Secretary’s Message

Michael O. Leavitt

Secretary of Health and Human Services

The President of the United States has given me a very clear mission: to help Americans live longer, healthier, and better lives, and to do it in a way that protects our economic competitiveness as a Nation.

To meet this charge, the HHS Strategic Plan, Fiscal Years 2007–2012 (Strategic Plan), will address health care; public health promotion and protection, disease prevention, and emergency preparedness; human services; and scientific research and development over the next 5 years. These broad goals represent the mission of the U.S. Department of Health and Human Services (HHS) and encompass its central functions.

Health Care – At some point in our lives, every one of us is or will become a health care consumer. HHS’s strategic objectives focus on increasing the value of health care by measuring quality and cost in a standardized and comparable way, broadening access to health insurance coverage and access to health care, and investing in the health care industry infrastructure and personnel. These efforts will provide better health care at lower cost for more Americans.

Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness – Events such as Hurricane Katrina and the attacks of September 11, 2001, are reminders that HHS must be prepared to respond efficiently and effectively to a natural or manmade public health disaster. At the same time, chronic and infectious diseases claim hundreds of thousands of lives in this country each year. Efforts to improve and protect public health range from a focus on healthy lifestyles, immunizations, food safety, and health literacy to developing planning tools and building stockpiles of medicine and supplies to respond to an outbreak of pandemic influenza.

Human Services – The economic and social well-being of individuals, families, and communities is fundamental to human dignity and a healthy life. HHS is dedicated to encouraging the development of healthy and supportive families and communities and to promoting economic independence and social well-being across the lifespan. HHS is particularly committed to ensuring the safety, stability, and healthy development of the Nation’s children and youth.

Scientific Research and Development – In order to continue leading the world in cutting-edge science and medicine, HHS must invest in the expansion of scientific knowledge and the pool of qualified researchers. Today, Americans have an unparalleled opportunity to attain more personalized health care through the marvels of modern science. HHS will continue to provide educational grants, training, and fellowship programs and to fund research and clinical trials that are ethical and have the potential to improve public health and well-being.

This Strategic Plan lays out the action steps that HHS will take to meet the President’s vision for a stronger, healthier United States. I appreciate the hard work and dedication that more than 67,000 employees throughout the HHS family of agencies have shown in advancing the Department’s initiatives this year, and I look forward to working together to continue meeting expectations for the present and the challenges of the future.

Michael O. Leavitt

Secretary

Health and Human Services

Executive Summary

Healthy and productive individuals, families, and communities are the foundation of the Nation’s present and future security and prosperity.Through leadership in the medical sciences and public health and human service programs, the U.S. Department of Health and Human Services (HHS) seeks to improve the health and well-being of people in this country and throughout the world.

Since HHS submitted its last strategic plan to the U.S. Congress in 2004, HHS has made significant strides in improving the lives of Americans. HHS has made progress through the efforts of every HHS operating and staff division.Breakthroughs in health information technology have accelerated the development and adoption of this promising resource. Medicare beneficiaries have greater access to their medications because of the Medicare prescription drug benefit. Medicaid can tailor benefits to needs because its modernization efforts have made the program more flexible and sustainable. HHS deployed medical supplies and Federal Medical Shelters from the Strategic National Stockpile to help with mass casualty care needed after Hurricanes Katrina and Rita. The newly created Drug Safety Oversight Board has provided independent recommendations related to drug safety to the Food and Drug Administration and shared information with health care professionals and patients. HHS Compassion Capital Fund has strengthened the capacity of grassroots, faith-based, and community organizations to provide a wide range of social services. Advances in the understanding of basic human biology enabled sequencing of the human genome 2 years ahead of schedule.

Although HHS has made great progress, it must continue its current efforts to sustain positive outcomes and augment them with new, innovative strategies to continue to improve the Nation’s health and well-being. At the same time, HHS must work diligently to address emerging and reemerging health threats. These include a possible influenza pandemic; the rise of drug-resistant strains of tuberculosis and HIV; and potential terrorist attacks involving chemical, biological, radiological, and nuclear agents.

HHS Strategic Plan, Fiscal Years 2007–2012 (Strategic Plan), provides direction for HHS efforts to improve the health and well-being of the Nation. The Strategic Plan’s goals and objectives direct HHS efforts to improve health care, promote and protect the public’s health, enhance human services, and advance the research and development enterprise. The Strategic Plan also addresses emerging threats to the health and well-being of Americans.

The Strategic Plan encompasses the major areas of focus for HHS at the goal level and lays out the primary strategies for achieving these goals. However, it does not include all actions that HHS might take to achieve any one objective. Given the size and breadth of HHS and its programs, it would be impractical to provide a comprehensive list of all HHS-supported strategies and activities. Strategic objectives are not meant to be a catalog of all potential implementation plans; they merely indicate the priorities and general direction HHS intends to take.

Chapter 1: Introduction and Overview

Mission

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

Core Principles^{^[i]}

The Secretary has developed core public policy principles, which serve as the basis for the Department’s efforts toward achieving its mission. These principles of governance form the philosophical backbone for how HHS approaches and solves problems. The nine principles, listed to the right, are not all inclusive, but they do provide the philosophical underpinnings for this Strategic Plan, and they will be incorporated into other planning documents used by HHS.

Organization

Eleven operating divisions, including eight agencies in the United States Public Health Service (USPHS) and three human service agencies, administer HHS’s programs. Eighteen staff divisions provide leadership, direction, and policy and management guidance to the Department. (A complete list of HHS’s operating and staff divisions and a brief description of their activities appear in Appendix F.) HHS works closely with State, local, and tribal governments, and many HHS-funded services are provided at the local level by State, county, local, or tribal agencies, or through grantees in the private sector, including faith-based and community-based organizations.

HHS accomplishes its mission through more than 300 programs and initiatives that cover a wide spectrum of activities, including the following:

Providing Medicare (health insurance for Americans who are 65 or older, who are disabled, or who suffer from end stage renal disease) and Medicaid (health insurance for low-income people);
Assuring the safety of food and medical products;
Delivering comprehensive health care for Native Americans;
Promoting access to insurance for the uninsured and necessary health services for medically underserved individuals;
Creating an environment that supports the use of health information technologies;
Preventing disease through immunization;
Promoting healthy lifestyles;
Promoting healthy dietary practices, good nutrition, and regular physical activity;
Improving the oversight of imported food and medical products;
Supporting the prevention and treatment of substance abuse;
Improving maternal and infant health;
Planning and preparing for public health emergencies, including those that result from terrorism;
Providing Head Start (preschool education and services);
Preventing child abuse and domestic violence;
Supporting faith-based and community initiatives;
Improving systems of services in communities to enhance the health and well-being of children and youth with special health care needs and their families;
Providing financial assistance and services for low-income families;
Offering services for older Americans, including home-delivered meals;
Furthering access to health and human services by protecting health information privacy and preventing discrimination in the delivery of these services; and
Conducting, supporting, and overseeing scientific and biomedical research and development related to health and human services.

With an FY 2007 budget of $698 billion, HHS represents almost a quarter of all Federal expenditures and administers more grant dollars than all other Federal agencies combined. More than 66,000 people work for HHS.[ii] Every 3 years, HHS updates its strategic plan, which describes its operating and staff divisions that work individually and collectively to address complex, multifaceted, and ever-evolving health and human service issues.

