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Performance and Accountability Report
Fiscal Year 2002

Overview of Program Performance

HHS manages more than 300 programs that aim to improve the health and well-being of Americans, and uses more than 750 annual performance measures to direct program activities and assess progress and achievement. These performance measures, as required by the Government Performance and Results Act (GPRA) of 1993, assess program processes, outputs, outcomes, and results. Due to the volume and complexity of HHS programs and measures, this report discusses the key programs that are well known to the American public, including: Medicare, Medicaid, SCHIP, TANF (welfare reform), Child Care, Child Welfare, Child Support Enforcement, and Head Start, as well as Substance Abuse Prevention and Treatment block grants, Infectious Diseases, and Biomedical and Medical Research. This report also discusses performance relative to several key Secretarial priorities. Many of the programs discussed are interrelated and have multiple purposes; therefore, they may contribute to several goals and objectives. The FY 2002 Department-level performance report is presented in Section II of this report and summarized in the table on the following pages.

The following table highlights some of HHS' performance measures and FY 2002 results as of September 30, 2002, that are provided in greater detail in Section II of this report. However, performance data availability lags do occur, particularly in HHS programs that must rely on third parties for that data. In addition, some data collections are not conducted annually. Therefore, assessment of HHS performance can best be determined by a comparison of annual trends from year to year, as more performance information becomes available. Where FY 2002 data was not available, this report includes activities that exemplify HHS' continuing efforts to achieve program performance goals and targets. HHS used the same data collection systems to report on both Department- and OPDIV-level performance. However, data presented here may differ from that in OPDIV-level reports due to data lag times. OPDIVs may have more recent information than was available when this report was prepared.

This report presents selected performance information for HHS' key programs. OPDIVs also prepare individual performance plans and reports, which are submitted annually to the President and Congress, that collectively address all of the Department's program performance measures in greater detail. For more information on HHS' performance measures, readers are encouraged to view the OPDIV-level Performance Plans and Reports available though the HHS web-site at: http://www.hhs.gov. Readers should refer to these OPDIV plans and reports, and Section II of this report for additional context and detail regarding the following summarized measures.

