U.S. Department of Health and Human Services President’s Management Agenda Report
Fiscal Year 2004
TO HHS EMPLOYEES:
The Department of Health and Human Services has accomplished a
great deal over the past year thanks to your efforts and focus on
results. It is important that we take time to look back on
all we have accomplished together and celebrate even as we look
forward to future achievements.
OVERVIEW
The Department of Health and Human Services (HHS) is the United
States government's principal agency for protecting the health
of all Americans and providing essential human services, especially
for those who are least able to help themselves. The
Department manages more than 300 programs, covering a wide spectrum
of activities. Some highlights include:
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Health and social science research
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Preventing disease, including immunization services
Assuring food and drug safety
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Medicare and Medicaid
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Financial assistance and services for low-income families
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Improving maternal and infant health
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Head Start (pre-school education and services)
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Preventing child abuse and domestic violence
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Services for people with disabilities
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Substance abuse treatment and prevention
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Services for older Americans, including home-delivered
meals
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Comprehensive health services for Native Americans and Alaska
Natives
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Medical preparedness for emergencies, including potential
terrorism.
HHS represents almost a quarter of all federal outlays, and it
administers more grant dollars than all other federal agencies
combined. HHS' Medicare program is the nation's largest
health insurer, handling more than 900 million claims per year.
Medicare and Medicaid together provide health care insurance for
one in four Americans.
HHS works closely with state and local governments, and many
HHS-funded services are provided at the local level by state or
county agencies, or through private sector grantees. The
Department's programs are administered by 11 operating
divisions, including eight agencies in the U.S. Public Health
Service and three human services agencies. In addition to the
services they deliver, the HHS programs provide for equitable
treatment of beneficiaries nationwide, and they enable the
collection of national health and other data.
In FY 2004 HHS realized many accomplishments, including:
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"Steps to a Healthier US" Ad Campaign (the
"body parts" ads) – Announced with the news
that overweight/physical inactivity is about to overtake smoking as
the leading cause of preventable death. Food and Drug
Administration (FDA) has established a task force to focus its
anti-obesity efforts, and National Institutes of Health (NIH) has
developed a research program. (64% of Americans are
overweight, and the cost is $117 billion per year.)
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Medicare Obesity Coverage Policy – In July 2004 HHS
took another important step in the fight against obesity. HHS'
Centers for Medicare and Medicaid Services (CMS) revised its
Medicare coverage policy to allow members of the public to request
that Medicare review the scientific evidence to determine whether
specific anti-obesity interventions could be covered by Medicare.
The new policy opens the door to allowing Medicare to cover
treatments for diseases related to obesity, improving the health
outcomes for seniors and disabled Americans. As a first step, CMS
will convene its Medicare Coverage Advisory Committee in the fall
to evaluate the medical evidence on obesity-related surgical
procedures that may reduce the risk of heart disease and other
illnesses.
Health IT – President Bush has called for the
widespread adoption of interoperable Electronic Health Records in
ten years. Interoperability through standards will enable us
to share electronic patient records, which will improve the quality
of health care. Standards are adopted for health IT use by
all Federal agencies through the efforts of the multi-agency
Consolidated Health Informatics (CHI), a joint venture of HHS,
Department of Veterans Affairs (VA) and Department of Defense
(DOD). Adoption of these standards will increase our ability to
share medical data within the health community.
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Pharmaceutical Bar-coding - FDA’s final regulation on
bar-coding for pharmaceuticals was published in February. The
measure aims to protect patients from preventable medication errors
by helping ensure that health professionals give patients the right
drugs at the appropriate dosages. FDA estimates that the rule
will help prevent nearly 500,000 adverse events and transfusion
errors while saving $93 billion in health costs over 20 years.
New Anthrax Vaccine – Requested proposals for
development, testing and manufacture of a new anthrax
vaccine. We will acquire up to 75 million doses of the
recombinant protective antigen (rPA) anthrax vaccine for the
Strategic National Stockpile (SNS). The new rPA anthrax vaccine
will be stronger and more effective than the vaccine being used
today. It will require fewer doses per individual to provide
immunity against the effects of anthrax inhalation. The
vaccine would be used to protect the public against a terrorist
attack in which anthrax spores are released.
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Safety in Dietary Supplements– FDA developed a
new legal approach using existing authority to protect Americans
from unsafe dietary supplements. The effort to remove ephedra
is succeeding. FDA is also considering action against andro.
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Countering Drug Counterfeiting – The nation’s
drug supply is being infiltrated by a marked increase in the
incidence of counterfeit drugs. In addition, illicit
diversion and theft of prescription drugs in domestic and
international markets has increased dramatically in recent years
causing an increased vulnerability to the introduction of
counterfeit drugs and further compromising legitimate distribution
channels. The public health implications stemming from this
problem has never been greater. FDA has launched an
initiative to detect and prevent the sale of counterfeit drugs.
First-ever Multistate Purchasing Pools – Approved
plans by five states to pool their collective purchasing power to
gain deeper discounts on prescription medicines for their state
Medicaid programs (Michigan, Vermont, New Hampshire, Alaska,
Nevada). This give states unprecedented leverage in
negotiating with drug manufacturers for lower prices. The ability
to purchase drugs at lower cost will help states continue to
provide critical medications to the millions of low-income citizens
who depend on the Medicaid program. CMS will also provide
guidance to states on forming new purchasing pools and joining
existing purchasing pools.
New Initiative on Care for Chronic Illnesses – New
Medicare initiative, under Medicare Modernization Act (MMA), will
improve quality of care for people with multiple chronic illnesses
by helping them manage their conditions and encouraging better
coordinated care. The initiative will reach about 150,000 to
300,000 beneficiaries who have multiple chronic conditions,
including congestive heart failure, complex diabetes and chronic
obstructive pulmonary disease.
Ending Chronic Homelessness – In March of 2003,
Secretary Thompson became chair of the Interagency Council on
Homelessness and released Strategies for Action, the first
comprehensive HHS plan to focus HHS resources on reducing and
ultimately ending chronic homelessness. Accomplishments
include: First Step, a compilation of information
front–line caseworkers need to assist homeless people
including programs in HHS, Department of Housing and Urban
Development (HUD), VA, Social Security Administration (SSA),
Department of Agriculture and Department of Labor; and, State
Policy Academies which bring State policymakers together to improve
service coordination for homeless. Forty-five States will
have attended at least one policy academy by April of 2004.
HHS has committed $33 million towards collaboration with HUD and VA
on new approaches to chronic homelessness.
These and many other accomplishments were realized in part due to
improved effectiveness of management practices being implemented
across the Department with the help of the President’s
Management Agenda.
THE PRESIDENT’S MANAGEMENT AGENDA
The President's Management Agenda (PMA) is a bold strategy for
improving the management and performance of the federal government.
The PMA contains five government-wide goals to improve federal
management and deliver results that matter to the American
people:
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Strategic Management of Human Capital
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Competitive Sourcing
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Improved Financial Performance
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Expanded Electronic Government
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Budget and Performance Integration
The PMA was designed to "address the most apparent
deficiencies where the opportunity to improve performance is the
greatest." It focuses on remedies to problems generally agreed
to be serious, and commits to implementing them fully.
In addition to the five government-wide management initiatives, the
PMA also focuses on nine-agency specific reforms, of which HHS has
three of the Program Initiatives:
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Faith-Based and Community Initiative
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Better Research and Development (R&D) Investment Criteria
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Broadened Health Insurance Coverage Through State Initiatives
In keeping with the PMA, HHS has achieved management performance
results in FY 2004 that are important to HHS’ mission and to
the American taxpayer. HHS has done well in
institutionalizing our focus on results and citizen-centric
government, and we have achieved a "green" in all areas
of the PMA for progress. We have also moved to
"green" for status in the areas of Competitive Sourcing
and R&D Investment Criteria, and "yellow" for Human
Capital, Budget and Performance Integration, Broadening Health
Coverage, and Faith-based and Community Initiatives.
As we continue our focus on management results, we look forward to
the benefits of a fully integrated department providing
21st century service to our employees and customers, in
a more cost effective and timely manner.
STRATEGIC MANAGEMENT OF HUMAN CAPITAL
To accomplish our many critical mission objectives, HHS has
implemented strategies to ensure our ability to recruit and retain
appropriately skilled employees. We have conducted
comprehensive workforce analyses to provide a solid foundation for
workforce planning. We have launched strategic recruiting
initiatives to build a diverse and competent workforce. We
have revamped the Human Resources organization to achieve new
levels of efficiency, providing improved services to job
applicants. We have implemented comprehensive workforce
development programs that will nurture the knowledge and leadership
required to meet new challenges, and have implemented
accountability systems and executive performance contracts to
ensure that goals and objectives are met. These many
activities give evidence of HHS' commitment to strategic
management of human capital, so that we are always able to put the
right person in the right job at the right time.
Emerging Leaders Program
One of our greatest successes has been the Emerging Leaders
Program, a 2-year internship for recent college graduates that
leads to permanent employment. In its first two years, the
Emerging Leaders Program has allowed us to recruit over 120 highly
qualified individuals into public service, with a very high
retention rate. In the third year of the program, the number
of emerging leaders selected has expanded to over eighty
individuals who will begin their rotations in July.
Senior Executive Service (SES) Candidate Development
Program
Recognizing that a significant proportion of SES employees are
available for retirement in the next 5 years, we established an SES
candidate development program to encourage the smooth transition of
leadership in the department. From a pool of 350 applicants,
we chose 25 participants for the SES candidate development
program. Individuals were chosen both from inside and outside
government, and have developmental assignments within HHS, as well
as training in core executive leadership skills.
HHS University
HHS University was established in January of 2003 to provide
consistent and equitable learning opportunities for all Department
of Health and Human Services employees. HHS U provides numerous
opportunities for employees to sharpen their skills and prepare
themselves to meet the organization’s strategic objectives.
Improved Human Resources Services
In FY 2004, HHS completed the consolidation of 40 personnel offices
scattered throughout the Operating Divisions (OPDIVs) into four
departmental Human Resource (HR) service sites. In doing so,
we eliminated redundancy and duplication of effort, reduced HR
staffing levels, and improved service delivery by installing
automated tools to replace labor and paper intensive processes,
including hiring, job classification, and maintenance of employee
records.
EXPANDED ELECTRONIC GOVERNMENT (E-GOV)
HHS participates in the 20 of the 24 PMA e-gov initiatives that
apply to our mission, as well as the in the cross-cutting
e-Authentication initiative. HHS serves as the leader for two
initiatives (grants.gov and Federal Health Architecture) and
actively participates on executive level boards or councils, as
required. In addition, HHS is a strong contributor to
the Lines of Business Task Forces for Financial Management, Grants
Management, and Federal Health Architecture.
Information Technology (IT) Security
Prior to 2001, the IT security effort at HHS was
decentralized. Individual programs were managed at the
Operating Division (OPDIV) level, with little oversight from the
Department, resulting in very different IT security programs across
HHS. HHS as a whole was not meeting federal mandates and
reporting requirements due to a lack of an integrated,
enterprise-wide IT security program.
Since that time HHS has improved and will continue to improve the
overall HHS IT security posture to protect confidentiality,
integrity, and availability of IT resources; ensure minimum
security standards enterprise-wide that are consistent with Federal
guidelines and best practices; support integration of IT security
into HHS lines of business; and promote an environment in which all
employees’ actions reflect the importance of IT security.