Developing and Updating the Strategic Plan

An agency strategic plan is one of three main elements required by the Government Performance and Results Act (GPRA) of 1993 (Public Law 103-62). The basic requirements for strategic plans appear in the Office of Management and Budget (OMB) Circular No. A-11, Part 6, Section 210. According to OMB, “an agency’s strategic plan keys on those programs and activities that carry out the agency’s mission. Strategic plans will provide the overarching framework for an agency’s performance budget.[iii]

In constructing the Strategic Plan, HHS sought to respond to the requirements of both GPRA and OMB. At the same time, HHS incorporated priorities and concepts from the Secretary’s 500-Day Plan, the Secretary’s Ten Health Care Priority Activities, the Departmental Objectives, and the Healthy People 2010 Objectives. Although some of these plans and priorities may change from year to year, the most recent versions appear later in this chapter, in a special section called In the Spotlight: HHS Plans and Priorities.

Each of the Department’s operating and staff divisions contributed to the development of this Strategic Plan, from the goals and the broad strategic objectives to the baselines and targets for performance indicators. Representatives from HHS operating and staff divisions provided expert knowledge of HHS’s programs, initiatives, priorities, and performance indicators. This process emphasized creating alignment between the long-range Strategic Plan and annual GPRA reporting in the HHS Annual Performance Plan, Annual Performance Budgets, and Performance and Accountability Report. More information about this alignment appears in Appendix C, Performance Plan Linkage.

In developing and selecting performance indicators, HHS sought to include broad health and human service impact measures as well as more intermediate processes and outcomes that have contributed to distal impacts. In several cases, numerous operating and staff divisions play a role in achieving these impacts. Operational and staff division personnel regularly monitor thousands of additional performance indicators to improve program processes and examine effectiveness. However, in this Strategic Plan, HHS focused on a limited set of broad outcomes and impacts to demonstrate Departmental progress.

Consultation

HHS regularly consults with external stakeholders, as noted in Chapters 2 through 5. In complying with OMB guidance and GPRA, HHS consulted widely with stakeholders to garner input on the Strategic Plan. HHS posted a draft on its Web site (http://www.hhs.gov), invited public comment through a notice in the Federal Register, and briefed a number of State, local, and tribal organizations. HHS also sought input from the U.S. Congress and OMB.

During its consultation process, HHS received correspondence from more than 40 individuals or organizations, containing nearly 200 unique suggestions. Input ranged from editorial to more substantive comments. HHS has incorporated many of these changes and additions to the final plan.

Structure

Chapters 2 through 5 present the four strategic goal areas:

Health Care. Promote access to insurance for the uninsured and necessary health services for individuals who are medically underserved;
Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness. Prevent and control disease, injury, illness, and disability across the lifespan, and protect the public from infectious, occupational, environmental, and terrorist threats;
Human Services. Promote the economic and social well-being of individuals, families, and communities; and
Scientific Research and Development. Advance scientific and biomedical research and development related to health and human services.

Chapter 2 focuses on the Health Care strategic goal. It highlights the efforts of HHS to improve the safety, quality, affordability, and accessibility of health care, including behavioral health care and long-term care. HHS’s Administration on Aging (AoA), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA), and the Indian Health Service (IHS) have a significant role to play in realizing this goal. In addition, HHS’s Food and Drug Administration (FDA), Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office for Civil Rights (OCR), Office on Disability (OD), Office of Public Health and Science (OPHS), and Substance Abuse and Mental Health Services Administration (SAMHSA) play roles in addressing this goal.

There are four broad strategic objectives under Health Care:

Broaden health insurance and long-term care coverage;
Increase health care service availability and accessibility;
Improve health care quality, safety, cost, and value; and
Recruit, develop, and retain a competent health care workforce.

This chapter also highlights two sections of particular significance to HHS in the area of health care, both now and over the next 5 years:

In the Spotlight: Reducing Health Disparities gives a brief overview of disparities that still exist in America and outlines the HHS response to combat these disparities.
In the Spotlight: Advancing the Development and Use of Health Information Technology provides a brief but indepth explanation of the efforts HHS will be undertaking to promote the use of this important tool.

Chapter 3 explains the strategic goal of Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness. This chapter outlines the steps that HHS will take to prevent and control disease, injury, illness, and disability across the lifespan and to protect the public from the health consequences of infectious, occupational, environmental, and terrorist threats. Key operating and staff divisions that contribute to this goal include the Centers for Disease Control and Prevention (CDC), FDA, HRSA, Office of the National Coordinator for Health Information Technology (ONC), Office of the Assistant Secretary for Preparedness and Response (ASPR), and SAMHSA. In addition, AoA, CMS, OCR, OD, the Office of Global Health Affairs (OGHA), and OPHS play roles in addressing this goal.

There are four broad strategic objectives under Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness:

Prevent the spread of infectious diseases;
Protect the public against injuries and environmental threats;
Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery; and
Prepare for and respond to natural and manmade disasters.

This chapter also features two significant public health efforts HHS is undertaking and will continue to develop over the next 5 years:

In the Spotlight: Emergency Preparedness, Prevention, and Response explains how HHS will prepare for and respond to public health and medical emergencies.
In the Spotlight: Global Health Initiatives explains the strategies to promote health and public health beyond our own borders.

Chapter 4 details the Human Services strategic goal. This goal seeks to protect and value life, family, and human dignity by promoting the economic and social well-being of individuals, families, and communities; supporting the safety and well-being of children, youth, older people, and other vulnerable populations; and strengthening communities. The Administration for Children and Families (ACF), AoA, the Center for Faith-Based and Community Initiatives (CFBCI), and OD are among the divisions primarily responsible for achieving this strategic goal. In addition, CDC, HRSA, OCR, OPHS, and SAMHSA play important roles.

There are four broad objectives under Human Services:

Promote the economic independence and social well-being of individuals and families across the lifespan;
Protect the safety of children and youth, and foster their well-being;
Encourage the development of strong, healthy, and supportive communities; and
Address the needs, strengths, and abilities of vulnerable populations.

This chapter also discusses how a changing America will impact HHS’s efforts and strategies in the coming years. In the Spotlight: Demographic Changes and Their Impact on Health and Well-Being explains how HHS is working to meet the health, public health, and human service needs of a population that will grow older and increasingly diverse in the next 5 years.

HHS’s commitment to Scientific Research and Development appears in Chapter 5. The chapter outlines efforts to advance scientific and biomedical research and development related to health and human services. This strategic goal will be achieved through the contributions of AHRQ, CDC, FDA, OPHS and, most significantly, the National Institutes of Health (NIH).

There are four broad objectives under Scientific Research and Development:

Strengthen the pool of qualified health and behavioral science researchers;
Increase basic scientific knowledge to improve human health and development;
Conduct and oversee applied research to improve health and well-being; and
Communicate and transfer research results into clinical, public health, and human service practice.

Chapters 2 through 5 describe how HHS will accomplish the goals and measure their achievement:

Strategic objectives for each broad goal organize the activities into four distinct areas of focus. In most cases, several HHS operating and staff divisions contribute to the realization of a strategic objective;

Narrative sections, organized by strategic objective, illustrate some of the major strategies and activities undertaken by HHS operating and staff divisions. These sections present key intradepartmental and interdepartmental coordination efforts;

Specific performance indicators for each objective are listed, with baselines and 2012 targets. Appendix B provides a list of the data sources for these performance indicators; and

External influences that affect successful achievement of the goals, and HHS’s strategies in response to these influences, are described.

