Strategic Goal 1: Strengthen Health Care

Objective A:  Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured

Objective B:  Improve health care quality and patient safety

Objective C:  Emphasize primary and preventive care, linked with community prevention services

Objective D:  Reduce the growth of health care costs while promoting high-value, effective care

Objective E:  Ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations

Objective F:  Improve health care and population health through meaningful use of health information technology

In March 2010, the President signed into law the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), collectively referred to as the Affordable Care Act.  The Affordable Care Act increases access to care, makes health insurance more affordable, strengthens Medicare, and ensures that Americans have more rights and protections — and more security that health insurance coverage will be available when it is needed.  The Affordable Care Act has given states the option to expand access to Medicaid for low-income adults and families.  The federal government will pay for 100% of the costs of covering newly eligible adults for three years beginning in 2014.  The federal amount decreases gradually and becomes 90% of the costs in 2020 and subsequent years.

HHS is responsible for implementing many of the provisions included in the Affordable Care Act that seek to expand coverage, emphasize prevention, improve the quality of health care and patient outcomes across health care settings, ensure patient safety, promote efficiency and accountability, and work toward high-value health care.  The Health Insurance Marketplace, also known as Exchanges, helps consumers find health insurance that fits their budget.  Every health insurance plan in the Marketplace will offer core benefits and increased protections from high out-of-pocket expenses, and consumers will be able to compare their insurance options based on price, benefits, and quality. Lower- and moderate-income families and many small businesses will be eligible for financial assistance, including a premium tax credit and cost-sharing reductions, to help pay for health insurance.  In addition to increased coverage options, the Affordable Care Act protects against medical bankruptcy because it prohibits insurers from imposing an annual or lifetime dollar limit on essential health benefits, and it makes it illegal for them to discriminate against anyone because of a pre-existing condition.  The goal is to lower overall health care costs by improving health status among individuals and communities.

HHS is providing the American public with the means to make more informed choices about their health care through resources such as HealthCare.gov, which provides information about health insurance options.  HHS is developing evidence-based tools, health care provider incentives, and payment reforms that support the delivery of high-quality, effective, and efficient health care services; expanding coordinated care through integrated care models; and promoting the meaningful use of electronic health records and other health information technology.  HHS also is working to reduce disparities in health and access to health care among vulnerable populations.

Within HHS, the following agencies are working to strengthen health care: Administration for Community Living (ACL), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), National Institutes of Health (NIH), Office of Medicare Hearings and Appeals (OMHA), and Substance Abuse and Mental Health Services Administration (SAMHSA). HHS offices supporting the coordination of efforts across the Department include the Office of the Assistant Secretary for Financial Resources (ASFR), Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office of the Assistant Secretary for Health (OASH), Office for Civil Rights (OCR), and Office of the National Coordinator for Health Information Technology (ONC).

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Objective A:  Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured

The Affordable Care Act is making health insurance coverage more secure, reliable, and more affordable for families, small business owners, and employees.  HHS is committed to strengthening and sustaining Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), as well as connecting all Americans with quality health care and access to affordable health insurance options through the Health Insurance Marketplace.

Already, millions of Americans benefit from Affordable Care Act provisions.  According to the Census Bureau, 48 million people in the United States were uninsured in 2012, a statistically significant decrease from the nearly 50 million people uninsured in 2010.  New health plans now cover recommended preventive services and screenings with no cost sharing, and young adults under age 26 can have coverage under their parents’ health insurance.  The percentage of uninsured young adults declined from 31.4% in 2009 to 27.2% in 2012.

In implementing the Affordable Care Act, HHS is helping ensure that a Health Insurance Marketplace is established in every state to reduce the number of uninsured and help eligible individuals receive assistance with the cost of health insurance.  HHS is providing guidance, resources, and flexibility for states to enable them to construct competitive, affordable insurance Marketplaces that best meet the needs of their citizens.  HHS also is working with states as they expand Medicaid coverage to more low-income Americans.  An estimated additional 25 million people will obtain health coverage by 2016 as a result of the policies and provisions of the Affordable Care Act.