HHS has deployed the "Secure One HHS" program,
resulting in raised compliance with security mandates, better
security, and better systems at HHS. Privacy Impact
Assessments (PIA) on systems that may collect personally
identifiable information are being conducted to ensure the
protections of individual privacy.
Finally, HHS system security analyses have dramatically improved:
Increased from 8% to 96% of systems having been assessed for
risk assessments as of June 30, 2004; 2004 goal: complete risk
assessments on 100% of reportable systems.
Increased from 3% to 93% of systems having been Certified and
Accredited (C&A’d) as of June 30, 2004; 2004 goal: 90%
C&A’s systems.
HHS security training of employees has increased from 56% (2001)
to 81% (2003) to our 2004 goal of 100% of HHS employees having
received annual security awareness training.
Enterprise Architecture
Enterprise Architecture (EA) identifies and defines an
organization’s business processes and practices, the data
required to support those processes, the applications to process
that data, and the technology that supports those
applications. A unified EA allows for a better use of
resources to support the business activities of HHS, both
administrative and health related.
Prior to 2001, there was no formalized process to address an
HHS-wide enterprise information technology architecture. In
2003, formal HHS-wide Enterprise Architecture efforts began, with
the establishment of EA Program Management Office. Planned EA
efforts will firmly define the HHS-wide roadmap to achieve our
Department’s mission through optimal performance of our core
business processes within a more supportive IT environment.
HHS EA program aligns with and supports Office of Management and
Budget’s (OMB) Federal Enterprise Architecture and its
strategy to implement e-government solutions in order to better
serve the business, citizen, and government communities. HHS
has developed and published an Enterprise Architecture blueprint
with performance linkages to strategic and capital planning and
budget processes.
HHS.gov
In late 2001 the HHS Web Portal Project began with the goal of
recasting the Department’s philosophy and approach to
reaching out to the public via the Web in a more citizen-centric
and usable way to offer the public instant access to timely, often
urgently needed, information on HHS’ vital health and human
services programs. Usability testing of the new site
demonstrated that over 90% of test users could find the information
sought versus just over 40% in old design.
Since October 2002, when the new site was launched, integration
among HHS web sites and managers has improved; enterprise-wide
search capabilities reach across the entire HHS web presence
(includes NIH, Centers for Disease Control and Prevention (CDC),
FDA); and the development and maintenance of the frequently asked
questions (FAQs) database now allows customers to answer their own
questions, resulting in fewer unique questions directed to the
Department.
Site statistics show an average increase for the corresponding nine
months of October through June of approximately 80,000 visits per
month. In addition, the frequently asked questions database
received an average increase in visitors of only 22,000. Despite
the increase in visitors to FAQs, approximately 18,000 fewer
questions and answers were viewed each month, and over 120 fewer
unique questions per month submitted to the Department. The
statistics demonstrate that the HHS.gov Web site serves more
visitors per month, more effectively, as visitors find the
information sought through information available on the Web site
and in the FAQ database.
Perhaps the most significant business impact has been in the area
of Health Insurance Portability and Accountability Act (HIPAA)
privacy rule information dissemination. From April 2003 through
April 2004, OCR had over 1,000,000 visits to its Privacy web pages
and also had over 1.9 million Privacy Rule answers viewed on
the frequently asked questions site maintained by HHS. These
materials have consistently been the most in demand of all HHS.gov
subject matter resources. Office for Civil Rights (OCR) and its
sister divisions in the Department, particularly CMS, but also the
NIH, CDC, and the Substance Abuse and Mental Health Services
Administration (SAMHSA) among others, have worked and continue to
work in concert to produce materials and guides responsive to the
needs of the wide range of healthcare industry segments that are
affected by the Privacy Rule. For example, OCR has created a page
on its website that allows smaller providers, and other small
businesses, to quickly access resources and guidance of particular
interest to them. In addition, in anticipation of the April
14, 2004 small health plan compliance date, OCR published new FAQs
targeted to small health plans, particularly group health plans.
HHS continues to improve upon the site, include continued web site
analyses, and integrate usability principles and evidence-based
design. HHS also established in FY 2004 a Web Management Team
that will manage the Department’s Web presence and serve as a
Department-wide resource for delivering effective and usable Web
communications to the American public. In addition, HHS
served on a federal interagency work group tasked to establish
standards for Frequently Asked Questions e-mail responses under the
PMA e-gov initiative, USA Services. HHS also complied with a
requirement of the e-gov initiative, GovBenefits, by ensuring a
link from hhs.gov to the GovBenefits.gov site is present where
applicable.
Grants.gov
Prior to 2001, there was no unified, integrated mechanism for the
public to find and apply for grant opportunities within the federal
government. Today, "Grants.gov" is up and running
and is one of 24 e-government initiatives that are fulfilling the
President’s Management Agenda. The goal of Grants.gov
is to make the grant location, application, and submission process
faster, easier, and more efficient. Grant-making agencies are
required to post summaries of all discretionary grant funding
opportunities. HHS serves as the Managing Partner for this
cross-government initiative, and HHS was an early adopter to
Grants.gov and began posting all of its competitive grant
opportunities during February 2003.
All twenty-six federal grant-making agencies have followed suit and
are posting all of their active grant opportunities on
Grants.gov. As of July 21, 2004 there are almost 1,500 active
grant opportunity postings and over 3,800 total postings on
Grants.gov. HHS has over 390 active funding opportunities
posted, and over 1,300 total postings on Grants.gov. On
average, Grants.gov’s "Find" mechanism receives
over 1.2 million hits per week. The heavy use of the
Grants.gov Find mechanism allows HHS to reach a broader and more
diverse applicant pool by increasing exposure and awareness across
the grantee community of available funding opportunities.