Chapter 6, Responsible Stewardship and Effective Management, illustrates the commitment of HHS to formulate, implement, and execute efficient administrative support for its programs. These activities do not appear as goals in the Strategic Plan because they are not intended to be separate from the overall management process that supports the Department. The chapter details strategies for effective management of human capital, information technology, and resources, as well as effective planning, oversight, and strategic communications.

Finally, appendixes provide additional specific information about supporting materials related to the Strategic Plan.

HHS conducts high-quality program evaluations to learn more about the effectiveness of its interventions and uses the findings to improve program performance. These comprehensive, independent studies are an important component of the HHS strategy to improve overall effectiveness by assessing whether programs are effective, well designed, and well managed. Appendix A, HHS Program Evaluation Efforts, describes how HHS has used program evaluations to develop the Strategic Plan. This appendix offers examples of existing and planned program evaluations that will inform decisions and activities over the next 5 years.

Appendix B, Performance Indicators—Supplemental Information, lists the data sources for each of the performance indicators listed in the Strategic Plan, as well as fiscal year information for baselines and targets. This information is presented by strategic goal.

Appendix C, Performance Plan Linkage, describes how the Strategic Plan will drive the Annual Performance Plan and Annual Performance Budgets, as well as how it will complement Secretarial priorities.

Because of the rapid changes in computer technology in recent years, HHS has included an additional section focused on this issue. Appendix D, Information Technology, details HHS’s enterprise and information architecture strategies and presents insights on innovations and future trends. Unlike In the Spotlight: Advancing the Development and Use of Health Information Technology, which focuses on the use of this resource to support the public, this appendix focuses on how HHS uses this resource internally.

Finally, several appendixes offer useful reference material for readers: The HHS organizational chart is in Appendix E; Appendix F consists of an overview of HHS operating and staff divisions and their primary functions; Appendix G lists acronyms used throughout the Strategic Plan; and endnotes are listed in Appendix H.

In the Spotlight: HHS Plans and Priorities

This Strategic Plan for FY 2007–2012 incorporates priorities and concepts from the Secretary’s 500-Day Plan, the Secretary’s Ten Health Care Priority Activities, the Departmental Objectives, and the Healthy People 2010 Objectives. Although some of these plans and priorities may change from year to year, a sampling of the most recent versions is included here.

Secretary’s 500-Day Plan

Secretary Leavitt uses a 500-Day Plan, updated every 200 days, as a management tool to guide his energies in fulfilling the vision of a healthier and more hopeful America. The Secretary focuses on specific strategies that will achieve significant progress for the American people over a 5,000-day horizon. The 500-Day Plan supports the Strategic Plan in guiding the Department in achieving its broad policy and program objectives. The priorities include:

Transform the Health Care System;
Modernize Medicare and Medicaid;
Advance Medical Research;
Secure the Homeland;
Protect Life, Family, and Human Dignity; and
Improve the Human Condition Around the World.

Secretary’s Health Care Priorities

In 2006, the Secretary developed 10 HHS Priority Activities for America’s Health Care; these too are updated annually:

Health Care Value Incentives;
Health Information Technology;
Medicare Rx;
Medicaid Modernization;
New Orleans Health System;
Personalized Health Care;
Obesity Prevention;
Pandemic Preparedness;
Emergency Response and Commissioned Corps Renewal; and
International Health Diplomacy.

Departmental Objectives

Last updated in 2006, 20 Departmentwide objectives express the breadth and scope of the Department’s activities. Updated annually, they expand on the Secretary’s goals from the 500-Day Plan and include objectives related to effective management and responsible stewardship:

Accelerate Personalized Health Care;
Recruit, Develop, Retain, and Strategically Manage a World-Class HHS Workforce;
Modernize Medicaid;
Continue Our Leadership Role and Success in Competitive Sourcing;
Turn Adversity to Advantage for the New Orleans Health System;
Improve Financial Performance;
Promote Health Information Technology;
Expand Electronic Government;
Continue to Improve Medicare;
Improve Budget and Performance Integration;
Harness the Power of Transparent Health Care;
Implement the Real Property Asset Management Program and Strategically Manage Our Real Property;
Emphasize Prevention and Healthy Living;
Broaden Health Insurance and Long-Term Care Coverage;
Prepare for an Influenza Pandemic;
Promote Quality, Relevance, and Performance of Research and Development Activities;
Enhance Emergency Response and Renew the Commissioned Corps;
Improve the Service of Management Functions and Administrative Operations for the Support of the Department’s Mission;
Emphasize Faith-Based and Community Solutions; and
Eliminate Improper Payments.

Healthy People 2010

Healthy People 2010 is a comprehensive set of disease prevention and health promotion objectives for the Nation to achieve over the first decade of the new century. Overarching goals are to increase quality and years of healthy life and eliminate health disparities. There are 28 focus areas:

Access to Quality Health Services;
Arthritis, Osteoporosis, and Chronic Back Conditions;
Cancer;
Chronic Kidney Disease;
Diabetes;
Disability and Secondary Conditions;
Educational and Community-Based Programs;
Environmental Health;
Family Planning;
Food Safety;
Health Communication;
Heart Disease and Stroke;
HIV;
Immunization and Infectious Diseases;
Injury and Violence Prevention;
Maternal, Infant, and Child Health;
Medical Product Safety;
Mental Health and Mental Disorders;
Nutrition and Overweight;
Occupational Safety and Health;
Oral Health;
Physical Activity and Fitness;
Public Health Infrastructure;
Respiratory Diseases;
Sexually Transmitted Diseases;
Substance Abuse;
Tobacco Use; and
Vision and Hearing.

Chapter 2: Strategic Goal 1: Health Care

Improve the safety, quality, affordability, and accessibility of health care, including behavioral health care and long-term care.

Text Box: STRATEGIC GOAL 1: HEALTH CARE

Strategic Objective 1.1: Broaden health insurance and long-term care coverage.

Strategic Objective 1.2:
Increase health care service availability and accessibility.

Strategic Objective 1.3:
Improve health care quality, safety, cost, and value.

Strategic Objective 1.4:
Recruit, develop, and retain a competent health care workforce. Today, disease, illness, and disability can be as much a threat to Americans’ financial well-being as they are to Americans’ physical and mental well-being. Every American deserves reliable, high-quality, and reasonably priced health care that will be there when it is needed. Health care has to be available, affordable, portable, transparent, and efficient.

Health care in the United States is second to none, but it can be better. Although our Nation’s health care facilities and medical professionals are the best in the world, improving quality, constraining costs, and providing greater access remain key priorities.

Americans spend an increasing share of their income on health care. Health care spending in America has increased from 5 percent of Gross Domestic Product (GDP) in 1960 to more than 16 percent in 2006, and is predicted to continue to rise.[iv] The increasing burden of health spending on the U.S. economy is unsustainable. Higher spending on public programs such as Medicare and Medicaid strains Federal and State budgets. Higher insurance premiums burden workers with higher health costs and pose a challenge for employers to cover both wage increases and health insurance premiums.

