Justification of Budget Estimates FY 2006

Program Support

Authorizing Legislation: Federal funds pursuant to Title IX and Section 927(c) of the Public Health Service Act.

A. Statement of the Budget

A total of $2,700,000 is provided for Program Support, the same level as the FY 2005 Appropriation. These funds will are directly related to AHRQ's work on the President's Management Agenda.

B. Program Description

This activity supports the overall direction and management of the AHRQ. This includes the formulation of policies and program objectives; and administrative management and services activities.

C. Performance Analysis

AHRQ has instituted a systematic approach to addressing and implementing the President's Management Agenda. The five government-wide agenda reforms—Strategic Management of Human Capital; Competitive Sourcing; Improve Financial Performance; Budget and Performance Integration; and Expanding Electronic Government—are teamed with other program reforms with which the Department has been charged. In a realignment announced in May 2003, the AHRQ Director created a new organizational entity—an Office of Performance, Accountability, Resources and Technology—to better manage the Agency's progress against these reforms as well as other management initiatives that cross-cut Agency components.

Over the past year, AHRQ has taken advantage of automation to streamline processes and increase efficiency where feasible. Examples include:

• Automating the annual OGE 450 (Confidential Financial Disclosure Report) filing process. Instead of sending each employee a paper copy of the required memo and OGE-450, employees are notified via e-mail of the reporting requirements as well as link to the on-line form and accompanying instructions. This reduces staff time needed to create the documents, collate, and disseminate to staff.
• AHRQ staff is systematically being trained on the "sign in" and "sign out" feature of the Integrated Time and Attendance System (ITAS). This will allow employees greater control over their time and attendance reporting and will allow us to reduce the number of timekeepers from 14 to three.
• Ninety percent of Agency vacancies are filled through the automated QuickHire staffing mechanism. This has reduced the amount of paperwork generated for each announcement and also created a standardized approach to recruiting positions.
• AHRQ has begun deploying the Enterprise Human Resource Program (EHRP) to select Offices and Centers in AHRQ. This allows designated staff to independently generate documents (e.g., award nomination forms, SF-52 [Request for Personnel Action]) without having to contact either the Rockville HR Center or program staff in the Office of Performance, Accountability, Resources and Technology (OPART) for HR-related information (e.g., position title, series, grade, salary, etc.). In FY 2005, AHRQ will begin the process of using the automated SF-52 process in select Offices/Center. This will minimize the number of people involved in the routing/clearance of an SF-52.

In FY 2003, AHRQ conducted eleven streamlined competitive sourcing studies in the functional areas of accounting, visual information, program/management analysis, information technology, and program assistance. The performance decision for each of these studies was in favor of the agency. In FY 2004, AHRQ conducted a streamlined (with MEO) competitive sourcing study in the functional area of secretarial/program assistance. This study encompassed 20 FTEs and the performance decision made was for the agency, which utilized a Most Efficient Organization. The Most Efficient Organization is in the process of being staffed and implemented.

AHRQ's major activities regarding the integration and implementation of the President's Management Agenda (PMA) through e-Government technologies within the Agency include:

1. Government Paperwork Elimination Act (GPEA).
2. Security.
3. Full participation in HHS PMA activities that intersect with the mission of the Agency, Patient Safety, and Consolidated Health Informatics initiatives that cross Government Agency boundaries.

In line with these program initiatives, AHRQ's Information Technology (IT) services team explicitly defined its mission and vision, buttressed by three strategic goals:

• Provide quality customer service to AHRQ developed applications and operations support to AHRQ's centers, offices and outside stakeholders.
• Ensure AHRQ's IT initiatives are aligned with departmental and agency enterprise architectures.
• Ongoing development of IT systems that link AHRQ's IT initiatives directly to the mission and performance goals of the Agency by developing an electronic planning system that allows selection and tracking of business investments (Grants, Contracts and Intramural research) that link directly to the Agency mission and GPRA goals and budget performance.

Financial accountability is a cornerstone of the "Improved Financial Performance" initiative of the President's Management Agenda. Federal managers continue to experience growing pressures from their executive leaders, Congress, the public, and their customers to achieve more under the programs they manage. To that end, this initiative asks agencies to evaluate their financial management capabilities to ascertain if sufficient internal controls are in place to safeguard against the misuse of federal funds, and to ensure that these controls provide the accountability required to make certain funds are spent as intended. The essential goal of this initiative is for managers to have access to and use financial information to make informed program and management decisions on a "day to day" basis. The following highlights AHRQ's progress on the "Improved Financial Performance" goal for the President's Management Agenda.

