HHS Strategic Plan
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LinkageThe Department of Health and Human Services (HHS) Annual Performance Plan is the primary mechanism for implementing the Department’s Strategic Plan. The two planning documents are intertwined. The HHS Strategic Plan sets broad, long-term objectives for the Department; for example: Increase Immunization Rates Among Adults and Children (Objective 1.3). It also describes the principal implementation strategies for achieving the strategic objective; for example: 1) disseminate public information to patients and providers about the importance of vaccinations; 2) educate the public about the efficacy and safety of vaccines; 3) support research to learn more about adverse reactions and develop safer and more effective vaccines; or 4) help countries and global partners increase their capacity to detect, monitor and investigate diseases that emerge abroad that could affect Americans. In turn, the Department’s Annual Performance Plan sets annual performance goals for HHS programs and relates these goals to the task of carrying out the strategies and long-term objectives in the Department’s Strategic Plan. In so doing, the link between annual program activities and goals and the strategic plan is established. The link can occur in various ways. In many cases, annual performance goals may be identical to the strategic objective or the principal implementation strategies contained in the strategic plan. In these cases, the performance plan provides more detail and often sets annual targets for the strategic objective or implementation strategy. For example, a FY 2001 –FY 2005 annual performance goal for the Centers for Disease Control is to ensure that 90% of two-year-olds are appropriately vaccinated. Another CDC annual performance goal for FY 2002 – FY 2005 is to eliminate vaccine-associated paralytic polio by 2010. A final example is the FY 2003 – FY 2005 CDC annual performance goal to eliminate indigenous measles transmission in all 47 countries of the Americas. The relationship with the Department’s Strategic Plan strategies cited in the preceding paragraph is evident. Cumulatively, the HHS Annual Performance Plan outlines–in the form of annual performance goals for HHS programs–the incremental steps the Department will take each year to achieve its strategic objectives. Likewise, the annual performance data generated to report on annual performance goals can be useful in assessing progress toward achieving the strategic objectives. First, the performance plans and reports provide an extensive body of information on programs, performance measures, and program strategies that are relevant to the objectives in the strategic plan. Second, the performance plans and reports will provide annual performance data that allow HHS to analyze progress toward the achievement of the Departments goals and objectives on a continuous basis. Finally, the performance plans and reports provide a mix of measures, particularly process, output, and outcome measures, that provide for a richer assessment of progress than can be provided by long-term outcome measures alone. In summary, the HHS performance plans and reports will continue to identify an extensive set of strategies, initiatives, programs, and performance goals that will support all of the strategic objectives and serve as the primary mechanism for tracking progress toward achievement of the HHS Strategic Plan’s goals and objectives. Success IndicatorsTable A provides examples of indicators that can be used to gauge whether we are making progress toward achieving strategic plan objectives. Some of the indicators are illustrated by a graph or chart when sufficient trend data were available to merit such an approach. Data sources for the indicators are varied, and some representative sources are listed within the table. However, it should be noted that responsibility for accomplishment of the indicators is not necessarily linked to the entity collecting the data. For example, CDC’s National Center for Health Statistics (NCHS) serves a unique role within the Department, providing data support for a myriad of programs not necessarily carried out by CDC. As stated, performance data from the HHS Annual Performance Plan is relevant in demonstrating progress toward achieving the Department’s Strategic Plan objectives. We have incorporated an illustrative set of measures from the FY 2002 performance plan into the table to demonstrate this linkage.