Performance Improvement 1996. Foreword


The Department of Health and Human Services (HHS) promotes and protects the health and well-being of all Americans and provides world leadership in biomedical and public health sciences. It does so through a diverse array of programs in basic and applied science, public health, income support, child and adolescent development, the financing of health and social services, and regulation.

Healthy individuals, families, and communities are the foundation of our nation's current and future security and prosperity. The success of this Department's programs should be measured against the objective of steady, broad-based improvements in the health of the people and communities of this country. Individual, family, and community health should be measured against a standard of well-being that includes the capacity and resources to enjoy a fulfilling and productive life. The Department's programs are in a continuous cycle of renewal and reinvention in response to changing internal and external assessments of what is working well and what needs to be improved, as well as in response to emerging needs, priorities, and opportunities. We welcome change and renewal, guided by our core commitment to be vigilant in safeguarding the nation's health and welfare and to administer with compassion and integrity the laws and programs entrusted to the Department.

Evaluations are an important source of knowledge for the process of renewal and re-invention. They provide knowledge for planning new directions and for adapting programs to meet new demands. HHS evaluations are designed to determine whether our programs and services achieve their intended results and how they can be improved. Evaluation is one of the most important tools we use to measure the success of programs in reaching and helping our customers.

Recent HHS evaluations, presented in this report, have been important in planning, budgeting, and developing legislation. For example, in 1995, the Health Care Financing Administration completed an evaluation of the Medicare Participating Heart Bypass Centers' demonstration of new approaches to cost containment. The study found negotiated package pricing helped reduce costs and improve coordination of services while maintaining quality of care. Based on the success of that demonstration, the Administration has requested new legislative authority to implement negotiated package pricing under the regular Medicare program, which should result in savings of more than $38 million annually.

Evaluation activities are also playing a major role in HHS's preparations for implementing the Government Performance and Results Act (GPRA). The Health Resources and Services Administration (HRSA) has used evaluation funds to design a system of performance measurement for assessing HRSA's program activities and outcomes. The performance measurement framework developed in this project can be used by other Federal agencies as they develop their planning strategies to implement GPRA.

Future HHS evaluations will place even greater emphasis on examining the impact of transformations in health and human services, the development of performance measures, and overall program performance improvement. A major collaboration involving Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC), and Office of the Secretary has developed health outcome-based performance measures for assessing the success of public health programs managed by CDC and SAMHSA. The effort involved a stakeholder outreach effort that engaged the participation of more than 1,400 individuals representing consumers; providers; State, local, and tribal officials; and program experts nationwide. A panel of technical experts at the National Academy of Sciences has refined the output of these consultations into proposed performance measures. The lessons learned in this process will underpin multiple efforts in the Department and at the State, local, and tribal level to manage programs on the basis of outcomes.

In keeping with the HHS commitment to produce quality and useful evaluations, the Department is pleased to present Performance Improvement 1996: Evaluation Activities of the U.S. Department of Health and Human Services--the first annual report documenting comprehensive evaluation efforts across all HHS agencies and offices. The report has three audiences: decisionmakers who need information on program results across the broad spectrum of health and human service activities; program managers who want to know how other service programs are operating and how performance can be improved; and the community of researchers, advocates, and practitioners who will use the program information and evaluation tools.

The report contains information on projects completed in fiscal 1995. It also provides information on HHS agency and office evaluations in progress, and future directions for evaluation.

Program Performance 1996 is organized into three chapters. Chapter I describes the organization of HHS evaluations--its activities, funding, planning and management, and future directions. Chapter II highlights the results from 11 fiscal 1995 evaluations selected for their potential application by the health and human services community. Chapter III presents the evaluation activities of the 11 HHS agencies and the Office of the Secretary, including information on their evaluation programs, evaluations completed in fiscal 1995, evaluations in progress, and future directions. A complete inventory of the 148 HHS evaluation projects completed in fiscal 1995 is provided in appendix A, and the HHS agency projects currently in progress are listed in appendix B.

We hope that you will find this report useful and informative.

Donna E. Shalala
U.S. Department of Health and Human Services

David F. Garrison
Principal Deputy Assistant Secretary for Planning and Evaluation