HHS Strategic Goals and Objectives - FY 2001 . Goal 3 - Improve Access to Health Services and Ensure the Integrity of the Nation's Health Entitlement and Safety Net Programs

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

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

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

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

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

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

  • How We Will Accomplish Our Objective

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

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

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

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

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

    3.1 Implementation Strategies

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

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

    We will promote adoption of legislation to:

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

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

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

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

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

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

    We will conduct research to:

    • study the most effective ways to enroll children.

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

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

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

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

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

     

• Objective 3.2 - Eliminate Disparities in Health Access and Outcomes

  • How We Will Accomplish Our Objective

    

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

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

    3.2 Implementation Strategies

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

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

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

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

    We will conduct research and demonstrations to learn:

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

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

    • how disparities in access affect health outcomes.

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

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

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

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

  • How We Will Accomplish Our Objective

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

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

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

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

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

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

    • providing financial assistance to additional federally funded health centers.

    3.3 Implementation Strategies

    Increasing Provider Supply Primary Care Services Service Integration Research

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

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

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

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

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

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

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

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

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

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

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

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

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

  • How We Will Accomplish Our Objective

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

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

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

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

    3.4 Implementation Strategies

    Preventive Services Beneficiary Education Quality Oversight Improving Services

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

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

    We will improve our Medicare services by:

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

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

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

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

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

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

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

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

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

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

    HHS Agencies contributing to this objective: AHRQ HCFA OCR OS

    • conducting research on how to solve service problems.

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

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

  • How We Will Accomplish Our Objective

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

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

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

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

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

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

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

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

    3.5 Implementation Strategies

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

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

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

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

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

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

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

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

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

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

    • educating beneficiaries to identify and report instances of fraud.

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

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

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

    HHS Agencies contributing to this objective: AoA HCFA OIG OS

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

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

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

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

  • How We Will Accomplish Our Objective

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

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

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

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

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

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

    • maintaining accreditation of health care facilities.

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

    3.6 Implementation Strategies

    Improving Service Access/Quality Nutrition Programs Applying Public Health Practices

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

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

    We will apply public health practices to:

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

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

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

    • identify and disseminate best practices in health care.

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

  • How We Will Accomplish Our Objective

    

    We will support expanding financial resources for:

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

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

    3.7 Implementation Strategies

    Expanding Prevention/Treatment Services Information Dissemination

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

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

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

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

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

     

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

  • How We Will Accomplish Our Objective

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

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

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

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

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

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

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

    3.8 Implementation Strategies

    Capacity Building Anti-Stigma Campaign Knowledge Development

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

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

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

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

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

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

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

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

     

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

  • How We Will Accomplish Our Objective

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

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

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

    3.9 Implementation Strategies

    Developing Community Health Systems Capacity Education Performance Measurement Research

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

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

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

    • a nationwide survey on access and utilization.

    • development of better payment and funding methods.

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