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

Archived Strategic Plan.

This is not the most current Strategic Plan. Please see:
http://www.hhs.gov/secretary/about/priorities/priorities.html
for the current plan.

Table of Contents


Secretary’s Message
Executive Summary
Chapter 1: Introduction and Overview
    Mission
    Core Principles[i]
    Organization
    Developing and Updating the Strategic Plan
    Consultation
    Structure
    In the Spotlight: HHS Plans and Priorities
        Secretary’s 500-Day Plan
        Secretary’s Health Care Priorities
        Departmental Objectives
        Healthy People 2010
Chapter 2: Strategic Goal 1: Health Care
    Strategic Objective 1.1: Broaden health insurance and long-term care coverage.
        Health Insurance
            Medicare
            Medicaid
            Children’s Health Insurance
            Affordable Choices
            Outreach To Raise Awareness
            Demonstrations and Waivers
            Indian Health Programs
        Long-Term Care
    Strategic Objective 1.2: Increase health care service availability and accessibility.
        American Indians and Alaska Natives
        People With Disabilities
        Rural Health
        Health Centers
        Mental Health
        New Orleans Health System
        Ryan White HIV/AIDS Program
        Substance Abuse Services
        Nondiscrimination and Privacy Protection
    Strategic Objective 1.3: Improve health care quality, safety, cost, and value.
        Health Care Transparency
        Personalized Health Care
        Electronic Health Records
        Value-Based Purchasing
        Quality Improvement Efforts
        Medical Product Safety
        Health Disparities
    Strategic Objective 1.4: Recruit, develop, and retain a competent health care workforce.
        Recruitment/Retention Efforts
        Workforce Support Efforts
    Performance Indicators
    Meeting External Challenges
    In the Spotlight: Reducing Health Disparities
        Disparities Persist
        Changes in Disparities
        Opportunities for Improvement
    In the Spotlight: Advancing the Development and Use of Health Information Technology
        Office of the National Coordinator
        Public/Private Partnerships
        Standards Harmonization
        Certification Process
        Health Information Exchange
        Policy Council
        Federal Health Architecture
        Public Health Information Network
        Privacy and Security Solutions
        The Challenge
Chapter 3: Strategic Goal 2: Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness
    Strategic Objective 2.1: Prevent the spread of infectious diseases.
        Immunization
        HIV/AIDS
        Zoonotic[7]/Vectorborne Diseases
        Foodborne/Waterborne Illnesses
        Global Health
    Strategic Objective 2.2: Protect the public against injuries and environmental threats.
        Workplace Injuries
        Fire-Related Injury Prevention
        Environmental Hazards
        Childhood Lead Poisoning Prevention
        Violence Against Women
        Youth Violence Prevention
    Strategic Objective 2.3: Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery.
        Preventive Services
        Heart Disease and Stroke
        Cancer
        Overweight and Obesity
        Diabetes
        Oral Health
        Substance Use/Abuse
        Suicide Prevention
        Risk Reduction
    Strategic Objective 2.4: Prepare for and respond to natural and manmade disasters.
        Workforce Readiness
        Threat Agent Identification
        Emergency Preparedness
        Countermeasures
        Pandemic Influenza
        People With Disabilities
        Equal Access
        Information Technology Support
     Performance Indicators
    Meeting External Challenges
    In the Spotlight: Emergency Preparedness, Prevention, and Response
    In the Spotlight: Global Health Initiatives
        HHS’s Mandate
        Meeting Its Mandate
        Achievements
        Interagency Efforts
Chapter 4: Strategic Goal 3: Human Services
    Strategic Objective 3.1: Promote the economic independence and social well-being of individuals and families across the lifespan.
        Work/Economic Self-Sufficiency
        Well-Being Across the Lifespan
    Strategic Objective 3.2: Protect the safety and foster the well-being of children and youth.
        Child Maltreatment
        Safety and Permanency
        Early Care and Education
        Mentoring
        Abstinence Education
        Collaborative Efforts for Youth
    Strategic Objective 3.3: Encourage the development of strong, healthy, and supportive communities.
        Faith-Based and Community Initiatives
        Capacity-Building Efforts
        Comprehensive Community Initiatives
    Strategic Objective 3.4: Address the needs, strengths, and abilities of vulnerable populations.
        People With Disabilities
        American Indians and Alaska Natives
        People Affected by Disasters
        Refugees and Other Entrants
        Victims of Human Trafficking
        People Experiencing Homelessness
    Strategic Goal 3:  Human Services Performance Indicators
    Meeting External Challenges
    In the Spotlight: Demographic Changes and Their Impact on Health and Well-Being
        Aging Population
        Racial/Ethnic Diversity
Chapter 5: Strategic Goal 4: Scientific Research and Development
    Advance scientific and biomedical research and development related to health and human services.
    Strategic Objective 4.1: Strengthen the pool of qualified health and behavioral science researchers.
    Strategic Objective 4.2: Increase basic scientific knowledge to improve human health and human development.
        Brain Research
        Alzheimer’s Disease
        Human Development
        Cancer Research
        Asthma
        Pandemic Influenza
