Topics on this page: Goal 1. Objective A | Table of Related Performance Measures | Analysis of Results | Plans for the Future | Objective Progress Update Summary
Goal 1. Objective E: Ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations
With the growing diversity of the U.S. population, healthcare providers are increasingly called on to address their patients’ differing social and cultural experiences and language needs. Provision of culturally competent care can increase quality and effectiveness, increase patient satisfaction, improve patient compliance, and reduce racial and ethnic health disparities. A number of HHS programs help make health care more accessible to people whose circumstances call for special attention, including older adults, children, people with disabilities, uninsured populations, persons with limited English proficiency, low income individuals, and those who live in remote areas and tribal communities. The 2014 National Healthcare Disparities Reportissued by AHRQ finds that many racial and ethnic minorities have more limited access to care and receive lower quality care.
CMS programs facilitate health services for older adults, people with disabilities, and many low-income adults and children. Service delivery programs in HRSA, IHS, and SAMHSA enhance the availability of care in areas of high need. These HHS components strive to improve the quality of care their programs deliver. AHRQ regularly monitors healthcare quality and disparities, and through its grants and contracts, it focuses on improving how providers deliver care. Given the federal government’s unique legal and political relationship with tribal governments, IHS has a special trust obligation to provide health services for American Indians and Alaska Natives. HHS follows the President’s 2009 tribal consultation policy to partner with tribes to ensure access to quality health care.
ACF, ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, OASH, OCR, and SAMHSA have significant roles to play in realizing this objective. The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.
Objective 1.E Table of Related Performance Measures
By September 30, 2017, expand the availability of evidence-based early intervention services for individuals with serious mental illness (SMI) funded through the SAMHSA Community Mental Health Services Block Grant by increasing the number of states with at least one evidence-based early intervention program by 50 percent. (Lead Agency - SAMHSA; Measure ID - TBD)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | Set Baseline | N/A | 20 States | |||
| Result | 13 States | Sep 30, 2016 | Sep 30, 2017 | |||
| Status | Baseline | Pending | Pending |
Proportion of American Indian and Alaska Native adults 18 and over who are screened for depression (Lead Agency - IHS; Measure ID - 18)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 56.5 % | 58.6 % | 66.9 % | 64.3 % | 67.2 % | 68.5 % |
| Result | 61.9 % | 65.1 % | 66 % | 67.4 % | Sep 30, 2016 | Sep 30, 2017 |
| Status | Target Exceeded | Target Exceeded | Target Not Met but Improved | Target Exceeded | Pending | Pending |
American Indian and Alaska Native patients with diagnosed diabetes achieve Good Glycemic Control (A1c Less than 8.0%) (Lead Agency - IHS; Measure ID - 2)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 32.7 % | Set Baseline | 48.3 % | 47.7 % | 49.5 % | 50.4 % |
| Result | 33.2 % | 48.3 % 1 | 48.6 % | 47.4 % | Sep 30, 2016 | Sep 30, 2017 |
| Status | Target Exceeded | Baseline | Target Exceeded | Target Not Met | Pending | Pending |
Implement recommendations from Tribes annually to improve the Tribal consultation process (Lead Agency - IHS; Measure ID - TOHP-SP)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 3 recommendations | 3 recommendations | 3 recommendations | 3 recommendations | 3 recommendations | 3 recommendations |
| Result | 4 recommendations | 4 recommendations | 9 recommendations | 9 recommendations | Sep 30, 2016 | Sep 30, 2017 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending |
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 (Lead Agency - ACL; Measure ID - 2.10)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 62 weighted average | 63 weighted average | 62 weighted average | 62.5 weighted average | 63 weighted average | 63.25 weighted average |
| Result | 63 weighted average | 64.2 weighted average | 63.8 weighted average | Dec 31, 2016 | Dec 31, 2017 | Dec 31, 2018 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending | Pending |
