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October 14, 2013

HHS Issues 2014-2018 Draft Strategic Plan

The U.S. Department of Health and Human Services (HHS) recently published its draft of the Fiscal Year 2014-2018 Strategic plan. Every 4 years, HHS updates its strategic plan, which describes its work to address complex, multifaceted, and ever-evolving health and human service issues, including: 

  • Health Care
  • Research and Innovation
  • Prevention and Wellness

An agency strategic plan is one of three main elements required by the Government Performance and Results Act (GPRA) of 1993 (P.L. 103-62) and the GPRA Modernization Act of 2010 (P.L. 111-352).  An agency strategic plan defines its mission, goals, and the means by which it will measure its progress in addressing specific national problems over a four-year period.

The comment period is open until October 15th, 2013. Submit your comments online here, or several other ways.


HHS is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.  HHS is responsible for almost a quarter of all federal expenditures and administers more grant dollars than all other federal agencies combined.

Eleven operating divisions, including eight agencies in the United States Public Health Service and three human service agencies, administer HHS's programs.  In addition, staff divisions provide leadership, direction, and policy management guidance to the Department.  The 2014-2018 plan has four (4) strategic goals:

Goal 1: Strengthen Health Care

Goal 2: Advance Scientific Knowledge and Innovation

Goal 3: Advance the Health, Safety, and Well-Being of the American People

Goal 4: Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs

Each goal has several objectives and within each objective are strategies. Below is a summary of selected objectives and strategies for each goal.

Goal 1: Strengthen Health Care

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 healthcare settings, promote efficiency and accountability, ensure patient safety, and work toward high-value health care.

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

HHS and its various sub-agencies will use some of the following strategies to achieve this objective:

  • Reduce the prescription drug coverage gap (the "donut hole") for those receiving the Medicare Prescription Drug benefit;
  • 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).
  • Make health insurance more affordable by working with states to establish a rate review process that identifies and reviews unreasonable rate increases by health insurance plans, prohibiting discriminatory premium rates based on health status, occupation, or gender, protecting issuers against the financial risk of enrolling a disproportionate number of individuals with significant medical needs, and requiring insurance companies to spend at least 80% of health insurance premiums on medical care, not on profits and overhead;
  • Collect data to assess the Affordable Care Act's effect on coverage of vulnerable populations, the impact on out-of-pocket expenses on the non-elderly, and how coverage obtained through the Health Insurance Marketplaces may affect access to care for those previously insured, and use these analyses to adjust Affordable Care Act programs to maximize their effectiveness

Objective B: Improve healthcare quality and patient safety

HHS and its various sub-agencies will use some of the following strategies to achieve this objective:

  • Educate healthcare professionals about health disparities, cultural competencies, and health literacy as part of a curriculum to promote a culture of safety and quality;
  • Identify innovative solutions to minimize harm in all settings, by engaging local front-line providers, patients, and families in multi-stakeholder meetings;
  • 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;
  • Implement Learning and Action Networks to share best practices for promoting quality, patient safety, prevention, health literacy, and improved care transitions;
  • 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;
  • Implement payment reforms that reward quality care (e.g., care related to provider-preventable conditions), and work with physicians and other care providers and across the public and private sectors;
  • Assist professional organizations with 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;
  • 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 error;
  • 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;
  • Facilitate public and private collaborations to promote safe medication use by identifying specific, preventable medication risks and developing, implementing, and evaluating cross-sector interventions with partners who are committed to safe medication use;
  • Increase access to safe and effective medical products;
  • Improve surveillance, domestically and abroad, of adverse events, errors, or near misses in blood, organ, and tissue procedures, transplant-associated parasitic infections, urgent antimicrobial resistance, drug and medical product safety problems, and other major breaches in infection prevention in healthcare;
  • 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 healthcare-associated infections and other nationally notifiable diseases

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

HHS and its various sub-agencies will use some of the following strategies to achieve this objective:

