicate clear expectations of performance to all employees and it will validate accountability through defined priorities and goals that apply across the executive leadership team.

Quality of Work Life. The Quality of Work Life Plan reflects the Department's commitment to three characteristics: improve employee satisfaction, strengthen workplace learning, and better manage change and transition. Achievement of these objectives requires a willingness to share power, extensive training for workers, managers, and executives, and considerable patience by all involved. Further, it requires openness, trust, and information sharing by management. It cannot be mandated by management, but rather it must involve process in which the employees buy into the concept. The HHS Quality of Work Life effort has identified a number of issues, including:

• Improving communication.

• Strengthening family friendly programs.

• Evaluate and enhance diversity practices.

• Better planning and management of change.

INFORMATION TECHNOLOGY MANAGEMENT

To carry out its corporate mission and ensure critical infrastructure protection, HHS will optimize management of its information systems infrastructure.

Enterprise Infrastructure Management (EIM). Building on the information technology tools provided by the Clinger-Cohen Act and PDD 63: Critical Infrastructure Development, EIM signals the Department's intention to build greater consistency and efficiency into information technology management across HHS. Threats to computer security and the need to minimize information technology costs invite the enterprise approach to technology management that HHS is pursuing. The EIM effort that has been undertaken by the Office of Information Resources Management (OIRM) of the Office of the Assistant Secretary for Management and Budget emphasizes the importance of developing information systems that meet the need for more reliable network and systems availability, improved configuration management and software distribution, and flexibility in supporting changing needs while providing state of the art security and privacy.

PROPERTY MANAGEMENT

HHS will prudently manage the personal and real property assets owned by HHS. To ensure high-quality stewardship over the Department's investment in property, HHS will continue to improve the accuracy of accounting for real and personal property.

For real property tracking, HHS will continue the implementation of the Foundation Information for Real Property Management (FIRM) database, an automated tool provided by the General Services Administration to enhance accountability for real property across the federal government. FIRM will ensure consistent, automated management and accounting for real property Department-wide. To assure high-quality stewardship over the Department's investment in property, HHS will continue to improve the accuracy of accounting for real and personal property and it will establish a self-assessment program for personal property management. The Department has already exceeded initial annual performance targets for the "location accuracy" of personal property, achieving a 97% accuracy rate in 1999, when a 92% rate was planned. HHS will now pursue maintaining this 97% accuracy rate over time.

PROGRAM INTEGRITY PARTNERSHIP WITH THE HHS OFFICE OF INSPECTOR GENERAL

The detection and elimination of health care fraud and abuse is a top priority of federal law enforcement.

Although by design the Office of Inspector General (OIG) is an independent entity to ensure the objectivity of its findings and reports, HHS and the OIG have established an unprecedented partnership to reduce fraud and abuse and improve program integrity, especially in the large Medicare and Medicaid programs. For this purpose, the Congress and the Administration have provided the tools that have made this partnership possible, and they have extended the partnership to include the Department of Justice. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) will continue to allow for the consolidation and coordination of HHS, OIG, and Department of Justice efforts to combat fraud through prosecutions and other enforcement actions, through collaboration and information sharing, and through prevention and outreach to the business community.

CUSTOMER SERVICE

Customer service is a prominent element of HHS accountability and self-assessment.

Vice President Gore's National Partnership for Reinventing Government (NPR) has provided multiple tools that have enhanced the focus of HHS and other federal agencies on customer service over the past five years. In addition to an extensive array of programmatic initiatives focused on customer service throughout HHS, the Department will continue to work with the NPR in its use of customer service tools such as the High Impact Agency customer satisfaction surveys and public conversations with Americans to identify and act on feedback from HHS beneficiaries and customers. HHS will collaborate with the President's Management Council (PMC) and other federal agencies in their efforts to encourage federal agencies to look to the customer service features offered by the Balanced Scorecard method for their programs, particularly as an element that underlies agency and employee performance assessment.

GAO AND OIG DESIGNATED "MAJOR MANAGEMENT CHALLENGES"

HHS performance plans are a prominent tool for addressing the management challenges identified by the General Accounting Office and the HHS Office of Inspector General.

The Office of Inspector General (OIG) and the General Accounting Office (GAO) have also served HHS and other federal agencies through ongoing review and analysis of high-risk areas and major management challenges. HHS uses GAO and OIG findings to improve the management of its programs. Specifically, nearly all of the GAO and OIG major management challenges that were identified in an August 1999 letter to the Secretary of HHS from the Senate Committee on Governmental Affairs were addressed in the HHS GPRA performance plans. For example, one of the management challenges that were cited was "Medicare payment errors." As reflected in its GPRA annual performance plan and annual performance report, HCFA exceeded its FY 1999 GPRA performance goal of reducing Medicare fee-for-service payment errors to 9 percent. Medicare fee-for-service payment errors were 14 percent in 1996 and dropped to 7.9 percent in 1999. HCFA seeks to reduce the error rate to 6 percent in 2001 and 5 percent in 2002.