Increase the number of program participants exposed to substance abuse prevention education services (Lead Agency - SAMHSA; Measure ID - 2.3.56)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 1,535 | 5,734 2 | 3,891 | 3,000 3 | 2,580 4 | 2,580 |
| Result | 6,593 | 6,437 | 3,507 5 | Aug 31, 2016 | Aug 31, 2017 | Aug 31, 2018 |
| Status | Target Exceeded | Target Exceeded | Target Not Met | Pending | Pending | Pending |
Increase the percentage of children receiving Systems of Care mental health services who report positive functioning at 6 month follow-up (Lead Agency - SAMHSA; Measure ID - 3.2.26)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 63.1 % | 64.2 % | 64.2 % | 62.7 % | 62.7 % | 62.7 % |
| Result | 64.2 % | 62.7 % | 62.7 % | 64.5 % | Dec 31, 2016 | Dec 31, 2017 |
| Status | Target Exceeded | Target Not Met | Target Not Met | Target Exceeded | Pending | Pending |
Field strength of the NHSC through scholarship and loan repayment agreements (Lead Agency - HRSA; Measure ID - 4.I.C.2)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 9,193 persons | 7,128 persons 6 | 7,522 persons | 8,495 persons | 9,153 persons | 10,155 persons |
| Result | 9,908 persons | 8,899 persons | 9,242 persons | 9,683 persons | Dec 31, 2016 | Dec 31, 2017 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending |
Percentage of individuals supported by the Bureau of Health Workforce who completed a primary care training program and are currently employed in underserved areas (Lead Agency - HRSA; Measure ID - 6.I.C.2)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 43 % 7 | 43 % | 33 % 8 | 34 % 9 | 34 % 10 | 40 % |
| Result | 43 % 11 | 43 % 12 | 46 % 13 | Dec 30, 2016 | Dec 26, 2017 | Dec 31, 2018 |
| Status | Target Met | Target Met | Target Exceeded | Pending | Pending | Pending |
Number of patients served by Health Centers (Lead Agency - HRSA; Measure ID - 1.I.A.1)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 20.6 million | 22.2 million | 24.3 million | 27.5 million | 27.0 million | 27.0 million |
| Result | 21.1 million | 21.7 million | 22.9 million | Aug 31, 2016 | Aug 31, 2017 | Aug 31, 2018 |
| Status | Target Exceeded | Target Not Met but Improved | Target Not Met but Improved | Pending | Pending | Pending |
Number of unique individuals receiving direct services through the Federal Office of Rural Health Policy (FORHP) Outreach Grants (Lead Agency - HRSA; Measure ID - 29.IV.A.3)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 390,000 people | 395,000 people | 400,000 people | 405,000 people | 410,000 people 14 | 415,000 people 15 |
| Result | 747,952 people | 703,070 people 16 | 820,176 people | Oct 31, 2016 | Oct 31, 2017 | Oct 31, 2018 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending | Pending |
Number of adult volunteer potential donors of blood stem cells from minority race or ethnic groups (Lead Agency - HRSA; Measure ID - 24.II.A.2)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 2.66 Million | 2.85 Million | 3.18 Million | 3.26 Million | 3.49 Million | 3.74 Million |
| Result | 2.88 Million | 3.05 Million | 3.25 Million | 3.35 Million | Dec 31, 2016 | Dec 31, 2017 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending |
Reduce infertility among women attending Title X family planning clinics by identifying Chlamydia infection through screening of females ages 15-24. (Lead Agencies – HRSA and OASH; Measure ID - 36.II.B.1)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 1,296,300 | 1,340,300 | 1,196,600 | 1,155,500 | 1,195,000 | 1,032,500 |
| Result | 1,247,525 | 1,164,140 | 996,379 | Oct 31, 2016 | Oct 31, 2017 | Oct 31, 2018 |
| Status | Target Not Met | Target Not Met | Target Not Met | Pending | Pending | Pending |
Proportion of persons served by the Ryan White HIV/AIDS Programs who are racial/ethnic minorities (Lead Agency - HRSA; Measure ID - 16.I.A.1)
| FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | FY 2017 | |
|---|---|---|---|---|---|---|
| Target | 5 percentage points above CDC data | 5 percentage points above CDC data | 5 percentage points above CDC data | Within 3 percentage points of CDC. 17 | Within 3 percentage points of CDC data 18 | Within 3 percentage points of CDC data |
| Result | 72.6% (CDC= 67.1%) |
72.4% (CDC= 68.2%) |
Oct 31, 2016 | Oct 31, 2017 | Oct 31, 2018 | Oct 31, 2019 |
| Status | Target Met | Target Not Met | In Progress | In Progress | In Progress | In Progress |
Analysis of Results
