FY 2021 Annual Performance Plan and Report - Goal 1 Objective 3

Fiscal Year 2021
Released March, 2020

Goal 1. Objective 3: Improve Americans' access to health care and expand choices of care and service options

Accessing health services involves gaining entry into the health care system, usually through payment; gaining access to diverse options for receiving treatment, services, and products, including physical locations and online options; and having a trusted relationship with a health care provider. Efforts to improve access to care are not limited to physical health care. Improving access to behavioral and oral health care, including through innovative solutions that use health information technology, also is critical, especially for populations experiencing disparities in access. HHS has removed regulatory barriers, created incentives for increased access to newly developed drugs and devices, expanded patient access and choice through Health Reimbursement Arrangements, and launched the Rural Health Strategy to improve access to care in Medicare and Medicaid.  To improve outcomes in this objective, HHS continues to address the high cost of care, lack of availability of services, and lack of culturally competent care.

The Office of the Secretary leads this objective. The following divisions are responsible for implementing programs under this strategic objective: ACL, CMS, HRSA, IHS, IOS, OCR, OGA, and SAMHSA. In consultation with OMB, HHS has determined that performance toward this objective is making noteworthy progress.  The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

Objective 1.3 Table of Related Performance Measures

Improve patient and family engagement by improving shared decision-making (Lead Agency - CMS; Measure ID - MCR31)13, 14

  CY 2014 CY 2015 CY 2016 CY 2017 CY 2018 CY 2019
Target Baseline N/A N/A 76% Baseline Discontinued
Result 74.6% 75.2% 75.4% 75.85% Baseline not established N/A
Status Actual Actual Actual Target Not Met but Improved Target Not Met N/A

The purpose of this performance goal was to help assess an important component of patient experience of care with their provider. Shared decision making between patient, caregiver, and provider is a fundamental component of a patient-centered health care system that leads to improved health outcomes for patients. This measure reports survey results from the Shared Decision Making Summary Survey Measure (SSM). The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for Physician Quality Reporting programs collects and reports SSM data.

CMS set the CY 2017 target for this goal at 76 percent, which is between the 80thand 90th percentiles for all Shared Savings Program Accountable Care Organizations (ACOs) that used the CY 2015 Shared Savings Program quality measure benchmarks. The mean performance on this measure was 75.40 percent in CY 2016 and was 75.85 percent in CY 2017.

HHS did not set targets for CY 2019 and CY 2020 and discontinued this goal due to data reporting issues. The methodology for this measure changed in CY 2018.  A new baseline cannot be established due to the lack of available, stable, and trend data from the recent CAHPS update. The agency implemented a revised shortened version of the survey in CY 2018 for both ACOs and Merit-based Incentive Payment System (MIPS). The CY 2018 performance period was a developmental year.

Increase tele-behavioral health encounters nationally among American Indians and Alaska Natives (Lead Agency - IHS; Measure ID - MH-1)

  FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021
Target N/A 8,600 8,901 10,359 11,600 13,600 21,860 26,647
Result 8,298 9,773 10,388 12,212 13,204 17,933 12/31/20 12/31/21
Status Actual Target Exceeded Target Exceeded Target Exceeded Target Exceeded Target Exceeded Pending Pending

Telehealth services have proven effective in providing access to care where there are provider shortages or other barriers to care. IHS has increased its efforts to expand access to care through the integration of telemedicine with community-based services. Behavioral health services are important services delivered through the telehealth option. Expanding access to telehealth services may include increased access to specialty care, such as child psychiatry and addiction psychiatry. This measure shows that demand for these services exceeds expected targets. The target increase between FY 2018 and FY 2021 is close to 40 percent. IHS exceeded its FY 2019 target by 32 percent. In FY 2020 and FY 2021, IHS will expand access to care for telehealth behavioral services.

13 The methodology for this measure changed in CY 2018.

14 A new baseline cannot be established due to the lack of available, stable, and trend data resulting from the recent CAHPS survey update.


Content created by Office of Budget (OB)
Content last reviewed