Objective 1.2: Reduce costs, improve quality of healthcare services, and ensure access to safe medical devices and drugs

HHS supports strategies to reduce costs, improve quality of healthcare services, and ensure access to safe medical devices and drugs for everyone.  HHS develops and implements payment models in partnership with healthcare providers and establishes other incentives to improve quality care while reducing healthcare spending.  HHS implements and assesses approaches to improve healthcare quality, and address disparities in healthcare quality, treatment, and outcomes.  The Department also improves patient safety, strengthens access to safe and effective medical products and devices, and expands approaches to safely exchange information among patients, providers, and payers. 

Objectives represent the changes, outcomes and impact the HHS Strategic Plan is trying to achieve.  This objective is informed by data and evidence, including the information below. 

• Percent of adults aged 18 and over who failed to obtain needed medical care due to cost is 8.3 percent.  (Source: Early Release of Selected Estimates Based on Data From the 2019 National Health Interview Survey)
• Growth in out-of-pocket spending will increase to an average of 4.1 percent over 2021–2023 and again to 4.3 percent over 2024–2028.  (Source: Early Release of Selected Estimates Based on Data From the 2019 National Health Interview Survey)
• Prescription drug spending growth for the next two years is projected to accelerate, averaging 5.4 percent, due to faster drug price increases and higher growth in the use of prescription drugs.  Price growth for medical goods and services will accelerate, averaging 2.4 percent per year for 2019–2028.  (Source: National Health Expenditure Projections 2019–2028)
• Some disparities in healthcare quality saw reductions from 2000 through 2016–2018, but disparities persist and some worsened, especially for poor and uninsured populations.  (Source: 2019 National Healthcare Quality and Disparities Report)  For about 40 percent of quality measures, Blacks and American Indians and Alaska Natives received worse care than Whites.  For more than one-third of quality measures, Hispanics received worse care than Whites.  For nearly 30 percent of quality measures, Asians received worse care than Whites, but Asians received better care than Whites for nearly one-third of quality measures.  (Source: 2019 National Healthcare Quality and Disparities Report)
• Nearly four in 10 patient portal users accessed their health information using a smartphone health app in 2020.  Nearly 40 percent of individuals nationwide accessed a patient portal in 2020—a 13 percentage point increase since 2014.  (Source: Individuals’ Access and Use of Patient Portals and Smartphone Health Apps, 2020)

Contributing OpDivs and StaffDivs

AHRQ, ASPE, CDC, CMS, FDA, HRSA, IHS, NIH, OASH, ONC, and SAMHSA work to achieve this objective.

HHS OpDivs and StaffDivs engage and work with a broad range of partners and stakeholders to implement the strategies and achieve this Objective.  They include: the Accelerating Medicines Partnership (AMP), Advisory Commission on Childhood Vaccines, Advisory Committee on Immunization Practices (ACIP), American Indian/Alaska Native Center, Bespoke Gene Therapy Consortium, FDA CDER Professional Affairs and Stakeholder Engagement, Materials Genome Initiative, Medicaid and CHIP (MAC) Learning Collaboratives, Mutual Recognition Initiative, National Advisory Council (NAC), National Vaccine Advisory Committee (NVAC), Regenerative Medicine Innovation Project (RMIP), and World Health Organization Member State Mechanism.

Strategies

Partner with providers to develop payment models and other incentives to expand options for quality care at lower costs

• Collaborate with states, community-based organizations, and other stakeholders to design innovative, targeted, value-based payment models to increase recruitment of providers that care for predominantly underserved populations and provide them with support to improve their awareness of the benefits of alternative payment models that aim to decrease health inequities.
• Partner with private payers, states, and other regional healthcare organizations to move primary care providers away from fee-for-service and into payment models that support the delivery of effective, comprehensive, patient-centered care for their patients through the testing of models that reward providers for delivering high-quality care, improve health outcomes, and advance health equity.
• Support states’ efforts to shift toward more value-based payments in their Medicaid and Children's Health Insurance Program (CHIP) Programs.
• Partner with states and external quality measure development experts to define and encourage use of a core set of metrics to measure provider effectiveness in Medicaid, CHIP, and pay-for-performance programs, including reliable metrics of access to care, gaps in care, disparities, health equity, and achieving positive outcomes for all populations.