The National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH) estimates that the direct and indirect financial costs of serious mental illness (SMI)—including health expenditures, disability benefits, and loss of earnings—exceed $300 billion per year in the United States. Individuals with SMI often experience barriers to treatment, including difficulty accessing and initiating treatment. Significant delays in the identification and treatment of SMI are common; for example, research has repeatedly found that individuals with psychosis in the U.S. often do not receive appropriate treatment for that condition for one to three years. HHS is starting a new Agency Priority Goal for FY 2016 - 2017 to address the challenges of SMI in the U.S. The new measure provided above tracks one aspect of this effort, whether evidence-based early intervention services are available for individuals with SMI. This key indicator specifically focuses on early intervention programs that are funded through the SAMHSA Community Mental Health Services Block Grant. Specifically, the indicator measures the number of states with at least one evidence-based early intervention program that provides a team-based approach to treatment including services such as case management, recovery-oriented cognitive and behavioral skills training, supported employment, supported education services, family education and support, and low doses of medications when indicated. The goal for FY 2017 is to increase the number of states by 50 percent from a baseline of 13 in 2015.
IHS focuses on some key health related issues for vulnerable tribal members. These include helping patients with diabetes maintain good glycemic control and increasing the number of adults screened for depression when visiting IHS facilities. Good glycemic control among diabetic patients can help prevent associated health problems caused by diabetes. Glycemic control requires frequent medical visits, medications, and laboratory testing for blood sugar control. In FY 2014, IHS implemented new clinical standards of care, changing the glycemic control measure threshold. The FY 2015 result is IHS missing the FY 2015 target of 47.7 percent by 0.3 percent.
IHS uses depression screening to help fulfill its mission of raising the physical, mental, social, and spiritual health of American Indian and Alaska Native people to the highest level. Depression is often an underlying component contributing to suicide, accidents, domestic/intimate partner violence, and alcohol and substance abuse. Early identification of depression allows providers to plan interventions and treatment options which positively impact the mental health and overall well-being of American Indian and Alaska Native people experiencing depression. As a result of a more focused educational campaign conveying the benefits of early identification of depression, depression screening within IHS-operated facilities increased to 67.4 percent in FY 2015, exceeding its target.
To strengthen the federal/tribal partnership, IHS engages American Indian and Alaska Native Tribes in open, continuous, and meaningful consultation. IHS incorporates tribal consultation to improve services for American Indians and Alaska Natives, setting a goal of implementing three recommendations from tribes per year to improve the consultation process. IHS exceeded this goal in FY 2015 by implementing nine recommendations. These included budgeting, contracting, health, fitness, and tax filing improvements, as well as enhanced communication and deliberation opportunities.
Community based services and assistance to caregivers are crucial to enabling frail elderly clients to delay or defer nursing home placement. According to Genworth 2014 Cost of Care Survey the average cost in the US for a semi-private room in a nursing home is $80,300 per year. For many people, that level of annual expenditure for care cannot be obtained without spending down savings and liquidating other assets. Seeking alternatives to this level of costly care, while providing quality care in familiar surroundings for elderly individuals, is something that many senior citizens and family members prefer. ACL uses a “nursing home predictor” index which measures the prevalence of characteristics that frequently lead to nursing home placement. For FY 2014, the result score of 63.8 is a decline over the previous year, but remains a 37 percent improvement over the FY 2003 baseline. As the score on the index increases it indicates an increase in the proportion of the high risk elderly population served through ACL funded services in the community. Since FY 2003, the index has increased substantially, demonstrating that in tight economic times ACL is succeeding in targeting community services and diverting individuals from more costly care.
SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. Increased awareness of the consequences of substance abuse and risky sexual behaviors reduces the likelihood that those at highest risk and who are hardest to treat will engage in behaviors that place them at risk of HIV/AIDS transmission. The goal of the Minority AIDS Initiative (MAI) is to prevent and reduce the onset of substance abuse and transmission of HIV among at-risk minority populations by delivering evidence-based substance abuse and HIV prevention interventions, including testing. SAMHSA monitors the numbers of individuals receiving education in the areas of substance abuse prevention and health promotion, thus enhancing protective factors against substance abuse, and transmission of HIV and other sexually transmitted diseases. In FY 2014, 3,507 program participants received substance abuse prevention education services, substantially missing the target. The result was affected by the more recent active grantees providing different services and data than earlier cohorts, e.g. recent grantees offered fewer direct services options, which are captured in this measure, and more indirect service options, which are not captured in this measure.
SAMHSA’s Children's Mental Health Services program seeks to increase the percentage of children receiving systems of care mental health services who report positive functioning at 6 month follow-up. A "system of care" is a strategic approach to the delivery of services and supports that incorporates family-driven, youth-guided, strength-based, and culturally and linguistically competent care. This occurs through collaboration across agencies, families, and youth, while positive functioning relates to the general ability of the child to perform routine life activities. In FY 2015, the percentage of children reporting positive functioning increased to 64.5 percent, exceeding the target. Children’s mental health experts consider a target performance level of approximately 60 percent to be appropriate, given the serious mental health issues of children served by this program.
The nation’s healthcare workforce is facing a number of significant challenges that are increasing demand, including changing population demographics, demand for health care services arising from increased health insurance coverage, and the imminent retirement of many Baby Boomer health professionals. The National Health Service Corps addresses the nationwide shortage of health care providers in areas of need by providing recruitment and retention incentives in the form of scholarship and loan repayment support to health professionals committed to a career in primary care and service to underserved communities. In FY 2015, the Corps field strength was 9,683. Field strength is generally dependent upon variables such as the number of qualified applicants and the mix of scholarship and loan repayment support provided, among others.
HRSA’s Bureau of Health Workforce programs are designed to improve the health of the nation’s communities, especially vulnerable populations, by supporting programs to augment the supply of health care providers who enter practice in underserved areas and increase access to quality health care. The overall percentage of graduates and completers who were directly supported by a Title VII or Title VIII program and went on to practice in a medically underserved community or health professional shortage area was 46 percent in FY 2014.
HRSA plays a vital role in ensuring access to quality, culturally competent care for vulnerable populations through its mission to improve health and achieve health equity through access to quality services. Health centers are community-based, patient-directed organizations that serve populations lacking access to high quality, comprehensive, cost-effective primary health care. Health Centers served 22.9 million patients in FY 2014. This is 1.2 million more than the 21.7 million patients served in FY 2013 and represents a 75 percent increase within a ten year period. Success in increasing the number of patients served has been due in large part to the development of new health centers, new satellite sites, and expanded capacity at existing clinics. Through the Office of Rural Health Policy, HRSA improves access to care in rural communities by utilizing Outreach grants that focus on community coalitions and partnerships. In FY 2014, 820,176 persons received direct services supported by these grant programs.
HRSA manages the C.W. Bill Young Cell Transplantation Program to increase the number of unrelated blood stem cell transplants facilitated for patients in need. In FY 2015,3.35 million persons on the donor registry self-identified as belonging to racial/ethnic minority populations, compared to 3.25 million in FY 2014. Increases in potential donors of minority race and ethnicity will lead to more minority patients receiving unrelated donor cell transplants, ensuring more equitable access to this potentially life-saving treatment.