[1] In addition, we have coordinated the indicators with other performance measurement activities. One of the five initiatives in the President’s Management Agenda is budget-performance integration. As an element of this initiative, the Office of Management and Budget developed the Program Assessment Rating Tool (PART). PART was designed to be a common, transparent approach to assessing federal programs. It examines program purpose, strategic planning, program management, and results. As a prelude to the FY 2004 budget, OMB and HHS examined 31 HHS programs—more than any other federal department. HHS is actively using PART to improve programs, support budget decision making, and refine the performance measurement process. HHS will continue to assess progress toward achievement of the Department’s strategic goals and objectives in the HHS Annual Performance Plan which accompanies the detailed performance plans and reports (which contain a broad range of performance measures on HHS programs) submitted to the Congress each year with the HHS Budget. For example, in the HHS Annual Performance Plan submitted to the Congress in February 2000, the Department described how selected results for measures in the annual performance plans provided substantive evidence of HHS progress toward the achievement of its strategic goals. As the data in the table are examined, please note that apparent differences may not reflect statistically significant differences in trends. Closer analysis of data would be necessary to determine if there are actual differences in trends. Table A
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Strategic Objective |
Indicator(s) for Objective |
Data Source[2] |
|---|---|---|
| GOAL 1: Reduce major threats to the health and well being of Americans |
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Objective
1.1 |
Reduce the proportion of Americans defined as obese (by age group) |
National Health and Nutrition Examination Survey (HP2010, indicator 19-2, 19-3) 1999-2000 Baseline: 30.9% HP2010Target: 15% |
| Decrease hospitalizations due to asthma for states that have implemented a comprehensive asthma control program. |
National Vital Statistics System (HP2010, indicator 24-1) FY 2001 Baseline: <5 years: 60.9/100,000; 5-64 years: 13.8/100,000; >64 years: 19.3/100,000 FY 2005 Target: 12% reduction in each age group |
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| Decrease new diabetes cases (per 1,000 population per year) |
National Health Interview Survey (HP2010, indicator 5-2) 1999-2001 Baseline: 6.4 per 1,000 HP2010 Target: 2.5 new cases per 1,000 population per year |
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| Objective
1.2 |
Reduce the incidence of gonorrhea in women aged 15-44 |
Sexually Transmitted Diseases Surveillance System (CDC) (APP) FY 2000 Baseline: 278 cases per 100,000 population FY 2009 Target: < 250 cases per 100,000 |
| Reduce the number of HIV infection cases diagnosed each year among people under 25 years of age |
HIV/AIDS Surveillance System (CDC) (HP2010 indicator 13.5- Developmental Measure) FY 2002 Baseline: Overall – 2185 reported cases (data from 25 states with HIV reporting) FY 2009 Target: 25% reduction |
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| Decrease the number of perinatally acquired AIDS cases, from the 2002 base of 141 cases |
HIV/AIDS Surveillance System (CDC) (APP) FY 2002 Baseline: 141 cases FY 2009 Target: < 90 cases |
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| Objective
1.3 |
Achieve or sustain immunization coverage of at least 90% in children 19 to 35 months of age 3 doses DtaP vaccine 3 doses Hib vaccine 1 dose MMR vaccine 3 doses hepatitis B vaccine 3 doses polio vaccine 1 dose varicella vaccine 4 doses pneumonococcal conjugate vaccine |
National Immunization Survey (CDC) (APP) FY 2002 Baseline: DtaP – 95% Hib – 93% MMR – 91% hepatitis B – 90% varicella vaccine – 81% FY 2005 Target: Maintain 90% immunization rate |
| Increase the vaccination rate among non-institutionalized high-risk adults ages 18 to 64 years for influenza and pneumococcal pneumonia |
National Health Interview Survey (non-institutionalized population) (CDC) (APP/HP2010 indicator 14.29) FY2001 Baseline: flu – 29%, pneumonia – 17% FY 2005 Target: flu – 32%, pneumonia – 22% |
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| Objective
1.4 |
Decrease the percentage of adolescents and adults engaged in binge drinking in past 30 days |
National Household Survey on Drug Abuse (SAMHSA) FY 2001 Baseline: 20.5% HP2010 Target: 11% (high school seniors); 20% (college students) |
| Increase the proportion of adolescents not using alcohol or any illicit drugs during the past 30 days. |
National Household Survey on Drug Abuse (SAMHSA) (APP) FY 2001 Baseline: 10.8% HP2010 Target: 11% |
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| Decrease the percentage of adults age 18 years and over who have used illicit drugs in past 30 days |
National Household Survey on Drug Abuse (SAMHSA) (APP/ HP2010 indicator 26-10c) FY 2001 Baseline: 6.6% HP2010 Target: 2% |
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| Objective 1.5 |
Reduce the percentage of youth (grades 9-12) who smoke |
Youth Risk Behavioral Surveillance System (CDC)(APP) FY 2001 Baseline: 28.5% FY 2009 Target: 26.5% |
| Objective