AHRQ submitted its Improper Payment Risk Assessment in accordance with the Improper Payment Information Act (IPIA) of 2002 to the Department in FY 2004. This assessment looks at whether AHRQ's Research on Healthcare Costs, Quality and Outcomes (HCQO) program activities are susceptible to significant erroneous payments. The report focuses on identifying the types of erroneous payments (i.e., whether the errors are administrative in nature such as user errors or are due to system/process limitations, as opposed to the more consequential causes such as lack of internal controls, oversight, and/or monitoring; inadequate eligibility controls; and fraud, waste and abuse) and evaluating the related internal controls. The report offers the opinion that AHRQ's HCQO program is at low risk of incurring significant erroneous payments.

AHRQ continues to gather evidence of erroneous payments encountered by using a standard form to pinpoint their exact nature and extent. The information collected will be evaluated in November, and used to determine what corrective action is appropriate.

AHRQ responded to the Department's survey requesting information on how/if the Agency uses performance and financial information on a day to day basis to support routine decisions. The purpose of the survey was to highlight the best practices already in place and to identify areas for improvement, with the ultimate goal of enhancing the utility of the Unified Financial Management System (UFMS) once implemented. AHRQ's responses included examples of:

• Efficiency measures in our current Performance Plan.
• Financial and performance reports used by managers to support management decisions.
• Actions/decisions made based on performance and financial data.
• How efficiency measures are integrated into senior management's individual performance plans.

AHRQ continued to support the Department's efforts to develop and implement UFMS by participating in the Steering Committee and the Planning and Development Committee meetings.

AHRQ continued to work on enhancing our information systems and developing new applications to create an Agency-wide enterprise financial network to improve our access to relevant programmatic and budgetary information. Our long-range plan is to interface AHRQ systems with the Department's Unified Financial Management System (UFMS) to help management substantially reduce the cost of providing accounting services through the Department while enabling program administrators to make more timely and informed decisions regarding their operations. AHRQ's automated system captures electronic funding decisions for extramural research grants and ties financial resources to the Agency's strategic plan goals, GPRA goals and measures, budget execution and formulation, and financial management activities. The system interfaces with IMPAC II and interconnects with the existing Agency budget system through a shared research/financial data base. Funding modules for contracts and interagency agreements were tested and integrated into the system in the 3rd quarter of FY 2004. A module for capturing intramural research projects was also completed and put into production in the 3rd quarter.

General program direction and budget and performance integration is accomplished through the collaboration of the Office of the Director and the offices and centers that have programmatic responsibility for portions of the Agency's research portfolio. The Agency links budget and performance management through its focus on the Annual Performance Plan.

As a result of the increased emphasis on strategic planning, the Agency has shifted from a focus on output and process measurement to a focus on outcome measures. These outcome measures are being developed to cascade down from our strategic goal areas of safety/quality, effectiveness, efficiency and organizational excellence. Portfolios of work (combinations of activities that make up the bulk of our investments) support the achievement of our highest level outcomes.

In continuing AHRQ's commitment to budget and performance integration, we reorganized the management structure. This new structure aligns those who are responsible for budget formulation, execution and providing services and guidance in all aspects of financial management with those who are responsible for planning, performance measurement and evaluation. These functions are now within one office.

Current and future efforts include continuing the development of a software application that maps each AHRQ funded activity to the portfolio structure and associated performance. This is a work in progress and we look forward to sharing our success as we continue this journey.

Finally, AHRQ completed comprehensive program assessments on five key programs within the Agency:

• The Medical Expenditure Panel Survey (MEPS).
• The Healthcare Cost and Utilization Project (HCUP).
• The Consumer Assessment of Healthcare Plans Survey (CAHPS®).
• The grant component of the Agency's Translation of Research into Practice (TRIP) activity.
• The Patient Safety program.

The Pharmaceutical Outcomes Portfolio was the latest program to undergo a PART review. These reviews provide the basis for the Agency to move forward in more closely linking high quality outcomes with associated costs of programs. Over the next few years, the Agency will focus on fully integrating financial management of these programs with their performance.

D. Rationale for the FY 2006 Request

The FY 2006 Request for Program Support is maintained at the FY 2005 Appropriation. These funds will provide for mandatory increases, including funds for the Unified Financial Management System (UFMS). Select for additional information on UFMS costs.

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Internet Citation:

Program Support. From: Justification for Budget Estimates for Appropriatation Committees, Fiscal Year 2006, February 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/cj2006/prog06.htm