Another example of HHS’s support for providing care to a vulnerable population is evident through the provision of family planning and related preventive health services in Title X family planning clinics. For more than 40 years, Title X family planning clinics have played a critical role in ensuring access to a broad range of family planning and related preventive health services for millions of low-income or uninsured individuals and others. Through these clinics, this Title X program implemented by OASH screens young women for Chlamydia as part of the full range of family planning and related preventative health services provided by Title X clinics. An untreated Chlamydia infection can lead to pelvic inflammatory disease and potential infertility. The number of screenings was 996,379 in FY 2014.
More than 1.1 million people in the United States are living with HIV infection, and almost 1 in 6 (15.8 percent) are unaware of their infection. The CDC and HRSA are both striving to improve prevention and treatment results. Though new HIV infections among racial/ethnic minorities overall have been roughly stable, compared with non-racial/ethnic minorities, they continue to account for a higher proportion of cases at all stages of HIV – from new infections to death. The proportion of the Ryan White Program’s service population that comprises racial/ethnic minorities is an indicator ofaccess to treatment for populations disproportionately impacted by HIV/AIDS. In FY 2013, 72.4 percent of Ryan White program clients were racial/ethnic minorities. This compares to 68.2 percent of CDC-reported AIDS cases.
Plans for the Future
IHS will screen for depression in all patients 18-years-old and older. The screening will be standardized across all IHS sites and will use a valid and reliable screening tool (PHQ-2). Screening will be documented in the EHR accurately and in a timely manner. To accomplish this, IHS will develop and provide online training addressing depression, screening, documentation, and treatment. This training will be targeted to nursing staff and primary care support staff, who are the primary staff that will be implementing this measure. Training will be provided bi-annually and be available via recordings. In FY 2017, IHS is proposing a measure name change to specify the American Indian and Alaska Native (AI/AN) population is measured and IHS is developing a separate measure for depression screening among AI/AN youth ages 12-17 years.
ACL will continue to provide high quality technical assistance, work with program resource centers to support the Aging Network to continue effective service delivery for caregivers and home and community-based services that are instrumental in the delay or deferral of nursing home placement of the elderly and persons with a disability.
SAMHSA will continue to support systems of care that supports children and youth (including their families) with serious mental illness through collaboration across agencies and providers. A Systems of Care (SoC) approach also promotes access and expands the array of coordinated community-based, culturally and linguistically competent services. Additional technical assistance is provided to promote improvements. National program evaluation data reported annually to Congress indicate that the SoC approach is successful, resulting in many favorable outcomes for children, youth, and their families, including sustained mental disorder improvements for youth and children who participate for as little as six months, reductions in suicide-related behaviors, and cost reductions based on fewer days in residential care.
HRSA will continue to support the National Health Service Corps (NHSC) to address health professional shortages in high-need rural and urban communities across the country. HRSA will continue to seek to increase the scope and presence of the program.
The Health Center Program will continue to emphasize coordinated primary and preventive services to promote reductions in health disparities for low income individuals, racial and ethnic minorities, rural community, and other underserved populations through an emphasis on the coordinated and comprehensive care, the ability to manage patients with multiple health care needs, and the use of key quality improvement practices.
HRSA's Federal Office of Rural Health Policy Outreach Grants will continue to support demonstrations of collaborative models to deliver basic health care services that are uniquely designed to meet local rural health needs. A particular focus is on improving the coordination of health services in rural communities and strengthening the rural healthcare system as a whole.
HRSA's C.W. Bill Young Cell Transplantation Program will continue to engage in a number of critical functions related to stem cell transplantation including the ongoing recruitment and tissue-typing of new donors. In FY 17, the program will continue to serve a diverse patient population with a focus on increasing the number of blood stem cell transplants facilitated for patients from racially and ethnically diverse backgrounds by adding to the pool of potential adult volunteer blood stem cell donors from these groups.