  • 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;
  • 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;
  • 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;

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

HHS and its various sub-agencies will use some of the following strategies to achieve this objective:

  • Design, implement, and evaluate healthcare provider value-based payment programs and initiatives that encourage the delivery of high quality and efficient healthcare services throughout the continuum of care;
  • Create aligned incentives across Medicaid and Medicare to support healthcare 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;
  • Develop, test, refine, and expand successful models that incentivize healthcare 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;
  • Improve accessibility and integration of healthcare databases so researchers can identify cost-saving, health-protective, and quality-enhancing practices;

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

  • Encourage widespread meaningful use of health IT by providers across the care continuum through incentives, grants, certification, and technical assistance;
  • Use health IT to improve quality, safety, and preventive services across care settings;
  • Use health IT to support the business requirements of alternative and innovative health delivery and payment models, e.g., Accountable Care Organizations and patient-centered medical homes;
  • Increase interoperable health information exchange by healthcare providers across public and private systems;
  • Support electronic information exchange for notification and reporting among public health and clinical entities;
  • Engage standards developers, health IT vendors, and other stakeholders to accelerate development, assure availability, and support effective use of consensus standards that meet electronic health information management and exchange needs of consumers and providers throughout the health care system;

Goal 2: Advance Scientific Knowledge and Innovation

Objective A:  Accelerate the process of scientific discovery to improve health

  • Foster and establish the necessary collaboration of government and private sector research activities to achieve fastest possible discovery and promote translation of research into practice;  
  • Identify critical gaps in knowledge of healthcare-associated infections and implement prevention research to fill these gaps;
  • Develop evidence-based infection prevention guidelines that provide the scientific foundation for healthcare-associated infection prevention interventions;
  • Increase the external validity of intervention trials by ensuring that older adults and individuals with multiple chronic conditions are not unnecessarily excluded;
  • Leverage public-private collaborations to adapt translational research to meet the varying needs of diverse communities in culturally and linguistically appropriate ways.

Objective B:  Foster and apply innovative solutions to health, public health, and human services challenges

  • Support the design and execution of innovative solutions through the use of challenge and prize competitions.  Explore new ways to engage communities and leverage public-private partnerships through innovative use of challenge competitions and authorities granted to us under the America Competes Reauthorization Act of 2010 (P.L.111-358);
  • Expedite the development of breakthrough therapies intended to treat serious and life-threatening diseases or conditions;
  • Develop and implement innovative approaches to address the complex global regulatory environment; improve surveillance, monitoring, analysis, and reporting; and help bring to market new drugs, diagnostics, and biologic products;
  • Use public health data to characterize emerging threats to patient and consumer safety;
  • Explore ways to integrate health data into mobile health technologies and related social networking platforms to more effectively reach healthcare professionals, patients, families and other members of the public; and
  • Work closely with HHS agencies and stakeholders to work through the privacy and regulatory issues associated with use of these new technologies in health care and wellness settings.

Objective C:  Advance the regulatory sciences to enhance food safety, improve medical product development, and support tobacco regulation

  • Ensure that HHS personnel have the scientific expertise to address new challenges presented by cutting-edge medical technologies, such as nanotechnologies;
  • Develop improved methods for rapidly detecting, investigating, and stopping foodborne contaminants;
  • Develop science-based standards for preventive controls for food and feed safety across the "farm to table" continuum;
  • Develop an innovative e-learning system to improve the speed, efficiency, and effectiveness of training and best practice dissemination related to food safety efforts in areas such as restaurant inspection and environmental assessments of foodborne illness outbreaks;
  • Promote the development of new antibacterial drugs to address foodborne pathogens of public health importance;
  • Develop strategies, such as changes in medication packaging, to prevent medication overdoses in children in collaboration with public and private partners; and
  • Update medical product review standardsand provide new regulatory pathways for new medical technologies, including those intended for use during public health emergencies;
  • Support comprehensive and efficient regulatory review, using high standards of transparency and scientific integrity, of new medical treatments and devices and new tobacco products;
  • Develop new knowledge and tools that can help translate basic scientific discoveries into life-saving medicines, and reduce the time, complexity, and cost of medical product development;
  • Support regulatory science to facilitate medical countermeasure development and regulatory review; and
  • Expand regulatory science research to support tobacco product regulation.