The system needs to make progress in providing the excellent quality of care that all Americans deserve. We need to increase the rate at which patients receive recommended services and to reduce the number of unnecessary services. We also must eliminate preventable medical errors.

Forty-six million Americans do not have health insurance.[v] These individuals may face barriers to obtaining timely and continuous care. Because of their limited access to the system, their health problems may become more severe and further increase health care costs in the future.

One critical part of HHS’s strategy to address these problems is to improve transparency within the health care system. Because third parties such as insurance companies, employers, and governments finance the vast majority of health care spending, most Americans do not know—and do not have access to information about—the cost and quality of health care services in order to decide whether they want to receive those services.

Making health care affordable, accessible, and high quality depends on providing consumers with the knowledge they need to make informed choices about their health care coverage. The Federal Government must lead in accomplishing these objectives. We are encouraged that others in the private sector have joined in such efforts; we will continue to pursue these goals, which characterize a value-driven health care system.

The increasing costs of health care services, our increasingly older population with multiple chronic conditions, and an increasingly complex health care system challenge us to continue our efforts to develop new strategies to maintain safe and affordable services designed to meet Americans’ needs in their various income, family, and health circumstances. HHS is working to improve the efficiency and quality of health care that it finances and delivers. Promoting greater use of health information technology will ensure that accurate and timely information on a patient’s condition is available to all providers involved in the patient’s care and will reduce unnecessarily redundant diagnostic tests and office visits that add to health care costs. Implementation of value-based purchasing systems that include incentives to providers for treatment outcomes, rather than just reimbursements for treatments, will again help move the system toward more efficient and cost-effective provision of care aimed at improving the health and quality of life of the citizens touched by HHS programs.

At the same time, we must ensure that our efforts to reduce the cost of high-quality health care are reflected in more affordable and accessible health insurance coverage, to address the problem of the Nation’s growing number of citizens without health insurance. HHS continues to explore options for increasing the portability and accessibility of health insurance through innovative vehicles such as Health Savings Accounts coupled with high-deductible health plans, which have grown in popularity in recent years. Additionally, HHS is working to increase access to private health insurance for those who do not yet have it through initiatives such as Affordable Choices. Together, these initiatives will assist individuals in maintaining their health and prevent health spending from overburdening the economy.

Finally, the need to rebuild the health care infrastructure in New Orleans in the wake of Hurricane Katrina offers the Department and its State and local partners the challenge of coordinating coverage; system capacity; and workforce recruitment, retention, and development in new ways that result in a revitalized health care system for that community.

Strategic Goal 1, Health Care, targets the need for people to be able to obtain and maintain affordable health care coverage; receive efficient, high-quality health care services; and access appropriate information for informed choices. HHS’s Administration on Aging (AoA), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA), and Indian Health Service (IHS) have significant roles to play in realizing this goal. In addition, the Food and Drug Administration (FDA), Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office for Civil Rights (OCR), Office on Disability (OD), Office of Public Health and Science (OPHS), and Substance Abuse and Mental Health Services Administration (SAMHSA) play roles in addressing this goal.

There are four broad objectives under Health Care:

Broaden health insurance and long-term care coverage;
Increase health care service availability and accessibility;
Improve health care quality, safety, cost, and value; and
Recruit, develop, and retain a competent health care workforce.

Below is a description of each strategic objective, followed by a description of the key programs, services, and initiatives the Department is undertaking to accomplish those objectives. Key partners and collaborative efforts are included under each relevant objective. The performance indicators selected for this strategic goal also are presented with baselines and targets. These measures are organized by objective. Finally, this chapter discusses the major external factors that will influence HHS’s ability to achieve these objectives, and how the Department is working to mitigate those factors.

Strategic Objective 1.1: Broaden health insurance and long-term care coverage.

HHS is committed to broadening health insurance and long-term care coverage. The multifaceted approach to expanding consumer choices includes strengthening and expanding the safety net through programs such as Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP); creating new, affordable health insurance options; and creating new options for long-term care, including State Long-Term Care Partnership Programs. The operating and staff divisions contributing to the achievement of this objective include CMS, SAMHSA, AoA, HRSA, and OD.

The growing availability of prescription drugs and their cost have had a significant impact on health insurance. The first selected performance indicator, at the end of this chapter, measures the percentage of Medicare beneficiaries who have insurance coverage for prescription drugs through the Medicare drug benefit (Part D) or other coverage. This enrollment is expected to increase. Also, health care coverage for millions of present and future Medicare participants is protected by ensuring that the level of improper payments in the Medicare Fee-For-Service program remains low.

Health Insurance

Medicare

Medicare is a health insurance program for people age 65 years or older, people younger than age 65 with serious disabilities, and most people of all ages with end stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Three major categories of Medicare include: Part A, which covers inpatient hospital care, skilled nursing facilities, certain home health care, and hospice care; Part B, which encompasses physicians’ services, outpatient hospital care, and many other medical services; and Part D, the newest component of Medicare, which offers a voluntary prescription drug benefit to beneficiaries. There is also a Part C for Medicare, known as Medicare Advantage, that allows beneficiaries to choose a private health insurance plan that covers the Part A and Part B services and, in most circumstances, additional benefits and/or lower cost-sharing payments than under the traditional Medicare FFS program.

Medicare Part D. Part D is celebrated as the most significant improvement to the program since Medicare was created in 1965. More than 39 million Medicare beneficiaries now have prescription drug coverage through Part D or another source, including almost 24 million beneficiaries in Part D plans.[vi] CMS continues to improve program administration of the Medicare prescription drug benefit and to expand awareness of the program through relationships with States and pharmacists, increased use of electronic technology, and education and outreach efforts with more than sixteen thousand partners. CMS will continue these efforts to ensure that beneficiaries can get the prescriptions they need. In particular, CMS has collaborated with AoA and its grassroots Aging Services Network, consisting of State agencies on aging, area agencies on aging, and local service providers, to provide one-on-one assistance and outreach directly to beneficiaries and their caregivers.

A number of other initiatives to broaden access are currently underway or in development, such as the “My Health. My Medicare.” campaign and Medicare Medical Savings Accounts.

The “My Health. My Medicare.” campaign helps people with Medicare maximize their understanding of the benefits Medicare offers. CMS promotes beneficiary awareness through mailings, media activities, a strong Internet presence, a 24-hour-a-day toll-free telephone service, grassroots alliances, and enhanced beneficiary counseling with State Health Insurance Assistance Programs. CMS partners in this effort include the National Medicare Education Program Partnership Alliance, AoA and its Aging Services Network, State and local agencies, grassroots organizations, the AARP,[1] Medicare Today, the National Caucus and Center on Black Aged, national disability provider and constituent organizations, and other stakeholders. CMS continues to build committed partnerships at the community level; these partnerships will ensure the agency can successfully build on the “My Health. My Medicare.” campaign, as well as other health-related initiatives, in future years. These partnerships are having a profound impact on helping CMS reach the Medicare population, especially the program’s most vulnerable beneficiaries. For example, in collaboration with AoA, in addition to working with the general Medicare population, special efforts are being made to target minority populations to reduce health disparities in the Hispanic, Asian, and African-American communities, as well as in rural communities.