Also, HHS was one of the first agencies to post a grant application
package on the website and will be able to collect grant
applications electronically through Grants.gov.
As of July 21, 2004 there are over 160 grant programs available for
electronic application, and over 850 applications have been
received electronically through the Grants.gov system. HHS
has posted 115 application packages on Grants.gov, and has received
525 electronic applications. NIH, Administration for Children
and Families (ACF), and Health Resources and Services
Administration (HRSA) have been working with Grants.gov to develop
system-to-system interfaces to electronically accept applications
automatically into their existing backend grants management
systems. Grants.gov accomplishes the mandates of the
President’s Management Agenda to provide to the public a
unified citizen-centric web site that provides accurate, reliable
information in a centralized location and simplifies the burden of
the application process for the grant community by delivering a
unified location to apply for grants across the federal government.
Health Information Technology
Before 2001, there were no medical data standards universally
recognized by the U.S. government; however, many were commonly
used. In 2002, under HHS’ leadership, the multi-agency
Consolidated Health Informatics (CHI) endeavor began. The
goal of CHI is for the Federal government to adopt health data
standards and require that those who interact with the government
do so using those standards and result in moving the entire health
community toward interoperability byusing those standards.
HHS and the other federal departments that deliver health care
services -- the Departments of Defense and Veterans Affairs -- are
working with other federal agencies to identify appropriate,
existing 24 "domains" or "data standards,"
and to endorse them for use across the federal health care sector.
Adoption of these standards will increase our ability to share
medical data within the health community and they will be used as
agencies develop and implement new information technology systems.
Interoperability through standards will enable us to share
electronic patient records, which will improve the quality of
health care.
Some highlights of CHI to date:
In 2003, the U.S. Government adopted five standards for use.
In 2004, standards were adopted in 15 more domains. Also a
medical vocabulary (Systemized Nomenclature of Medicine Clinical
Terms or SNOMED CT) has been licensed for use throughout the
United States at no cost to the users. This is a key part
of the emerging National Health Information Infrastructure
(NHII).
In 2004, CHI became a part of the new Federal Health
Architecture (FHA) E-Gov initiative. CHI will continue to
examine additional health data domains to be considered for
adoption as a federal standard.
In 2004, based on the President’s Executive Order,
Secretary Tommy Thompson recently identified a new HHS position,
the National Health Information Technology Coordinator and named
Dr. David Brailer to fill that role. Dr. Brailer is
charged with guiding ongoing health information standards
development work, coordinating partnerships between government
agencies and private sector stakeholders to speed adoption of
health information technology, and achieving the
President’s vision for most Americans to have a personal
electronic medical record within 10 years. Dr. Brailer
will work closely with the HHS-managed federal-wide FHA program.
Citizen Centric Service
In 2004, the Centers for Disease Control and Prevention (CDC)
launched its newly redesigned website. CDC has one of the
most frequently visited websites in the government. CDC is
the authoritative trusted source of public health information for
healthcare providers, public health officials, the media, and the
general public, attracting an average of over nine million
different visitors per month. The Severe Acute Respiratory Syndrome
(SARS) outbreak resulted in over 17 million different visitors in
April 2003, alone.
The Bioterrorism Preparedness and Response Act of 2002 required the
Food and Drug Administration (FDA) to implement several changes to
strengthen its’ food safety regulations including the
registration of Food facilities. Because FDA has other
registration activities including Drug Registration and Listing,
FDA chose to merge these activities into one modular system
referred to as FDA Unified Registration and Listing System
(FURLS). This system uses the Internet as a vehicle for
collecting vital registration information. FURLS was
successfully implemented on schedule to enable the food industry to
register on line as required by Congress. Approximately
190,000 facilities are registered, with slightly more than half
foreign facilities and the remainder domestic.
The Administration on Aging (AoA) continues to use the AoA.Gov web
site to disseminate information to the Aging Network. The AoA
E-Newsletter is a successful informational publication distributed
electronically to the Aging Network and AoA partners. States
and tribes working with AoA report electronically on activities
supported by AoA funds through the AoA.Gov web site by uploading
quarterly reports and inputting various statistics on the
site. AoA has updated and enhanced its public Internet web
site for improved accessibility and enhanced data segregation
allowing better search capabilities for our constituents.
IT Consolidation
In 2001, employees of HHS were provided IT support via
organizationally "stove-piped" help desks and support
teams, which resulted in disparate IT practices and policies as
well as incompatible implementations of hardware, software, and
security systems and services. This situation represented
significant annual cost as well as cross-OPDIV incompatibility.
In 2004, the Information Technology Service Center
("ITSC") was created to eliminate unnecessary
duplication of functions and infrastructure by consolidating and
replacing the IT help desks at the "Small OPDIVs" (ACF,
Agency for Healthcare Research and Quality (AHRQ), AOA, HRSA
regional offices, SAMHSA, Office of the Secretary (OS), Program
support Center (PSC) and the Office of the Inspector General
(OIG)). This consolidated IT infrastructure ensures that all
HHS Small OPDIVS are able to meet their unique business objectives
while achieving compatibility, interoperability, standardization
and open communication. The ITSC:
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Provides help desk support for over 8,000 HHS staff and on-site
contractors
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Handles 400 help desk contacts per day with a single help desk
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Has taken responsibility for over 500 servers across the small
OPDIVs
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Reduced the number of federal staff providing IT infrastructure
services for these small OPDIVs from 144 to 55, for a savings of
$8.7 million.
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Reduced the number of contractors from 183 to 125, for a savings
of $6.8 million.
