FY 2007 HHS Annual Plan

Stategic Goal 3
Increase the Percentage of the Nation's Children and Adults Who Have Access to Health Care Services

On this page:
Program 3a: Health Center Program Health Resources and Services Administration (HRSA)
Program 3b: National Diabetes Program Indian Health Service (IHS)
Program 3c: Medicare Centers for Medicare & Medicaid Services (CMS)
Program 3d: Medicaid Centers for Medicare & Medicaid Services (CMS)
Program 3e: State Children's Health Insurance Program Centers for Medicare & Medicaid Services (CMS)

Highlighted Programs:

• 3a. Health Center Program (HRSA)
• 3b. National Diabetes Program (IHS)
• 3c. Medicare (CMS)
• 3d. Medicaid (CMS)
• 3e. State Children's Health Insurance Program (CMS)

HHS is committed to its many efforts aimed at increasing the percentage of the Nation's children and adults who have access to care and to expanding consumer choices. In FY 2007, the Department will continue to work hard to promote increased access to health care, especially for uninsured and underserved people and for those whose health care needs are not adequately met by the private health care system.

In support of this goal, HHS will continue to promote a wide variety of activities intended to increase access to health care; encourage the development of low-cost health insurance options, reduce health disparities, and to strengthen and improve health care services for targeted populations with special health care needs.

Over 34 HHS programs in six OPDIVs contribute to achieving this strategic goal. Five programs are highlighted in this strategic goal:

• HRSA's Health Centers Program: Provides regular access to high quality, family oriented, and comprehensive primary and preventive health care regardless of patients' ability to pay.
• Indian Health Service (IHS) National Diabetes Program: Works with communities to prevent and treat diabetes in American Indian/ Alaska Native people.
• Centers for Medicare and Medicaid (CMS) Medicare program: Helps pay medical bills for millions of aged and disabled Americans and has provided them with comprehensive health benefits.
• CMS' Medicaid program: Serves as the primary source of health care for a large population of medically vulnerable Americans, including poor families, the disabled, and persons with developmental disabilities requiring long-term care.
• CMS' State Children's Health Insurance Program (SCHIP): Stimulates enormous change in the availability of health care coverage for children, in coordination with Medicaid.

Program 3a: Health Center Program
Health Resources and Services Administration (HRSA)

Performance Measure:

• Increase the number of uninsured and underserved persons served by health centers.
• Increase new and expanded health center sites.

The Health Centers program is a major component of America's health care safety net for the Nation's indigent populations. Expansion of this program, which is nearly 40 years old, is a Presidential initiative to increase health care access for those Americans who are most in need. Millions of Americans are uninsured and lack access to a regular source of health care. Health centers provide regular access to high quality, family-oriented, and comprehensive primary and preventive health care regardless of patients' ability to pay. The ultimate goals of the Health Centers program are to contribute to improvements in the health status of underserved and vulnerable populations and to contribute to the elimination of health disparities.

Growth in the number of persons served by health centers is an indicator of improved access to care. The projection is that the Health Centers program will serve 15.8 million persons in FY 2007. The Health Centers program served 13.1 million people in FY 2004, achieving more than 99 percent of its target even though it generally takes several years for newly established sites to become fully operational. The increase from 2003 to 2004 represents a growth of more than 700,000 additional persons served.

A critical element in expanding access to care for the Nation's most vulnerable populations is the establishment of new health center sites and the expansion of existing sites to provide required facilities, personnel and services, particularly in communities of greatest need. The target for FY 2007 is 302 new or expanded sites. In FY 2005, the Health Centers program funded 158 new or expanded sites, which exceeded the target.

A PART review of the Health Centers program was conducted in CY 2002. The program was rated Effective, the highest rating a program can achieve. The assessment found that the program purpose is clear, the program is designed to have a unique and significant impact, the program uses performance information to improve administrative and clinical outcomes, and the program is making progress in achieving its long-term outcome goals.

