HHS Strategic Plan - Appendix E

The Office of Management and Budget’s Program Assessment Rating Tool (PART) measures program evaluation activities, among other things. In response to the latest PART ratings, HHS is conducting additional evaluations in the areas identified by the PART review (such as IHS sanitation facilities, the drug treatment initiative, effectiveness of immunizations, and the nurse education loan repayment program).

HHS is continuously striving to enhance the quality and quantity of program evaluations to learn more about the effectiveness of our interventions. Program evaluations can play an important role in formulating goals, objectives, and implementation strategies for a variety of planning activities throughout the Department of Health and Human Services (HHS). Program evaluations also tell us whether our efforts are successful. While there are still gaps in what we know, we now are beginning to assemble a body of evaluative information that supports the way we craft our various goals and objectives and substantiates the effectiveness of strategies to achieve those goals and objectives. To illustrate this, we provide a discussion of the evaluative information that contributed to setting our goals and objectives. We discuss program evaluations that demonstrate the effectiveness of implementation strategies that we will use. In addition, we provide a list of future evaluations that will provide additional insight into the effectiveness of our strategies and cumulative impact of our efforts.[1] Information gained from evaluation studies plays an important role in planning for the future of the Department’s programs. This information has been used to assist in identifying critical health care issues, developing the best available strategies for addressing those issues; understanding the characteristics of various populations, as well as their service utilization and expenditure patterns; examining differences in costs, quality, and access to care under alternative service delivery models; and identifying improvements that can be made in administering various programs. A goal by goal discussion follows.

GOAL 1: Reduce the major threats to the health and well-being of Americans

A variety of statistical data on health trends in the United States contributed to the creation of Goal 1. For example, information from the National Vital Statistics Report provided the basis for establishing strategic objectives that address major causes of premature mortality and morbidity in the United States. Also useful was a wide variety of information on specific behavioral trends and incidences of disease available from national surveys and public health surveillance systems, such as the Behavioral Risk Factor Surveillance System, the Total Diet Survey (Food and Drug Administration) and the National Household Survey on Drug Abuse.[2]

Available evaluation studies underline the effectiveness of a number of the strategies that the Department will use to achieve its objectives. For example, a key element in our strategy to reduce tobacco use among youth is the support of tobacco education programs. A recent evaluation of a major anti-tobacco media campaign in Florida demonstrated the effectiveness of a paid advertising campaign in preventing tobacco use, especially when targeted to younger persons. As a deterrent to tobacco sales to minors, the effectiveness of strategies to enforce the prohibition on sales to minors (Synar) is supported by recent evaluations.

Similarly, evaluations, such as the review of the Child and Adolescent Trial for Cardiovascular Health (CATCH) program, point to the effectiveness of education programs in changing behaviors and attitudes toward diet and physical activity (Objective 1.1). Also, findings from Food and Drug Administration’s (FDA) Food Label and Nutrition Tracking System indicate that consumers are reading, understanding, and changing their minds about food products as a result of FDA food labeling activities. The positive impact of consumer education on diets is also supported by the study The Effects of Education and Information Source on Consumer Awareness of Diet-Disease Relationships.

Examples of other evaluations that underline the effectiveness of our strategies in Goal 1 include: preliminary results from the National Cross-site Evaluation of High Risk Youth substance abuse prevention programs, results from the National Treatment Improvement Evaluation Studies (NTIES) evaluation showing that treatment works (Objective 1.4), and evaluations of behavior counseling programs such as Project RESPECT (Objective 1.2).

GOAL 2: Enhance the ability of the Nation’s health care system to effectively respond to bioterrorism and other public health challenges

Concern about the need for effective response to public health challenges has been heightened by the experience with Anthrax and awareness of potential bio-terrorist threats. Effective response to ongoing and emerging threats requires strength in all elements of the public health infrastructure and effective coordination among all elements of the health care delivery and public health systems.