1.6 |
Decrease the death rate from unintentional injuries including those resulting from falls, residential fires, drowning, or motor vehicles (per 100,000 population) |
National Vital Statistics System 2001 Baseline: 35.7 deaths per 100,000 HP2010 Target: 17.5 deaths per 100,000 |
| Decrease the death rate from homicides including those resulting from child maltreatment, intimate partner violence, and youth violence (per 100,000 population) |
National Vital Statistics System (HP2010 Indicator 15-32) 2001 Baseline: 7.1 deaths per 100,000 HP2010 Target: 3.0 death per 100,000 |
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| GOAL 2: Enhance the ability of the nation’s health care system to effectively respond to bioterrorism and other public health challenges |
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| Objective
2.1 |
States develop state-wide plans (including the development of emergency mutual aid agreements and/or compacts, and provision for regular exercises that test regional response proficiency) for responding to incidents of bioterrorism, other infectious disease outbreaks, and other public health threats and emergencies | CDC/HRSA Bioterrorism Preparedness Cooperative Agreement Programs FY 2002 Baseline: 0% of states FY 2005 Target: 100% of states |
| States develop and implement regional hospital plans for a potential epidemic involving at least 500 patients in each State or region |
CDC/HRSA Bioterrorism Preparedness Cooperative Agreement Programs FY 2002 Baseline: 0% of states FY 2005 Target: 75% of states |
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| Objective 2.2 |
Increase the number of import field exams and sample analyses conducted on products with suspect histories |
Field Data Systems (FDA) (APP) FY 2003 Baseline: 78,659 field examinations FY 2005 Target: 97,000 field examinations |
| GOAL 3: Increase the
percentage of the Nation’s children and adults who have
access to health care services, and expand consumer choices
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| Objective 3.1 |
Increase the proportion of persons with health insurance (age-adjusted under 65) |
(1) National Health Interview Survey (NHIS) (CDC) (2) Health Insurance Coverage (HIC) (U.S. Census Bureau) (HP2010 indicator 1-1) 2001 Baseline: 84% 2010 Target: 100% |
| Objective
3.2 |
Increase the number of uninsured and underserved persons who have access to Health Centers |
Program data/Uniform Data System (Health Resources and Services Administration–HRSA) (APP) FY 2002 Baseline: 11.3 million FY 2006 Target: 16.39 million |
| Increase the proportion of persons in rural areas who have a specific source of ongoing care |
National Health Interview Survey (HP2010 indicator 1-4) Performance: 2001 Baseline: 90% HP2010 Target: 96% |
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| Objective
3.3 |
Reduce the percentage of improper payments made under the Medicare fee-for-service program |
Comprehensive Error Rate Testing (CERT) methodology with oversight by the HHS Office of the Inspector General (CMS) (APP) FY 1996 Baseline: 14% FY 2008 Target: 4.0% |
| Reduce the Medicare contractor error rate |
Comprehensive Error Rate Testing (CERT) methodology with oversight by the HHS Office of the Inspector General (CMS) (APP) Baseline: Error rate for FY 2004 FY 2008 Target: All Medicare claims will be processed by contractors who have an error rate less than or equal to the previous year’s actual unadjusted national paid claims error rate |
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| Decrease the provider compliance error rate |
Comprehensive Error Rate Testing (CERT) methodology with oversight by the HHS Office of the Inspector General (CMS) (APP) Baseline: FY 2004 level FY 2007 Target: Decrease the provider compliance error rate 20% below the 2006 level |
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| Objective
3.4 |
Increase the proportion of persons with health insurance (by available race/ethnicity) |
Health Insurance Coverage (U.S. Census Bureau) (HP2010 indicator 1-1) 2001 Baseline: 84% (overall) 2010 Target: 100% |
| Decrease infant deaths (under the age of 1 year) (per 1,000 live births, collected by available race/ethnicity) |
National Vital Statistics System (HP2010 indicator 16-1c) 2008 Target: 6.5 per 1,000 |
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| Objective
3.5 |
Increase the proportion of HIV-infected adolescents and adults who receive testing, treatment, and prophylaxis consistent with current Public Health Service (PHS) treatment guidelines |
Adult Spectrum of Disease Surveillance Project (HP2010 indicator 13-13) 1997 Baseline: Treatment: any antiretroviral therapy – 80%; Highly Active Antiretroviral therapy- 40% Prophylaxis: Pneumocystis carinii pneumonia prophylaxis – 80%; Mycobacterium avium complex prophylaxis – 44% HP2010 Target: 95% |
| Increase the proportion of persons with serious mental illness who are employed |