Program 3b: National Diabetes Program
Indian Health Service (IHS)

Performance Measure: Address the proportion of patients with diagnosed diabetes that have demonstrated glycemic control at the ideal level (HbA1c<7).

The IHS Division of Diabetes Treatment and Prevention (DDTP) is an integral part of the IHS Hospitals and Health Clinics Program. The mission of the DDTP is to develop, document, and sustain a public health effort to prevent and control diabetes in AI/ANs. IHS currently has seven diabetes performance measures within its annual Performance Budget.

Glycemic control refers to how well blood sugars are controlled in a person with diabetes. It is measured with a blood test called the hemoglobin A1C (A1C). A lower A1C percentage indicates better blood sugar control. Keeping Hemoglobin A1C levels below 7 (ideal glycemic control) can slow or prevent the onset and progression of complications, including cardiac, eye, kidney, and nerve disease caused by diabetes.

The IHS Diabetes Care and Outcomes (DCO) Audit process divides these levels of glycemic control into percentage categories: "Ideal" (<7); "Good" (7.0-7.9); "Fair" (8.0-9.9); "Poor" (10-11.9); and "Very Poor" (>12), based on national diabetes care standards. The first graph illustrates IHS' ongoing ability to improve glycemic control in AI/AN populations (broken into age categories for patients under 55 years, 55 to 64 years and 65 years and older). The second graph illustrates improving glycemic control over time among the IHS population as a whole.

Diabetes Care and Outcomes Audit

Diabetes Care and Outcomes Audit

In FY 2007, IHS will maintain the 36 percent of patients with diagnosed diabetes that have demonstrated glycemic control at the ideal level (HgbA1C<7) based on the IHS DCO Audit. Since 1998, IHS has met the targets for this measure based on the IHS DCO Audit data. The FY 2005 indicator was to maintain the proportion of AI/AN patients with diabetes that have ideal glycemic control; IHS exceeded the target by two percent. IHS also met and surpassed the FY 2004 ideal glycemic control indicator by two percent.

IHS targets continue to be ambitious in overcoming the diabetes epidemic in AI/AN populations. There is a historical and projected annual increase in diabetes prevalence of four percent. Since 1997, the number of patients with diabetes served by the I/T/U system has increased by 45 percent, according to a review of diabetes program data by diabetes statisticians.

The elimination of diabetes-related health disparities that AI/AN patients experience depends on meeting the growing demand for treatment services, as well as identifying additional cost-effective preventive interventions.

The CY 2002 PART process included a review of the IHS Direct Federal Programs and the Hospital and Clinics Budget, where the diabetes funding resides; the program received a rating of Moderately Effective. The PART assessment focused attention on the continued importance of assuring valid and reliable performance data; thus, the diabetes measure has also been addressed in later PART reviews. It was included in both the Urban Indian Health Program and RPMS/IT PART reviews during the CY 2003 PART process. In addition, the CY 2004 Facilities PART and the CY 2005 Tribally Operated Health Facilities include the proportion of patients achieving ideal glycemic control as one of the program measures.

Program 3c: Medicare
Centers for Medicare & Medicaid Services (CMS)

Performance Measures:

• Implement the new Medicare Prescription Drug Benefit.
• Improve Satisfaction of Medicare Beneficiaries With the Health Care Services They Receive

CMS is helping the Department meet its goal of expanding consumer choice and access to healthcare by implementing the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which extends Medicare prescription drug coverage to Medicare beneficiaries. CMS is also collaborating with health care providers to improve the health status for Medicare beneficiaries and, through the survey and certification of providers, ensure the safety and quality of healthcare services and devices provided to beneficiaries. To inform beneficiaries of their benefits and choices within the Medicare program CMS administers comprehensive outreach and education programs including, regular and continuous surveys, complaint investigations and mediation with healthcare providers.