Medicare Medical Savings Accounts. CMS is implementing an enhanced consumer-directed Medicare Advantage product called a Medicare Medical Savings Account (MSA) plan. This type of plan combines a high-deductible health plan with a medical savings account that beneficiaries can use to manage their health care costs. CMS will offer regular MSA plans and new demonstration MSA plans. These plans will provide Medicare beneficiaries with the freedom to exercise increased control over their health care utilization while providing them with important coverage against catastrophic health care costs. CMS is providing increased flexibility with the demonstration MSA plans to make the MSAs more like the popular consumer-directed Health Savings Accounts (HSAs) available in the private sector. Examples of the types of flexibility being made available under the demonstration that are not available under the regular MSA rules include coverage of preventive services during the deductible period, a deductible below an out-of-pocket maximum, cost sharing up to the out-of-pocket maximum, and cost differentials between in- and out-of-network services.

Medicaid

Medicaid is a joint Federal- and State-funded, State-administered health insurance program available to certain low-income individuals and families who fit into an eligibility group that is recognized by Federal and State law. Using a variety of State plan options and waivers, each State establishes its own rules and guidelines regarding eligibility and service offerings, subject to approval by CMS.

CMS also offers flexible State plan options and community-living incentives. In support of these options and incentives, CMS and AoA will continue to target home- and community-based long-term care services to frail older adults who are at high risk of nursing home placement or at risk of spending down their assets. SAMHSA and CMS also will continue to collaborate on issues regarding Medicaid coverage for substance abuse and mental health services.

Children’s Health Insurance

The State Children’s Health Insurance Program (SCHIP), a State-administered program, addresses the growing problem of children without health insurance. SCHIP was designed as a Federal-State partnership, similar to Medicaid, with the goal of expanding health insurance to children whose families earn too much money to be eligible for Medicaid, but not enough money to purchase private insurance. CMS will work with the U.S. Congress to reauthorize SCHIP to ensure that these vital programs continue.

Affordable Choices

HHS has begun to work with other Federal departments and with States to increase access to private health insurance for those who do not yet have it through the Affordable Choices initiative and related efforts. This proposal would redirect inefficient institutional subsidies to individuals and would need to be State based and budget neutral, not create a new entitlement, and not affect savings contained in the President’s Budget that are necessary to address the unsustainable growth of Federal entitlement programs.

Outreach To Raise Awareness

Health Insurance Enrollment and Long-Term Care Coverage Outreach is a collaboration of CMS, AoA, ACF, HRSA, State and local health departments, State Medicaid and SCHIP agencies, State and area agencies on aging, child care and early education providers, and State departments of agriculture and education. This collaborative effort conducts outreach to raise awareness of public health insurance and long-term care benefits and provides information and access assistance.

Demonstrations and Waivers

States have many options, including Federal waivers, for broadening coverage to underserved populations. Using Health Insurance Flexibility and Accountability waivers, States can develop comprehensive insurance coverage for individuals at twice the Federal Poverty Level (FPL) and below, using SCHIP and Medicaid funds. These waiver programs target vulnerable, uninsured populations, such as children on Medicaid and SCHIP, and pregnant women. Emphasis is placed on broad statewide approaches that maximize both private health insurance coverage and employer-sponsored insurance.

Indian Health Programs

IHS provides a comprehensive health services delivery system for American Indians and Alaska Natives with opportunity for maximum tribal involvement in developing and managing programs to meet their health needs. The mission of IHS, in partnership with American Indian and Alaska Native (AI/AN) people, is to raise their physical, mental, social, and spiritual health to the highest level. The goal of IHS is to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all American Indians and Alaska Natives. IHS promotes healthy AI/AN people, communities, and cultures and honors the inherent sovereign rights of tribes as part of the Federal Government’s special relationship through treaty obligations with tribes.

In 2005, IHS provided health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 States.[vii] Both primary care physicians and nurse practitioners provide primary care.[viii] Those children or adults in fair or poor health with only IHS coverage probably did not see a physician in the past year. Adults in good or excellent health with only IHS coverage were probably less likely to have seen a physician in the past 2 years, compared to similar adults with Medicaid or private insurance.[ix] IHS access alone does not constitute health insurance coverage. Those not served by IHS may use private or State insurance out of preference or lack of proximity to IHS or tribal facilities. Limitation of contracted health service funds and insurance reduces the use of specialty care physician services for American Indians and Alaska Natives.

In response to these and other emerging challenges, IHS is focused on expanding access for American Indians and Alaska Natives to comprehensive primary health care services. In addition, IHS recognizes the importance of retinopathy screening for those with diabetes and colorectal screening for early cancer detection and prevention. CMS has joined in efforts to expand access for American Indians and Alaska Natives to health care services covered by Medicare, Medicaid, and SCHIP. The Indian Health Care Improvement Act of 1976 (Public Law 94-437), as amended, extended the Federal obligation to CMS by authorizing payment for Medicare and Medicaid services provided through IHS facilities. This responsibility includes services provided by tribal governments administering health programs under authorities through the Indian Self-Determination and Education Assistance Act of 1975 (Public Law 93-638), as amended. The Indian Health Care Improvement Act further expanded this responsibility by authorizing 100 percent Federal Medical Assistance Percentage to States for payments to IHS and tribal facilities for Medicaid services. CMS works with IHS and the tribes to ensure they follow the Payor of Last Resort rule. According to this rule, IHS pays after Medicare or Medicaid has paid for eligible services, whether IHS and tribes provide services directly or a private source provides them under referred services.

Long-Term Care

Long-term care can be required by individuals with disabilities needing assistance with activities of daily living, individuals with frailty and/or dementia associated with aging, individuals with advanced chronic conditions, and other individuals at or near the end of life. The central vision for an efficient long-term care system is one that is person centered, i.e., organized around the needs of the individual rather than around the settings where care is delivered. The evolving long-term care system of the future will provide coordinated, high-quality care; optimize choice and independence; be served by an adequate workforce; be transparent, encouraging personal responsibility; be financially sustainable; and utilize health information technology to improve access and quality of care.

In an effort to facilitate this system transformation, CMS, in partnership with the U.S. Congress, provides funding to States, territories, and tribal entities to expand choices to persons who need long-term care services. Real Choice Systems Change grants, Medicaid Infrastructure grants, and Systems Transformation grants are a few examples of HHS efforts to assist States in building the needed infrastructure for expanding choices.

HHS also works closely with States, territories, and tribal entities to achieve more flexibility in the Medicaid program. To that end, the Money Follows the Person Rebalancing Demonstration project builds on the President’s New Freedom initiative.[2]

The Money Follows the Person Rebalancing Demonstration project will help States further address the institutional bias in coverage inherent in the Medicaid program. Selected States will be awarded additional Federal funds to pay for home- and community-based services for the first year that individuals transition from institutional care to a community-based setting of their choice.

The Long-Term Care Insurance Partnership Program is a federally supported, State-operated initiative that allows individuals who purchase a qualified long-term care insurance policy to protect a portion of their assets that they would typically need to spend down prior to qualifying for Medicaid coverage. Once individuals purchase a long-term care insurance partnership policy and use some or all of their policy benefits, the amount of the policy benefits used will be disregarded for purposes of calculating eligibility for Medicaid. This stipulation means that they are able to keep their assets up to the amount of the policy benefits they purchased and used. For example, in a State that chooses to participate in the partnership program, once individuals have used part or all of their maximum lifetime benefit under their long-term care insurance coverage, their assets would be protected up to the amount used, up to that maximum lifetime benefit. Individuals would not need to spend those assets before qualifying for that State’s Medicaid program.

The Aging and Disability Resource Center grant program, a cooperative effort between CMS and AoA, assists States with their efforts to streamline access to long-term care. Program funding supports the development of “one-stop shop” programs to serve as a single, coordinated system of information, assistance, and access. Persons seeking knowledge about long-term care will receive information that will minimize confusion, enhance individual choice, and support informed decisionmaking. Persons seeking knowledge about public and private long-term care options will receive information that will minimize confusion, enhance individual choice, and support informed decisionmaking.

Building on this effort, AoA’s Choices for Independence demonstration project aims to provide seniors and their caregivers with information, assistance, and counseling to confront the difficult decisions they face regarding long-term independence in the community, by seeking to reduce the current systemic bias in favor of institutional care. Choices for Independence will target people while they are still healthy and able to plan for their care and will encourage them to take positive steps to maintain their own health. If people need care, Choices for Independence will help them to bolster their own support system and resources before they enter a nursing home and spend down to Medicaid.

CMS is working with ASPE and AoA on the HHS Own Your Future campaign, in partnership with six States (Georgia, Massachusetts, Michigan, Nebraska, South Dakota, and Texas). Own Your Future is an aggressive education and outreach effort designed to increase consumer awareness about planning for long-term care. The campaign uses Federal-State partnerships to help individuals from ages 45 to 65 take an active role in planning by evaluating their future long-term needs and resources. Own Your Future provides objective information and resources to help individuals and their families plan for future long-term care needs. To enhance this effort, AoA, ASPE, and CMS have launched the National Clearinghouse for Long-Term Care Information Web site to increase public awareness about the risks and costs of long-term care and the potential need for services.

CMS is working with the U.S. Department of Housing and Urban Development to explore options for the provision of long-term care services for beneficiaries living in affordable housing. ASPE and AoA are also collaborating on strategies to develop reverse mortgage programs that will encourage homeowners to use existing assets to acquire long-term care services in the community. CMS is also collaborating with AoA, ASPE, the Administration on Developmental Disabilities (ADD) in HHS’s Administration for Children and Families (ACF), OD, and Federal agencies such as the U.S. Departments of Education and Labor to address long-term care workforce issues.

Strategic Objective 1.2: Increase health care service availability and accessibility.

In addition to broadening health care and long-term care coverage, HHS is committed to increasing the availability and accessibility of health care services. This commitment includes reaching out to vulnerable and underserved populations, such as American Indians and Alaska Natives, people with disabilities, and rural populations. In addition, the Department is committed to enhancing and expanding existing services, such as health centers, long-term care options, substance abuse and mental health treatment programs, and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) programs. Among the operating and staff divisions contributing to the achievement of this objective are AoA, CMS, HRSA, IHS, OCR, OD, ONC, OPHS, and SAMHSA.

Selected HHS performance indicators that best capture the impact of the wide array of HHS services provided under this strategic objective follow:

Key aspects of having regular access to a source of ongoing care for the entire population;
Receipt of services by American Indians and Alaska Natives, with whom HHS has a special treaty relationship;
Efforts to expand access to publicly funded health centers and substance abuse treatment programs; and
Rates at which programs funded by Title XXVI of the Public Health Service Act as amended by the Ryan White HIV/AIDS Treatment Modernization Act (Ryan White HIV/AIDS Program) serve racial and ethnic minorities, disproportionately affected by HIV/AIDS.

The joint planning initiative, Empower Consumer Access to Health Care, Long-Term Care, and Behavioral Health Services, is responsible for development, implementation, and coordination of health care, long-term care, and behavioral health service policies and programs. Ten HHS divisions partner with the U.S. Departments of Agriculture, Education, and Interior, as well as with State and local health departments, Medicaid and SCHIP State agencies, State and area agencies on aging, child care providers, early education providers, and tribal governments.

American Indians and Alaska Natives

Health services are provided to American Indians and Alaska Natives through several means. In FY 2006, IHS provided health care services directly at 33 hospitals, 59 health centers, and 50 health stations and supports essential sanitation facilities (including water supply, sewage, and solid waste disposal) for American Indian/Alaska Native (AI/AN) homes and communities. IHS professional staff include approximately 2,700 nurses, 900 physicians, 400 engineers, 500 pharmacists, 300 dentists, and 150 sanitarians. IHS also employs various allied health professionals, such as nutritionists, health administrators, and medical records administrators. More than half of the IHS budget is now used to provide funding for American Indian Tribes, tribal organizations, and Alaska Native corporations that choose to contract or compact with IHS to provide health care under the Indian Self-Determination and Education Assistance Act of 1975 (Public Law 93-638), as amended. These entities administer 15 hospitals, 221 health centers, 9 residential treatment centers, 97 health stations, and 176 Alaska village clinics. Both IHS and tribal entities purchase additional health care services from private providers.[x]

HHS and the U.S. Department of Veterans Affairs (VA) have entered into a Memorandum of Understanding to encourage cooperation and resource sharing between IHS and the Veterans Health Administration. The goal is to use the expertise of both organizations to deliver quality health care services and enhance the health status of AI/AN veterans. An interagency advisory committee, involving IHS and the Office of Minority Health (OMH) in OPHS, identifies health disparities for American Indians and Alaska Natives compared to the general U.S. population.

People With Disabilities

The four goals included in The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities are as follows:

Increase understanding nationwide that people with disabilities can lead long, healthy, and productive lives;
Increase knowledge among health care professionals and provide them with tools to screen, diagnose, and treat the whole person with a disability with dignity;
Increase awareness among people with disabilities of the steps they can take to develop and maintain a healthy lifestyle; and
Increase accessible health care and support services to promote independence for people with disabilities.

Virtually every HHS operating and staff division has initiatives to support this critical effort, headed by OPHS’s Office of the Surgeon General (OSG) and OD. Moreover, a broad array of Federal agencies, including the U.S. Departments of Agriculture, Defense, Education, Housing and Urban Development, Interior, Justice, Labor, Veterans Affairs, and the National Science Foundation, the Office of National Drug Control Policy, and the Social Security Administration, as well as many non-Federal stakeholders, have committed to pursuing these goals.

Of particular note is HRSA’s effort to provide health and community resource information and peer support to families having children and youth with special health care needs. Family-to-Family Health Information Centers, funded under the Dylan Lee James Family Opportunity Act,[3] will be family-run, statewide centers in every State and the District of Columbia and will be responsible for developing partnerships with those organizations serving these children and their families. They also will be charged with monitoring the progress of programs with responsibility for payment and direct services of this population through a statewide data collection system.

Rural Health

Through collaborative initiatives such as the HHS Rural Task Force and the National Advisory Committee on Rural Health and Human Services, HHS works to address the difficulties of providing health care in rural communities. A technical assistance Web site and targeted dissemination of information about innovative models for health services delivery in rural communities are part of HHS’s overall strategy.

The HHS Underserved Populations effort focuses on delivery of health care services for underserved populations in rural and urban areas and involves CMS, HRSA, IHS, OD, SAMHSA, State and local health departments, health care providers, and the Tribal Technical Advisory Group.