A variety of assessments of the capacity of the Public Health Service to identify and respond to health challenges in the United States are available and support the need to strengthen the public health infrastructure. For example, a 1999 GAO study (GAO/HEHS-99-26) documented difficulties with laboratory capacity. This is supported by a Department assessment (1997), Public Health Workforce: An Agenda for the 21^st Century, which singles out laboratory capacity as a pressing challenge. Healthy People 2010 documents the need for better information technology. The Institute of Medicine (1988) published perhaps the most comprehensive view of the challenge, The Future of Public Health.

Achievement of Goal 2 rests largely on the dual strategies of improving the surveillance and response capacity of federal, state, and local health agencies and improving the effectiveness and timeliness of communications throughout the public health system. Our adoption of these strategies is supported by assessments that are beginning to show successes in several areas. For example, assessments of efforts in the CDC’s National Center for Health Statistics (NCHS) to improve the timely release of surveillance and survey data have been positive. Also, an assessment of the CDC Assessment Initiative to enhance the ability of state and local health departments to use data for policy making has been positive.

In the area of medical device safety, evidence suggests that FDA information dissemination about faulty medical products, transmitted through advisories, has a positive impact on product safety, although further review is indicated. There is evidence that the implementation of FDA Adverse Event Reporting System for Biologics has resulted in improved products through changes in product labeling. The success of foodsafety consumer education strategies is supported by analytic findings in Background Research and Recommendations for the Food Safety Campaign. Finally, strategies to make drug prescription information more easily available and understandable seem to be successful, according to information obtained through our biennial National Survey of Prescription Medicine Information Received by Consumers.

GOAL 3: Increase the percentage of the Nation’s children and adults who have access to health care services, and expand consumer choices

Data from a number of health related surveys, such as the U.S. Census and Current Population Survey, were instrumental in helping set Goal 3 objectives that address challenges such as the lack of access to health care insurance and services and health disparities. Examples include the Medical Expenditure Panel Survey (Agency for Healthcare Research and Quality), the National Survey of Health Insurance (Kaiser/Commonwealth), the National Vital Statistics System (CDC), policy briefs of the National Center for Cultural Competence, and the report of the Surgeon General on Mental Health. Also useful were program data from the Health Resources and Services Administration on medical shortage areas and cost data from the Agency for Healthcare Research and Quality (AHRQ) on the cost of services to persons with HIV/AIDS (see AHRQ Pub No. 99-RO28). Information from the Department’s Office of the Inspector General (OIG) contributed to the development of our objective on the integrity of the Medicare and Medicaid programs. Data from the Medicare Current Beneficiary Survey were useful for assessing issues related to the effectiveness of and access to Medicare services.

A number of evaluative studies and other evidence illustrate the effectiveness of Goal 3 implementation strategies in increasing access to and effectiveness of health care services. For example, increasing the supply of physicians in underserved areas is a successful strategy for improving access to health care services. In addition, there is a similar impact where community health centers are located, and considerable evidence supports the success of Ryan White programs in increasing access to health care services for persons with HIV/AIDS. Finally, a continuing national evaluation of the strategy to support comprehensive community mental health services for children and their families shows improvements in a range of child outcome indicators (e.g., school attendance and behavior).

GOAL 4: Enhance the capacity and productivity of the nation’s health science research enterprise

Almost every day, the American health science research community announces new discoveries that hold tremendous potential for the prevention and treatment of disease and injury. The promise of these discoveries argues for the nurture of the research infrastructure that produces the discoveries. As a result of this productivity, strengthening this country’s health sciences enterprise has become and remains one of the strategic goals of the Department.

Success in achieving Goal 4 will rely on how effectively our strategies nourish health research. One element is to facilitate the conduct of research and to move successful research into practice and products. Evaluative information supporting our direction is continuing to emerge. For example, attempts to accelerate the development of new medical products through streamlining the product application and review process has led to shorter review times, and we are seeing new products approved under Fast Track processes. (Two such products for the treatment of HIV were approved in 1999.) Overall, streamlining efforts in response to the Prescription Drug User Fee Act (PDUFA) and the Food and Drug Administration Modernization Act (FDAMA) efforts are working to decrease product approval times, as reported in the FY 1999 Performance Report to Congress.

Objective	Subject	Methodology	End Date	Agency
Objective 4.1 Advance the understanding of basic biomedical and behavioral science and how to prevent, diagnose, and treat disease and disability	Review and assessment of results achieved from funded research, conducted as a normal part of scientific planning and priority setting	Various mechanisms, involving numerous internal and external groups	Continuous	NIH
	Development of PET and SPECT Ligands for Brain Imaging (Phased Innovation Award)	Workshop	FY 2008	NIH
	Conference on the Analysis of Multiple Unit Activity	Conference	FY 2003	NIH
	Chemical Sciences Roundtable	Case studies	FY 2003	NIH
	AIDS International Training and Research Program – Phase I Feasibility Study	Database analysis, modified case study	FY 2003	NIH
	AIDS International Training and Research Program – Phase II Outcome Evaluation	Database analysis, modified case study, literature review, survey	FY 2004	NIH
	International Biodiversity Cooperative Groups-Outcome Evaluation	Database analysis, modified case study, site visit, literature review	FY 2005	NIH
	International Training and Research Program in Population and Health: Phase I, Feasibility Study	Database analysis, modified case study	FY 2004	NIH
	International Training and Research Program in Population and Health: Phase II, Outcome Evaluation	Database analysis, modified case study, literature review, survey	FY 2005	NIH
	Minority International Research and Training Grant Outcome Evaluation	Database analysis, literature review, site visit, survey	FY 2008	NIH
	Fogarty International Research Collaboration Award Phase I: Feasibility Study	Database analysis, modified case study	FY 2003	NIH
	Fogarty International Research Collaboration Award Phase II: Outcome Evaluation	Database analysis, literature review, survey, modified case study	FY 2004	NIH
	Evaluation of Special Funding Program for Type I Diabetes Research	Survey, database analysis	FY 2003	NIH
	Evaluation of NIDDK Special Emphasis Funding	Comparison study	FY 2005	NIH
	Assessment of Division of AIDS Research Networks	Database analysis	FY 2008	NIH
	HIV Prevention Trial Network Program Review	External panel assessment	FY 2003	NIH
	Annual Review of New Imaging Technologies for Autoimmune Diseases	Program review	FY 2003	NIH
	Expert Panel on Food Allergy	Expert panel	FY 2003	NIH
	The Center for Scientific Review’s Integration and Reorganization of Behavioral and Social Science Review: A Retrospective Evaluation	Survey	FY 2005	NIH
	Hepatitis C Program Review	External program review	FY 2003	NIH
	Sexually Transmitted Diseases Program Review	External program review	FY 2003	NIH
Objective 4.2 Accelerate private sector development of new drugs, biologic therapies, and medical technology	Evaluation of statutory performance for the Prescription Drug User Fee Act (PDUFA) of 1992 as authorized by the Prescription Drug User Fee Amendments of 2002.	Analysis of premarket review data for human drugs and biological products	Annual	FDA
Objective 4.3 Strengthen and diversify the pool of qualified health and behavioral science researchers	Survey of graduate science student support – ongoing	Survey	Biennial	NIH
	Survey of doctorate recipients – ongoing	Survey	Biennial	NIH
	Evaluation of the NIH-wide program to conduct outreach to increase the number of minority institutions interested in applying to participate in biomedical and behavioral research	Survey and Case Study Design	FY 2006	NIH
	Network of minority research investigators	Effectiveness Assessment	FY 2008	NIH
Objective 4.4 Improve the coordination, communication, and application of health research results	Evaluation of Internet-based tools to improve cancer clinical trials	Comparison groups	2003	NIH
	Qualifying the value of R and E investments in chemistry and related disciplines	Case studies and database analysis	FY 2004	NIH
Objective 4.5 Strengthen the mechanisms for ensuring the protection of human subjects and the integrity of the research process	Ethics program review	Site visits and random sampling of ethics forms for review	FY 2004	NIH

GOAL 5: Improve the quality of health care services

Setting the Goal/Objectives

Goal 5 development was substantially influenced by recent findings of the Advisory Commission on Consumer Protection and Quality in the Health Care Industry and the Institute of Medicine’s report on medical errors. The Commission found that medical errors occur in hospitals, nursing homes, pharmacies, urgent care centers, and home care, and that all medical errors cost the nation approximately $37.6 billion annually. Also, the challenge to improve health care quality in the United States is well outlined in the Department’s report, The Challenge and Potential for Assuring Quality Health Care for the 21st Century. In developing Goal 5, we also considered the continuing need to improve the quality of human services based on widely available trend data on the well-being of children and families in the United States.

Effectiveness of our Implementation Strategies

Although much of the initiative to improve care quality is new and evaluations of programs and activities are just beginning, some evidence of effectiveness has emerged. This is linked to the design of our strategies. For example, a key component of our quality improvement strategies is to develop evidence-based findings on effective health services and promote use of the findings. Evaluation findings of the Agency for Healthcare Research and Quality in 1999 (Publication No. 99-R043) and evidence from other studies (Publication No. 95-N012) support the conclusion that evidence-based research is making its way into practice and, in turn, is contributing to improvements in patient outcomes. Similarly, GAO testified in 1995 (GAO/T-HEHS-95-221) that AHRQ practice guidelines seemed to have a positive impact on patient outcomes.

Efforts to increase consumer and patient use of health care information are the focus of an ongoing evaluation of the Centers for Medicare & Medicaid Services education program–Medicare & You–which is designed to help beneficiaries make the best use of new benefits and program flexibility. This evaluation will continue to provide feedback on the program and guide future directions. Finally, ongoing assessments of the impact and effectiveness of the Mammography Quality Standards Act has shown the value of certification and inspection strategies as an effective means of addressing patient protections.

A key implementation strategy for improving the quality of human services programs is the development of a broad framework that includes quality data, performance measurement systems, and program evaluations. As policy and program design devolve to state and local levels, it is vital that these levels of government have reliable information on which to base their decisions and that the effects of different policy and program choices on quality and accessibility is understood. Documenting, understanding, interpreting, and facilitating the exchange of information and experiences among states is essential to providing high quality services that promote the well-being of families and children.

Future Evaluations

Objective	Subject	Methodology	End Date	Agency
Objective 5.1 Reduce medical errors	Evaluation of Centers for Education and Research on Therapeutics to assess their effectiveness in translating and disseminating objective information on the appropriate and safe use of therapeutics	Citation analysis; other methodologies under development – evaluation	FY 2004	AHRQ
Objective 5.1 Reduce medical errors	Assessment of State Rules and Practice Regarding Collection and Reporting of Racial and Ethnic Data by Health Insurers and Managed Care Plans	Database analyses and selected site visits	FY 2004	OPHS
Objective 5.2 Increase the appropriate use of effective health care services by medical providers	Quality Improvement Organization Assessments of state performance	Annual reviews/ assessments	Ongoing	CMS
Objective 5.3 Increase consumer and patient use of health care quality information	Ongoing evaluation of Medicare & You (the national education campaign to help Medicare beneficiaries make choices among health benefits and plans)	MCBS Survey	Ongoing	CMS
Objective 5.4 Improve consumer and patient protections	National Assessment of Culturally and Linguistically Appropriate Services in Managed Care Organizations (MCOs) Serving Racially and Ethnically Diverse Communities	Survey of random sample of MCOs	Ongoing	OPHS
Objective 5.5 Accelerate the development and use of an electronic health information infrastructure	Centers of Excellence in Cancer Communications Research	Survey, textual analysis, and observational data	FY 2008	NIH
	MEDLINEplus Follow-Up Evaluation	On-line user survey	2003	NIH
	Physician-Patient Outreach Evaluation	Case studies, interviews, focus groups	FY 2004	NIH
	Hispanic Outreach Evaluation	Case studies, interviews, focus groups	FY 2003	NIH
	Tribal Connections Phase III Evaluation	Case studies, interviews, focus groups	FY 2003	NIH
	Four Corners Tribal Evaluation Project	Case studies, interviews, focus groups	FY 2004	NIH
	Spanish MEDLINEplus evaluation Part II	On-line focus groups	FY 2003	NIH
	Spanish MEDLINEplus Evaluation	On-line user survey	FY 2003	NIH
	Senior Citizen Outreach Evaluation	Case studies, interviews, focus groups	FY 2003	NIH
	Assessment of use of health information technology in community health centers	Case studies	FY 2003	ASPE
	Assessment of progress on the national health information infrastructure	Hearings and other ongoing activities under the auspices of the National Committee on Vital Health Statistics	Ongoing	ASPE