HHS is building partnerships among issuers, consumers, communities, and other stakeholders and is working with state insurance agencies to increase oversight activities to strengthen consumer protections against private insurance abuses.  The health insurance website at HealthCare.gov empowers consumers to make informed health care decisions about options available to them in their state, while promoting market competition.

Within HHS, ACL, AHRQ, CDC, CMS, OASH, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

• Help establish Health Insurance Marketplaces in every state to expand access to coverage for individuals and small businesses, reduce administrative expenses, and increase competition;
• Provide coverage with premium- and cost-sharing assistance through the Health Insurance Marketplace for people who cannot afford to purchase insurance on their own;
• Work with states to expand Medicaid coverage to more low-income Americans;
• Reduce the prescription drug coverage gap (the “donut hole”) for those receiving the Medicare Prescription Drug benefit;
• Maximize the participation of small businesses and eligible individuals in affordable health insurance coverage by helping them understand insurance options including cost, available tax credits, and benefit levels, and providing a simplified enrollment process that is coordinated between the Marketplaces, Medicaid, and CHIP;
• Work with states, communities, private organizations, and grantees to provide outreach and enrollment assistance and to enforce the market reform provisions of the Affordable Care Act;
• Use the increased resources and policy options available through the Children’s Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3) and the Affordable Care Act to augment the ability of states to identify and enroll children who are eligible for coverage through Medicaid or CHIP but have not enrolled;
• Consult with tribes and tribal organizations to provide outreach, information, and assistance to ensure that American Indians and Alaska Natives are aware of and can benefit from Indian-specific and generally applicable provisions of the Affordable Care Act, as well as benefits available under the Indian Health Care Improvement Act (P.L. 94-437);
• Work with states to establish a process that reviews rates and identifies unreasonable rate increases by health insurance plans; prohibit discriminatory premium rates based on health status, occupation, gender, or sexual orientation; protect issuers against the financial risk of enrolling a disproportionate number of individuals with significant medical needs; and require insurance companies to spend at least 80% or 85% of health insurance premiums on medical care and quality-improving activities, not on profits and overhead, and to report how they spend premiums;
• Increase consumer protections in the private health insurance market by requiring new health plans to implement an appeals process for coverage determinations and by prohibiting insurers from placing lifetime limits on essential health benefits, denying coverage based on pre-existing conditions, and dropping people from coverage when they get sick;
• Enhance HealthCare.gov, which empowers consumers to make informed choices about health care options;
• Collect data to assess the Affordable Care Act’s impact on out-of-pocket expenses of the previously uninsured non-elderly, and how coverage obtained effective January 1, 2014 and beyond in the individual and small group health insurance markets may affect access to care for those previously insured, and use these analyses to adjust Affordable Care Act programs to maximize their effectiveness; and
• Improve access to mental health and substance abuse disorder treatment services through implementation of the Mental Health Parity and Addiction Equity Act (P.L. 110-343).

Performance Goals

• Maintain or exceed percent of beneficiaries in Medicare fee-for-service who report access to care.
• Maintain or exceed percent of beneficiaries in Medicare Advantage who report access to care.
• Improve availability and accessibility of health insurance coverage by increasing enrollment of eligible children in CHIP and Medicaid.
• Reduce the average out-of-pocket share of prescription drug costs while in the Medicare Part D Prescription Drug Benefit coverage gap for non-Low-Income Subsidy Medicare beneficiaries who reach the gap and have no supplemental coverage in the gap.
• Maintain the number of months to produce the Insurance Component tables following data collection (Medical Expenditure Panel Survey-Insurance Component (MEPS-IC)).
• Increase the percentage of enrolled homeless persons in the Projects for Assistance in Transition from Homelessness (PATH) program who receive community mental health services.
• Track the number of individuals who have confirmed enrollment through the Affordable Insurance Exchanges.
• Reduce the percentage of the nonelderly (civilian, noninstitutionalized) United States population who are uninsured.