Implement and assess approaches to improve healthcare quality, and address disparities in healthcare quality, treatment, services, and outcomes

• Promote and support implementation of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care by health professionals, health systems and organizations and in HHS programs to improve the quality of care and reduce health disparities by ensuring the provision of services that are respectful of and responsive to individuals’ health needs, preferences, culture, and preferred language.
• Improve healthcare quality by defining and tracking progress on core clinical measures that target high-priority health conditions and services, such as cancer, chronic disease, prenatal care, HIV screening, antimicrobial resistance, and immunizations.
• Better understand the barriers and obstacles to using clinical decision support tools that improve health outcomes in healthcare settings.
• Implement equity impact strategies to support data-driven quality improvement approaches to identify and address health disparities in access to, use of, and outcomes from programs and policies among underserved populations.
• Assess treatment and service utilization to identify disparities in and barriers to access to effective, appropriate, and quality treatment and services for underserved populations, and implement policies to address identified disparities while assessing progress made toward narrowing the gap.
• Support research and evaluation of expanded use and availability of telehealth and telemedicine, including effects on quality, access, costs, reimbursement, and care outcomes and harms, to inform the long-term approach to using telehealth and to improve access to care for underserved populations.
• Engage stakeholders from underserved populations to provide opportunities for input to inform program and policy efforts to improve healthcare quality.
• Engage in Tribal and Urban Indian Organization consultation and confer on what improving quality healthcare services mean.

Strengthen patient safety improvements and access to affordable medications and medical products to reduce spending for consumers and throughout the healthcare system

• Collaborate with partners and stakeholders to identify, design, implement, evaluate, and sustain patient safety improvements that address patient risks, hazards, and harm.
• Support patient safety research to prevent threats to patient safety including healthcare-associated infections.
• Improve access to safe and effective prescription drugs, biologics, and medical devices, and lower costs by promoting generic and biosimilar competition, developing over-the-counter medical products, and providing discounts on medicines to safety-net hospitals and clinics.
• Ensure equitable, adequate, and continued access to safe and effective medical products by developing novel approaches to increase domestic manufacturing capacity, agility, and efficiency, including through partnerships.
• Ensure continued access to safe medical devices and drugs by assessing the role of foreign and U.S. supply chains in addressing shortages of drugs, medical devices, or required ingredients and components, and providing options for strengthening and improving coordination of global supply chain systems.
• Foster innovation by supporting public-private research and prioritizing payment and service delivery models that test ways to reduce program and beneficiary spending on prescription drugs, support increased utilization of biosimilars and generic drugs, and lower overall spending while improving quality and beneficiary health.

Expand approaches to safely and securely exchange health information between patients, providers, and payers

• Enable individuals to access their health information by ensuring they can view and interact with their data via secure mobile apps, patient portals, and other technologies.
• Promote interoperability and data sharing through consensus-based standards to ensure health information, including social determinants of health information, is available for care across settings, public health, research, and emergency and disaster preparedness, response, and recovery.

Performance Goals

The HHS Annual Performance Plan provides information on the Department’s measures of progress towards achieving the goals and objectives described in the HHS Strategic Plan for FY 2022–2026.  Below are the related performance measures for this Objective. 

• 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 (LIS) Medicare beneficiaries who reach the gap and have no supplemental coverage in the gap
• Increase the percentage of Medicare healthcare dollars tied to Alternate Payment Models (APMs) incorporating downside risk
• Review and act on 90 percent of standard original Abbreviated New Drug Application (ANDA) submissions within 10 months of receipt
• Increase the cumulative number of evidence-based resources and tools available to improve the quality of healthcare and reduce the risk of patient harm
• Percentage of health centers with at least one site recognized as a patient centered medical home
• Increase the number of communities that have access to tele-behavioral health services where access did not exist in the community prior to Telehealth Network Grant Program grant
• For the Title X program, number of service sites that participate in the program