Performance Measure	2002 Target	2002 Actual Result or Date Data Available
Strategic Goal 1: Reduce the Major Threats to the Health and Well-Being of Americans.
Increase the percentage of diabetes control programs that adopt, promote, and implement guidelines for improving the quality of care for persons with diabetes.	100% of state diabetes control programs.	12/2002 Met target of 100% in FY 2001.
Initiate, expand, or strengthen HIV/AIDS voluntary counseling and testing globally (Measure # countries/regions).	25	09/2003 Target (19) not met in FY 2001 (18).
Increase the percentage of TB patients who complete a course of curative TB treatment within 12 months of initiation (some patients require more than 12 months).	88%	Mid-2005 Target (85%) not met in FY 1999 (79.9%).
Strategic Goal 2: Reduce the Major Threats to the Health and Well-Being of Americans.
Maintain a national pharmaceutical stockpile for deployment in response to terrorist use of biological or chemical agents against U.S. civilian population.	Maintain a pharmaceutical stockpile as required by FY 2002 HHS Bioterrorism Strategic Plan.	Exceeded
Inspect at least 95% of high-risk domestic food establishments once every year.	95%	Not available. Did not meet FY 2001 target to inspect 90% of establishments. Inspected approximately 80% of 6,800 establishments.
Perform 48,000 physical exams and conduct sample analyses on products with suspect histories.	Hire 300 new investigators and analysts who will increase the number of physical exams by 97% to 24,000 exams and conduct sample analyses on products with suspect histories.	Not available. No target in FY 2001
Strategic Goal 3: Increase the Percentage of the Nation's Children and Adults Who Have Access to Health Care, and Expand Consumer Choices.
Improve satisfaction of Medicare beneficiaries with the health care services they receive (Managed Care).	Collect (& share) data.	Data collected; goal met.
Improve satisfaction of Medicare beneficiaries with the health care services they receive (fee-for-service).	Collect (& share) data.	Data collected; goal met.
Increase annual influenza (flu) and lifetime pneumococcal vaccination - FLU.	72%	12/2003
Increase annual influenza (flu) and lifetime pneumococcal vaccination C PNEUMOCOCCAL.	66%	12/2003
Increase biennial mammography rates (National Claims History FileBNew Data Source).	52%	08/2003 Exceeded (51.6%) FY 2001 target (51%).
Improve beneficiary understanding of basic features of the Medicare program (developmental).	Baselines /future targets to be developed.	Data being analyzed. Baselines/target data will be available by the end of CY 2002.
Increase the percentage of Medicaid 2-year old children who are fully immunized:
Group I States............................................................	Staggered development of state-specific baselines and targets.	FY 2002, 5 of 16 states reporting. FY 2001: 15 of 16 states reporting.
Group II States...........................................................	States establish baselines and targets.	All states in group established baselines and targets.
Group III States.........................................................	Recruit States.	Recruitment successful.
Assist states in conducting Medicaid payment accuracy studies for the purpose of measuring and ultimately reducing Medicaid payment error rates.	9 states conduct pilot payment accuracy study.	Met target.
Increase the number of children enrolled in regular Medicaid or SCHIP.	+1,000,000 over FY 2001.	12/2002
Increase the proportion of IHS, Tribal, or Urban (I/T/U) clients with diagnosed diabetes that have improved their glycemic control.	Improve from FY 2001.	06/2003 Improvement has occurred each year since FY 1999.
Assure that the unintentional injury-related mortality rate for American Indian/Alaskan Natives (AI/AN) people is no higher than FY 2001 rate.	Revised: target to be FY 2001 actual rate.	Not available.
Assure that the unintentional injury-related mortality rate for American Indian/Alaskan Natives (AI/AN) people is no higher than FY 2001 rate.	Revised: target to be FY 2001 actual rate.	Not available.
Maintain 100% accreditation of all IHS hospitals and outpatient clinics	100%	100%
Serve a proportion of racial/ethnic minorities in Title I-funded programs that exceeds their representation in national AIDS prevalence data, as reported by CDC, by a minimum of 5 percentage points.	70%	01/2004 FY 2001 data available 01/2003.
Increase the number of AIDS Drug Assistance Program (ADAP) clients receiving Human Immunodeficiency (HIV)/AIDS medications through state ADAPs during at least one month of the year.	84,800	02/2004 Exceeded (73,784) target (72,000) in FY 2001.
Increase the percent of clinicians retained in service to the underserved.	76%	04/2003 Exceeded (80%) target (75%) in FY 2001.
Increase the percent of children with special health care needs (CSHCN) in the states= programs with a source of insurance for primary and specialty care.	91%	01/2004 FY 2001 number available 01/2003.
Assist rural facilities in converting to Critical Access Hospital status.	240	657
Continue to assure access to preventative and primary care for racial/ethnic minority individuals.	65%	08/2003 Did not meet (64%) target (65%) in FY 2001.
Award nursing loan repayment contracts.	560	12/2002
Strategic Goal 4: Enhance the Capacity and Productivity of the Nation's Health Science Research Enterprise.
Review and act on standard original New Drug Application (NDA) submissions within twelve months of receipt.	90%	Not available. FY 2001 results available. 01/2003.
Review and act upon fileable generic drug applications within 6 months after submission date.	65%	Not available. Exceeded target (50%) in FY 2001 (84% of 298).
Review and act on 90% of Pre-Market approval applications (PMA) of an estimated 80 PMA first actions within 180 days.	90%	Not available. Exceeded target (90%) in FY 2001 (97% of 70).
Strategic Goal 5: Improve the Quality of Health Care Services.
Decrease the prevalence of restraints in nursing homes.	10.0%	9.9% (FY 2002 interim data)
Decrease the prevalence of pressure ulcers in nursing homes.	9.5%	10.3% (FY 2002 interim data
Streamline Adverse Drug Event Reporting System (AERS).	Accepting electronic submission from companies and be current with MedDRA coding versions.	Not available. Next generation of IT system completed and initial reports submitted in FY 2001.
Expand the automated extraction of GPRA clinical performance measures and improve data quality.	Assess five sites for five performance measures.	Assessments completed.
Strategic Goal 6: Improve the Economic and Social Well Being of Individuals, Families, and Communities, Especially Those Most in Need.
All states meet the TANF two-parent families work participation rate (Rate = 90%).	100%	09/2003 Target (100%) not met in FY 2001 (88%).
Increase the percentage of adult TANF recipients who become newly employed.	43%	09/2003
Maintain at the FY 1998 baseline the number of recipients of child protective services funded wholly or in part by SSBG funds.	1,302,895	12/2003 Exceeded target in FY 2001 (1,411,427).
A significant percentage of Older Americans Act (OAA) Title III service recipients live in rural areas.	25%	02/2004
Maintain a high ratio of Leveraged funds to AoA funds.	$ 1.50 to $1.00	02/2004
Strategic Goal 7: Improve the Stability and Healthy Development of our Nation's Children and Youth.
Increase the number of children served by Child Care and Development Fund (CCDF) subsidies.	2.2 million	09/2003
Increase by 1 % the number of regulated child care centers and homes accredited by a nationally recognized early childhood development professional organization.	9,725	09/2003 9,237. Did not meet FY 2001 target (9,725).
Increase the collection rate for current support.	55%	09/2003 Exceeded target in FY 2001.
Increase the Paternity Establishment Percentage among children born out of wedlock.	97%	09/2003 Exceeded target in FY 2001.
Maintain the percentage of children who exit the foster care system through reunification within one year of placement.	67%	06/2003 Exceeded target in FY 2001.
Increase the number of adoptions of children in the foster care system.	56,000	09/2003; Did not meet FY 01 target.
Strategic Goal 8: Achieve Excellence in Management Practices.
Total expected Medicare and Medicaid recoveries and savings per dollar Invested (in millions).	$79 : 1	01/2003
Reduce the Medicare fee-for-service payment error rate.	5%	FY 2003
Number of Clients served (with funding from Substance Abuse Prevention and Treatment Block Grant Program).	1,751,537	09/2004

Many external factors and influences, beyond the control of HHS, may impede achievement of our strategic goals and objectives. These factors pose challenges for HHS officials by introducing risks and uncertainties that affect how well we achieve our strategic goals and objectives. In some cases, it may be possible to ameliorate the impacts of these conditions but not in all cases. For example, building the the health system's capacity to respond to public health threats in a more timely and effective manner, especially bioterrorism threats, can be hampered by new threats emerging that outpace capacity or communication links between the public health and hospital/health care sectors. In addition, national and local economic conditions can influence whether we are successful in helping families on welfare become economically independent. Also, the public's personal health habits (e.g., diet, exercise, smoking) can impact the incidence of chronic disease.

HHS is prepared to respond as challenges arise due to these external factors and influences. For example, HHS is improving it's capacity to identify new strains of pathogenic microorganisms; conducting meetings to address communications issues; and building enhanced communication though joint training exercises at state and local levels between the public health and hospital sectors. States have also been provided greater flexibility to accomplish welfare objectives under TANF including ensuring that families moving to work remain connected to other safety net programs for which they are eligible. HHS also offers a wide range of training programs focused on the correlation between personal health habits and the incidence of chronic disease.

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