        Antimicrobial Resistance
    Strategic Objective 4.3: Conduct and oversee applied research to improve health and well-being.
        Birth Defects/Developmental Disabilities
        Substance Abuse Treatment
        Lung Cancer
        Obesity
        Cardiovascular Disease
        Public Health Protection
        Food, Drug, and Device Safety
    Strategic Objective 4.4: Communicate and transfer research results into clinical, public health, and human service practice.
        Community Preventive Services
        Clinical Preventive Services
        Dissemination of Findings
        Dissemination of Information
        Evidence-Based Practices
        National Registry
    Performance Indicators
    Strategic Goal 4: Scientific Research and Development Performance Indicators
    Meeting External Challenges
        Pace and Success of Research
        Business Interests
        Intellectual Property
        Recruiting and Retaining Expertise
Chapter 6: Responsible Stewardship and Effective Management
    Effective Human Capital Management Recruit, develop, retain, and strategically manage a world-class HHS workforce.
    Effective Information Technology Management Provide a well-managed and secure enterprise information technology environment.[19]
    Effective Resource Management Use financial and capital resources appropriately, efficiently, and effectively.
    Effective Planning, Oversight, and Strategic Communications
Appendix A: HHS Program Evaluation Efforts
    Evaluation Oversight
    Quality Assurance and Improvement
    Program Assessment Rating Tool
    Role of Program Evaluations in Strategic Planning
        Strategic Goal 1: Health Care
        Strategic Goal 2: Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness
        Strategic Goal 3: Human Services
        Strategic Goal 4: Scientific Research and Development
    Table A-1: Selected Current Program Evaluation Efforts
    Table A-2 Selected Future Program Evaluation Efforts
Appendix B Performance Indicators—Supplemental Information
Appendix C: Performance Plan Linkage
    HHS Strategic Plan, Annual Plan, and Annual Performance Budgets
    A Culture of Excellence: Comprehensive Performance Management System for Employees
        Senior Executive Service and Organizational Performance Management System
        Performance Management Appraisal Program
Appendix D: Information Technology
    Initiatives
        Secure One HHS
        Infrastructure
        Health Information Technology
        HHS Data Council
        Confidentiality and Data Access Committee
        Web Services
    Innovations and Future Trends
        E-Government
        Integrated Planning
        Knowledge Management
Appendix E: HHS Organizational Chart
Appendix F: HHS Operating and Staff Divisions and Their Functions
    Operating Divisions
    Office of the Secretary: Staff Divisions
Appendix G: Acronyms
Appendix H: Endnotes

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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
U. Department of Health and Human Services

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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.


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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.

Text Box: CORE PRINCIPLES
National standards, neighborhood solutions.
Collaboration, not polarization.
Solutions transcend political boundaries.
Markets before mandates.
Protect privacy.
Science for facts, process for priorities.
Reward results, not programs.
Change a heart, change a nation.
Value life.
	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.

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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:

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.

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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.

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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.

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Structure

Chapters 2 through 5 present the four strategic goal areas:

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:

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:

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:

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

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:

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:

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.

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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.

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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:

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Secretary’s Health Care Priorities

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

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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:

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

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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:

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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:

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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:

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.

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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.

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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:

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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:

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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: