The Department has established eight “One HHS” Outcome goals to fulfill its mission:

HHS Goals and Objectives – FY 2004-2009

        “PREVENTING DISEASE AND ILLNESS”

“PROTECTING OUR HOMELAND” 

“CLOSING THE GAPS IN HEALTH CARE”

“IMPROVING HEALTH SCIENCE”

“REALIZING THE POSSIBILITIES OF 21ST CENTURY HEALTH CARE”

 “WORKING TOWARD INDEPENDENCE”

     “LEAVING NO CHILD BEHIND”

                                    “IMPROVING DEPARTMENT MANAGEMENT”

STRATEGIES FOR ACCOMPLISHING OUR GOALS

In this section we describe our strategies for accomplishing our strategic goals and objectives.  Legislation and/or regulations required to accomplish objectives are presented as part of the strategies.  In general, we conduct a number of activities to achieve objectives and goals, such as disseminating information; providing technical assistance to contractors, states, and local governments; conducting research and demonstrations; financing services for program beneficiaries; and delivering services directly to program recipients.  The strategic indicators (how we will track and measure the extent to which we are achieving our objectives) are presented in Appendix A.  A discussion of resources that will support these strategies is found in Appendix F, and a matrix relating the Department’s strategic objectives to programs is shown in Appendix J. 

The design and implementation of strategies/actions to accomplish our objectives and goals is a process that is influenced by information gained through program evaluation.  Appendix E provides an in-depth discussion of program evaluations and the Department’s plans to look at the effectiveness of the implementation strategies.

Goals / Objectives / Strategies

“PREVENTING DISEASE AND ILLNESS”

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

Research indicates that a significant percentage of premature mortality and morbidity in the United States can be prevented if individuals avoid certain high-risk behaviors, adopt a healthy lifestyle, and reduce exposure to major environmental risks to health.  The strategic objectives under this goal focus Department efforts on changing behaviors and reducing the risks that are associated with the leading causes of premature mortality and morbidity (e.g., heart disease and stroke) in the United States.  

The importance of this goal is evident from the health and economic consequences of the behaviors that are addressed. A recent HHS report (U.S. Department of Health and Human Services. “Prevention Makes Common ‘Cents’”. Washington, D.C.: U.S. Department of Health and Human Services, 2003.), found that,

• Tobacco use is the single most preventable risk factor for death and disease, contributing to more than 440,000 premature deaths annually in the United States from 1995-1999. 
• Recent estimates indicated that more than 129 million U.S. adults are considered to be overweight or obese. Obesity is believed to be associated with more chronic disorders and worse physical health-related quality of life than is smoking or problem drinking. Estimates of the deaths of U.S. adults due to causes related to obesity range from 280,000 to 325,000 each year.
• In 2000, it was estimated that 17 million people – 6.2 percent of the population – had diabetes. Untreated or poorly treated diabetes can result in death or significant disability, including heart disease and stroke, kidney failure, blindness, and lower limb amputations.
• Heart disease and stroke are the first and third leading causes of death in the United States, respectively, in both men and women.  The costs of cardiovascular disease have steadily increased past the $300 billion dollar mark over the past three years.
• Asthma is the 6^th-ranking chronic condition among the general U.S. population in terms of prevalence and the leading serious chronic illness of children in the U.S. Both the prevalence and costs of asthma have increased markedly over the past decade and a half.

Other examples include,

• Alcohol abuse exacts a financial toll on the nation, costing over $166 billion annually by some estimates. [2]
• Drug abuse, estimated to cost society over $100 billion per year, is linked to other public health problems, such as suicide, homicide, motor-vehicle injury, sexually transmitted diseases, and HIV  infection. [3]

Objective 1.1     Reduce behavioral and other factors that contribute to the development of chronic diseases 

How We Will Accomplish Our Objective

• Prevention
  • Support programs to train current practitioners and health professions students on how to incorporate disease prevention concepts into clinical practice.
  • Support the “Steps to a Healthier U.S.” Initiative to improve community-based health promotion and disease prevention activities.
  • Promote the use of early detection and screening services, especially through HHS-supported programs such as Medicare.
  • Support research to determine the causes of chronic diseases (such as asthma) and develop effective interventions to prevent their onset.
  • Disseminate information to providers about effective interventions that reduce the incidence and effects of chronic diseases, particularly asthma and diabetes.
  • Enable consumers to make informed decisions through enhanced communication of empirically-based health benefit/risk information associated with foods, drugs, and other medical products.
• Physical Activity and Diet
  • Promote proper nutrition and regular physical exercise with a focus on public education, content labeling for foods, and nutritious meals for the elderly.
  • Support research to better understand the effects of nutrition and physical exercise, on health, and to better understand the factors that act as incentives or barriers to physical activity or healthy eating.
  • Study how changes in the physical environment affect levels of physical activity.
• Treatment
• Provide patient information and training for health personnel on the care for chronic diseases, such as diabetes, to prevent the complications of the diseases.
• Encourage the use of evidence-based chronic disease treatment protocols in health programs funded by the department.
• Test the effectiveness of disease management models for the chronically ill Medicare population through disease management demonstrations.
• Environmental Conditions
  • Provide assistance to states and tribes to develop and implement surveillance and prevention programs that reduce environmental and occupational health threats.
  • Support research to better understand the effects of environmental toxins on health, and develop more effective monitoring and prevention interventions.
  • Help enhance the capacity of other countries in risk assessment for, and in response to, toxic substances, hazardous wastes, and other forms of pollution introduced into the environment.

Objective 1.2     Reduce the incidence of sexually transmitted diseases and unintended pregnancies

How We Will Accomplish Our Objective

• Expand abstinence education programs and use evaluation and technical assistance to identify and promote successful approaches, especially those oriented toward young people.
• Incorporate abstinence messages into Department programs that target adolescents.
• Provide assistance for state, tribal, and local efforts to monitor and reduce the incidence of sexually transmitted diseases (STD). 
• Promote the implementation of effective HIV and STD prevention programs that target populations most at risk, including implementation in HHS-funded programs such as community health centers.
• Provide assistance to help states, tribes, schools, faith-based and community-based organizations, and medical and public health professionals develop curricula and train staff in the prevention of STD and HIV infection. 
• Support research to learn more about the prevention of STDs and HIV and develop more effective prevention strategies, including biomedical and behavioral interventions.