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Objective B:  Improve health care quality and patient safety

As reported in the National Strategy for Quality Improvement in Health Care , health care-related errors harm millions of American patients each year and needlessly add billions of dollars to health care costs. CDC estimates that more than 1 million health care-associated infections occur each year, at a cost of approximately $30 billion annually.  Adverse drug events are estimated to cause more than 1 million emergency department visits and 125,000 hospital admissions, impacting approximately 1.9 million hospital stays each year.  The cost of treating patients who are harmed by adverse drug events is estimated to be as high as $5 billion annually.

To help Americans receive the best possible health care, HHS is taking action to protect patient safety, improve quality of medical products and devices, and improve care provided in various health care settings and by various practitioners.  HHS also is working to improve communication between providers and patients to support informed patient engagement, quality, and safety.

Research and evaluations inform the Department’s understanding of where efforts can have the greatest impact.  For example, Medicare evaluations are informing HHS efforts to improve the quality of care in nursing homes.  Internally, and in partnership with leading academic institutions, hospitals, physicians’ offices, health care systems, and other settings, HHS health services research investigates how people get access to health care, how much care costs, and what happens to patients as a result of the care they receive.  Applied research tests new strategies to protect patients from healthcare-associated infections, antibiotic resistance, and other adverse events.  HHS produces and disseminates scientific information, evidence-based tools, recommended clinical practices, and other guidelines to facilitate health care organizations’ efforts to promote a culture of patient safety and optimize patient outcomes.  HHS provides leadership in the identification and reporting of important behavioral health quality measures and measures of access to health care services.

HHS employs a range of strategies to ensure patient safety and health care quality across settings.  Surveillance and laboratory services quickly detect infections and outbreaks.  Federally funded Health Centers and community-based Ryan White Programs promote quality and patient safety through their distinctive models of care.  Meaningful use of health information technology and payment incentives to providers further ensure patient safety.  Public awareness campaigns promote safe medication use and address prescription drug abuse.  Health care professions training programs help to strengthen the quality of the health care workforce.  Technical assistance and training materials for nursing homes help improve the quality of care for vulnerable older Americans.

Within HHS, ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, NIH, OASH, OCR, ONC, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