Learn More About HHS Work in this Objective

• Annual Intellectual Property Report: HHS participates in this White House report that advises the President, coordinate policy, and advocate for American interests abroad.  Its efforts have focused on coordinating and developing the United States’ overall intellectual property enforcement policy and strategy, to promote innovation and creativity, and to ensure effective intellectual property protection and enforcement, domestically and abroad.
• Coronavirus Treatment Acceleration Program (CTAP): FDA created this program to leverage cross-agency scientific resources and expertise for COVID-19 therapeutic development and review.
• Disparity Impact Strategy: The HHS Office of Minority Health is implementing a comprehensive data-driven approach in its grant portfolio for identifying and addressing health disparities to promote health equity for racial and ethnic minority populations.  This approach includes working with OMH grant recipients to develop disparity impact statements and to enhance their capacity to use data and implement strategies to address the differential access to, use of, or outcomes from grant activities to eliminate health disparities among racial and ethnic minority populations.
• Healthcare Associated Infections (HAI): AHRQ funds work to help frontline clinicians and other healthcare staff prevent HAI by improving how care is actually delivered to patients.
• Helping to End Addiction Long-term (HEAL) Initiative: The NIH HEAL Initiative is a trans-NIH effort to improve prevention and treatment strategies for opioid misuse and addiction and to enhance pain management.
• Information Blocking: Information blocking means a practice that is likely to interfere with the access, exchange, or use of electronic health information except as required by law or specified by HHS.  Legal enforcement of penalties for information blocking will roll out over time for applicable entities to give them time to grow more experienced with regulations.
• Initial Targeted Engagement for Regulatory Advice on CBER producTs (INTERACT): The INTERACT meetings fosters industry engagement with FDA on issues critical to early product development, so innovators meet the FDA’s science-based requirements more effectively and development is streamlined by avoiding unnecessary pre-clinical studies.
• Medical Device Safety Action Plan: The Medical Device Safety Action Plan outlines a vision for how FDA can continue to enhance our programs and processes to assure the safety of medical devices throughout the total product lifecycle, to provide for the timely communication and resolution of new or increased known safety issues, and to advance innovative technologies that are safer, more effective and address unmet needs.
• Mutual Recognition Initiatives with the European Union and the United Kingdom on pharmaceutical products: U.S. FDA maintains mutual recognition agreements with the EU and with the UK to allow drug inspectors to rely upon information from drug inspections conducted within each other’s borders.
• Patient-Centered Outcomes Research (PCOR) Implementation and Training: PCOR compares the impact of two or more preventive, diagnostic, treatment, or healthcare delivery approaches on health outcomes, including those that are meaningful to patients.  Congress instructed AHRQ to invest in disseminating and implementing PCOR findings into clinical practice and in training future PCOR researchers.
• Patient Safety Organization (PSO): AHRQ certifies public and private organizations with expertise in the analysis of patient safety and hazards in healthcare.
• Medicare Shared Savings Programs: The Medicare Shared Savings Program (Shared Savings Program) is committed to achieving better health for individuals, better population health, and lowering growth in expenditures.
• Supply Chain Security Toolkit for Medical Products: The FDA and Asia Pacific Economic Cooperation (APEC) economies collaborated to create this toolkit to maximize available global resources, deliver quality trainings and best practices, and secure the global supply chain for medical products.  New APEC Training Centers of Excellence for Regulatory Science will support training and use of the toolkit.
• Think Cultural Health: Through this initiative, the HHS Office of Minority Health offers online continuing education programs and other resources to promote awareness and implementation of culturally and linguistically appropriate services and the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care among health professionals, health organizations, and students.
• Trusted Exchange Framework and Common Agreement (TEFCA): ONC will establish minimum national standards of universal interoperability, which will allow users in different networks to securely share basic clinical information with each other.
• U.S. Core Data for Interoperability (USCDI): ONC created this standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange.
• U.S. Trade Agreements: HHS supports implementation of trade agreements that promote efficient, transparent, and science-based regulatory frameworks for medical products.
• Value Based Payments: For many states, a critical component of Medicaid delivery system reform is payment reform, specifically implementing value-based payment approaches (i.e., payment models that range from rewarding for performance in fee-for-service (FFS) to capitation, including alternative payment models and comprehensive population-based payments). Within the Medicaid Innovation Accelerator Program (IAP) functional area of value-based payment (VBP) and financial simulations, CMS provided technical assistance to Medicaid agencies in building and strengthening their VBP capacity as they design and implement Medicaid delivery system reforms. Medicaid agencies could choose among technical assistance programs in three different areas: general VBP and financial simulations; maternal and infant health VBPs; and children’s oral health VBPs. IAP provided individualized technical assistance to participating Medicaid agencies and, developed resources and tools that could be used by Medicaid agencies.