HHS’ five large OPDIVs (CDC, CMS, FDA, Indian Health Service
(HIS) and NIH) have also taken steps over the prior three years to
consolidate IT services, including:
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CDC: Reduced e-mail servers by 40%; reduced remote access
servers from 6 to 2; and reduced public call center services
from 36 to 1
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CMS: Consolidated into a single integrated help desk for
desktop services, voice communications, mainframe, network
services, and hardware/software service.
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FDA: Consolidated to one call center; provided secure remote
access.
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IHS: Consolidated IHS national Help Desk from four systems
to a single system; pursuing administrative system consolidation
to reduce the number of ARMS servers from 13 to 1.
NIH: Consolidated 20,000 e-mail accounts into the central NIH
server; consolidated 29 NIH Help Desks into one.
FINANCIAL MANAGEMENT
In FY 2004, HHS made important performance improvements in its
financial management activities. Specifically, HHS:
Streamlined and accelerated the annual financial reporting process
making financial information more useful in decision-making by
shortening the time for providing financial information from 6
months to 45 days after the fiscal year-end.
Combined in our Performance and Accountability Report for the first
time our annual audited financial statements with program
performance information to better assess the Department’s
performance relative to its strategic goals and objectives.
Performed more frequent financial analyses thereby strengthening
the accuracy of our financial data.
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Initiated an OPDIV-wide analysis to identify the extent to which
financial and performance information is currently being used to
support routine or 'day-to-day' management decisions.
This analysis is intended to ultimately help identify core mission
business functions within OPDIVs and across the Department and to
improve the utility and use of routine financial and performance
information to support program and Department management
decision-making.
Added a quarterly financial reporting cycle to provide more timely
information and to facilitate the annual reporting cycle.
Began a phased-in implementation plan for a standardized financial
management system (Unified Financial Management System) in all
operating components beginning with NIH effective FY 2004,to
culminate with IHS and the final phase of CMS contractors in FY
2007.
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Began to leverage economies of scale by replacing 5 obsolete
systems thus reducing administrative costs.
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Initiated a study to consolidate resources performing similar
activities, typically spread across the Department, facilitating
enhanced service delivery for core financial processes.
Utilizing a shared services delivery environment will standardize
and streamline traditional financial transaction processes; such as
Accounts Payable, Accounts Receivable, General Ledger, and
Procurement thereby lowering costs, improving efficiency, and
reducing processing cycle times. Implementing a shared
services solution will achieve operating efficiencies by leveraging
technological investments and standardizing processes across
business units.
Reduced by more than half the Medicare error rate of 13.8% in FY
1996 to 5.8% in FY 2003 (HHS is currently working on measuring
payment errors for six other major programs – Medicaid, State
Children’s Health Insurance Program (SCHIP), Temporary
Assistance for Needy Families (TANF), Foster Care, Head Start, and
Child Care.)
Developed and implemented internal PMA scorecard to communicate to
OPDIV employees their responsibilities and achievements under the
PMA.
Awarded a contract for Recovery Auditing services.
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Developed and began implementing a project plan to comply with the
Improper Payments Information Act (IPIA).
BUDGET AND PERFORMANCE INTEGRATION
In FY 2004, HHS successfully integrated performance information into
budget decisions and activities through several critical action steps. These
are highlighted below:
Senior Level Manager Meetings
Senior management staff actively uses performance information to
inform budget decisions. The following examples are
highlighted below:
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Reducing payment errors by contractors who process payments to
Medicare providers is an important priority for the Medicare
program. At CMS, senior officials routinely consider
financial and performance data on Medicare payments when making
decisions in the Comprehensive Error Rate Testing (CERT)
program. In January 2004, CMS produced for the first time
contractor-specific error rates for Fiscal Intermediaries. In
June, senior CMS officials were briefed on the error rate findings
and were presented with a draft CMS Error Rate Reduction
Plan. Decisions were made regarding changes needed to the
plan. In addition, senior CMS officials briefed the
Department and Office of Management and Budget officials on the CMS
Error Rate Reduction Plan. A number of decisions were made
concerning the high provider non-response rate for 2003 and
corrective actions to reduce the amount of improper payments in
2004.
In the third quarter of FY 2004, the Assistant Secretary for Aging
and AoA executives met on multiple occasions specifically to
develop budget initiatives based on program performance and
financial data. With OMB endorsement of AoA’s
efficiency, consumer assessment, and targeting data in the FY 2005
Program Assessment Rating Tool (PART) process, AoA executives
determined that the most significant improvements to AoA’s
base programs would be possible with continued emphasis on program
innovation activities. The performance data and PART results
were also prominent in the decision of the Assistant Secretary and
senior AoA executives to evaluate three major program subcomponents
in FY 2004 and 2005.
SAMHSA senior managers use performance and financial information to
inform decisions about management of SAMHSA programs. For
example, the Center for Substance Abuse Treatment’s
implementation of a sophisticated data collection system for
Program of Regional and National Significance allows the Center
Director and Agency management as well as Center program and
management staff access to timely program performance
information.
On a quarterly basis, the Chief of Staff of HHS meets with OPDIV
heads to assess financial, budget and performance issues affecting
HHS programs. In addition, OPDIV Executive Officers meet monthly in
a Management Forum with the Assistant Secretary for Administration
and Management (ASAM) and the Assistant Secretary for Budget,
Technology and Finance (ASBTF) to examine reports that integrate
financial and performance information and use them to make
decisions about the management of the Department’s programs.
Budget and Performance Conference
In November 2003, the Office of Budget sponsored a Budget and
Performance Integration (BPI) conference to have open dialogue and
share information with the Department regarding BPI.