• Engage individuals and families as partners in their care by incorporating patient and caregiver preferences; using clear and productive communication strategies; improving the experience of care for patients, caregivers, and families; integrating health literacy principles; and promoting patient self-management;
• Identify innovative solutions to minimize harm in all settings by engaging local front-line providers, patients, and families in multi-stakeholder meetings;
• Implement Learning and Action Networks to share best practices for promoting quality, patient safety, prevention, health literacy, and improved care transitions;
• Facilitate public and private collaborations to promote safe medication use by identifying specific, preventable medication risks and by developing, implementing, and evaluating cross-sector interventions with partners who are committed to safe medication use;
• Expand quality improvement efforts in Medicaid, Medicare, and CHIP, and continue to utilize Medicare Quality Improvement Organizations and External Quality Review Organizations in Medicaid, as well as public reporting and payment changes, to foster reduction of hospital readmissions, hospital-acquired infections, and other health care-acquired conditions;
• Develop new collaborative models of care that incentivize team-based practice and reduce inappropriate care, and use evidence-based medicine to reduce harm and improve outcomes;
• Work with states to design and test incentives to provide more effective and efficient care, including better coordination of care for Medicare-Medicaid enrollees;
• Enhance coordination of Medicare and Medicaid to improve quality, cost, and coordination of care, including behavioral health and long-term services and supports, for Medicare-Medicaid enrollees with chronic conditions and functional impairments;
• Implement payment reforms that reward quality and efficiency of care (e.g., care related to provider-preventable conditions), and work with physicians and other care providers and across the public and private sectors;
• Improve the quality of, safety of, and access to care in long-term services and supports settings, behavioral health services, and acute care hospitals, and through state health departments;
• For American Indians and Alaska Natives that access healthcare through the IHS system, increase access to high-quality preventive and clinical care services;
• Educate health care professionals about health disparities, cultural competencies, and health literacy as part of a curriculum to promote a culture of safety and quality;
• Educate health care professionals about providing optimal care to and care coordination for individuals with multiple chronic conditions, to improve health status and reduce risks for adverse medical events such as medication errors;
• Assist professional organizations in developing clinical practice guidelines that address care for individuals with multiple chronic conditions to improve their overall health outcomes and reduce adverse events, including medication errors, while respecting patients’ goals for their care;
• Promote quality care for patients by providing data, evidence-based science, and guidelines to prevent costly health care-associated infections (e.g., central line-associated bloodstream infections and catheter-associated urinary tract infections) and readmissions that add to Medicare and Medicaid costs;
• Promote effective communication and coordination of care by supporting appropriate discharge planning and care transition, embedding best practices to manage transitions to all practice settings, and enabling effective health care system navigation;
• Improve care transitions, including transitions from the inpatient hospital setting to care settings such as the home or nursing homes, to improve quality of care and to reduce readmissions for high-risk beneficiaries;
• Invest in health services research to identify the most effective ways to organize, manage, finance, and deliver high-quality care, reduce medical errors, and improve outcomes;
• Promote the development and use of child and adult quality measures related to patient safety in the Medicaid, CHIP, and Medicare programs;
• Promote the development of patient experience and patient-reported outcome measures for use across all programs and settings;
• Link quality measurement to clinical decision support to help providers more effectively use both to improve health care safety and quality;
• Support data collection in order to identify and target issues of harm and inappropriately delivered care within a community or practice location, or to a disparate patient population;
• Improve surveillance in hospital and non-hospital settings, such as outpatient clinical settings, emergency care, and nursing homes, to identify sources of and control of health care-associated infections, urgent antimicrobial threats, and other nationally notifiable diseases; and
• Implement new projects under the Health Information Technology Patient Safety Program to promote the health care industry’s use of health information technology to make care safer and to improve the safety of health information technology.

Performance Goals

• Reduce the central line-associated bloodstream infection standardized infection ratio.
• Increase the number of hospitals and other selected health care settings that report into the National Healthcare Safety Network.
• Improve children’s health care quality across Medicaid and CHIP.
• Improve adult health care quality across Medicaid.
• Decrease the prevalence of pressure ulcers in nursing homes.
• Increase the number of users of research using AHRQ-supported research tools to improve patient safety culture.
• Reduce hospital-acquired catheter-associated urinary tract infections.
• Decrease the percentage of long-stay nursing home residents receiving an antipsychotic medication.
• Review and act on original ANDA submissions within the established time frame.
• Increase the percentage of health centers with at least one site recognized as a patient centered medical home.
• Increase the percentage of hospitals reporting implementation of antibiotic stewardship programs fully compliant with CDC Core Elements for Hospital Antibiotic Stewardship Programs.
• Decrease the total morphine milligram equivalents dispensed.
• Increase the number of prescriptions dispensed for naloxone.
• Increase the number of unique patients receiving prescriptions for buprenorphine and naltrexone in a retail setting.

Related Topics

• National Strategy for Quality Improvement in Health Care
• Partnership for Patients
• National Action Plan to Prevent Health Care-Associated Infections

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Objective C:  Emphasize primary and preventive care, linked with community prevention services

Primary care and public health services are vital components of high-quality health care.  Community-based services that support health promotion, such as exercise programs, educational classes, self-management training, and nutrition counseling, are fundamental for supporting a health care system that provides better care for better health while lowering health care costs.  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.  HHS aims to improve public health surveillance and collect more complete and accurate data and to link clinical care and supportive community-based services and policies.  These efforts will improve the Department’s ability to reach high-risk populations and support the delivery of comprehensive, culturally acceptable, and easily navigated services.  HHS, through the Center for Medicare & Medicaid Innovation (Innovation Center) at CMS, has introduced a range of initiatives to support care coordination practices and population-based care.  The Comprehensive Primary Care Initiative is one example of a new model that HHS is testing to strengthen health care delivery.  The Comprehensive Primary Care Initiative utilizes a team-based approach while emphasizing prevention, health information technology, care coordination, and shared decision-making among patients and their providers.