National Health Interview Survey (HP2010 indicator 18-4) 2001 Baseline: 35.6% HP2010 Target: 51% |
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| Increase the number of children served by Maternal and Child Health Block Grants (Title V of the Social Security Act) |
State block grant reports (HRSA) (APP) FY 2002 Baseline: 22.8 million FY 2009 Target: 23.0 million |
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| Objective
3.6 |
Decrease cancer mortality rates for AI/AN population |
National Vital Statistics System (with miscoding adjustments) (HP2010 indicator 3-1) 1997-99 Baseline: 124.5 per 100,000 HP2010 Target: 21% improvement |
| Increase proportion of AI/AN diabetics with ideal blood sugar control |
IHS Diabetes Care and Outcomes Audit FY 2003 Baseline: 28% HP2010 Target: 40% |
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| Decrease childhood obesity rates for AI/AN children |
IHS automated record system (Resource and Patient Management system/Patient Care Component-RPMS/PCC) data (IHS) FY2004 Baseline: Under development FY 2009 Target: 10% reduction of FY 2004 baseline |
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| GOAL 4: Enhance the capacity and productivity of the nation’s health science research enterprise |
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| Objective 4.1 |
By 2007, evaluate the efficacy of three new treatment strategies for HIV infection in clinical trials in an effort to identify agents or combinations of agents that are more effective, less toxic, and/or simpler to use than the current recommended HIV treatment regimen |
Science advances, science capsules, and stories of discovery (qualitative description with relevant citations as appropriate) (NIH) (APP) FY 2004-2005 Baseline: 1) 23 approved antiretroviral drugs exist for HIV infection treatment 2) Clinical trials for the next generation of fusion inhibitors and lead compounds representing integrase inhibitors are being completed FY 2003-2007 Targets: 1) Develop three anti-HIV compounds; 2) Initiate four drug clinical trials; 3) Develop/test two agents to prevent/treat drug complications; and 4) Develop/test one new approach to inhibit mother-to-child transmissions |
| Objective
4.2 |
Meet PDUFA III commitments for the review of
original new drug application (NDA) submissions by reviewing
90% of standard NDAs within 10 months and 90% of priority
NDAs within 6 months |
Center-wide Oracle Management Information System (COMIS); New Drug Evaluation/Management Information System (NDE/MIS) (FDA) FY 2001 Baseline: Standard - 90% of 86 submissions; Priority – 100% of 10 submissions FY 2007 Target: Standard – 90%; Priority – 90% |
| Complete review and decision on 70% of expedited premarket approval application actions within 300 days |
Center for Devices and Radiological Health Premarket Tracking System and Receipt Cohorts (FDA) (APP) Baseline: New measure FY 2007 Target: 90% |
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| Objective
4.3 |
Ensure that the proportion of predoctoral trainees and fellows (NRSA program) applying for and receiving NIH research grants exceed relevant comparison groups |
Evaluations of career development programs FY 2003 Baseline: NRSA Group – 7,125; Comparison Group A – 9,985; Comparison Group B - 9,229 FY 2004 Target: Proportion of NIH trainees receiving grants exceeds comparison groups by 10% within 10 years of termination |
| Increase the number of research training and career development position occupied by individuals from underrepresented racial and ethnic groups |
NIH monitoring and evaluation surveys FY 2003 Baseline: White-9,957; Asian-1,862; African American – 1,112; American Indian – 106; Pacific Islander – 52 FY 2004 Target: 1% increase over baseline |
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| Objective 4.4 |
Increase the dissemination of health data in innovative ways |
Research Coordination Council FY 2009 Target: Implement recommendations from the Research Coordination Council on research translation, dissemination, implementation |
| Objective
4.5 |
Increase the percentage of institutional policies for responding to allegations of scientific misconduct that have been reviewed for compliance with federal regulations |
Administrative files (OPHS) (APP) FY 2003 Baseline: 47% FY 2009 Target: 53% |
| GOAL 5: Improve the quality of health care services |
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| Objective 5.1 |
Increase the number of medical errors identified while decreasing the number of severe ones |
Evaluative studies/surveys Baseline: Establish in 2005 FY 2009 Target: Under development |
| Objective
5.2 |
Maintain the percentage of women aged 40 and over who have received a mammogram and clinical breast exam within the preceding two years |
National Health Interview Survey HP2010 indicator 3-13) 2000 Baseline: 70% HP2010 Target: 70% |
