FY 2017 Annual Performance Plan and Report - Executive Summary
Cross-Agency Priority Goals
Per the Government Performance and Results Modernization Act (GPRAMA) requirement to address Cross-Agency Priority (CAP) Goals in the agency strategic plan, the annual performance plan, and the annual performance report, please refer to www.Performance.gov for the agency’s contributions to those goals and progress, where applicable. The Department of Health and Human Services currently contributes to the following CAP Goals: Customer Service, Benchmarking, Open Data, Lab-to-Market, and People and Culture.
Strategic Goals Overview
HHS developed a new strategic plan in 2013 to encompass the period from FY 2014 to 2018. This plan, available at http://www.hhs.gov/strategic-plan/priorities.html, identifies four strategic goals and 21 related objectives. The four strategic goals are:
Goal 1: Strengthen Health Care
Goal 2: Advance Scientific Knowledge and Innovation
Goal 3: Advance the Health, Safety, and Well-being of the American People
Goal 4: Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs
Management Objectives and Priorities
The structure of the FY 2014-2018 HHS Strategic Plan aligns Strategic Goals 1 through 3 to mission-focused efforts while Strategic Goal 4 aligns to HHS’s overall management objectives. The emphasis on efficiency, transparency, accountability, and effectiveness of HHS programs in Goal 4 serves to highlight efforts across the Department to enable enhanced program performance in strengthening program integrity, creating innovations for data access and use, investing in the HHS workforce, and promoting sustainability. The planned actions, performance targets, and indicators used to measure progress for these efforts can be found in the Goal 4 section of this document.
Performance goals and measurement are powerful tools to advance an effective, efficient, and productive government. HHS regularly collects and analyzes performance data to inform decisions. HHS staff constantly strives to achieve meaningful progress and find lower-cost ways to achieve positive impacts, in addition to sustaining and spreading information on effective and efficient government programs.
Responding to opportunities afforded by GPRAMA, HHS continues to institute significant improvements in performance management including:
- Developing, analyzing, reporting, and managing five Priority Goals for the period of FY 2014-2015 and conducting quarterly performance reviews between HHS component staff and HHS leadership to monitor progress toward achieving key performance objectives.
- Coordinating Strategic Reviews process supporting decision-making and performance improvement across the Department.
- Enhancing the coordination of performance measurement, budgeting, strategic planning, and program integrity activities within the Department.
- Continuing to foster a network of component Performance Officers who support, coordinate, and implement performance management efforts across HHS.
- Sharing of best practices in performance management at HHS through webinars and other media.
HHS Agency Priority Goals
HHS, along with other federal agencies, uses Agency Priority Goals to improve performance and accountability for priorities of agency leadership and the Administration. In FY 2014, HHS established a set of near-term (18 – 24 month) Agency Priority Goals, each aligned to a HHS Strategic Plan Goal, and began holding quarterly data-driven reviews to monitor progress towards the achievement of these Priority Goals. These goals reached the completion of their two year cycle in FY 2015 and the final progress summaries are available below.
The Department has developed new Agency Priority Goals for the FY 2016-2017 cycle, described below. Working groups collaborated across the Department to identify those activities that would reflect HHS priorities and benefit from the focus and communication of the Agency Priority Goal process. Some of these Goals are continuations from the previous set from FY 2014-2015, reflecting their continued importance across the Department. These Agency Priority Goals are largely cross-cutting in nature, requiring active management across HHS components for success. Please refer to www.Performance.gov for additional information on Agency Priority Goals and the HHS components’ contributions to those goals.
HHS Agency Priority Goals Progress Summary FY 2014 – FY 2015
Improve health care through meaningful use of health information technology: By the end of FY 2015, increase the number of eligible providers who receive incentive payments from the CMS Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for the successful adoption or demonstration of meaningful use of certified EHR technology to 450,000.
Results Reported: As of September 2015, over 478,379 providers had received their first incentive payment. CMS recently presented the following data on early provider progress from stage 1 to stage 2 attestation milestones:
57,726 Medicare eligible professionals (EPs) successfully attested to stage 2.
1,553 Medicare eligible hospitals (EHs) successfully attested to stage 2.
