Goal 1. Objective C: Emphasize primary and preventive care, linked with community prevention services
Improved access to primary care services and more effective public health measures are critical to ensuring that individuals have access to high-quality services at the place and time that best meets their needs. As part of the effort to emphasize primary and preventive care, HHS is focused on creating key linkages between the healthcare system and effective community prevention services that support healthy living and disease management.
ACL, AHRQ, CDC, CMS, HRSA, IHS, OASH, ONC, and SAMHSA are committed to accelerating their emphasis on primary and preventive care, with a focus on community prevention services. HRSA programs deliver healthcare services to millions of Americans, especially vulnerable and underserved populations. CDC implements a number of programs promoting healthy behaviors, such as reducing obesity through physical activity and better nutrition.
The measures below demonstrate HHS’s targets and results for primary and preventive care linked with community prevention services. Key features of the Affordable Care Act focus on preventive care. HHS and component managers use these and other related measures to focus attention on achieving positive preventive care results. The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.
Objective 1.C Table of Related Performance Measures
Increase the proportion of adults (age 18 and older) that engage in leisure-time physical activity (Lead Agency - CDC; Measure ID - 4.11.9)
|FY 2012||FY 2013||FY 2014||FY 2015||FY 2016||FY 2017|
|Result||70.4% 1||69.7%||70%||Dec 30, 2016||Dec 30, 2017||Dec 31, 2018|
|Status||Target Exceeded||Target Exceeded||Target Not Met but Improved||Pending||Pending||Pending|
Percentage of pregnant Health Center patients beginning prenatal care in the first trimester (Lead Agency - HRSA; Measure ID - 1.II.B.1)
|FY 2012||FY 2013||FY 2014||FY 2015||FY 2016||FY 2017|
|Result||70%||72%||72%||Aug 31, 2016||Aug 31, 2017||Aug 31, 2018|
|Status||Target Exceeded||Target Exceeded||Target Exceeded||Pending||Pending||Pending|
Analysis of Results
The CDC is working on population-level approaches to address one of the America’s most important problems - obesity. The prevalence of obesity among adults and children remains a public health concern. Obesity increases the risk of many health conditions, including heart disease, stroke, high blood pressure, and cancer. Reducing obesity prevalence, especially among population groups with the highest burden of disease, will improve health outcomes related to chronic diseases and conditions, lower morbidity rates, and reduce health care spending. The CDC barely missed its FY 2014 target for increasing the proportion of adults that engage in leisure-time physical activity, but the result was an improvement over the previous year.
Prenatal care is one of the most important interventions for ensuring the health of pregnant women and their newborn babies. Early high-quality prenatal care is critical to improving pregnancy outcomes. Monitoring timely entry into prenatal care assesses both quality of care as well as health center outreach efforts that are associated with improving birth outcomes. HRSA tracks the percentage of pregnant health center patients receiving prenatal care and in FY 2014, 72 percent of those patients began care in the first trimester, exceeding the target. Health Centers serve a higher risk prenatal population than seen nationally, making progress on this measure a particular accomplishment.
Plans for the Future
The CDC is working with communities, businesses, early child and education centers, and schools to increase the number of people 18 and older who are physically active. Creating more safe spaces to exercise in communities can improve individuals’ overall health. CDC estimates 73.9 percent of adults will be participating in at least 150 minutes of physical activity a week by FY 2017 through its efforts to increase the availability of safe environments for physical activity.
HRSA's Health Center Program will continue to be a critical element of the health system, providing an accessible and dependable source of primary care services in underserved communities. HRSA will continue to support efforts to improve access to comprehensive primary health care services, including prevention services. In FY 2017, the program will continue to assess both quality of care and health center outreach efforts through monitoring timely entry into prenatal care.
FY 2014 Strategic Review Objective Progress Update Summary
Please note that this section summarizes the result of the FY 2014 HHS Strategic Review process, limiting the scope of content to that available prior to spring of 2015. Due to this constraint, the following may not be the most current information available.
Analysis: Integrating primary health care services and public health efforts, including linking to community prevention services, can promote efficiency, positively affect individual well-being, and improve population health. The Affordable Care Act provides a unique opportunity to maximize the value of America’s health investment by integrating public health approaches and health care service delivery. For example, as a result of delivery system reform efforts, healthcare providers are looking beyond traditional clinical services to address other determinants that impact individuals’ health and well-being, healthcare quality and cost. Rather than reinventing the wheel, providers and payers have begun looking to community-based social services for their expertise in supporting seniors and people with disabilities. Through a collaborative learning experience community-based organizations developed bundled “packages” that integrated care providers can purchase to reduce unnecessary hospital and nursing facility admissions and support community living. To date, 15 contracts have been completed with integrated care entities (such as health plans, physician practices and health systems) to provide care transitions, evidence-based programs, and other services.
In 2014, the Million Hearts® Learning Collaborative assisted state and local health agencies in implementing evidence-based strategies to identify, control and improve blood pressure. In the first year, 10 states implemented high-impact strategies including standardization of hypertension screenings, use of electronic health records, and development of disease self-management tools. During this rapid scale-up of services, which included over 150 partners, 89,187 individuals were reached.
The Title X Program has greatly contributed to preventive services by decreasing unintended pregnancy among women and families, as well as significantly reducing unintended pregnancy rates among teens and young adults. According to the most recent data (CY 2013), of the more than 4.5 million individuals served in Title X clinics, approximately 18 percent were under 20 years of age and more than 2.31 million (51 percent) were in their 20’s. In addition, Title X centers have also made an impact by screening for chlamydia infection to reduce infertility. Title X centers screened a total of 1,181,534 clients under the age of 25 for Chlamydia.
The review identified some potential challenges such as the roll-out of the Dietary Guidelines for Americans especially as it relates to sodium reduction. Access to timely and reliable data within a complex and fluid health care environment is a significant challenge because there are statutory obligations to test and expand models that demonstrate positive results. If adequate and timely data necessary to conduct evaluation are not available, then no determination about the success of a model can ultimately be made. In addition, as a greater number of individuals become insured through private plans, Title X providers have to contract with private health plans, a challenge for small providers. These providers are struggling to ensure high quality care while adapting to new health care technologies.
HHS will continue to analyze the implications of the Affordable Care Act on federally funded public health programs. It will continue to build capacity and infrastructure of community based human service organizations so they can partner and obtain better outcomes in cooperation with health providers.
1 Results prior to FY 2013 have been updated to reflect Healthy People data. Previous result estimates came from multiple annual reports released by CDC’s National Center for Health Statistics