Health Centers

At the beginning of FY 2007, HRSA’s Consolidated Health Center Program was providing comprehensive primary and preventive health care in more than 3,800 sites across the country to an estimated 14.8 million people.[xi] Most Health Center patients have incomes at or below 200 percent of the FPL. Many Health Center patients have no health insurance, and most patients are racial or ethnic minorities.

Health Centers help to improve the availability of health services by providing a range of essential services. As new or expanded sites are funded in medically underserved communities, a major focus will be on poor rural and urban counties consistent with the President’s goal of establishing new Health Centers in the poorest counties in the Nation. Health Centers help to improve the availability of health services by providing a range of essential services, including pharmacy services onsite or by paid referral, preventive dental care, and mental health and substance abuse services at most centers.

Mental Health

The final report of the President’s New Freedom Commission on Mental Health (2003) called for a fundamental transformation of how mental health care is delivered in America. SAMHSA’s Center for Mental Health Services will continue to work to transform the mental health system so that Americans understand that mental health is essential to overall health; mental health care is consumer and family driven; disparities in mental health services are eliminated; early mental health screening, assessment, and referral to services are common practice; excellent mental health care is delivered and research is accelerated; and technology is used to help consumers access mental health care and information.

New Orleans Health System

Hurricane Katrina incapacitated the Greater New Orleans health care system, ravaged its health care infrastructure, and severely impacted health care delivery in a number of Louisiana parishes. Eighty percent of New Orleans Health Centers were destroyed; the teaching hospitals of New Orleans were devastated; and countless people lost all of their medical records.

The Louisiana Health Care Redesign Collaborative strives to build an efficient

21st century health care system implementing technology, transparency, emergency preparedness, and greater personal health care choices. HHS is supporting the Collaborative in its effort by helping to convene stakeholders, providing expert assistance and other HHS resources, removing barriers to progress, and reviewing Medicaid waiver and Medicare demonstration concepts submitted by the Louisiana Health Care Redesign Collaborative in accordance with the guiding principles.

The goal is to improve health care by providing every citizen with access to health care that is prevention centered, neighborhood located, and electronically connected. Health care providers could use electronic health records and meet certain quality measures in order to provide care. Success means that Louisiana and New Orleans will have health care systems that can serve as models for the Nation. More information about how HHS is promoting electronic health records is included later in this chapter, In the Spotlight: Advancing the Development and Use of Health Information Technology.

Ryan White HIV/AIDS Program

HRSA’s programs through the Ryan White HIV/AIDS Programcurrently provide services to approximately 531,000 individuals who have little or no insurance and are impacted by HIV/AIDS.[xii] Key pieces of this program include its efforts to prioritize lifesaving services, medications, and primary care for individuals living with HIV/AIDS. Providing more flexibility to target resources to areas that have the greatest needs is also a key piece of the Ryan White HIV/AIDS Program. The program also encourages the participation of any provider, including faith-based and other community organizations, that shows results, recognizes the need for State and local planning, and ensures accountability by measuring progress.

Substance Abuse Services

SAMHSA’s Center for Substance Abuse Treatment promotes the quality and availability of community-based substance abuse treatment services for individuals and families who need them. The Center for Substance Abuse Treatment works with States and community-based groups to improve and expand existing substance abuse treatment services under the Substance Abuse Prevention and Treatment Block Grant Program. The Center also supports SAMHSA’s free treatment referral service to link people with the community-based substance abuse services they need.

Among SAMHSA’s efforts to improve the health of the Nation by increasing access to effective alcohol and drug treatment is the Access to Recovery program. Access to Recovery is designed to accomplish three main objectives: to expand capacity by increasing the number and types of providers, including faith-based and community providers, who deliver clinical treatment and/or recovery support services; to require grantees to manage performance, based on patient outcomes; and to allow recovery to be pursued through many different and personal pathways. Vouchers, State flexibility, and executive discretion combine to create profound positive change in substance abuse treatment financing and service delivery. The innovative and unique Access to Recovery program is focused on consumer empowerment. Under Access to Recovery, consumers will continue to have the ability to choose the path that is personally best for them and to choose the provider that best meets their needs, whether physical, mental, emotional, or spiritual.

Nondiscrimination and Privacy Protection

OCR ensures compliance with the nondiscrimination requirements of Title VI of the Civil Rights Act of 1964 (Public Law 88-352), as amended, requiring recipients of HHS Federal financial assistance to ensure that their policies and procedures do not exclude or limit, or have the effect of excluding or limiting, the participation of beneficiaries on the basis of race, color, or national origin. These efforts, which reach beneficiaries of all health and human service programs that HHS funds, seek to achieve voluntary compliance and corrective efforts when violations are found. OCR has collaborated with the U.S. Departments of Agriculture and Justice to produce a video and informational brochure in multiple languages to advise service providers and consumers with limited English proficiency about their responsibilities and rights under Title VI. OCR also enforces the federal privacy protections for individually identifiable health information provided by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Privacy enforcement activities provide consumer confidence in the confidentiality of their health information so that privacy concerns are not a deterrent to accessing care and full and accurate information is provided at treatment and payment encounters.

OCR will continue to work with Federal and State partners and with providers and consumer groups, including faith-based and community organizations, to ensure nondiscriminatory access to health and human services, to eliminate health disparities, and to protect the privacy of identifiable health information.

Strategic Objective 1.3: Improve health care quality, safety, cost, and value.

In the future, American health care will be shaped into a system in which doctors and hospitals succeed by providing the best value for their patients. Value in health care means delivering the right health care to the right person, at the right time, for the right price. Providing reliable health care cost and quality information can empower consumer choice at all levels. Systemwide improvements can occur as providers and payers can track how their practice, service, or plan compares to others. As value in health care becomes transparent to consumers and providers alike, HHS anticipates the following benefits: Costs will stabilize; more people will acquire insurance; more people will get access to better health care; and economic competitiveness will be preserved. Ultimately, this is a prescription for a value-driven system—a prescription of good medicine that works for everyone. HHS will work to achieve this value-based system over the next 5 years.

Several HHS operating and staff divisions contribute to this goal of improving the quality, safety, cost and, ultimately, the value of health care, including AHRQ, AoA, CMS, FDA, HRSA, IHS, NIH, ONC, OPHS, and SAMHSA.

The performance indicators for this strategic objective, listed in full at the end of this chapter, measure:

Adoption of electronic health care records, which affect the long-term quality, value, and safety of health care;
Quality of care that residents receive in nursing home facilities; and
Number of States implementing specific approaches to improve the quality of Medicaid-funded health care, on which many low-income people depend.

Health Care Transparency

Health care transparency may restrain the growth of health care costs because consumers will know the comparative costs and quality of their health care—and they will have a financial incentive to seek out quality care at the lowest cost. Consumers will gain control of their health care and have the knowledge to make informed decisions. Health care transparency is built on four interconnected cornerstones:

Connect the System. Every medical provider has a system for keeping health records. Increasingly, those systems are electronic. Standards need to be identified so that all health information systems can quickly and securely communicate and exchange data.

Measure and Publish Data on Quality. Every case, every procedure, has an outcome. Some outcomes are better than others are. To measure quality, HHS must work with doctors and hospitals to define benchmarks for what constitutes quality care.

Measure and Publish Data on Price. Price information is useless unless cost is calculated for identical services. Agreement is needed on what procedures and services are covered in each “episode of care.”