Objective 1.3     Increase immunization rates among adults and children

How We Will Accomplish Our Objective

• Disseminate public information to patients and providers about the importance of vaccinations, and educate the public about the efficacy and safety of vaccines for children and adults.
• Provide assistance to health departments, state Medicaid agencies and State Children’s Health Insurance Programs, health care providers, and community health organizations to purchase and administer vaccines.
• Publicize coverage of immunization services under Medicare and the State Children’s Health Insurance Program and Medicaid.
• Support and conduct research to learn more about adverse reactions to vaccines and develop safer, more effective vaccines.
• Help countries and global partners increase their capacity to detect, monitor, and immunize against diseases that emerge abroad that could affect Americans.

Objective 1.4     Reduce substance abuse

How We Will Accomplish Our Objective

• Prevention
  • Support a coordinated approach to addressing the risk and protective factors that are associated with problem behaviors, including substance abuse, in order to achieve positive health outcomes.
  • Support communities in assessing factors impacting substance abuse; developing a strategic plan; identifying, adapting, and adopting evidence-based practices; mobilizing the community through coalitions; and evaluating outcomes.
  • Support surveillance and data systems that monitor substance abuse, especially among populations disproportionately affected by substance abuse.
  • Conduct research to understand the causes of addiction and to develop new prevention methods.
• Treatment
  • Provide support to states, tribes, and communities to improve alcohol and drug treatment programming.
  • Develop mechanisms that enable those in need of addiction treatment and recovery support services to choose the programs and providers that will help them the most.
  • Develop innovative ways to encourage public and private financing alternatives for treatment services.
  • Provide support for identification, dissemination, and adoption of evidence-based practices.
  • Provide support to strengthen the knowledge, skills, and competencies of treatment and related-health professionals.
  • Provide support for data systems that track substance abuse treatment service delivery characteristics and outcomes.
  • Conduct research to develop new treatment methods.

Objective 1.5     Reduce tobacco use, especially among youth

How We Will Accomplish Our Objective

• Develop and disseminate educational materials for youth, parents, schools, and sports officials to educate against tobacco use and exposure to secondhand tobacco smoke.
• Incorporate anti-tobacco education messages into Department programs that target youth.
• Promote the adoption of evidence-based guidelines on the treatment of tobacco dependence by health providers.
• Help states, tribes, schools, local governments, and anti-tobacco organizations develop tobacco control programs through financial and technical assistance.
• Participate in negotiations around the Framework Convention on Tobacco Control and provide technical assistance to international tobacco education and prevention programs. 
• Conduct research to understand addiction to tobacco and develop new biomedical and behavioral interventions to prevent and stop its use.
• Disseminate research findings and provide technical assistance to help states implement the Synar Amendment, which requires states to conduct random inspections of tobacco vendors to assess their compliance with state tobacco access laws.

Objective 1.6     Reduce the incidence and consequences of injuries and violence

How We Will Accomplish Our Objective

• Prevention
  • Provide financial assistance to community-based injury, suicide, and violence prevention programs. 
  • Disseminate information on how to prevent injuries and violence, such as use of seat belts, to public safety and community-based organizations, employers, the elderly, schools, and youth.
  • Disseminate information to industry on ways to improve workplace safety.
  • Provide technical assistance to hospitals and public health agencies on how to improve surveillance and monitoring activities for injuries in order to devise more effective methods of prevention.
  • Promote the development and improvement of state and tribal safety legislation.
  • Conduct research on the causes and risk factors for violence and injuries, and develop more effective prevention strategies. 
• Treatment
  • Educate health and human service providers on recognizing the symptoms of violence-related injuries, and develop and disseminate effective protocols for addressing the needs of those affected by violence.

“PROTECTING OUR HOMELAND”

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

There is little experience, especially in the United States, with the deliberate release of biological agents to cause major disease outbreaks.  However, events of the September 2001 terrorist attacks and the subsequent use of anthrax as a biological weapon have focused attention on the increasing possibility of such incidents, particularly to the possibility of terrorist incidents aimed at the civilian population.  Concern about deliberate use of disease agents presently focuses on anthrax, as well as smallpox, pneumonic plague, tularemia, viral hemorrhagic fevers, and botulism.

To respond to any future bioterrorist attack, a strong public health network (which includes hospitals, health networks, physicians, nurses, mental health workers, and public health officials, for example) would be needed to piece together early reports of a suspected attack, quickly determine what has happened, and mount an effective response to care for casualties and prevent further exposure.  Therefore, Goal 2 is concerned with the need to improve our network of infectious disease surveillance, including improving communications, upgrading laboratory facilities, developing advanced diagnostic techniques, and expanding the training of personnel to provide emergency health care.

Objective 2.1     Build the capacity of the health care system to respond to public health threats in a more timely and effective manner, especially bioterrorism threats

How We Will Accomplish Our Objective

• Upgrade the capacity of federal, state, tribal, and local public health systems (private and public), hospitals, and other health care facilities.
• Upgrade the Nation’s laboratory capacity to quickly identify and characterize suspected biological threat substances and respond to actual incidents.
• Create a national electronic communications (surveillance and response) system to link federal, state, tribal, and local public health and other health officials, health care providers, and other emergency responders, so that relevant information regarding public health threats can be rapidly shared.
• Establish “continuity of operations” plans to ensure that personnel and analytical capability will still be operational in the event of a terrorist attack.
• Facilitate the development and availability of medical countermeasures to limit the effects of a terrorist attack on the civilian or military populations.
• Identify shortages that exist in the healthcare workforce and upgrade the skills of the health care workforce, including first responders, emergency personnel, and mental health workers. 
• Increase the size and skills of the fully deployable PHS Commissioned Corps.
• Ensure the safety and security of personnel, physical assets, and sensitive information.
• Cooperate with other countries and with international organizations to enhance bioterrorism preparedness and response.
• Conduct and support research to produce more effective vaccines, therapeutics, rapid diagnostic tests and other monitoring technologies to address bioterrorism and other public health threats, such as SARS. 
• Ensure the security of food and medical products.

Objective 2.2     Improve the safety of food, drugs, biological products, and medical devices

How We Will Accomplish Our Objective

• Provide high quality, cost-effective oversight of industry manufacturing, processing, and distribution to reduce risk.
  • Use science-based risk management in all regulatory activities, so that limited resources can provide the most health promotion and protection at the least cost to the public.
  • Apply the most current scientific knowledge about risk management and quality assurance to FDA’s requirements, including current Good Manufacturing Practice (GMP) inspection, compliance, and enforcement activities.
  • Develop new inspection approaches to more effectively utilize new and existing resources.
  • Implement an efficient, risk-based system to promote the wide availability of safe FDA-regulated imports by: increasing the standards and improving the practices of source countries and at points of entry into US commerce; improving detection of noncompliant products; and developing standards and procedures to maximize the cost-effectiveness of Agency oversight.
• Assure the safety of the US food supply to protect consumers at the least cost for the public.
  • Develop and use new scientific knowledge and use public health systems to quickly and accurately identify food safety hazards so that disease risks can be properly managed.
  • Identify appropriate prevention standards, and apply appropriate preventive controls and inspection and monitoring systems to assure food safety for all Americans.
  • Measure results regarding health outcomes to verify that food borne illness and injury is being reduced.
  • Consider risk information in deciding how to manage food imports, whether by working with foreign countries and manufacturers to improve compliance with safe manufacturing abroad as an alternative to detailed inspections at the border, or by using better information on imports to focus border checks of final products that present significant potential risks, or by collaborating with domestic producers to improve checks on the safety of the ingredients they use.
• Develop methodological strategies and analyses to evaluate options, identify the most effective and efficient risk management strategies, and optimize regulatory decision-making.
  • Develop and evaluate strategies using scientific data to optimize pre-market and post-market regulatory decisions.
  • Develop timely, first-rate integrated risk assessment and economic analysis to identify risk management options for policy makers.

“CLOSING THE GAPS IN HEALTH CARE”

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

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 44 million persons in the United States 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 53 million residents would be limited without HHS community programs.  Access to treatment  for persons with HIV /AIDS , estimated to cost as much as $12,000 per year for antiretroviral therapy alone, could be severely limited without support for the cost of drug therapies and associated services.  A substantial majority of adults with diagnosable mental disorders do not receive treatment.  Many families cannot afford the cost of care for children with special health care needs.

Minority populations often have particular difficulties with access and they face a range of disparities  in health care.  For instance, approximately 35 percent of Hispanics and 23 percent of African-Americans are without health insurance, compared with 14 percent of white adults.  Blacks and Hispanics are more likely than whites to be in fair or poor health.

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     Encourage the development of new, affordable health insurance options

How We Will Accomplish Our Objective

• Support legislative changes [4] that remove excessive restrictions on Medical Savings Accounts and make them permanent.
• Promote the creation of purchasing groups and state high-risk insurance pools through grants and technical assistance to states. 
• Support adoption of income-based tax credits toward the purchase of health insurance for Americans without employer-subsidized insurance.
• Support adoption of temporary health credits for workers who have lost their jobs.
• Support medical malpractice litigation reform to reduce the need to practice defensive medicine, and thus restrain health care costs.
• Assist other federal departments in the implementation of the Health Coverage Tax Credit under the Trade Adjustment Assistance Reform Act of 2002, including helping interpret and determining the applicability of “qualified” health coverage under the Act.
• Conduct research to understand changes in the health insurance market and the impact of changes on access to care.

Objective 3.2     Strengthen and expand the health care safety net

How We Will Accomplish Our Objective

• Medicaid/SCHIP
  • Support legislative reform of the Medicaid program to allow states increased flexibility to design more effective ways to provide health coverage to children and families under the Medicaid and SCHIP programs.
  • Provide technical assistance to states and other public agencies to increase enrollment of SCHIP, Medicaid, and Qualified Medicare Beneficiary/Specified Low-Income Medicare Beneficiary eligible individuals.
  • Provide transitional medical assistance for welfare to work participants.
  • Monitor trends in children’s access to health services and inform policymakers about the health care received by children who are largely uninsured or underinsured.
• Underserved Rural and Urban Areas
  • Support effective telemedicine and distance learning programs to extend state-of-the-art health care and information to the Nation’s most isolated communities.
  • Provide Rural Health Outreach Grants to help establish new partnerships between health organizations and schools, churches, faith-based organizations, emergency medical services providers, private practitioners, social service organizations, and other groups, to improve the delivery of clinical care.
  • Support nursing education programs and promote practice and retention in underserved rural and urban areas.
  • Enhance flexibility in provision of health care in rural areas by helping communities tailor health care services to the needs of their communities.
  • Provide assistance for to doctors, nurses, emergency medical technicians, and other health professionals who serve in areas lacking adequate access to care.
  • Modernize the Consolidated Health Center and National Health Service Corps programs. 
  • Ensure that resource allocation methodologies direct resources to the underserved areas and populations most in need of services.
  • Conduct research on where and how uninsured and underinsured people receive health care, as well as research on primary care services, to identify difficulties in access, quality, and outcomes, and to develop better strategies to improve the efficacy of these services. 

Objective 3.3     Strengthen and improve Medicare

How We Will Accomplish Our Objective

• Support legislation to modernize and improve Medicare including:
  • providing all Medicare beneficiaries with access to prescription drug coverage, and while transitioning to full implementation, providing immediate assistance to low-income beneficiaries and access to lower drug prices for all beneficiaries through a prescription drug discount card.
  • providing options for Medicare beneficiaries that offer more choices and better benefits, including a comprehensive prescription drug benefit, full coverage of preventive care, and limits on high out-of-pocket costs.
  • providing the option for Medicare beneficiaries to keep traditional Medicare coverage, with access to discounted drugs and additional protection against high out-of-pocket prescription drug expenses.  In addition, providing new Medigap options that include prescription drug coverage and provide beneficiaries with additional protection against high out-of-pocket costs.
• Support interim measures to assist Medicare beneficiaries with accessing prescription drugs, such as through model Medicaid pharmacy waivers.
• Test new health plan options for beneficiaries by developing flexible demonstration programs.
• Provide more private health plan options for Medicare beneficiaries by ensuring that payment formulas are fair and by creating incentives for popular coverage options like preferred provider plans.
• Conduct demonstrations to test ways to incorporate disease management programs into Medicare.
• Develop strategies and tools to promote price and quality competition among health plans and providers.
• Support Medicare contractor reform through administrative steps to improve program management as well as customer service and Medicare contractor reform legislation.
• Streamline the process of approving national coverage of proven new medical procedures.
• Conduct research and surveys to measure and track beneficiary satisfaction with services.

Objective 3.4     Eliminate racial and ethnic health disparities

How We Will Accomplish Our Objective

• Undertake outreach efforts to raise awareness among minority communities about major health risks prevalent in their specific populations and provide access to information on how to reduce these risks. 
• Undertake outreach efforts, including working with faith-based and other community-based organizations, to raise awareness among minority communities about protections against illegal discrimination in access to and receipt of quality health care.
• Reduce communication barriers between health care providers and patients through provider education and training and the development and dissemination of appropriate technical assistance tools. 
• Partner with faith-based and other community-based organizations to help reach diverse racial and ethnic populations concerning major health risks and prevention in their communities.
• Conduct and support research to understand the underlying causes of racial and ethnic health disparities and develop and disseminate effective strategies to eliminate preventable disparities.

Objective 3.5     Expand access to health care services for targeted populations with special health care needs

How We Will Accomplish Our Objective

• Organ and tissue transplantations
  • Promote awareness of the importance of organ donations.
  • Evaluate strategies for increasing donations and promote what works.
  • Develop and disseminate the curriculum concerning organ and tissue donation for health care professionals.
  • Support research on alternative sources of tissue and organs suitable for transplantation.
• HIV/AIDS
  • Promote awareness of the Ryan White CARE Act, which provides resources for uninsured and underinsured people disproportionately affected by HIV/AIDS. 
  • Support HIV healthcare workforce development through training, technical assistance, and dissemination of evidence-based guidelines to Ryan White CARE Act grantees and providers.
  • Evaluate results and utilize evidence-based best practices as a part of quality management programs to ensure responsible provision of HIV/AIDS care and treatment.
  • Support Medicaid’s Maternal HIV Consumer Information Project.
  • Provide technical assistance to state Medicaid agencies on appropriate treatment and monitoring of HIV.
  • Provide technical and financial support to the Global Fund to Fight HIV/AIDS.
• Mental health services
  • Promote the adoption of evidence-based treatment services, support, and prevention strategies.
  • Conduct and support research to improve the effectiveness of existing mental illness treatments and develop new interventions to prevent and treat mental disorders.
  • Promote the integration of services, including mental health treatment, substance abuse treatment, primary care, and other needed services for people of all ages with co-occurring disorders, including individuals who are chronically homeless.
  • Enhance access to services by strengthening outreach and engagement approaches in relevant programs that will facilitate the enrollment of individuals who are chronically homeless.
  • Provide support for data systems that track mental illness, epidemiology, service system characteristics, and outcomes.  (See Appendix A.)
• Persons with special health care needs
  • Provide outreach to educate populations with special needs about systems of care.
  • Utilize information from national surveys and research to assist in filling gaps in services.
  • Promote fulfillment of the Americans with Disabilities Act and the President’s New Freedom Initiative that will improve the ability of people of any age who have a disability to live and participate in their communities.
  • Provide guidance to states to ensure that children with special needs receive appropriate care.
  • Conduct research to develop improved screening tools for identifying children with special needs.

Objective 3.6     Increase access to health services for American Indians and Alaska Natives (AI/AN)

How We Will Accomplish Our Objective

• Provide support for health professionals who serve in Indian health locations.
• Increase core capacity of tribes and tribal organizations to effectively assess needs, and implement and evaluate programs to eliminate health disparities.
• Support the integration of traditional healing practices into conventional health care.
• Increase the collection of payments to IHS, tribal, and urban Indian providers from third-party health insurance.
• Refine and expand the information technology infrastructure within the Indian health system to improve health status monitoring, health care quality and efficiency, and financial management.
• Allocate resources to services that address health conditions that disproportionately affect American Indian and Native Alaskan populations in urban and rural settings.
• Enhance and expand collaborative efforts between the Indian Health Service and other HHS agencies directed towards reducing the disparities in health status between American Indian and Alaska Native people and the U.S. general population.
• Increase the capacity of tribal epidemiology programs to assure that essential public health services are available in local, tribal, and urban settings.

“IMPROVING HEALTH SCIENCE”

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

The “health research” goal recognizes the prominence of health research in HHS and its importance in furthering the overall mission of improving the nation’s health.  Many strategies under other goals and objectives are also research based, so there is overlap among the goals and objectives.  The objectives under Goal 4 deal with creating knowledge that ultimately is useful in addressing health challenges.  In this respect, the objectives address the need to maintain and improve the research infrastructure that produces scientific advances.

Objective 4.1     Advance the understanding of basic biomedical and behavioral science and how to prevent, diagnose, and treat disease and disability

How We Will Accomplish Our Objective

• Continue to support basic, clinical, and applied biomedical and behavioral research, with stringent peer review for scientific quality of research proposals.  
• Develop and implement processes for setting research priorities that ensure that research is responsive to public health needs, scientific opportunities, and advances in technology. 
• Promote scientific and technology transfer through mechanisms such as interagency collaborations and partnerships with academia and industry.
• Ensure that women and members of minority groups are included in biomedical and behavioral clinical research projects.