GOAL 6: Improve the economic and social well being of individuals, families, and communities, especially those most in need

Setting the Goal/Objectives

Data from a variety of national, state and program-specific sources provided valuable insights and information useful for the development of Goal 6, including development of the objectives and implementation strategies. For example, there is substantial evidence that many welfare-to-work experiments supported by the Department have been adopted by states. Many elements of these successful demonstrations were adopted in the welfare reform provisions of Temporary Assistance to Needy Families (TANF) in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Effectiveness of our Implementation Strategies

In Goal 6, there are a number of implementation strategies that focus on identifying effective program practices and disseminating these to states and other service providers through federal technical assistance and capacity development activities. Evaluative assessments of these efforts point to their value and argue for continuing to help identify and disseminate best practices as a key strategy to achieve our objectives in Goal 6. For example, the national evaluation of welfare-to-work strategies is beginning to provide information on the effectiveness of the JOBS program in seven sites and is influencing welfare reform reauthorization discussions.

Future Evaluations

Objective	Subject	Methodology	End Date	Agency
Objective 6.1 Increase the proportion of low-income individuals and families including those receiving welfare who improve their economic condition	Evaluation of employment retention and advancement strategies; impact of welfare reform on child outcome measures; impact of rural welfare to work strategies; and the effectiveness of employ-ment services for special populations	Experimental	2005	Administration for Children and Families (ACF)
	Evaluation of the Workforce Investment Act One-Stop Centers for service to TANF and low income populations	Descriptive analysis using literature review and case studies	2003	ASPE
	Evaluation and demonstration of enhanced services for hard-to-employ parents	Experimental	2010	ACF and ASPE
Objective 6.2 Increase the proportion of older Americans who stay active and healthy	Evaluation of multi-faceted fall-prevention programs for community-dwelling elderly	To be determined	Being developed	CDC
	Evaluation of the following services provided to the elderly under the Older Americans Act: nutrition programs, community supportive services, and preventive health services	To be determined	Variable 2003-2006	AOA
Objective 6.3 Increase the independence and quality of life of persons with disabilities, including those with long-term care needs	Evaluation of the home and community-based services waiver program	Descriptive analysis and consumer survey	2002	CMS
	Evaluation of multi-state demonstrations for integrating acute and long-term-care services	Quasi-experimental using surveys, case studies and database analysis	2005	CMS
	Multi-state evaluation of dual eligibles demonstrations (cash and counseling demonstrations for making individuals more involved in planning and directing their community-based long-term care services)	Control group	2003	CMS
	Evaluation of the Alzheimer’s Disease Demonstration Grants to States	To be determined	Ongoing	AoA
Objective 6.4 Improve the economic and social development of distressed communities	Evaluation of impact of Individual Development Accounts	Non-experimental	2005	ACF
	Evaluation of the role of private employers and TANF recipients	Descriptive analysis using existing studies, surveys, data sources, and interviews with experts	2003	ASPE
	Evaluation of welfare reform in four large urban areas	Administrative and survey data, neighborhood indicators, implementation and an ethnographic study	2003	ASPE
Objective 6.5 Expand community and faith-based partnerships	Evaluation of state and local contracting for social services under Charitable Choice	Descriptive analysis using interviews and surveys	2004	ASPE, Center for Faith Based and Community Initiatives
	Evaluation of innovative practices and promising approaches that faith- and community-based organizations are using so that other organizations can benefit from their unique approaches	Faith based organizations will provide	Faith based organizations will provide	ASPE, Center for Faith Based and Community Initiatives