Conference attendance included at least one budget and one
performance person from each OPDIV. Conference workshops
included the Program Assessment Rating Tool (PART), Full Cost, One
HHS Action Plan, FY 2006 Performance Budgets, President’s
Management Agenda Scorecard and Performance Planning. After
the conference, budget and performance managers were prepared to
implement BPI into everyday activities and decisions. This
included the development of a design team to create the new
structure of the FY 2006 performance budget.
FY 2006 Performance Budget
In February 2005, the Department will submit to Congress an FY 2006
integrated performance budget that was created by a design team
following the November 2003 conference. The FY 2006
integrated performance budget ensures that budget and program
managers work together to inform management and budget decisions.
The FY 2006 performance budget includes a number of changes from
the traditional budget structure. First, it contains a
standardized performance budget overview that ties together
the OPDIV mission, HHS strategic goals, OPDIV performance
measurement, and the budget request. Second, a new
activity narrative section includes updated program
descriptions and new performance analysis section. Finally, the
outline includes a supporting information section that
combines performance exhibits required by Government Performance
and Results Act (GPRA) and budget exhibits required by HHS, OMB,
and Congress.
Methodology for Calculating Marginal Cost
In June 2004 HHS selected the FDA Animal Drugs and Feeds and CDC
Sexually Transmitted Disease programs to develop methodologies for
calculating the marginal cost of outputs and outcomes based on the
approach taken by National Aeronautics and Space Administration
(NASA). Being able to implement marginal cost methodology
allows HHS to estimate the cost of changing performance goals and
program design. The marginal cost methodology incorporates
the program’s current FY request level, full cost, and
full-cost allocation to selected performance measures; the budget
year targets, long-term targets, and strategic objectives for each
measure; estimated time period to achieve the long-term targets;
and desired outcome of achieving the long-term objectives,
including its relationship to broader agency goals and the HHS
strategic plan.
PART Assessment
ASBTF Principal Deputy Assistant Secretary sent a memo to OPDIV
Heads and the Assistant Secretary for Health initiating the FY 2006
PART process and emphasizing the importance of the PART process in
budget decision-making as well as the HHS scorecard for BPI.
The Office of Budget provided technical guidance and assistance
throughout the FY 2006 PART. HHS had 22 programs assessed in
the FY 2006 PART. HHS actively participated in the FY 2006
PART process with OMB and welcomed the opportunity to identify
program’s performance rating. To date, roughly 40% of
HHS programs have been assessed in the PART process. HHS
regularly uses PART information to inform decisions about program
budgets and management as discussed below.
PART Recommendation Follow-up Plan
In June 2004, the Deputy Assistant Secretary for the Office of
Budget sent a memo to OPDIVs outlining the Department’s
process for the PART recommendations. The objective is to
include PART recommendation updates in each of the three budget
submissions: the HHS submission in June, the OMB submission in
September, and the Congressional submission in February. This
process ensures that HHS has a systematic and discipline process
for implementing PART recommendations. On July 30, 2004
OPDIVs submitted the new PART recommendation plan, which includes
milestones and deadlines for all completed PART
recommendations. This will provide the baseline from which to
assess performance. The Office of Budget is also
collaborating with OIG and ASPE to coordinate evaluations on
programs that received a "Results Not Demonstrated" or
"Ineffective" PART rating.
The following examples highlight programs using PART
recommendations:
In preparation for the FY 2005 PART review, FDA made considerable
efforts to implement OMB's PART recommendations from FY
2004. OMB recommended that FDA develop specific long-term
outcome goals that were more directly associated with improvement
of public health and safety; and efficiency goals that demonstrated
more streamlined government operations. FDA identified a
limited number of ambitious long-term outcome goals along with
various management improvements that resulted in a significant
improvement to its PART score in FY 2005, and an overall rating
that improved from Results Not Demonstrated to Moderately
Effective. FDA senior management also developed a map of all
critical activities and annual performance measures in order to
achieve the agency long-term outcome goals. During the second and
third quarter of this year, FDA collected all the relevant data and
re-analyzed performance and measurable progress compared to the
baseline measures calculated for the set of long-term outcome goals
identified in FY 2005.
HRSA allocated a larger proportion of funds to the National Health
Service Corps’ loan category in response to PART
recommendation regarding flexibility in allocation of funds between
scholarships and loans.
HRSA’s Administrator is bolstering staff to bring a wider
range of skills to bear on improving the Bioterrorism Hospital
Preparedness ability to enhance performance and demonstrate
effectiveness in response to a PART recommendation.
At ACF, the PART assessment for the Office of Refugee Resettlement
(ORR) informed the request for additional funding in FY 2004 for an
independent and quality evaluation of the ORR social services
program.
Community Services Block Grant proposed legislation that would
require in Community Action Agencies to use a common set of
national measures to report outcomes based on the FY 2005 PART
recommendation.
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Head Start also proposed legislation to better integrate Head
Start, childcare, and state operated pre-school programs, and
created a new system to assess every Head Start center on its
success in preparing children for schools. Both of these
initiatives were recommended in the PART assessment for FY 2004.
Low-Income Home Energy Assistance Program requested funds in FY
2005 to conduct a nationally representative evaluation in order to
address performance measures identified in the PART review.
Performance Measures
In FY 2004, HHS implemented performance measures for 100 percent of
120 HHS performance program areas. These are identified in
the new structure of the FY 2006 performance budgets that will be
released in February 2005. HHS also reduced the total output
measures by 25 percent and increased the total number of outcome
measures. The reduction of output measures enables HHS
programs to focus on the results that programs achieve.