In 2014, the Office of Population Affairs, in collaboration with the Division of Reproductive Health, CDC, published an MMWR, "Providing Quality Family Planning Services, Recommendations of CDC and US Office of Population Affairs." This document, along with the release of updated screening guidance in the prior years regarding screening for Chlamydia infection emphasized the need for and the criteria around screening sexually active females 15-25 for Chlamydia. The proportion of those screened has increased to approximately 60 percent, most likely the result of improved adherence to the guidelines. Though the actual decrease in females screened has occurred, a reflection of the decrease in the number of clients in general as well as those in this age group, it is promising to see the increase in the proportion of the target population screened.
The Ryan White HIV/AIDS Program will continue to work to improve access to health care by addressing the disparities in access, treatment, and care for populations disproportionately affected by HIV/AIDS including racial/ethnic minorities.
FY 2014 Strategic Review Objective Progress Update Summary
Please note that this section summarizes the result of the FY 2014 HHS Strategic Review process, limiting the scope of content to that available prior to spring of 2015. Due to this constraint, the following may not be the most current information available.
Conclusion: Progressing
Analysis: Important progress has been made for this objective; data from the HHS Action Plan to Reduce Racial and Ethnic Health Disparities shows that progress has been made in implementing more than 90 percent of the plan’s action steps. For example, the Department of Health and Human Services leads the dissemination and implementation of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, to date awarding more than 1 million continuing education credits to providers who have completed e-learning programs designed to improve the competency of providers to deliver culturally and linguistically appropriate care to diverse populations. Numerous studies have also shown racial and ethnic minority practitioners are more likely to practice in medically underserved areas. Currently nearly 30 percent of the 9,200 clinicians serving in the National Health Service Corps are from minority groups, while more than half of the 1,100 Corps scholars in the training pipeline are from minority groups. Grantees are building networks with community health care facilities to promote effective, culturally appropriate, trauma-informed services that improve the safety and well-being of victims of human trafficking. Another example of culturally appropriate services is the Tribal Home Visiting program which is designed to utilize home visiting approaches to strengthen tribal capacity to support and promote the health and well-being of American Indian and Alaska Native families.
Though many people served by federally funded health centers are sicker and more frequently at risk than the national average progress has been made in serving a variety of conditions. The Ryan White HIV/AIDS Program provides HIV primary medical care, treatment, and supportive services to 56 percent of the people who have been diagnosed with HIV in the United States. Data show that 75 percent of these patients are virally suppressed, while overall in the U.S. only 30 percent of people living with HIV are virally suppressed. In another example, the rate of low birth weight babies born to health center patients has declined to 7.29 percent, lower than the national average of 7.99 percent. Sixty-three percent of health center patients with hypertension had their blood pressure controlled, exceeding the national average of 48.9 percent. Rural providers and patients experiencing depression in Indian country have benefitted from using televideo services for a range of behavioral health services and training and technical assistance. More than 100 rural communities were awarded grants to support access to care including grants that improve emergency medical services, provide resources for implementing telehealth solutions, or help communities build networks of care.
Surveys and focus groups were used by Medicare and Marketplace programs to understand perceptions and behaviors of consumers and guide messaging to support outreach and enrollment efforts. Through segmented analysis, CMS knows that about 25 percent of the uninsured are active seekers of health care information but need additional support to enroll in health care. In 2014 the Medicare language line handled 63,644 calls in 193 different languages, while the Marketplace Call Center handled 279,538 calls in 246 different languages.