Reduce foodborne illness in the population: By December 31, 2015, decrease the rate of Salmonella Enteritidis illness in the population from 2.6 cases per 100,000 (2007-2009 baseline) to 1.9 cases per 100,000.
Results Reported: CDC reported that the illness rate during the 12-month period ending June 30, 2015 was 2.9 illnesses per 100,000. This is a decrease from the 2010 rate (3.5 cases per 100,000) but is higher than the 2007-2009 baseline rate of 2.6 cases per 100,000 population. In support of this reduction, as of September 30, 2015, FDA has conducted a total of 136 inspections or investigations of small and large registered egg producers. The emergence of Highly Pathogenic Avian Influenza (HPAI) at commercial egg producing operations impacts FDA’s ability to monitor compliance with the Egg Rule. On May 5, 2015, FDA temporarily suspended physical inspections of egg laying facilities to safeguard against possible spread of HPAI. The FDA is working closely with USDA and other federal, state, and local agencies to track and manage the effects of recent outbreaks of HPAI. Prior to resuming inspection, the Agency will be providing enhanced biosecurity training to all food safety staff in FDA and states performing inspections on egg farms. All 10 FoodNet sites are transmitting exposure information to CDC. Information about the exposures of 979 people with domestically-acquired, sporadic SE illness in 2013 and 2014 has been mapped to exposures included in the attribution model and has been evaluated for quality.
Reduce combustible tobacco use: By December 31, 2015, reduce the annual adult combustible tobacco consumption in the United States from 1,342 cigarette equivalents per capita to 1,174 cigarette equivalents per capita, which will represent an approximate 12 percent decrease from the 2012 baseline.
Results Reported: The annual per capita adult cigarette consumption fell to 1,216; missing the FY 2014 target of 1,212 by only four cigarettes. This reduction represents an approximate 9 percent decrease from the FY 2012 baseline of 1,342. Additionally, the current smoking rate for adults is 16.8 percent (National Health Interview Survey 2014); showing progress toward the Healthy People 2020 goal, which aims to reduce adult prevalence to less than 12 percent by 2020.
Improve patient safety: To reduce the national rate of healthcare-associated infections (HAIs) by September 30, 2015 by demonstrating a 10 percent reduction in national hospital-acquired catheter-associated urinary tract infections (CAUTI) from the current standardized infection ration (SIR) of 1.03 to a target SIR of 0.92.
Results Reported: CDC changed the CAUTI definition in response to input from stakeholders and scientific data, which went into effect January 1, 2015. Because the baseline CAUTI SIR was calculated using the old CAUTI definition, a strategy to ensure continuity and validity of new SIR data across this goal has been established. The CDC constructed a new SIR by applying the new CAUTI definition to the current baseline SIR and data points. Under the new definition, the most current NHSN data for the time period through March 31, 2015 shows a CAUTI SIR of 0.69. This is a reduction from the previous quarters’ CAUTI SIR of 0.80. Analysis of the CAUTI data continues to reveal marked difference in reductions between intensive care and non-intensive care units. Non-ICUs achieved a 23.4 percent relative reduction in CAUTI rates, whereas ICUs achieved a 5.9 percent reduction in CAUTI rates. The CAUTI rate reduction in non-ICUs is greater than in ICUs in part because ICUs have higher rates of catheter utilization than non- ICUs.
Improve the quality of early childhood education: By September 30, 2015, improve the quality of early childhood programs for low-income children through implementation of the Quality Rating and Improvement Systems in the Child Care and Development Fund, and through implementation of the Classroom Assessment Scoring System (CLASS: Pre-K) in Head Start.
Results Reported: ACF continues to be on track to meet the key indicators associated with this Priority Goal, making progress to improve the quality of Early Childhood Education programs. In FY 2014, 29 states had a Quality Rating and Improvement System (QRIS) that met high quality benchmarks, meeting the previously established target. States expanded from pilot programs to statewide-systems and increased availability to quality information, leading them to meet more components of the QRIS measure. States were also supported by targeted technical assistance through state specific benchmarks and goals. The FY 2014 results show that states continue to make progress toward implementing QRIS that meet high-quality benchmarks. The FY 2015 (CLASS: Pre-K) result is a continued improvement over the previous FY 2014 result, further reducing the number of grantees scoring below a 2.5 from 23 to 22 percent. The ACF Office of Head Start continues to provide targeted technical assistance to grantees scoring in the low range, particularly for the Instructional Support domain, and develop strategies for improvement.
HHS Agency Priority Goals FY 2016 – FY 2017
HHS developed new Agency Priority Goals for FY 2016 - FY 2017. The goal statements and performance indicators for these are listed below:
Improve Early Childhood Education: Improve the quality of early childhood programs for low-income children. By September 30, 2017, HHS will improve the quality of early childhood programs for low-income children by increasing the number of states with Quality Rating and Improvement Systems (QRIS) that meet high quality benchmarks from a baseline of 17 states in FY 2011 to 37 states in FY 2017, reducing the proportion of grantees receiving a score in the low range on the basis of the Classroom Assessment Scoring System (CLASS) from a baseline of 25 percent (FY 2012) to 24 percent in FY 2017, and increasing the percent of teachers in Head Start and Early Head Start that have a Bachelor’s Degree (BA) or higher by 2 percentage points each year from a baseline of 52 percent (FY 2012).
- Increase the number of states with Quality Rating and Improvement Systems (QRIS) that meet high quality benchmarks for child care and other early childhood programs developed by HHS.
- Reduce the proportion of Head Start grantees receiving a score in the low range on the basis of the Classroom Assessment Scoring System (CLASS: Pre-K).
- Increase the percent of teachers in Head Start and Early Head Start that have a BA or higher.
Healthcare Payment Reform: A critical step toward better care, smarter spending, and healthier people is to use payment incentives to motivate higher-value care by increasingly tying payment to alternative payment models that reward value over volume. By December 31, 2017, increase the percentage of Medicare Fee-for-Service (FFS) payments tied to quality and value through alternative payment models (APMs) to 40 percent.
- Percent of Medicare Fee For Service payments tied to Quality and Value in Alternative Payment Models
Treat Serious Mental Illness: Improve the timeliness of initiation into treatment for individuals with serious mental illness. By September 30, 2017, expand the availability of evidence-based early intervention services for individuals with serious mental illness (SMI) funded through the SAMHSA Community Mental Health Services Block Grant by increasing the number of states with at least one evidence-based early intervention program that provides a team-based approach to treatment including services such as case management, recovery-oriented cognitive and behavioral skills training, supported employment, supported education services, family education and support, and low doses of medications when indicated. The goal is to increase by 50 percent from a baseline of 13 states in 2015.
- Increase access to early intervention services by increasing the number of states with early intervention programs by 50 percent.
Combating Antibiotic-Resistant Bacteria: Combat antibiotic-resistant bacteria to save lives. By September 30, 2017, HHS will increase the percent of hospitals that report implementation of antibiotic stewardship programs that comply with all of the CDC Core Elements for Hospital Antibiotic Stewardship Programs by 50 percent from a baseline of 39.2 percent.
- Increasing the percent of hospitals that report implementation of antibiotic stewardship programs that comply with all of the CDC Core Elements for Hospital Antibiotic Stewardship Programs by 50 percent
Reduce Opioid Abuse: Reduce opioid-related morbidity and mortality. By September 30, 2017, opioid-related overdose death and opioid use disorder will be addressed through the three priority areas of reforming opioid prescribing practices, increasing the use of naloxone, and expanding access to and use of medication-assisted treatment (MAT) for opioid use disorders.
- Decrease by 10 percent the total morphine milligram equivalents (MME) dispensed.
- Increase by 15 percent the number of prescriptions dispensed for naloxone.
- Increase by 10 percent the number of unique patients receiving prescriptions for buprenorphine and naltrexone in a retail setting.
Reduce Tobacco Use: By December 31, 2017, reduce the annual adult combustible tobacco consumption in the United States from 1,277 cigarette equivalents per capita to 1,127 cigarette equivalents per capita, which will represent an approximate 12 percent decrease from the 2013 baseline.
- Annual per capita adult combustible tobacco consumption in the United States (cigarette equivalents)
Improve Food Safety: By December 31, 2017, working with federal, state, local, tribal, and industry partners, improve preventive controls in food production facilities and reduce the incidence rate (reported cases per 100,000 population per year) of Listeria monocytogenes (Lm) infections by 8 percent.
- Reduce the incidence rate of Listeria