Objective 4.2     Accelerate private sector development of new drugs, biologic therapies, and medical technology                      

How We Will Accomplish Our Objective

• Use science-based risk management in all regulatory activities, so that limited resources can provide the most health promotion and protection at the least cost to the public.
• Provide timely, high quality, cost-effective processes for review of new technologies/pre-market submissions.
• Initiate the development of a continuous improvement/quality systems approach to the approval process throughout pre-market review of new applications.
• Direct Agency research programs and develop standards to effectively handle emerging technologies, especially in areas of pharmacogenomics, gene therapy, and combination devices.  The objective is more efficient and rapid translation of new scientific developments and breakthroughs into safe and effective medical products.
• Reduce avoidable delays and costs in product approvals through clear expectations and effective communication of standards to sponsors by: 1) analyzing root causes of multiple review cycles and establishing steps to prevent additional cycles when possible and 2) developing additional Agency guidance on innovative and cross-cutting product development where development pathways are particularly difficult or unclear.

Objective 4.3     Strengthen and diversify the pool of qualified health and behavioral science researchers

How We Will Accomplish Our Objective

• Invest in research training and career development programs in basic, clinical, and applied research.
• Conduct outreach activities to apprise minorities of research training and career development opportunities to expand the pool of those interested in applying for such programs.

Objective 4.4     Improve the coordination, communication, and application of health research results

How We Will Accomplish Our Objective

• Provide for easy access by academia and industry to HHS databases and findings from HHS research, with appropriate privacy and confidentiality protection.  
• Expand the use of electronic technology and media channels to gather and transfer research information to researchers, practitioners, and the public.
• Establish quality standards for the dissemination and strategic application of consumer/communication research findings.
• Establish partnerships with health professional associations, industry groups, patient representatives, community groups, disability groups, and purchasers of care to more widely disseminate research findings. 
• Support “implementation research” to determine how innovative, effective interventions can be implemented in actual settings and populations, including the means to reach diverse communities. 
• Ensure that consumer research, demonstration, and evaluation results are communicated effectively across HHS agencies and to all decision-makers. 
• Support development of data-based quality of care and outcome measurement systems to track adoption of evidence-based practices.

Objective 4.5     Strengthen the mechanisms for ensuring the protection of human subjects and the integrity of the research process

How We Will Accomplish Our Objective

• Human Subjects Protection 
  • Promote education of research sponsors, institutional administrators, investigators, and Institutional Review Board members and staff on the application of human subjects protection requirements. 
  • Promote programs to increase the quality, performance, and efficiency of an institution’s human subjects protection program and help institutions ensure compliance with federal regulations. 
  • Promote the development and use of valid voluntary accreditation for human subjects protection programs. 
  • Develop sensible, effective policies and procedures for dealing with financial relationships in human research as part of ensuring protections for human research participants without impeding appropriate research activities. 
• Research Integrity 
  • Expand education on conducting responsible research for our research partners.
  • Conduct research on research integrity, including methods to make education more effective, discovery of regulatory standards that work, and identification of best practices that can be adopted to ensure responsible research. 

“REALIZING THE POSSIBILITIES OF 21^ST CENTURY HEALTH CARE”

GOAL 5:  Improve the quality of health care services 

Improving quality of life and health in the United States also involves improving the quality of human services and health care that persons receive.  The focus of this goal and supporting objectives is on the implementation of a variety of strategies to improve service quality.  In this respect, several of the objectives parallel the goals in the Department’s health care quality initiative.  (Other elements of the initiative are included elsewhere in the Strategic Plan.) 

Objective 5.1     Reduce medical errors 

How We Will Accomplish Our Objective

• Support the development and dissemination of evidence-based practices, including information systems and new technology for the home and for clinical settings.
• Work with representatives from public and private sectors and standard development organizations to develop consensus on standards for content and transmission of patient-specific clinical information.
• Analyze data from health care organizations to better understand safety problems with medical products.
• Communicate risks and correct safety problems associated with medical products, dietary supplements and foods.
• Improve reporting systems for medical errors and adverse events (including those related to medical devices and drugs), and disseminate lessons learned from the data collected.
• Conduct research on the underlying causes of medical errors and adverse events.

Objective 5.2     Increase the appropriate use of effective health care services by medical providers

How We Will Accomplish Our Objective

• Provide quality improvement assistance to providers and practitioners and enhance the utilization of market forces though entities such as Quality Improvement Organizations and other public and private sector partnerships to spur quality improvement.
• Conduct research and evaluation to develop knowledge about effective health services.
• Translate this knowledge into strategies, educational tools, and information to help clinicians and health care policy makers improve health care quality.

Objective 5.3     Increase consumer and patient use of health care quality information       

How We Will Accomplish Our Objective

• Disseminate health care quality information through provider networks,  faith-based and community groups, and Internet information sites.
• Work with private sector partners to educate Medicare beneficiaries on making informed decisions about health care. 
• Work with private sector and health care provider communities to develop and make publicly available standardized, risk-adjusted indicators of health care quality that are meaningful to purchasers, providers, and consumers. 
• Conduct research to improve information about nursing home quality so that comparative information provided to consumers about nursing home quality is risk-adjusted, valid and reliable.

Objective 5.4     Improve consumer and patient protections                   

How We Will Accomplish Our Objective

• Support a prohibition on the use of genetic information to deny access to health insurance.
• Improve survey and certification processes for participation in Medicare and Medicaid. 
• Provide information to HHS beneficiaries on grievance and appeal rights in HHS health care programs, and on protections and complaint procedures for privacy of health information and civil rights. 
• Provide training and technical assistance to HHS “protection and advocacy programs” for persons who are elderly, mentally ill, or developmentally disabled.
• Develop and implement options to streamline the Medicare appeals process.

Objective 5.5     Accelerate the development and use of an electronic health information infrastructure

How We Will Accomplish Our Objective

• Provide leadership to promote the rapid development of the technology necessary for electronic health records, consistent with secure and confidential treatment of health information.
• Promote the voluntary adoption of national data standards, within the private and public health sectors, as the building blocks for a national health information infrastructure.
• Conduct research on the practical applications of a national health information infrastructure that serves consumers and patients, as well as serving professionals and other decision makers.