The review identified a challenge related to refugee health. There is the lack of institutionalized shared resources supporting domestic refugees. There are gaps in health literacy and culturally appropriate care; mainstream service providers can approach clients with messages that may not resonate with refugees due to lack of familiarity with Western medicine concepts and care. Another challenge relates to the Veterans Administration which has been using Provider Agreements to pay the Aging and Disability Network for veterans’ long term services and supports. Recently the VA has ceased using Provider Agreements until the statute is amended. Approximately 400 Veterans and their families in 13 states are at risk of losing service. Another group that is affected by limitations to high quality health care includes individuals that live in states that have not expanded Medicaid. Adults may fall into a “coverage gap” of having incomes above Medicaid eligibility but below the Marketplace premium tax credit income eligibility. Health centers in these states may provide services that may not be fully reimbursed. High quality care is based on having well-trained providers and National Health Service Corps Scholarship program was only able to fund 10 percent of applicants, indicating high demand for this program.
In the coming year, HHS plans to improve results and better manage progress by developing a Priority Goal related to improving access for those affected by serious mental illness. HHS is working to provide states an option to eliminate the assignment of court ordered medical support as a requirement of receiving Medicaid. In addition, HHS will solicit applications for a second phase of an initiative to reduce preventable inpatient hospitalizations among residents of nursing facilities while identifying the impact of a new payment model.
1 In FY 2013 this measure changes from Ideal Glycemic Control to Good Glycemic Control with an A1c (blood sugar) value of less than 8.0% to align with new diabetes standards of care. More patients will meet this goal; therefore, annual targets and results will increase. Prior to 2013, the A1c value for Ideal Glycemic control was set at less than 7.0%.
2 Target has been revised from previously reported. Target has been changed to include Cohorts VII, VIII, IX, and X. The FY 2014 actual reflects the closeout of HIV Cohort 7, which was comprised of 55 grants.
3 Decrease in target from previous year is due to cohort effects and includes Cohorts IX and X.
4 Target has been reduced to reflect a decrease in number of grants in 2015 resulting in fewer participants.
5 The FY 2014 actual results reflect the closeout of HIV Cohort 7, which is comprised of 55 grants.
6 Target differs from what is reflected in the FY 2013 Congressional Justification, as target is based on the most recent NHSC FY 2013 budget.
7 This figure differs from the FY 2012 Congressional Justification to better reflect realistic projections based on trend data.
8, 9, 10 The change in target is the result of improved methodology, elimination of duplicate counting and a more accurate estimate of individuals who are serving in underserved areas. HRSA is only using counts from programs that are able to accurately track individuals that are being provided direct financial support from the HRSA program.
11, 12, 13 Service location data are collected on students who have been out of the HRSA program for 1 year. The results are from programs that have ability to produce clinicians with one–year post program graduation.
14, 15, 16 A new cohort of FORHP Outreach grants is awarded a 3–year project period. During the 1st year of the project period, the number of people receiving direct services through the FORHP Outreach grants tends to be lower due to program start up. The numbers generally increase throughout the project period as outreach efforts are implemented.
17 This is a new target "Within 3 percentage points of CDC data" and it will be reported using national HIV/AIDS prevalence data provided to HRSA by CDC rather than previous target through FY 2014 of "5 percentage points above CDC data" as reported by national AIDS prevalence data reported in CDC's HIV Surveillance Report. HAB will report on this measure using the "5 percentage points above CDC data" as reported by national AIDS prevalence data from CDC's HIV Surveillance Report through FY 2014. The FY 2014 data from HAB's RSR will be available in October 2015 and the CDC comparison data from the HIV Surveillance Report may be available around July 2016.
18 This is a new target set in FY 2015 "Within 3 percentage points of CDC data" and it will be reported using national HIV/AIDS prevalence data provided to HRSA by CDC rather than the previous target through FY 2014 of "5 percentage points above CDC data" as reported by national AIDS prevalence data reported in CDC's HIV Surveillance Report. HAB will report on this measure using the "5 percentage points above CDC data" as reported by national AIDS prevalence data from CDC's HIV Surveillance Report through FY 2014. The FY 2014 data from HAB's RSR will be available in October 2015 and the CDC comparison data from the HIV Surveillance Report may be available around July 2016.
