As noted above, evaluations play an important role in setting the goals and objectives in strategic planning. Examples follow below.
Strategic Goal 1: Health Care
By closely monitoring the implementation of the new Medicare prescription drug benefit and the capacity to respond to Medicare beneficiaries’ questions, HHS was able to provide the resources needed to improve the ability of beneficiaries, and the others who assist them, to obtain the information they needed to enroll in a drug plan. In addition, the demographic and other information developed to describe Medicaid beneficiaries and the uninsured are helping policymakers determine how to address these issues.
Success in increasing health care service and availability relies, in part, on how effectively we are able to ensure the successful translation of research into safe and effective medical products. Evaluation information supports our ability to help human drug sponsors improve the quality of their drug development and related new drug applications. The Prescription Drug and User Fee Act of 1992 (Public Law 102-571), as amended (PDUFA III), effective from FYs 2003–2007, expanded user fee funding to support several initiatives to improve application submissions and FDA-sponsored interactions during drug development and application review. FY 2005 was the fifth consecutive year in which FDA received an increased number of priority original drug applications, which represent significant new medical treatments for American patients. Additionally, FDA found that new mechanisms for FDA-sponsored interactions, such as meetings and consultations during the drug development phase, had a positive impact on the rate of first-cycle approval of drug applications, which speeds the availability of safe and effective new medical treatments to patients.
Through the Medicaid program, a substantial number of people receive personal assistance services, which allow them to function independently in their own homes. Consumer-directed services further allow beneficiaries to manage not only their human assistance, but also other covered supportive services. Cash and Counseling is an expanded model of consumer-directed services. ASPE and the Robert Wood Johnson Foundation collaborated to fund the Cash and Counseling Demonstration Evaluation (CCDE) to track the experiences of beneficiaries and providers in three States—Florida, Arkansas, and New Jersey—that participated in a unique Medicaid waiver experiment. Because of the CCDE, 11 other States have been selected to participate in an expansion of Cash and Counseling. Equally important, consumer choice, control, and empowerment have been inculcated throughout the Medicaid program and are reflected in many of the long-term care initiatives highlighted in this Strategic Plan, including the Money Follows the Person demonstration.
Strategic Goal 2: Public Health Promotion and Protection, Disease Prevention, and Emergency Preparedness
The development of food labeling information strategies was based in part on information from the FDA Health and Diet Survey – 2004 Supplement. Through the data gained from this survey, we were able to identify that most people have a limited understanding of most dietary fats and their relationship to the risk of coronary heart disease. In addition, we gained new information on consumer attitudes toward diet, health, and physical activity.
As a part of a wide-ranging effort to improve patient safety, in 2004 FDA finalized a rule requiring barcodes on the labels of thousands of human drugs and biological products. The measure is to protect patients from preventable medication errors by helping ensure that health professionals give patients the right drugs at the appropriate doses. FDA estimates that the rule will help prevent nearly 500,000 adverse events and transfusion errors while saving $93 billion in health care costs over 20 years.
Obesity has reached epidemic levels and is a primary focus of many HHS public health interventions. However, little is known about the dynamics of how obesity affects disability and other health outcomes as people age. To help inform policy and programmatic decisions around research and interventions aimed at preventing and treating obesity and alleviating its potential effects on disability and other health outcomes, ASPE is analyzing data from the Health and Retirement Survey as well as the Assets and Health Dynamics Among the Oldest Old Study. These data will expand our understanding of how obesity affects disability and other health outcomes as people move from late adulthood to older ages.
Strategic Goal 3: Human Services
The National Evaluation of Welfare-to-Work Strategies and the State welfare waiver evaluations found that mandatory welfare employment programs that employed a work-first approach are effective in increasing the employment and earnings of welfare recipients, particularly long-term recipients. These findings helped to influence the provisions of the Deficit Reduction Act of 2005 (Public Law 109-171) that strengthen the TANF work requirements.
Early findings from the Family and Child Experiences Survey (FACES) showed that Head Start children were not performing well in the area of letter identification and vocabulary. These findings motivated Head Start’s intensive efforts to strengthen children’s preliteracy. According to more recent FACES data, Head Start children are coming closer to national norms for letter recognition. The percentage of Head Start parents reading to their children three or more times a week has also increased, after intensive efforts to improve early literacy activities. Head Start anticipates continued gains as it continues to focus training and technical assistance resources in this area.
ASPE conducted a study to assess the costs of providing supportive services to individuals and families who are experiencing homelessness and residing in the homeless assistance programs through the U.S. Department of Housing and Urban Development (HUD). The findings identified the actual cost of these services and the myriad funding streams used. The study findings helped guide subsequent HHS and Administration policies on supportive services for individuals and families experiencing homelessness, particularly those residing in HUD homeless assistance programs.
Strategic Goal 4: Scientific Research and Development
AHRQ sponsored the Combining Clinical and Administrative Hospital Data Evaluation project. AHRQ also identified the most efficient set of clinical data elements that can be added to administrative data to increase the reliability and validity of hospital-specific public quality reporting. The intent was to develop mixed clinical-administrative data models that are clinically sound and defensible. The study focused on adding key clinical data elements to specific measures from the AHRQ Quality Indicators (QIs) to create clinically enhanced QIs.
Health information technology (health IT) is increasingly viewed as a tool that can promote quality and cost-effective care in the United States. Although much progress has been made in the development of electronic health records and other infrastructure, the lack of robust evidence on health IT costs and benefits across settings has stymied efforts to develop such capabilities in the post-acute care (PAC) and long-term care environment. A deeper, evidence-based understanding of costs and benefits is needed and is essential to inform providers contemplating purchase of health IT systems. In addition, such an understanding can provide useful and reliable information to policymakers, payers, employers, and others who seek to influence health IT adoption. ASPE is designing an evaluation to assess the business case for health IT in PAC and long-term care settings and to provide additional support for a keystone of the Department’s vision for the health care delivery system of the future.