“WORKING TOWARD INDEPENDENCE”

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

The focus of this goal is to promote and support interventions that help disadvantaged and distressed individuals, families, and communities improve their economic and social well-being.  The objectives further prioritize Department efforts by targeting interventions toward low-income  families (including those receiving TANF ), children , the elderly , persons with disabilities, and distressed communities.

While substantial progress has been made in the past several years in reducing poverty, evidence supports a continued focus on helping those who need help. 

Also, as the American population ages, evidence points to the need to extend efforts to help the growing number of elderly  persons remain as active and healthy as possible and delay or avoid chronic medical  problems.  An aging society means that the number of persons needing long-term-care  services will increase and the availability of these services in the home and community will be a significant challenge if we are to help these citizens maintain their independence and quality of life.  The need for long-term support is not limited to the elderly.  As survival rates increase among people who are born with or acquire disabilities, and with more opportunities for them to lead better-quality lives in the community, there will be greater need to expand the options for home and community-based support structures for people of all ages.

Finally, despite the need to use a wide range of community resources and organizations to deliver services to improve the well-being of families and communities, there remains widespread bias against faith- and community-based organizations participating in Federal social service programs.

Objective 6.1     Increase the proportion of low-income individuals and families, including those receiving welfare, who improve their economic condition

How We Will Accomplish Our Objective

• Require states and tribes to engage all families on TANF in constructive activities leading to self-sufficiency as defined by their own state or tribal program.
• Encourage states and tribes to use their flexibility and capacity to coordinate human services and workforce programs so that families can better access services to obtain and maintain employment and to enhance child and family well-being.
• Provide support for child care services and parental choice that allows low income parents to enter and remain in the workforce.   
• Conduct research, provide technical assistance, and identify best practices on ways to eliminate barriers to employment for persons who experience significant employment difficulties, such as individuals with disabilities, homeless persons, and minority populations.
• Develop and implement a research, evaluation, and data strategy to create an integrated picture of the low-income population and understand the effects of welfare reform on children, families, and communities. 

Objective 6.2     Increase the proportion of older Americans who stay active and healthy              

How We Will Accomplish Our Objective

• Promote healthy lifestyles.
• Provide health care providers with information about the preventive care, primary health care, and chronic disease management needs of the elderly.
• Educate people over 50 about the benefits of health screening, immunizations, and life-style counseling and behavior changes.
• Support state, tribal, and community programs that provide basic services (meals and transportation) to combat factors (such as poor nutrition, social isolation, and accidents) that lead to functional decline among the elderly.
• Support nursing home ombudsmen, senior legal assistance, pension counseling, and other state and local programs to prevent elder abuse, neglect, and discrimination.
• Support biomedical, behavioral, and health services research to better understand the aging process and factors that prolong independent functioning, such as the use of assistive devices and technology. 

Objective 6.3     Increase the independence and quality of life of persons with disabilities, including those with long-term care needs

How We Will Accomplish Our Objective

• Support continuing attention to the Olmstead Supreme Court decision on community integration under the Americans with Disabilities Act and provide technical assistance to states in its implementation.
• Support tax and respite care benefits for home caregivers.
• Provide caregiver training and link caregivers to support networks.
• Facilitate development of new long-term care insurance products to give Americans more choice in covering long-term care needs.
• Support tax deductions for long-term care insurance.
• Continue attending to the President’s New Freedom Initiative and solutions identified in the Department’s report to the President entitled “Delivering on a Promise.”
• Identify and eliminate barriers to community living for persons with disabilities. 
• Allow states and tribes to demonstrate new options of community-based services, including options to children’s residential treatment facilities.
• Help communities develop comprehensive community-based, long-term care services.
• Develop and disseminate financing and service delivery models that improve the coordination and integration of home health, rehabilitation, and nursing facility services.
• Promote policies that empower individuals needing long-term care to be involved in the planning and direction of their services. 
• Improve the long-term care data infrastructure to better monitor the demand for and use of services and transitions across residential care settings. 

Objective 6.4     Improve the economic and social development of distressed communities

How We Will Accomplish Our Objective

• Support individual development accounts to encourage low-income individuals to save for purchasing homes and starting businesses, and for post-secondary education. 
• Provide employment and entrepreneurial opportunities for low-income individuals, including those with disabilities, through partnerships with industrial and commercial business and by providing assistance for self-employment and small business ventures.   
• Provide training, technical assistance, and financial resources to state, local, public, and private agencies for economic development and related social service support activities. 
• Assist community development corporations and community action agencies in leveraging existing federal, state, and local resources for neighborhood revitalization activities. 
• Sponsor programs that develop community leadership and empower residents to participate in the design and implementation of programs that best meet local needs.

Objective 6.5     Expand community and faith-based partnerships        

How We Will Accomplish Our Objective

• Identify and reduce unnecessary legislative, regulatory, and programmatic barriers to participation of these organizations in federal programs. 
• Improve the communication channels, disseminate information, and provide technical assistance to community and faith-based organizations on how to participate in federal programs, and work effectively together.
• Develop and disseminate “best practices,” highlighting successful community and faith-based programs.
• Establish a national resource center to provide technical assistance, training, and information to faith- and community-based organizations.
• Conduct research to determine how faith- and community-based organizations provide social services and the role they play in communities and in the lives of the people they serve.

“LEAVING NO CHILD BEHIND”

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

While trends in the well-being of our nation’s children and youth are positive, additional effort needs to be made.  Data illustrate the difficulties and the challenges.  The numbers of substantiated victims of child maltreatment remain high–over 900,000 cases in 2001.  Too many children are living in single parent households–28 percent in the year 2002, and an estimated 534,000 children were in foster care the last day of calendar year 2002.  Research is rife with evidence of the positive effects that marriage has on the stability and sound development of children, as well as the importance of fathers’ involvement with children’s lives on a daily basis.  Also, more needs to be done to ensure that non-custodial parents are meeting their financial obligations.  In 2002, although over 70 percent of parents who came to the child support enforcement program for help have child support orders in place, 32 percent of those parents did not receive child support payments.