Objective D:  Increase our understanding of what works in public health and human services practice

Objective E:  Improve laboratory, surveillance, and epidemiology capacity

Goal 3: Advance the Health, Safety, and Well-Being of the American People

Objective A: Promote the safety, well-being, resilience, and healthy development of children and youth

Objective B: Promote economic and social well-being for individuals, families, and communities

Objective C:  Improve the accessibility and quality of supportive services for people with disabilities and older adults

Objective D: Promote prevention and wellness across the lifespan

Objective E:  Reduce the occurrence of infectious diseases

Objective F:  Protect Americans' health and safety during emergencies, and foster resilience to withstand and respond to emergencies

Goal 4: Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs

Objective A: Strengthen program integrity and responsible stewardship by reducing improper payments, fighting fraud, and integrating financial, performance, and risk management

  • Foster early detection and prevention by focusing on preventing bad actors from enrolling or remaining in Medicare and Medicaid before improper payments are made, while ensuring that legitimate providers are able to enroll swiftly and easily;
  • Require Medicare and Medicaid providers and suppliers to undergo screening, including enhanced screening for certain high-risk providers and suppliers, and take action to exclude those known to commit fraud;
  • Strengthen oversight of Medicaid expenditures by working with state partners to improve financial accountability for managed care and fee-for-service, provider rate setting, accuracy of state claiming, and beneficiary and provider eligibility processes;
  • Conduct oversight of Medicare Part C and Part D plan sponsors by conducting audits that detect whether plans are delivering the appropriate healthcare services and medications for which they are being paid;
  • Improve contractor accountability, coordination and integration across Medicaid and Medicare program integrity initiatives;
  • Improve Medicare and Medicaid payment accuracy by supporting ongoing initiatives that address the causes of improper payments to ensure that in every case Medicare and Medicaid programs pay the right amount, to the right party, for the right recipient in accordance with the law and agency and state policies;
  • Enhance end-to-end acquisition management capabilities, including robust requirements development and cost estimating processes and procedures, improved contract management practices, and improved coordination and planning cycles;
  • Identify and proactively address internal and external risks to program performance, monitor programs, contractors, and grantees vigilantly, pursue prosecution and punishment for those who commit fraud, and remedy program vulnerabilities; and
  • Improve support of, and coordination with, law enforcement by working closely with the Office of the Inspector General, the U.S. Department of Justice and the Federal Bureau of Investigation, to focus on prevention, early detection, and data sharing, moving beyond the paradigm of pay-and-chase, while continuing an aggressive and robust program of criminal investigation and prosecution;
  • Meet White House Cross Agency Cybersecurity goals for trusted internet connection, continuous monitoring, and strong authentication to information technology networks;
  • Improve physical security and critical infrastructure protection by identifying HHS critical infrastructure, and updating security policies to provide guidance on mitigation of risk to these facilities, in accordance with Presidential Policy Directive 21, Critical Infrastructure Security and Resilience; and
  • Integrate programs and processes for personnel suitability and national security clearance adjudication to improve the quality and timeliness of background investigations.

Objective B: Enhance access to and use of data to improve HHS programs and support improvements in the health and well-being of the American people

  • Expand the focus of CMS's data environment from claims processing to state-of-the-art data analysis, predictive analytics and information sharing;

Objective C: Invest in the HHS workforce to help meet America's health and human service needs

Objective D: Improve HHS environmental, energy, and economic performance to promote sustainability


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