| Increase the percentage of people age 50 or over who have had a fecal occult blood test in the past two years (for colorectal cancer screening) |
National Health Interview Survey (HP2010 indicator 3-12) 2000 Baseline: 33% HP2010 Target: 50% |
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| Increase the percentage of mothers receiving prenatal care in the first trimester of pregnancy (by available race/ethnicity) |
National Vital Statistics System (HP2010 indicator 16-6) 2001 Baseline: 83% HP2010 Target: 90% |
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| Objective 5.3 |
Increase the number of visitors to HHS web pages containing information on health insurance and health care. |
On-line monitoring and surveys Baseline: FY 2004 usage FY 2009 Target: 30% increase over FY 2004 baselines. |
| Objective
5.4 |
Increase the percentage of individuals who have their complaint of abuse, neglect, discrimination, or other human or civil rights corrected |
Program Performance Reports of Protection and Advocacy Systems (ACF ) (APP) Baseline: Under development FY 2009 Target: 92% |
| Objective
5.5 |
Increase proportion of physicians using an electronic health record for patient data |
Evaluative studies/surveys FY 2002 Baseline: 15-17% FY 2009 Target: 17-23% |
| GOAL 6: Improve the economic and social well-being of individuals, families, and communities, especially those most in need |
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| Objective
6.1 |
Increase Temporary Assistance for Needy Families (TANF) workforce participation rates |
TANF data (ACF) (APP) FY 2002 Baseline: all families – 83%; two parent families – 100% FY 2009 Target: 100% |
| Increase the percentage of adult TANF recipients who become newly employed |
National Directory of New Hires (ACF) (APP) FY 2002 Baseline: 36.0% FY 2009 Target: 52.5% |
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| Increase the percentage of refugees entering employment through Administration on Children and Families (ACF)-funded refugee employment services |
ACF administrative data (ACF) (APP) FY 2002 Baseline: 53.5% FY 2009 Target: 65.8% |
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| Objective
6.2 |
Increase the proportion of older adults who have participated during the preceding year in at least one organized health promotion activity |
National Health Interview Survey (HP2010 Indicator 7-12) 1998 Baseline: 12% HP2010 Target: 90% |
| Objective
6.3 |
Increase the proportion of adults with disabilities reporting satisfaction with life |
Behavioral Risk Factor Surveillance System (HP2010 indicator 6-6) 1998 Baseline: 87% HP2010 Target: 96% |
| Objective
6.4 |
Increase the amount of non-federal dollars per 1,000 federal dollars (Community Service Network Block Grant) expended to support state and local activities to combat local conditions that keep people in poverty |
Community Services Block Grant Information System (ACF) (APP) FY 2002 Baseline: Under development Target: Under development |
| Objective
6.5 |
Increase the number of grant/contract awards annually to community and faith-based organizations |
HHS Administrative Data; Survey to Ensure Equal Opportunity for Applicants Baseline: Under development Target: Under development |
| GOAL 7: Improve the stability and healthy development of our Nation’s children and youth |
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| Objective
7.1 |
Increase the number of children in a state living in married couple families (as a percentage of all children in the state living in households) |
Current Population Reports (U.S. Bureau of the Census) FY 2002 Baseline: 60% Target: Under development |
| Objective
7.2 |
Increase the average percent gain in word knowledge (Head Start Children) |
Family and Child Experience Survey (FACES) (ACF) (APP) FY 2002 Baseline: 32% gain FY 2009 Target: 36% gain |
| Increase the average percent gain in letter identification for children completing the Head Start program (Head Start Children) |
(FACES) (ACF) (APP) FY 2002 Baseline: 38% gain FY 2009 Target: 70% gain |
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| Increase the percentage of parents who report reading to child three times per week or more (Head Start Children) |
(FACES) (ACF) (APP) FY 2002 Baseline: 69% FY 2009 Target: 72% gain |
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Objective
7.3 |
Increase the percentage of paternity established for children born out of wedlock |
State data from Child Support Enforcement data system (ACF) (APP) FY 2001 Baseline: 91% FY 2009 Target: 98% |
| Objective
7.4 |
Decrease the rate of substantiated cases of maltreatment that have a repeated substantiated report of maltreatment within 6 months |
National Child Abuse and Neglect data system (ACF) (APP) 2002 Baseline: 9% FY 2009 Target: 5% |
| Increase the percentage of children who exit foster care within two years of placement through guardianship or adoption |