COMPETITIVE SOURCING
In FY 2004 HHS was one of the leaders of the competitive sourcing
initiative. To date HHS has completed eight standard public-private
competitions in an average of 12 months or less, meeting the new
time standard. Two competitions covering more than 1,400 full-time
equivalent employees were completed in less than 10 months. These
stand out successes have clearly demonstrated both the viability
and credibility of OMB’s new requirement to conduct and
conclude standard cost comparisons in twelve months or less.
The Department has conducted competitive sourcing studies to almost
25 percent of its commercial activities. When fully implemented
over the next several fiscal years, these competitions are expected
to yield annual savings of $40M+ for the greater benefit of HHS
programs and the American taxpayer.
The FY 2004 Federal Activities Inventory Reform (FAIR) Act
inventory was submitted to OMB on June 30, 2004. In addition to
building a HHS FAIR Act dictionary of function code definitions and
requiring the OPDIVs to develop an accurate and complete FAIR Act
inventory, HHS has begun the process of implementing a FAIR Act
database that will maintain its FAIR Act inventory data. This
database system is currently being tailored to HHS specifications
and will allow greater ease in obtaining necessary information,
provide an ability to run numerous reports to assist with
dissemination of data, and promote consistency across the OPDIVs
through side-by-side comparisons of their FAIR Act Inventories.
FAITH-BASED AND COMMUNITY INITIATIVE
The mission of the Faith-Based and Community Initiative (CFBCI) at
HHS is to create an environment within HHS that welcomes the
participation of faith-based and community organizations as valued
and essential partners in assisting Americans in need. Our
mission is part of HHS focus on improving human services for our
country's most needy populations. Through work completed
in FY 2004, HHS has achieved a green progress rating for every
quarter this fiscal year by making the following accomplishments in
data collection, pilot projects, regulatory reform, and
outreach/technical assistance.
Data Collection
HHS awarded $567 million through 680 grants to faith-based and
community organization in 2003. This was a 19% increase in
the dollars awarded that went to faith-based and community groups
from 2002 and a 41% increase in number of grants awarded. $38
Million of those dollars went to 129 novice grantees that have not
previously received a federal grant from HHS. This was a 7%
increase from 2002 of dollars awarded to faith-based grantees and a
50% increase in number of grants awarded to these novice grantees.
HHS has begun to collect and meet the deadlines for the new data
additions to the management agreement and provide that data to the
White House and OMB.
HHS CFBCI continues to publish success stories about the impact
made on people’s lives by HHS faith-based grantees.
These stories are called "Snapshots of Compassion" and
can be found on the HHS CFBCI website
Pilot Projects
HHS continued its commitment to pilot projects with increase of
funding to the Mentoring Children of Prisoners Grant as well as the
Compassion Capital Fund. Both of these programs have also
held training for all grantees this past year. HHS also announced
the RFA for the Access to Recovery Program.
Regulatory Reform
HHS CFBCI published the HHS Department-wide Religious
Non-Discrimination regulations for public comment and the final
regulations as well. These regulations revise existing
Department regulations to remove barriers to the participation of
faith-based organizations in Department programs.
SAMHSA and ACF published the final Charitable Choice regulations in
the Federal Register. Implementation of these regulations
continues and is being monitored by HHS CFBCI.
Outreach/Technical Assistance
The Director of CFBCI held multiple outreach meetings throughout
the country with potential grant applicants to provide them with an
overview of the grant opportunities. This training utilized
the "Deciphering Grant Opportunities" handbook
developed by HHS CFBCI.
SAMHSA and HRSA both held national conferences on the faith-based
and community initiative as it dealt with organizations in health,
substance abuse, and mental health.
HHS CFBCI continues to improve the HHS CFBCI website by better
organizing and naming topics. We use the yellow navigation
bar to better attract and inform the public of new and urgent
information. New sections include the Snapshots of
Compassion, the Grants Opportunities Notebook, Publications and New
Information sections.
ACF completed and printed the Child Care brochure for churches and
religious organizations. A distribution schedule was used to
provide the childcare brochure to the faith-community.
RESEARCH AND DEVELOPMENT CRITERIA
HHS continues its commitment to ensuring that its investments in
R&D are effective and yield new knowledge that is applied to
the development of new diagnostics, treatments, and preventive
measures to improve health and health-related quality of
life. Central to the development and implementation of
objectives under the Department’s Strategic Plan Goal 4,
"Enhance the capacity and productivity of the Nation’s
health science research enterprise" are the OMB R&D
Investment Criteria.
These criteria—relevance, quality, and
performance—are carefully considered as research goals
and associated targets are developed, as management changes are
considered, and as budget decisions are made by HHS and its
OPDIVs.
The first criterion—relevance—is addressed in several
ways as it relates to research. One way is in setting
research priorities—by considering public health needs, as
judged by the incidence, severity, and cost of specific disorders
as a key factor in determining areas of research support.
Relevance is also ensured through seeking the views of the public
into the OPDIV’s research agendas. This occurs through
meetings of advisory councils or boards that include
representatives of the public as members, by publishing research
plans for public comment, and by meeting with representatives of
patient groups and presenting NIH research plans and seeking
feedback. In addition, relevance is also considered when
planning for activities that will occur after the research is
completed. These activities, e.g., developing and
disseminating educational materials or implementing public
education campaigns based on results from NIH-funded research, help
to ensure that the results of research reach the hands of those who
can put the information to practical use. Through all of
these efforts, in FY 2004, across the Nation, policymakers,
consumers, patients, and providers of care are making
better-informed health care decisions and are receiving higher
quality care thanks to HHS-supported research.