GOAL 7: Improve the stability and healthy development of our Nation’s children and youth

Setting the Goal/Objectives

State and program administrative data were particularly useful in assessing trends and establishing the objectives for child welfare, abuse and neglect, early learning (Head Start) and child care. The Federal Interagency Forum on Child and Family Statistics annual report, America’s Children: Key National Indicators of Well-Being, provided a secondary source of trend data for these objectives. Projections by the Department’s micro simulation model, the Transfer Income Model (TRIM), were useful in testing alternative approaches and strategies for human services programs. Census data and data from surveys of the National Center for Health Statistics (CDC) contributed to the development of objectives that address trends in aging and long term care.

Effectiveness of our Implementation Strategies

For Goal 7, we point to the success of bonus payments and technical assistance to help states reduce barriers to adoption (Objective 7.4). The National Survey of Child and Adolescent Well-being (NSCAW) will provide valuable descriptive information including risk factors, service needs, and services received on children and families who come into contact with the welfare system.

This evaluative evidence, which goes back a number of years, demonstrates the success of programs such as Head Start to prepare children for school. Results from the Family and Child Experiences Survey and the Early Head Start Evaluation are beginning to show positive trends for Head Start children in cognitive and social skills, indicating learning readiness for kindergarten and the Early Head Start evaluation, completed in May 2002, demonstrated that Early Head Start improves some of the early building blocks necessary for the development of literacy and school readiness (Objective 7.2).

Future Evaluations

Objective	Subject	Methodology	End Date	Agency
Objective 7.1 Promote family formation and healthy marriages	Multi-site evaluation and synthesis of Responsible Fatherhood Projects	Descriptive analysis using implementation evaluation, program and administration data, and client interviews	2003	ASPE, ACF/OCSE
	Evaluation of community marriage demonstrations	Impact study	FY 2010	ACF
	Evaluation of healthy marriage programs for low-income parents who are married or plan to marry	Experimental	FY 2010	ACF
Objective 7.2 Improve the development and learning readiness of preschool children	Continuing surveillance of the impact of Head Start children in social, cognitive, and other domains (Family and Child Experiences Survey)	Surveys, observations, childhood assessments	Ongoing	ACF
	Head Start Impact Study is examining the development and school-readiness of low-income children including language and literacy development	Experimental	Ongoing	ACF
	Child Care Subsidy Evaluation, multi-year, multi-site study evaluating effects of alternative state and community subsidy policies	Various	2008	ACF
	Early Head Start follow-up study examining Early Head Start and control group children’s progress through pre-kindergarten	Experimental	FY 2004	ACF
	Early Childhood Longitudinal Studies with the Department of Education, studying a cohort of Head Start children at kindergarten entry and continuing through the fifth grade	Observations, interviews, and data analysis	Ongoing	ACF
Objective 7.3 Increase the involvement and financial support of non-custodial parents in the lives of their children	Partners for Fragile Families Evaluation	Process evaluation—interviews and focus groups. Impact evaluation—program and administrative data, and surveys	2006	ASPE, ACF/OCSE
Objective 7.4 Increase the percentage of children and youth living in a permanent, safe environment	Continuation of a national longitudinal study of child welfare that looks at the outcomes for families and children	Surveys, interviews	Ongoing in three to five year cycles	ACF
	Assessment of child welfare outcomes in areas of safety, permanency, and child and family well-being	Annual state submission of data, monitoring visits	Ongoing	ACF
	Consortium for longitudinal studies of child maltreatment from time children are 4 years old until they reach adulthood	Interviews and assessments	Ongoing	ACF
	Research and evaluation related to the Promoting Safe and Stable Families program	Multiple methods	Date-phased	ACF

GOAL 8: Achieve excellence in management practices

Setting the Goal/Objectives

We envision a Department that has a citizen-based focus, is results-oriented, and where practicable, market-driven. To improve the functioning of government and achieve efficiencies in its operations, the President highlighted a series of government-wide management reforms for the federal government in the President’s Management Agenda. HHS continues to place special emphasis on these reforms. They include:

Strategic Management of Human Capital
Competitive Sourcing
Improved Financial Performance
Expanding Electronic Government
Budget and Performance Integration
Effectiveness of our Implementation Strategies

Work continues to progress in these five areas throughout the Department, and in some cases there are already impressive results (ASBTF to include examples). Because some of these are areas of new or expanded emphasis, new goals and measures in the Department’s and in HHS agencies annual performance plans have been developed to capture on-going activity. Even these new goals and measures are expected to show positive results.