Adoption and Foster Care Analysis and Reporting System (AFCARS) (ACF) (APP) FY 2002 Baseline: 31% FY 2009 Target: 39% |
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| Increase the percentage of children who exit foster care through reunification within one year of placement |
AFCARS (ACF) (APP) FY 2002 Baseline: 68% FY 2009 Target: 70% |
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| Increase the proportion of youth living in safe and appropriate settings after existing ACF-funded services |
Runaway and Homeless Youth Management Information System (RHYMIS) (ACF) (APP) FY 2002 Baseline: 89.5% FY 2009 Target: 96% |
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| GOAL 8: Achieve Excellence in Management Practices |
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| Objective
8.1 |
Increase coordination of research, demonstration, and evaluation activities across research agencies through the Secretary’s Research Coordination Council |
Internal HHS management reports Annual Target: Develop and implement annual recommendations of the Research Coordination Council that promote increased coordination of activities based on ongoing review of agency research budgets and associated narrative reports |
| Objective
8.2 |
Increase the percentage of the HHS workforce in mission-direct positions (as opposed to mission-support) to provide stronger alignment of human capital to accomplishing the Department’s mission |
Internal HHS reports FY 2002 Baseline: 57% mission direct FY 2006 Target: 67% mission direct |
| Objective
8.3 |
Increase the percentage of standard competitions complete within a 12-month time frame |
HHS Internal Management reports FY 2002 Baseline: 0% FY 2004 Target: 90% |
| Increase the percentage of streamlined competitions completed within a 90 day time frame |
HHS Internal Management reports FY 2002 Baseline: 0% FY 2004 Target: 95% |
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| Objective
8.4 |
Decrease percentage of improper payments under the Medicare fee-for-service programs (post-payment claims) |
Comprehensive Error Rate Testing (CERT) methodology with oversight by the HHS Office of Inspector General (CMS) (APP) FY 1996 Baseline: 14% FY 2008 Target: 4% |
| Objective
8.5 |
Increase the use of SNOMED in medical software to facilitate a common vocabulary (a basis for electronic commerce). |
Industry Surveys FY 2004 Baseline: Under development FY 2008 Target: 80% of electronic health record applications use SNOMED |
| Objective
8.6 |
Senior agency managers meet at least quarterly to examine reports that integrate financial and performance information. This information is used to make program management decisions. Strategic plans contain a limited number of outcome-oriented goals and objectives. Annual budget and performance documents incorporate all measures identified in the PART. Performance appraisal plans for at least 60 percent of agency positions link to agency mission, goals, and outcomes; effectively differentiate between various levels of performance; and provide consequences based on performance. Budget and performance documents report the full cost of achieving performance goals accurately (+/- 10 percent) and can accurately (+/- 10 percent) estimate the marginal cost of changing performance goals. All programs contain at least one efficiency measure. PART evaluations are used to direct program improvements and the ratings are used consistently to justify funding requests, management actions, and legislative proposals. Less than 10 percent of agency programs receive a ‘Results Not Demonstrated’ rating for more than two years in a row. |
President’s Management Scorecard FY 2003 Baseline: Red score (Status) and Green score (Progress) and PMA FY 2007 Target: Green scores on Status and Progress |
| Objective
8.7 |
Reduce the average time to marketing approval or tentative approval for safe and effective new generic drugs. |
Center-wide Oracle-based Management Information System (COMIS) and New Drug Evaluation/Management Information System (NME/MIS) (FDA) FY1998-2000 Baseline (3-year average)*: 17.9 months FY 2005-2007 Target (3-year average) *: 16.4 months *Sample is average approval time for the fastest 70% of approved or tentatively approved original generic drug applications submitted during the 3-year periods of 1998-2000 and 2005-07. |
[1] Performance goals and data presented here may change over time depending on outyear corrections and updates; the HHS performance plan and/or individual HHS agency annual performance plans should be consulted.
[2] The HHS Agency listed indicates that it is the source of the data, not that it is necessarily responsible for achieving the objective or for improvements in the measure.
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Questions? Please contact Lynn Nonnemaker at lynn.nonnemaker@hhs.gov
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