Create Positive Incentives. All parties—providers, patients, insurance companies, and payers—should participate in arrangements that reward both those who offer and those who purchase high-quality, competitively priced health care.

Employers committing to these cornerstones would agree to collect quality and price information through its health plan or benefit administrator, using the consensus standards. Employers committing to the goals also would be encouraged to share quality and price information with regional collaboratives, where information from many sources could be aggregated, thus producing the most broad-based and reliable information possible. The employer or its health plan would share quality information with enrollees and would provide specific costs the enrollee would expect to pay under the plan.

Six pilot programs to demonstrate how transparency can promote improvements in health care are underway, with support from CMS and AHRQ. These pilot programs are being coordinated under the Better Quality Information Data Aggregation and Reporting project, through a contract with the Maryland Medicare Quality Improvement Organization. The communities were selected using a set of criteria by a representative committee of the public/private entity Ambulatory Care Quality Alliance, which consists of 135 physician organizations, consumers, employers, and health plan representatives. The Alliance makes available quality information about physician care. The purpose is to measure and report on physician practice in a meaningful and transparent way for consumers and purchasers of health care.

Personalized Health Care

The future of health care in America is one in which care will be personalized, predictive, preemptive, and participatory. Advances in basic research have positioned us to begin to harness new and increasingly affordable potential in medical and scientific technology. With clinical tools that are increasingly targeted to the individual, our health care system can give consumers and providers the means to make more informed, individualized, and effective choices. Emphasis on personalized health care could make health care safer and more effective for every patient, especially when we are able to use the power of genetic information and health information technology to better understand each patient’s needs and more precisely target therapies. This may mean that the same medical condition requires different treatment for men and women, or for older persons, or for others whose inherited traits may put them at particular risk.

Ongoing activities across HHS are working toward the long-term goals of personalized health care, and the convergence of these efforts will act as a powerful force to educate both the patient and the health care provider to improve clinical outcomes. Basic research at NIH is improving the foundational knowledge of diseases; FDA’s Critical Path Initiativeis improving the speed and safety of product development; and CDC will use population data to understand the genetic basis of diseases.

FDA has initiated the Critical Path to Personalized Medicine, a program designed to modernize and ensure more efficient development and clinical use of medical products. Under the Critical Path Initiative, HHS anticipates being able to dramatically increase the success rate in providing patients with innovative solutions that strike an optimal balance of high benefit and low risk because they are “personalized.” Once both the disease and the person are understood at the molecular level, physicians will be able to provide treatment options uniquely suited to a patient’s particular needs.

Electronic Health Records

Patients cannot receive appropriate and efficient care unless clinical information about them is available at the point of care. When patients’ health information is not accessible to providers as they transition through the continuum of care, clinical decisions often must be made without full knowledge of patients’ history and health status. The absence of needed clinical information can lead to a requirement to duplicate tests that not only increase the costs of health care, but also subject patients to unneeded clinical interventions that always carry a degree of risk. Similarly, the absence of needed information could lead to incorrect decisions or medical errors that could result in adverse clinical outcomes. Over time, more advanced electronic health records will have integrated clinical decision support with the latest scientific evidence guiding clinical interventions at the point of care along with environmental data that should also influence many treatment decisions. Increasing the adoption of interoperable electronic health records will decrease these risks to both the efficiency and efficacy of care. Through the collaborative activities of the American Health Information Community, chaired by the Secretary of HHS, much work is underway to identify the functionality and standards that will support the development and adoption of interoperable electronic health records to achieve the President’s vision of making electronic health records available to most Americans by 2014.

More information about this effort can be found later in this chapter in In the Spotlight: Advancing the Development and Use of Health Information Technology.

Value-Based Purchasing

Value-based purchasing is the use of payment methods and other incentives to encourage substantive improvement for patient-focused, high-value care. At HHS, value-based purchasing is in its early stages of development. The Tax Relief and Health Care Act of 2006 (H.R. 6111) lays the groundwork for CMS to establish many models for financial and nonfinancial incentives used in value-based purchasing programs or strategies. Programs such as Medicare Hospital Pay for Performance, Medicare Demonstration Project to Permit Gainsharing, and the Premier demonstration are viewed as one component of a broader strategy of promoting health care quality. At least 12 States throughout the country have already implemented a wide range of value-based purchasing initiatives under Medicaid. States are using both payment differentials and nonfinancial incentives, such as auto-enrollment and public reporting, to reward performance. CMS will provide technical assistance to those States that voluntarily elect to implement value-based programs. CMS also will encourage States to include an evaluation component to provide evidence of the effectiveness of this methodology.

Quality Improvement Efforts

Medicare Quality Improvement Efforts. Improving quality of care and reducing medical errors are important goals in modernizing Medicare. The Medicare Web site will continue to display quality data that allow consumers to make informed choices by comparing the performance of hospitals, nursing homes, home health agencies, and dialysis facilities.

Medicaid Quality Improvement Efforts. States continue to advance efforts to improve overall quality of care as they seek new approaches to improve and expand insurance coverage. In many instances, State Medicaid programs have led the way in quality initiatives that have the potential to shape activities of other public and private payers across the country. Several States have implemented value-based purchasing programs with the objective of redesigning the payment structures to promote and reward the provision of high-quality care. At least 13 States now publicly report performance measurement data that can be used by State agencies, beneficiaries, policymakers, and others to promote transparency and personal responsibility in the care provided. CMS also has launched a Neonatal Care Outcomes Improvement project with an objective of decreasing infant morbidity and mortality.

Nursing Home Quality Initiatives. The CMS Nursing Home Quality Initiative is a broad-based effort that includes continuing regulatory and enforcement systems. New and improved consumer information is available through the 1–800–MEDICARE (1-800-633-42273) line and at the Medicare Web site. In addition, community-based nursing home quality improvement programs, and partnerships and collaborative efforts to promote awareness and support, are underway. The first goal of the initiative is to provide consumers with an additional source of information about the quality of nursing home care by establishing quality measures based on the Minimum Data Set and by publishing information on Medicare’s Nursing Home Compare Web site. The second goal is to help providers improve the quality of care for their residents by giving them complementary clinical resources, quality improvement materials, and assistance from the Quality Improvement Organizations in every State.

Collaborative Quality Improvement Initiatives. Two joint planning efforts focus on quality and improvement initiatives. With representation from CMS, CDC, AHRQ, and a number of non-Federal organizations, one effort experiments with approaches to create incentives for hospitals and physicians to provide both high-quality and efficient care (e.g., Gainsharing, Hospital Compare, Surgical Care Improvement Project, and others). The second effort, the Quality Workgroup, consists of CMS, AHRQ, IHS, ONC, the Office of Personnel Management, and a variety of non-Federal organizations representing labor, insurers, hospitals, and other stakeholders. The Quality Workgroup makes recommendations to the American Health Information Community (AHIC) so that health information technology can provide the data needed for the development of quality measures that are useful to patients and others in the health care industry. The Quality Workgroup seeks to automate the measurement and reporting of a comprehensive current and future set of quality measures and to accelerate the use of clinical decision support that can improve performance on those quality measures. In addition, this workgroup makes recommendations on how performance indicators should align with the capabilities and limitations of health information technology. More information about the AHIC’s wo

HHS Strategic Plan, Fiscal Years 2007–2012 (Strategic Plan)

Table Of Contents

Core Principles[i]

Core Principles^{^[i]}