HHS is increasing consumer and provider awareness of recommended preventive screenings and services covered by new health plans without cost sharing under the Affordable Care Act.  The website healthfinder.gov offers comprehensive, evidence-based, and actionable wellness information and tools to the public.  Easy-to-use, personalized consumer guidance about clinical preventive services covered under the Affordable Care Act can be found at healthfinder.gov  directly and through links at HealthCare.gov.

Within HHS, ACL, AHRQ, CDC, CMS, HRSA, IHS, OASH, ONC, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

• Support rapid communication and coordination between public health practitioners and clinicians to increase use of evidence-based prevention strategies to address risk factors for disease and health conditions;
• Assist state and community efforts to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living;
• Ensure quality delivery of recommended clinical preventive services through the entire continuum from preventive service through diagnostic follow-up and treatment;
• Increase the emphasis of Federally funded Health Centers on providing preventive services and linking with the public health community;
• Promote Medicare and Medicaid payment and delivery system and health information policies (including Accountable Care Organizations and primary care initiatives) that value primary care, care management services, and prevention and wellness, throughout the continuum of care;
• Expand the number of officially recognized patient-centered medical homes for children, youth, and adults to increase access to comprehensive primary, preventive, and specialty services;
• Increase the use of preventive services by promoting their availability, monitoring their uptake, and utilizing related improvement programs, such as Medicare Quality Improvement Organizations and End-Stage Renal Disease Networks;
• Promote early entry into primary care, education, and coordinated services for pregnant women and infants;
• Explore pathways to support primary prevention activities to control or eliminate health hazards in housing before people, particularly vulnerable populations such as children and older adults, are affected;
• Continue to work in partnership with states to build upon recent progress in improving access to oral health care among children and adolescents enrolled in Medicaid and CHIP;
• Promote effective prevention and treatment of chronic disease by increasing the appropriate use of screening and prevention services, particularly for cancer, heart disease and stroke, chronic lower respiratory disease, and unintentional injury;
• Promote development and implementation of preventive health and public health systems approaches that improve the quality of care for, and prevent new chronic conditions among, persons with multiple chronic conditions;
• Increase access to primary care and preventive services, particularly among vulnerable populations, by helping individuals who are newly insured, including those covered through the Health Insurance Marketplaces and Medicaid, to access health care providers;
• Expand community-based prevention programs to help improve the health and quality of life of individuals with, and at risk for, chronic diseases and conditions and functional impairments, including mental health problems; and
• Disseminate best practices for use of substance abuse screening and intervention in acute health care settings, including screening for excessive alcohol use and brief intervention.

Performance Goals

• Increase the proportion of adults (ages 18 and older) that engage in leisure-time physical activity.
• Percentage of pregnant Health Center patients beginning prenatal care in the first trimester.

Related Topic

• Million Hearts

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Objective D:  Reduce the growth of health care costs while promoting high-value, effective care

Health care costs consume a significant amount of our nation’s resources. In the United States, one source of inefficiency is a payment system that rewards medical inputs rather than outcomes, has high administrative costs, and lacks focus on disease prevention.  HHS, through the Innovation Center at CMS, established by the Affordable Care Act, identifies, tests, evaluates, and expands, as appropriate, innovative payment and service delivery models that can reduce program expenditures for Medicare, Medicaid, and CHIP, while improving or preserving beneficiary health and quality of care.  CMS Innovation Center initiatives will provide valuable information for payment and service delivery changes that will help improve the quality of care, while reducing the total cost of care for CMS beneficiaries.