Future Evaluations

Objective	Subject	Methodology	End Date	Agency
Objective 8.1 Create a unified HHS committed to functioning as one Department	Assessment of consolidation of functions, annual feedback on coordination of research, and standardization of electronic communcations systems	Qualitative assessments	Ongoing	OS
Objective 8.2 Improve the strategic management of human capital	Human Resources Accountability System	Developmental. We are developing a comprehensive system that will link evaluations to a balanced scorecard methodology.	FY 2004	OS
Objective 8.3 Enhance the efficiency and effectiveness of competitive sourcing	Competitive sourcing savings and productivity gains	Developmental: Pending OMB direction	Ongoing	Department-wide
Objective 8.4 Improve financial management	Evaluate financial performance of President’s Management Agenda items, as targeted in the HHS Financial 5 Year Plan and as reported in the HHS Performance and Accountability Report	Compare target versus actual performance for a variety of financial management activities	Ongoing, with annual assessments of trends and achievements	OS
Objective 8.5 Enhance the use of electronic commerce in service delivery and record keeping	Individual accountability agreements between OS/ASBTF and enterprise initiative-specific program managers. (See also HHS IT strategic plan, appendices for action plans on enterprise level initiatives.)	Establish work breakdown structures and schedules of delivery and milestones against which progress may be measured	Ongoing	OS
	Results-based management across all IT and management initiatives	IT Investment Review Board (ITIRB) Performance measurement and management by HHS CIO	Ongoing	OS/ASBTF/OIRM
Objective 8.6 Achieve integration of budget and performance information	Results-based management in NCI’s business management infrastructure	Multiple logic models	Ongoing	NIH
Objective 8.7 Reduce regulatory burden on providers and consumers of HHS services	Review of regulatory burden(s)	OMB review of regulations on a case by case basis	Ongoing/ periodic	OS

[1] Program evaluation information is displayed only for those objectives for which future evaluations are planned.

[2] This includes information tracking major health risks in America (e.g., the percentage of adults who are obese), behavioral risk factors among adults for cardiovascular disease (Centers for Disease Control and Prevention ), and information tracking other trends.

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HHS Strategic Plan
FY 2004-2009

APPENDIX E
Program Evaluations

GOAL 1: Reduce the major threats to the health and well-being of Americans

GOAL 2: Enhance the ability of the Nation’s health care system to effectively respond to bioterrorism and other public health challenges

GOAL 3: Increase the percentage of the Nation’s children and adults who have access to health care services, and expand consumer choices

GOAL 4: Enhance the capacity and productivity of the nation’s health science research enterprise

GOAL 5: Improve the quality of health care services

GOAL 6: Improve the economic and social well being of individuals, families, and communities, especially those most in need

GOAL 7: Improve the stability and healthy development of our Nation’s children and youth

GOAL 8: Achieve excellence in management practices

HHS Strategic Plan FY 2004-2009

APPENDIX E Program Evaluations

GOAL 1: Reduce the major threats to the health and well-being of Americans

GOAL 2: Enhance the ability of the Nation’s health care system to effectively respond to bioterrorism and other public health challenges

GOAL 3: Increase the percentage of the Nation’s children and adults who have access to health care services, and expand consumer choices

GOAL 4: Enhance the capacity and productivity of the nation’s health science research enterprise

GOAL 5: Improve the quality of health care services

GOAL 6: Improve the economic and social well being of individuals, families, and communities, especially those most in need

GOAL 7: Improve the stability and healthy development of our Nation’s children and youth

GOAL 8: Achieve excellence in management practices

HHS Strategic Plan
FY 2004-2009

APPENDIX E
Program Evaluations