Appendix I - HHS Department Organization

The Department of Health and Human Services (HHS) works to accomplish our mission through the separate and collaborative efforts of our operating divisions and staff offices within the Office of the Secretary (OS):

OPERATING DIVISIONS

Administration on Aging (AoA) serves as the primary federal focal point and advocacy agent for older Americans. Through a network of state and area agencies on aging, AoA funded programs deliver comprehensive in-home and community services; and make legal services, counseling, and ombudsmen programs available to elderly Americans.

Administration on Children and Families (ACF) leads the nation in improving the economic and social well-being of families, children, and communities though federal grant programs like Head Start, Child Support Enforcement, Child Welfare Services, Child Care and Development, and Temporary Assistance to Needy Families.

Agency for Healthcare Research and Quality (AHRQ) provides evidence-based information on health care outcomes; quality; and cost, use, and access. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.

Agency for Toxic Substances and Disease Registry (ATSDR) prevents exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment.

Centers for Disease Control and Prevention (CDC) monitors health; identifies and investigates public health problems; promotes healthy behaviors; and develops and advocates sound public health policies to prevent and control disease, injury, and disability.

Food and Drug Administration (FDA) promotes improvement in the health of the American public by ensuring the effectiveness and/or safety of drugs, medical devices, biological products, food, and cosmetics; and by encouraging the active participation of business and the public in managing the health hazards associated with these products.

Health Care Financing Administration (HCFA) pays Medicare benefits; provides states with matching funds for Medicaid benefits and funds for the State Children's Health Insurance Program; conducts research, demonstrations, and oversight to ensure the safety and quality of medical services, and and laboratories serving beneficiaries; and establishes rules for eligibility and benefit payments.

Health Resources and Services Administration (HRSA) promotes equitable access to comprehensive, quality health care for all, with a particular focus on under-served and vulnerable populations.

Indian Health Service (IHS) provides comprehensive health services for American Indian and Alaska Native people, with opportunity for maximum tribal involvement in developing and managing programs to improve health status and overall quality of life.

National Institutes of Health (NIH), through its 25 institutes, centers, and divisions, supports and conducts medical research, domestically and abroad, into the causes and prevention of diseases and promotes the acquisition and dissemination of medical knowledge to health professionals and the public.

Substance Abuse and Mental Health Services Administration (SAMHSA) through its three centers, works to improve quality and availability of prevention, early intervention, treatment, and rehabilitation services for substance abuse and mental illness, including co-occurring disorders, in order to improve health and reduce illness, death, disability, and cost to society.

STAFF DIVISIONS/OFFICE OF THE SECRETARY (OS)

Assistant Secretary for Management and Budget (ASMB) advises the Secretary on all aspects of administration and financial management, and provides general oversight and direction of the administrative and financial organizations and activities of the Department.

Assistant Secretary for Planning and Evaluation (ASPE) provides policy analysis and advice; guides the formulation of legislation; coordinates strategic and implementation planning; conducts regulatory analysis and reviews regulations; oversees the planning of evaluation, non-biomedical research, and major statistical activities; and administers evaluation, data collection, and research projects that provide information needed for HHS policy development.

Office for Civil Rights (OCR) promotes and ensures that people have equal access to and opportunity to participate in and receive services in all HHS programs without facing unlawful discrimination. Through prevention and elimination of unlawful discrimination, the Office for Civil Rights helps HHS carry out its overall mission of improving the health and well-being of all people affected by its many programs.

Office of Inspector General (OIG) improves HHS programs and operations and protects them against fraud, waste, and abuse. By conducting independent and objective audits, evaluations, and investigations OIG provides timely, useful, and reliable information and advice to Department officials, the Administration, the Congress, and the public.

Office of Public Health and Science (OPHS) provides senior professional leadership across HHS on population-based public health and clinical preventive services by providing scientifically sound advice on health and health policy to the Secretary, Departmental officials and other governmental entities and communicating on health issues directly to the American public; conducting essential public health activities through eleven program offices, and providing professional leadership on cross-cutting Departmental public health and science initiatives.

Program Support Center (PSC) provides a broad range of administrative services to HHS components and other federal agencies on a competitive, fee-for-service basis. PSC services are provided in three business areas: human resources, financial management, and administrative operations.

Appendix J - Strategic Objectives/HHS Programs Cross-Reference chart

The cross reference chart that follows relates the Department of Health and Human Services (HHS) Strategic Objectives to key HHS programs. Each diamond in the grid indicates that the program activity supports, or is related to, the respective strategic objective(s).

Internet users note: The charts below look best when printed. Set your browser to "landscape" orientation and set the left and right margins to .5. To do this, go to "Page Setup" under the "File" menu.