Finally, while an increasing number of children age three to five are enrolled in center-based early learning programs, children below the poverty line are lagging behind.  In 2001, 56 percent of all three to five year-olds were enrolled, while only 47 percent of children in poverty were enrolled.

Objective 7.1     Promote family formation and healthy marriages

How We Will Accomplish Our Objective

• Support research, evaluation, demonstrations, and technical assistance to develop and disseminate best practices in supporting healthy marriages, family formation, and nurturing the positive development of children and youth. 
• Encourage states to provide equitable treatment of two-parent married families under state TANF programs. 
• Provide competitive matching grants to states, territories, and tribal organizations to develop innovative approaches to support healthy marriages. 
• Provide grants to community and faith-based organizations to promote responsible fatherhood and help both custodial and non-custodial fathers become more involved in the lives of their children.
• Support international efforts to strengthen families.

Objective 7.2     Improve the development and learning readiness of preschool children

How We Will Accomplish Our Objective

• In Head Start and childcare, strengthen language and early literacy services through evidence-based training and technical assistance, while continuing to strengthen children’s social and emotional competence, health, and nutrition.
• Develop a new Head Start accountability system to assess learning in early literacy, language, and proficiency in math.
• Encourage state development of voluntary guidelines on literacy, language, and pre-reading skills that align with the K-12 learning standards adopted by each state.
• Promote the professional development and training of early child care and education teachers.
• Promote better coordination of services through service partnerships among Head Start, childcare, pre-kindergarten, family literacy, and health programs.
• Employ and provide training to parents of Head Start Children, and encourage parents to volunteer in their child’s classroom.
• Provide intergenerational activities (involving grandparents and other family members).
• Increase enrollment of children in Head Start programs.
• Conduct research on ways to improve children’s healthy development and school readiness, and use research findings to improve practice.

Objective 7.3     Increase the involvement and financial support of non-custodial parents in the lives of their children

How We Will Accomplish Our Objective

• Support rigorous enforcement of child support obligations.
• Provide states and tribes with financial incentives to increase the amount of collections on overdue child support given directly to families, especially those that have left welfare. 
• Require states and tribes to regularly review and adjust child support orders for families that participate in TANF.
• Provide training and technical assistance to state and tribal child support enforcement agencies on the use of the Federal Parent Locator Services and best collection practices.
• Identify access and safe visitation practices that encourage non-custodial parents to be more involved in their children’s lives. 

Objective 7.4     Increase the percentage of children and youth living in a permanent, safe environment  

How We Will Accomplish Our Objective

• Encourage adoptions, for example, by identifying and addressing the sources of delays in inter-jurisdictional adoptions and holding states to standards for improving the timeliness of adoptions, particularly for children with special needs.
• Provide support for developmental and other services to help homeless and runaway youth return home or live in secure alternative environments. 
• Provide support for independent living services to help foster youth transition to independence, including support for educational vouchers to help that transition. 
• Improve the safety, permanency, and well-being of children in the child welfare system by emphasizing outcomes for children in child and family services reviews and through technical assistance to states.
• Support research and demonstrations to better understand how to prevent and treat child abuse and neglect and family violence, and provide stable family situations.
• Support Protection and Advocacy Systems programs that investigate and resolve the inappropriate and unsafe treatment of children with disabilities.
• Promote the continuity of family reunification when safe and possible.

“IMPROVING DEPARTMENT MANAGEMENT”

GOAL 8:  Achieve Excellence in Management Practices

In order to accomplish all the other goals and objectives in HHS’ Strategic Plan, it will be necessary to improve management practices to achieve excellence in HHS management.  A central objective in achieving excellence is to function as One HHS.  To ensure that HHS is “One Department” rather than a collection of disparate and unrelated agencies, we are reforming the management of the Department, in part by consolidating activities and by improving collaboration among agencies in administering HHS programs, and in part, by re-engineering business practices to improve efficiency and support a unified approach. 

HHS is pursuing objectives consistent with the five government-wide elements of the President’s Management Agenda (Competitive Sourcing, Human Capital Management, Improve Financial Management, Strengthen E-Government, and Budget and Performance Integration).  These elements form the basis for objectives 8.2 through 8.6.  Highlights of recent HHS efforts and accomplishments in these areas follow.

The General Accounting Office estimates that more than 15 percent of the federal workforce will retire in the next five years, drastically hindering the government’s ability to serve the public.  Given the growing proportion of HHS staff eligible to retire in the next few years, HHS will improve the management of human capital through workforce planning as well as training and recruitment efforts.  We plan to enhance the effectiveness of the balance between work done by government employees and work conducted by private sector contractors.

We are implementing an integrated Department-wide financial management system—the Unified Financial Management System (UFMS).  This system will replace the five outdated legacy accounting systems currently in use across the HHS agencies.  The system will serve as the “hub” of the Department’s financial systems infrastructure and will support business operations and decision-making at all management levels.  The major source of health 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 2001 were estimated at $12.1 billion, or about 6.3 percent of the $191.8 billion in processed fee-for-service payments.

We will also build on previous efforts to improve financial management by reducing payment error rates to providers and by pursuing modernization of Medicare contractors’ financial systems.  We intend to reform regulations to reduce excessive paperwork and the burden on doctors, nurses, and other health care professionals so that they have more time to spend with patients.  With growing use of technology, enhancing the use of electronic commerce in service delivery, communications, and record keeping will contribute greatly to improved management practices.  HHS continuously strives to integrate performance information and budget information so that program results inform budget decisions, and all HHS agencies are collaborating on budget integration improvements.

Taken together, these efforts will greatly enhance management and program performance at HHS. 