In 2003, Medicare received a rating of Moderately Effective in the PART process, in part because the program needed to be updated, including making prescription drugs part of the benefits model. Since that time, as a result of MMA, the Medicare program has taken steps to address program challenges identified in the PART, including implementing the new prescription drug benefit.

As of January 2006, Medicare beneficiaries have access to a standard prescription drug benefit. People with limited assets and low income will receive a more generous benefit package. Data collection will begin in 2006 to monitor the effectiveness of the implementation phase.

One of CMS' ultimate goals is to assure satisfaction of its primary customer - the Medicare beneficiary. In 2006 and beyond, CMS will work to improve the already high satisfaction levels beneficiaries have with the Medicare program. CMS measures satisfaction using beneficiary responses to questions on the Medicare Consumer Assessment of Health Plan Survey (CAHPS) regarding access to care and specialists in both Medicare fee-forservice and Medicare Advantage. CMS will make modifications to the Medicare CAHPS to reflect MMA program changes, including measurement of experience and satisfaction with the care and services provided through the new Medicare Prescription Drug Plans as well as the Medicare Advantage and Medicare Fee-For-Service health plans. CMS will develop the revised survey instruments in FY 2006 with data collection to begin in FY 2007.

Program 3d: Medicaid
Centers for Medicare & Medicaid Services (CMS)

Performance Measure: Improve the Quality of Health Care for Medicaid Beneficiaries through Demonstrated Enhancements to Overall State Quality Strategies.

The Medicaid program directly supports HHS Strategic Goal 3 by providing the primary source of health care coverage for a large population of medically vulnerable Americans, including poor families, people with disabilities, and people with long-term care needs. Additionally, many other low-income uninsured individuals, who are not otherwise eligible for Medicaid, receive coverage through the use of waivers. In FY 2005, there were 49.1 million individuals enrolled in Medicaid, including those enrolled through the use of waivers.

In 2005, CMS released a Quality Roadmap with a vision for the "right care for every person every time" and a detailed strategy to improve the quality of care for Medicaid beneficiaries. To complement this vision, CMS developed a new performance measure to improve Medicaid beneficiary access to quality health care. The measure, to improve access to quality health care for Medicaid beneficiaries through demonstrated enhancements to overall State quality strategies, supports HHS Strategic Goal 3. This new quality improvement goal will evaluate State quality strategy assessments and use findings to improve efficiency and effectiveness in State quality improvement activities. In FY 2007, CMS will provide technical assistance to a minimum of five States with Managed Care Organizations or Prepaid Inpatient Health Plans. The technical assistance is intended to guide States through the process, including enhancing State Quality Strategies, through participation in activities such as regional collaboratives, and improving performance reporting.

Program 3e: State Children's Health Insurance Program
Centers for Medicare & Medicaid Services (CMS)

Performance Measure: Improve Health Care Quality Across SCHIP.

In direct support of HHS Strategic Goal 3, SCHIP is the largest expansion of health insurance coverage for children in more than 30 years. Its implementation has improved access to health care and the quality of life for millions of vulnerable children under 19 years of age. SCHIP was created through the Balance Budget Act of 1997 and was authorized through FY 2007. Under title XXI of the Social Security Act, States are given the option of creating their SCHIP program by expanding Medicaid (title XIX) coverage, setting up a separate SCHIP program, or creating a combination of the two. To date, SCHIP has 6.9 million beneficiaries enrolled and continues its focus on increasing healthcare enrollment for low income children.

The performance measure related to improving the quality of health care across the SCHIP program supports HHS Strategic Goal 3 by continuing to focus on the number of children who have access to quality healthcare. To focus on improving access to quality healthcare, CMS began collecting SCHIP performance data through State annual reports in FY 2003. Using this data, CMS is providing technical assistance to States on measurement methodologies and appropriate targets for SCHIP core measures to improve children's access to quality healthcare. Through the analysis of these reports, CMS has successfully tracked State progress since FY 2003. In order to increase the value of these reports for FY 2007, CMS will revise the FY 2006 annual report template to include state quality improvement effort data.

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