The Affordable Care Act is lowering costs for American families and individuals through insurance market reforms that ensure access to preventive care.  Through the implementation of health care reform, HHS is promoting better care coordination across providers and settings and is empowering informal caregivers who can effectively provide valuable support to their family.  CMS is implementing payment reforms to leverage the purchasing power of Medicare and Medicaid and to build an innovative, high-value system that delivers high-quality and efficient care.  For example, CMS is establishing value-based payment policies, programs, and initiatives that recognize and reward providers for delivering high-quality and efficient care.  Also under the Affordable Care Act, CMS established the Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office), which is charged with better integrating Medicare and Medicaid services to improve coordination between federal and state governments to ensure full access to entitled benefits.

The Department continues its work to identify and promote high-value interventions yielding health care savings while building the evidence base that health care providers, insurers, consumers, states, and policymakers need to improve patient outcomes and reduce disparities in costs and quality between population groups and regions.  The Affordable Care Act authorizes CMS, on behalf of HHS, to adopt and implement standards for certain transactions that achieve greater uniformity in the transmission of health information, enabling providers and payers to process financial and administrative transactions faster and at a lower cost than paper transactions.

Within HHS, AHRQ, CDC, CMS, HRSA,  NIH, and ONC will have roles in implementing the following strategies to achieve this objective.

Strategies

• Harness the best ideas from internal and external partners in the community to design, develop, test, and evaluate the most promising innovative payment and service delivery models that encourage high-value, effective care;
• Design, implement, and evaluate health care provider value-based payment programs and initiatives that encourage the delivery of high-quality and efficient health care services throughout the continuum of care;
• Implement and evaluate the Medicaid Health Home program, which allows states to build a person-centered health home that integrates and coordinates services and supports for individuals with chronic conditions, resulting in improved outcomes for beneficiaries and better services and value for Medicaid and other programs;
• Develop, test, refine, and expand successful models that incentivize health care providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes for high-quality and efficient service delivery, which include promoting enhanced primary care and bundled payments;
• Evaluate the impact of the End-Stage Renal Disease Quality Incentive Program, a value-based purchasing initiative, to learn from it and expand the model to other care settings;
• Create aligned incentives across Medicaid and Medicare to support health care innovation — the development of innovative, person-centered service delivery and payment models that improve quality, increase coordination of care, including long-term services and supports and behavioral health care, and reduce costs;
• Improve accessibility and integration of health care databases so researchers can identify cost-saving, health-protective, and quality-enhancing practices;
• Improve management of health care cost information to identify key drivers of high costs and reduce delivery of ineffective and inappropriate care;
• Produce the measures, data analytic tools, and evidence that health care providers, insurers, purchasers, states, and policymakers need to improve the quality, value, and affordability of health care and to reduce disparities in costs and quality between population groups and regions;
• Promote and test community-based models to improve care transitions from the hospital to other care settings, improve quality of care, reduce readmissions, and document measurable savings;
• Adopt and implement Affordable Care Act provisions to standardize administrative claims transactions and to achieve greater interoperability between administrative and clinical data;
• Accelerate diffusion of best practices and successful models by using multiple vehicles to spread knowledge, encouraging model participants to actively participate in dynamic learning networks, sharing early insights and feedback with stakeholders, and developing the operational infrastructure needed to scale models rapidly and efficiently; and
• Promote improved quality of care across Medicare Advantage organizations by requiring the implementation of projects that address reduction of cardiovascular disease and 30-day all-cause hospital readmissions for Medicare enrollees.

Performance Goals

• Reduce all-cause hospital readmission rates for Medicare beneficiaries by 1% over the previous year's target rate.
• Increase the amount of savings by State AIDS Drug Assistance Program (ADAP) participation in cost-saving strategies on medications.
• Increase the percentage of Medicare Fee-for-Service payments tied to alternative payment models. 

Related Topics

• Strategy for Accelerating Health Information Exchange

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Objective E:  Ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations

Health disparities among racial and ethnic minority populations persist in the United States.  With the growing diversity of the U.S. population, public health and health care providers are increasingly called on to address an individual’s social and cultural background and language or communication needs.  Providing culturally and linguistically appropriate care and services can increase the quality and effectiveness of care and services, improve patient satisfaction and compliance, and reduce racial and ethnic health disparities.