Objective 8.1     Create a unified HHS committed to functioning as one department

How We Will Accomplish Our Objective

•     Consolidate HHS operations, including:
  • facilities management, centralizing building and location-related decisions and to help co-locate HHS employees who work together;
  • Departmental personnel operations to enhance effectiveness and efficiency in hiring, training, and deployment of personnel; and administrative services.
•     Implement more effective coordination of HHS research and evaluation activities.
•     Enhance the coordination of administration of programs and policies, such as the State Children’s Health Insurance Program and privacy and confidentiality policies, across HHS to better leverage our collective resources so that services to program recipients from HHS agencies are seamless and complementary.
•     Consolidate the work and physical location of some of our agencies to increase efficiencies and reduce costs.
•     Eliminate excessive management layers to speed decision-making.
•     Consolidate and modernize existing financial management systems.
•     Establish a single corporate information technology enterprise system and standardize electronic communications systems and software so that all HHS agencies can communicate easily.

Objective 8.2     Improve the strategic management of human capital

How We Will Accomplish Our Objective

• Conduct ongoing workforce planning to assess the skills we need to accomplish the Department’s mission now and in the future.
• Attract, hire, and retain exceptional individuals in critical occupations throughout HHS.
• Hold employees accountable for achieving measurable results through performance contracts linked to the Department’s program and management priorities, and use the results to reward excellence.
• Provide better access to learning opportunities for all HHS employees so they can enhance their critical competencies.
• Design effective succession planning and career development programs to recruit the next generation of HHS leaders.

Objective 8.3     Enhance the efficiency and effectiveness of competitive sourcing

How We Will Accomplish Our Objective

• Require that Agencies set progressive targets for competitive sourcing of commercial activities each year, which align with identified areas for management improvement.
• Ensure that all resulting contracts with both public and private entities are “performance based” and provide a process for vigorous contract monitoring and administration.
• Produce a competitive sourcing plan, and require each HHS Agency to produce a plan, which studies a progressive percentage of commercial activities performed by Departmental staff.
• Use competitive sourcing information generated to identify new performance efficiencies and institute ongoing, continuous improvement.
• Ensure that competitive sourcing targets are aligned with HHS workforce restructuring plans, and conduct studies that examine each area of operations for cost comparison where efficiencies would be gained. 

Objective 8.4     Improve financial management

How We Will Accomplish Our Objective

• Reduce payment error rates and improve internal controls. [5]
• Assess programs’ risk of payment errors and take action to mitigate identified risks and minimize improper payments.
• We will test a Medicaid/SCHIP payment error rate measurement methodology through the Medicaid and SCHIP payment accuracy measurement pilots, and, when feasible, will implement the methodology nationally.
• Modernize Medicare contractors’ financial systems by implementing the Healthcare Information General Ledger Accounting System (HIGLAS).
• Develop a Department-wide integrated financial management system that supports (1) financial analysis, (2) performance measurement, and (3) operational decision-making.
• Maintain the Department’s standard of highly reliable financial reporting and deliver financial reports in accordance with the federal government’s accelerated reporting guidelines.

Objective 8.5     Enhance the use of electronic commerce in service delivery and record keeping                            

How We Will Accomplish Our Objective

• Implement electronic standards for archival and record keeping that facilitate electronic storage, access, and usage of critical information. 
• Support e-government initiatives with e-government productivity measures, strong Information Technology security, and integrated enterprise architecture.
• Institute seamless electronic communications systems within HHS with the use of standardized, compatible, electronic mail and software systems.
• Adopt electronic data interchange standards under the Health Insurance Portability and Accountability Act (HIPAA), and provide implementation assistance to providers and health plans.
• Implement the HHS IT Strategic Plan [6] , which has goals to:
  • Provide a secure and trusted IT environment,
  • enhance the quality, availability, and delivery of HHS information and services to citizens, employees, businesses, and governments,
  • implement an enterprise approach to IT infrastructure and common administrative systems that will foster innovation and collaboration,
  • enable and improve the integration of health and human services information, and
  • achieve excellence in IT management practices, including a governance process that complements program management, supports e-government initiatives, and ensures effective data privacy and information security controls.

Objective 8.6     Achieve integration of budget and performance information                  

How We Will Accomplish Our Objective

• Develop Departmental Agency Performance Plans that align budget requests and priorities with national health and human services outcomes.
• Develop Department-wide performance measures to measure overall, strategic direction in HHS crosscutting areas, such as measures of prevention and anti-bioterrorism efforts.
• Prepare a One HHS Action Plan which integrates both budgeting and performance information into one report.
• Use the Secretary’s Budget Council meetings to review information on program performance as well as how additional resources would be used to improve the program’s ability to meet its goals.
• Require that the HHS agencies include full cost estimates in their FY 2005 performance plans and beyond.
• Require HHS agencies to prepare an integrated performance budget in FY 2006 and beyond.
• Implement a multi-part strategy for improving program effectiveness.
• Implement a strategy for promoting accountability among program managers and other employees, including linking individual HHS employee performance assessment plans to strategic goals and objectives. 

Objective 8.7     Reduce regulatory burden on providers and consumers of HHS services

How We Will Accomplish Our Objective

• Seek advice from stakeholders.
• Examine the findings and recommendations from the Advisory Committee on Regulatory Reform.
• Clarify and simplify confusing regulations.
• Provide the health care provider community with regular and predictable information on new regulatory and other developments in the Medicare and Medicaid programs.
• Conduct open-door forums and other outreach efforts to enhance communication with beneficiaries, health care providers, and other stakeholders to increase responsiveness and identify areas for reducing regulatory burden under the Medicare and Medicaid programs.
• Promote health plan participation in Medicare by fostering stability and predictability in health plan payments and reducing administrative burden.

[2] Harwood H, Fountain D, Livermore G. “The Economic Costs of Alcohol and Drug Abuse in the United States, 1992.” Rockville, MD: U.S. Department of Health and Human Services, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, 1998. 

[3] ibid.

[4] All strategies that involve supporting legislative changes or reforms will be undertaken utilizing HHS’ official legislative proposal process.

[5] Please see Appendix H “Accuracy of Medicare Fee-for-Service Payments” section for additional information and FY 2008 targets.

[6] See also Appendix F, Information Technology section.  For further details, see the HHS IT Strategic Plan (to be available on the InterNet, a link from the HHS home page).

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