Annual Performance Plan and Report

Topics on this page: Goal 1. Objective C | Table of Related Performance Measures | Analysis of Results | Plans for the Future | Objective Progress Update Summary

Goal 1. Objective C: Emphasize primary and preventive care, linked with community prevention services

Improved access to primary care services and more effective public health measures are critical to ensuring that individuals have access to high-quality services at the place and time that best meets their needs. As part of the effort to emphasize primary and preventive care, HHS is focused on creating key linkages between the healthcare system and effective community prevention services that support healthy living and disease management.

ACL, AHRQ, CDC, CMS, HRSA, IHS, OASH, ONC, and SAMHSA are committed to accelerating their emphasis on primary and preventive care, with a focus on community prevention services. HRSA programs deliver healthcare services to millions of Americans, especially vulnerable and underserved populations. CDC implements a number of programs promoting healthy behaviors, such as sustaining reducing obesity through physical activity and better nutrition.

The measures below demonstrate HHS’s targets and results for primary and preventive care linked with community prevention services. Key features of the Affordable Care Act focus on preventive care. HHS and component managers use these and other related measures to focus attention on achieving positive preventive care results. The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.

Objective 1.C Table of Related Performance Measures

Increase the proportion of adults (age 18 and older) that engage in leisure-time physical activity. (Lead Agency - CDC; Measure ID - 4.11.9)

Percentage of pregnant Health Center patients beginning prenatal care in the first trimester (Lead Agency - HRSA; Measure ID - 1.II.B.1)

Analysis of Results

The CDC is working on population-level approaches to address one of the America’s most important problems - obesity. The prevalence of obesity among adults and children remains a public health concern. Obesity increases the risk of many health conditions, including heart disease, stroke, high blood pressure, and cancer. Reducing obesity prevalence, especially among population groups with the highest burden of disease, will improve health outcomes related to chronic diseases and conditions, lower morbidity rates, and reduce health care spending. The CDC exceeded its target in FY 2013 of increasing the proportion of adults that engage in at least some leisure-time physical activity.

Prenatal care is one of the most important interventions for ensuring the health of pregnant women and their newborn babies. Early high-quality prenatal care is critical to improving pregnancy outcomes. Monitoring timely entry into prenatal care assesses both quality of care as well as health center outreach efforts that are associated with improving birth outcomes. HRSA tracks the percentage of pregnant health center patients receiving prenatal care and in FY 2013, 72 percent of those patients began care in the first trimester, exceeding the target.

Plans for the Future

The CDC is working with communities, businesses, early child and education centers, and schools to increase the number of people 18 and older who are physically active. Creating more safe spaces to exercise in communities can improve individuals’ overall health. CDC estimates 73.2 percent of adults will be participating in at least 150 minutes of physical activity a week by FY 2016 through its efforts to increase the availability of safe environments for physical activity.

HRSA projects that over the next few years the percentage of patients beginning prenatal care in the first trimester will progressively increase to 67 percent, given the changing mix of the pool of health centers. Health centers serve a higher risk prenatal population than the nation as a whole. HRSA will continue work to improve the percentage of pregnant health center patients that begin prenatal care in their first trimester.

Objective Progress Update Summary

HHS demonstrated progress toward this objective as shown by the representative performance measures described in the HHS Annual Performance Plan and Report. Further evidence of progress is described below.

• HRSA health centers continue to provide quality primary and related health care services, improving the health of the Nation’s underserved communities and vulnerable populations. Results over the past few years demonstrate improved performance as the percentage of pregnant health center patients that began prenatal care in the first trimester grew from 57.8 percent in 2000 to 72 percent in 2013, exceeding the target of 64 percent.
• ACL’s Chronic Disease Self-Management Education (CDSME) Programs provide older adults and adults with disabilities with education and tools to help them better manage chronic conditions. A process evaluation and retrospective outcome evaluation found positive results in terms of community based implementation, and participant outcomes. Specifically, “Report to Congress: The Centers for Medicare & Medicaid Services’ Evaluation of Community-based Wellness and Prevention Programs under Section 4202 (b) of the Affordable Care Act - PDF” indicated that:
  • CDSME program participation was associated with an 8 percent increase in average adherence (proportion of days covered) to chronic obstructive pulmonary disease (COPD) combination regimens of long-acting anticholinergics (LAAC) and long-acting beta-agonists (LABA) over controls. This is important because, according to an article in the April 2011 issue of the journal Mayo Clinic Proceedings (available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/), poor medication adherence is linked to increased hospital admissions resulting in $100 billion in costs annually.
• The Affordable Care Act added an important new preventive service in the Medicare program - an Annual Wellness Visit (AWV) with a health professional. In calendar year 2013, our most recent result, 4.1 million Medicare beneficiaries used this benefit.
• Hospitals are a primary source of data for public health agencies because they are often the first-line of support for patients seeking care and a key integrator of health data at the community level. As of December 2013, 87 percent of hospital attestations within the CMS Electronic Health Records Incentive Programs included the ability to report at least one public health measure.

The Department is continuing to support and execute the programs contributing to this objective, monitoring progress, performance, and program integrity while adjusting to any budgetary constraints or changes to programmatic demands.

¹⁴ Results prior to FY 2013 have been updated to reflect Healthy People data. Previous result estimates came from multiple annual reports released by CDC’s National Center for Health Statistics
¹⁵ The targets reflect performance expectations due to the significant expansion of the health center program over the indicated timeframe, and the potential impact on this measure of serving a significant increase in vulnerable populations.