Whether it is promoting health for racial and ethnic minorities, children, older adults, people with disabilities, uninsured people, rural populations, persons with Limited English Proficiency or limited health literacy skills, refugees and immigrants, or other historically underserved populations, HHS agencies are playing significant roles in promoting access to care, developing a diverse, culturally competent health care workforce, and preventing discriminatory practices.

Through the Affordable Care Act, HHS agencies are working to address health disparities experienced by minority and underserved populations who have historically had limited access to care and poor health outcomes.  Coordinated team-based primary medical care with a mix of health care professionals, and coordination with public health across federal, state, and local agencies, have been proven to improve the quality and effectiveness of care and to reduce health care disparities.

HHS released the first Action Plan to Reduce Racial and Ethnic Health Disparities, which builds on the foundation of the Affordable Care Act and charges all HHS operating and staff divisions to heighten the impact of HHS policies and programs to reduce health disparities.  The Action Plan to Reduce Racial and Ethnic Health Disparities focuses on reducing disparities in access to and quality of care, increasing the diversity and cultural competency of the health care and public health workforces, investing in community-based programs to reduce disparities in population health, and increasing the availability and quality of data collected and reported on racial and ethnic minority populations.

HHS supports a number of programs to help develop, distribute, and retain a diverse, culturally competent workforce — one that is responsive to the evolving needs of the public health and health care system and special populations and skilled in productive communication.  HHS also actively promotes the adoption and implementation of the enhanced National Standards for Culturally and Linguistically Appropriate Services in health and health care and the National Action Plan to Improve Health Literacy .

HHS works to address the needs of vulnerable populations by providing awareness of, access to, and payment for high-quality primary care and clinical preventive services and by strengthening the primary care workforce to meet the nation’s health care needs.  Federally funded Health Centers deliver comprehensive, high-quality, and cost-effective primary care to patients regardless of their ability to pay.  Many have received formal recognition as patient-centered medical homes, coordinating a wide range of medical, dental, behavioral, and social services for underserved populations.  IHS is using the patient-centered medical home model to advance innovative patient care concepts across the IHS health care system.  Telemedicine and other health information technology strategies can support quality health care delivery in rural communities.

The Older Americans Act (P.L. 89-73) supports HHS’s efforts for the aging population with nutrition and supportive home- and community-based services, disease prevention and health promotion services, and elder rights programs.  The Developmental Disabilities Assistance and Bill of Rights Act (P.L. 95-602) supports HHS efforts to assure that individuals with developmental and intellectual disabilities and their families participate in the design of and have access to needed long-term services and supports and to other forms of assistance that promote self-determination, independence, productivity, and integration and inclusion in all facets of community life.  HHS is addressing the community living service and support needs of both the aging population and individuals with disabilities, protecting their individual and civil rights, promoting consistency in community living policy across the federal government, and enhancing access to quality health care and long-term services and supports for those individuals.

HHS is working with the U.S. Departments of Defense and Veterans Affairs, the National Guard, states, and community-based organizations to improve access to needed behavioral health care and supportive services for active duty, guard, reserve, and veterans and their families.

Within HHS, ACF, ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, OASH, OCR, and SAMHSA will have roles in implementing the following strategies to achieve this objective.

