FY 2019 Annual Performance Plan and Report - Goal 1. Objective 3

Topics on this page: Goal 1. Objective 3 | Objective 1.3 Table of Related Performance Measures

Goal 1. Objective 3: Improve Americans’ access to health care and expand choices of care and service options

The Department defines access to health services as “the timely use of personal health services to achieve the best health outcomes.”  It involves gaining entry into the health care system, usually through payment; gaining access to diverse options for receiving treatment, services, and products, including physical locations and online options; and having a trusted relationship with a health care provider.  Efforts to improve access to care are not limited to physical health care.  Improving access to behavioral and oral health care, including through innovative solutions that use health information technology, also is critical, especially for populations experiencing disparities in access.

To improve outcomes in this objective, HHS is working to address the high cost of care, lack of availability of services, and lack of culturally competent care. Strategies related to promoting affordability and strengthening the workforce are addressed in Strategic Objectives 1.1 and 1.4. This Strategic Objective focuses on how HHS, rather than instituting government mandates, is giving people more control over how they access care, through increasing the spectrum of consumer options and expanding competition among health care providers, including by removing barriers to participation in the health care sector for religious, faith-based, and other providers.

The Office of the Secretary leads this objective.  The following divisions are responsible for implementing programs under this strategic objective: ACL, CMS, HRSA, IHS, IOS, OCR, OGA, and SAMHSA.

Objective 1.3 A Table of Related Performance Measures

Track the number of individuals who receive direct services through Federal Office of Rural Health Policy (FORHP) Outreach grants, subject to the availability of resources (Lead Agency - HRSA; Measure ID - 29.IV.A.3) ^[10]

The purpose of this performance goal is to help assess an important component of patient experience of care with their provider.  Specifically, shared decision making between patient, caregiver and provider is considered to be a fundamental component of a patient-centered health care system that leads to improved health outcomes for patients.  The Shared Decision Making section of the Summary Survey Measures (SSM) asks beneficiaries questions such as when they talked to their provider about starting or stopping a prescription medicine, did the provider ask what they thought was best for them.  It also asks beneficiaries whether they and their provider talked about how much of their personal health information they wanted shared with family or friends.  As beneficiaries become more empowered to actively participate in their care, we would expect better performance in the Shared Decision Making section of the SSM, as this section of the Consumer Assessment of Health care Providers System (CAHPS) survey focuses on beneficiary engagement related to their care.  And as more beneficiaries actively participate in their care decisions, CMS should also see improved health outcomes for beneficiaries.

The Shared Decision Making section of the SSM is collected and reported through the CAHPS survey for Physician Quality Reporting programs, the Merit-Based Incentive Program beginning in 2017 and the CAHPS for ACOs Survey administered by Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (Shared Savings Program).  Congress created the Shared Savings Program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For- Service (FFS) beneficiaries and reduce unnecessary costs.  Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an ACO.

The performance target set for this measure was established using Shared Savings Program's quality measure performance benchmark distribution.  Prior to the start of a performance year, CMS publishes quality measure performance benchmarks that are set using all available Medicare FFS quality data.  These data-driven benchmarks are used to assess quality attainment (and more recently, quality improvement) and ultimately translated into points used in the program’s financial performance calculations.  The 76 percent target set for the Shared Decision Making measure in 2017 (available for reporting in 2018) was set using the 2015 Shared Savings Program quality measure benchmarks, assuming continued improvement in measure performance over the next two years.

Specifically, the performance target focuses on measuring continued improvement of the scores related to beneficiary responses to the Shared Decision Making section of the SSM.  The performance on this measure was 75.40 in CY 2016.  For CY 2018 CMS would like to delay setting a target, as the OpDiv anticipates implementing a revised shortened version of the survey in 2018.  The revised shortened version of the survey results in substantive changes to the Shared Decision Making SSM.  Specifically, the number of questions contained in this SSM is reduced from eight to two questions.  

To ensure ACOs attain high measure performance, and improve measure performance, CMS provides training webinars, dedicated resource webpages and materials including a CAHPS toolkit to support ACOs and group practices to improve their CAHPS scores.  In an effort to streamline the CAHPS for ACO survey, CMS is currently reviewing potential survey revisions.  Revisions to the survey will likely shorten the survey, but maintain or strengthen the reliability and validity of the survey.  While the potential survey revisions being considered could impact the ability to compare data from the old survey to the new survey, over time CMS will again be able to calculate trend data on the revised survey.  Additionally, CMS believes that the revised survey will be less burdensome to complete for beneficiaries and may increase response rates.  The revised shortened survey was piloted tested with ACOs from November 2016 – February 2017.  Results from the pilot study suggest that administration of the shortened version of the survey (i.e., the pilot survey) is likely to result in improvements in overall response rates.  Findings show that the response rate to the pilot survey was 3.4 percentage points higher than the response rate to the FY 2016 CAHPS for ACOs survey among ACOs participating in the pilot study.  Increases in response rates tended to be larger among ACOs that had lower response rates in the prior year.   

In addition, after accounting for survey questions that were removed from the pilot survey, the average survey responses for ACOs who participated in the pilot study were mostly similar across the two survey versions (pilot and FY 2016).

Increase tele-behavioral health encounters nationally among American Indians and Alaska Natives (Lead Agency - IHS; Measure ID - MH-1)

The IHS has increased efforts to expand access to care through the integration of telemedicine with community-based services.  An important specialty care delivered through this telehealth option includes behavioral health services.  The FY 2017 target was 10,359 and the FY 2017 result was a total of 12,212 encounters; IHS exceeded its FY 2017 target by 18%.  From FY 2013 to FY 2017 results for this measure have increased by 65%.