Quality—the second criterion—is embodied by a
commitment on the part of HHS OPDIVs to support work of the highest
scientific caliber. The OPDIVs ensure quality through the
peer review process for grants, and the principles guiding this
review for scientific merit are contained in the Public Health
Service Scientific Peer Review regulations. Peer review takes
place in multiple steps. The initial step of the peer review
process takes place in Scientific Review Groups or study sections,
and the second level of peer review is carried out by the National
Advisory Councils. A major effort has been underway at one of
the OPDIVs to reorganize many of these review groups to keep pace
with the ever-changing landscape of science, thus helping to ensure
the quality of peer review. In FY 2004, the final phase of
implementing that reorganization was begun and new study sections
created within the reorganization framework began to meet.
The third criterion—performance—is key to each and
every R&D goal set by the Department. Once priorities are
set, peer review occurs, and funding decisions are made,
performance is monitored on a regular basis. For example,
grantees must submit annual progress reports, and this information
is reviewed to assess their performance and follow-up actions taken
when necessary. In addition, there are other oversight
mechanisms for reviewing progress, e.g., site visits. Aside
from project-specific reviews, there are state-of-the-science
reviews, workshops, and other scientific meetings where knowledge
in a particular area of research is reviewed, and progress and
performance are assessed. The performance criterion is also
executed through HHS efforts to accelerate research
productivity. For example, the time from identifying a
disease, e.g., influenza, to characterizing its cause, formerly
took decades. But the time to identify Human Immunodeficiency
Virus (HIV) was only 3 years, and with SARS, NIH-funded scientists
characterized the disease within four weeks. Similarly, with
the development of treatments, it took 60 years from the discovery
of the infectious agent in tuberculosis to the first promising drug
treatment; but for HIV, the initial treatments were introduced in 3
years; and with SARS, barely one year after characterizing the
agent, we already have two candidate treatments in therapeutic
trials. Because we cannot predict discoveries or anticipate
the opportunities fresh discoveries will produce, HHS supports
research along a broad — in fact, expanding —
frontier. The overall performance of the research enterprise
also requires that HHS support the human capital and material
assets of science.
BROADENING HEALTH INSURANCE COVERAGE THROUGH STATE
INITIATIVES
The Medicaid program provides a lifeline to millions of low-income
Americans who otherwise would lack health insurance coverage.
However, many Americans still lack either private or public
insurance coverage. Through a variety of initiatives, and in
partnership with the Nation’s Governors, the Administration
has made significant strides in addressing access to coverage for
uninsured Americans.
The Health Insurance Flexibility & Accountability
Initiative—Eligibility For New Health Care Coverage Affects
Hundreds of Thousands
Since 2002, when CMS first announced the Health Insurance
Flexibility and Accountability (HIFA) demonstration initiative, a
new approach to demonstrations in Medicaid and the State
Children's Health Insurance Program (SCHIP), the Administration
has encouraged new comprehensive state approaches to increase the
number of individuals with health insurance coverage within
current-level Medicaid and SCHIP resources. HIFA puts a particular
emphasis on broad statewide approaches that maximize private health
insurance coverage options and target Medicaid and SCHIP resources
to populations with income below 200 percent of the Federal poverty
level (FPL). By supporting private coverage options in the
states, the Administration has sought to promote new health care
coverage without encouraging a "one-size-fits-all"
approach. In addition to HIFA, CMS has approved broad-based section
1115 demonstrations in states such as Utah that expanded coverage
to previously uninsured individuals. CMS estimates that HIFA
demonstrations, if fully implemented, could potentially enroll as
many as approximately 822,000 new people and non-HIFA
demonstrations could enroll as many as 681,000.
New Condition-Specific Health Care Coverage: Breast and Cervical
Cancer
Many uninsured women need treatment for breast and cervical cancer,
and CMS has been working to ensure that as many states as possible
take advantage of the opportunity for enhanced Federal funding
under the Breast and Cervical Cancer Prevention and Treatment Act
of 2000 (BCCPTA). BCCPTA gave states enhanced
federal matching funds to provide Medicaid eligibility to a new
group of women previously not Medicaid eligible. The new
option allows states to provide full Medicaid benefits to uninsured
women under age 65 who are identified through the CDC’s
National Breast and Cervical Cancer Early Detection Program
(NBCCEDP), are in need of treatment for breast or cervical cancer,
including pre-cancerous conditions, and are not otherwise eligible
for Medicaid. This program, effective October 1, 2000, also
allows states to extend presumptive eligibility to applicants in
order to ensure that needed treatment begins as early as possible
and that life-saving interventions may be made in a timely fashion.
Through the efforts of the Administration and the states, 49
states and the District of Columbia are now participating in the
BCCPTA partnership with the CDC. Furthermore,
nearly half of those participating states also have adopted
a presumptive eligibility option. As of mid-2004, states
reported having enrolled an additional 18,315 women in Medicaid
since January 20, 2001.
Health Care Coverage for Individuals with Disabilities—Improved
Access and Improved Services
Access to health care coverage is also a crucial factor in allowing
Americans with disabilities realize their fullest employment
potential. To ensure that the contributions of disabled individuals
in the workforce are not overlooked and that the business community
takes full advantage of disabled individuals’ skills and
talents, CMS has designed and implemented two groundbreaking
employment initiatives mandated by the Ticket to Work and Work
Incentives Act of 1999 (TWWIA): the Demonstration to Maintain
Independence and the Medicaid Infrastructure (MIG) Grants.
These initiatives enable states to build supports for people with
disabilities who would like to be employed. Specifically,
CMS has awarded grants to 45 states to: develop an optional
working disabled eligibility group (also known as "Medicaid
buy-in"), increase the availability of statewide personal
assistance services, form linkages with other state and local
agencies that provide employment related supports, and create a
seamless infrastructure that will maximize the employment potential
of all people with disabilities. Since passage of the
TWWIA legislation, the number of states with a Medicaid buy-in
program has increased from 1 to 27 and enrollment has increased
from 2,000 to over 60,000.
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