Strategies

• Monitor access to and quality of care across population groups, and work with federal, state, local, tribal, urban Indian, and nongovernmental actors to address observed disparities and to encourage and facilitate consultation and collaboration among them;
• Evaluate the impact of Affordable Care Act provisions on access to and quality of care for vulnerable populations, as well as on disparities in access and quality;
• Leverage the nonprofit hospital Community Health Needs Assessment process, required by the Affordable Care Act, to improve community environments and related community health status;
• Promote expanded access to high-quality, culturally competent health care services to improve health equity, and address health disparities among populations including racial and ethnic minorities, individuals with disabilities, refugees, lesbian, gay, bisexual, and transgender (LGBT) individuals, and people with Limited English Proficiency and limited health literacy skills;
• Support programs that build the health literacy skills of children, youth, and their families, and promote proven methods of checking patient understanding to ensure patients understand health information, recommendations, and risk and benefit tradeoffs;
• Help eliminate disparities in health care by educating and training physicians, nurses, and allied health care professionals on disparities and cultural competency while increasing workforce diversity in medical and allied health care professions;
• Implement activities of the HHS Language Access Plan , including training staff, consulting with stakeholders, conducting self-assessments, adopting effective methods for providing language assistance services, improving practices for reaching and serving populations with Limited English Proficiency, and notifying external stakeholders about the availability of language assistance services through the Web, social media, or other outreach initiatives;
• Improve access to care through implementation of health insurance market reforms, and prevention and correction of discriminatory actions and practices;
• Conduct outreach and education activities to promote the Health Insurance Marketplaces and expanded Medicaid coverage to minority, underserved, and vulnerable populations;
• Deliver the most appropriate range of services at Federally funded Health Centers, school-based health centers, patient-centered medical homes, Health Homes, and IHS-funded health programs to enhance access to comprehensive primary and preventive services for historically underserved areas;
• Improve access to mental health and substance abuse treatment services at parity with medical and surgical services;
• Promote access to primary oral health care services and oral disease preventive services in settings including Federally funded Health Centers, school-based health centers, and IHS-funded health programs that have comprehensive primary oral health care services, and state and community-based programs that improve oral health, especially for children, pregnant women, older adults, and people with disabilities;
• Improve access to comprehensive primary and preventive medical services to historically underserved areas and support Federally-funded Health Centers, the range of services offered by these centers, and increased coordination with partners at the community level including the Aging Services Network;
• Assist states in strengthening and further developing high-performing long-term services and supports systems that focus on the person, provide streamlined access, and empower individuals to participate in community living;
• Implement the HHS Strategic Plan in a manner that involves consulting with tribes; renewing and strengthening the Department’s partnership with tribes; conferring with urban Indian organizations; and ensuring that Plan processes are accountable, transparent, fair, and inclusive;
• Consult with communities experiencing health disparities such as low-income groups and groups promoting environmental justice;
• Support efforts to ensure access to health care services by participating in coordinated transportation planning, particularly in rural areas, with a special emphasis placed on coordinated transportation funding efforts at all levels; and
• Promote and test integrated care models that integrate primary care, acute care, behavioral health care, and long-term services and supports to provide comprehensive, coordinated, and quality care for older adults and people with disabilities.

Performance Goals

• Increase the likelihood that the most vulnerable people receiving Older Americans Act Home and Community-based and Caregiver Support Services will continue to live in their homes and communities.
• Increase the percentage of children receiving Systems of Care mental health services who report positive functioning at six-month follow-up.
• Increase the number of people receiving direct services through the office of Rural Health Policy Outreach Grants.
• Number of patients served by Health Centers.
• Maintain the proportion of persons served by the Ryan White HIV/AIDS Program who are racial/ethnic minorities.
• Increase the number of adult volunteer potential donors of blood stem cells from minority race or ethnic groups.
• Reduce infertility among women attending Title X family planning clinics by identifying chlamydia infection through screening of females ages 15 to 24.
• Increase the number of American Indian and Alaska Native patients with diagnosed diabetes who achieve Good Glycemic Control (A1c less than 8.0%).
• Increase the proportion of adults ages 18 and over who are screened for depression.
• Increase the number of program participants exposed to substance abuse prevention education services.
• Implement recommendations from tribes annually to improve the tribal consultation process.
• Field strength of the National Health Service Corps through scholarship and loan repayment agreements.
• Percentage of individuals supported by Bureau of Health Professions Programs who completed a primary care training program and are currently employed in underserved areas.
• Increase the percentage of office-based physicians who are electronically sharing patient information with any providers outside their organization.
• Increase the percentage of non-federal acute care hospitals that are electronically exchanging patient health information with any providers outside their organization.

Related Topics

• Action Plan to Reduce Racial and Ethnic Health Disparities