United States General Accounting Office

Health and Human Services:
Status of Achieving Key Outcomes and Addressing Major Management Challenges

Overall, the reports and plans of HHS components indicated that they had made mixed progress in achieving their key outcomes. In general, the components' strategies for achieving these outcomes appeared to be clear and reasonable. The following paragraphs summarize our findings:

• Planned outcome: Less fraud, waste, and error in Medicare and Medicaid. While the Health Care Financing Administration's (HCFA) performance report and plan indicate that it is making some progress toward achieving its Medicare program integrity outcome, tracking progress was difficult because of continual changes in its goals. HCFA had no program integrity goal for Medicaid for fiscal year 2000 but has since added a developmental goal. A major HCFA strategy to tackle the problem of fraud the addition of new goals appears to be reasonable. However, a number of the new goals outlined the need to establish a process to address problems, and in some cases, targets to measure progress had not yet been developed.
   
• Planned outcome: Beneficiaries receive high-quality nursing home services. HCFA's performance report and plan indicate that it continues to make progress toward ensuring that nursing home residents receive high-quality care, but its three goals under this outcome are surprisingly narrow in light of its broader agenda, embodied in about 30 ongoing initiatives to improve the quality of care in America's nursing homes. The lack of recognition of the initiatives is even more surprising in light of congressional direction that HCFA establish benchmarks and track progress in implementing each of the initiatives. HCFA's strategies for achieving this outcome appear to be clear and reasonable.
   
• Planned outcome: Poor and disadvantaged families and individuals become self-sufficient. Similar to last year's review, we could not fully assess the Administration for Children and Families' progress in achieving this outcome because the agency again was unable to provide timely performance data for many of the related measures. The little data that were available for fiscal year 2000 portray mixed success, and newly available fiscal year 1999 data generally indicated a similar picture. Few Administration for Children and Families' strategies for achieving this outcome are directly linked to specific performances that fell below fiscal year 2000 or 1999 target levels, and the strategies do not address in detail reporting delays from program partners, as we urged in last year's review.
   
• Planned outcome: Improved prevention of infectious diseases, including vaccine-preventable diseases. The performance reports and plans of HHS components indicate that they have made mixed progress toward achieving the 15 infectious disease prevention goals associated with this outcome, but in some cases data to measure progress were unavailable. Several agencies acknowledged their problems with data time lags, and some pointed to trend data to suggest that they are getting closer to their targets. While the component' strategies for achieving some goals are clear and reasonable, they do not always discuss how they plan to attain unmet goals, and some strategies are not directly tied to goal attainment.
   
• Planned outcome: Reduced use of illegal drugs. The Substance Abuse and Mental Health Services Administration's (SAMHSA) performance report and plan indicate that it has made some progress in achieving this outcome. While it continues to have problems collecting data for about half of its 80 goals, SAMHSA reported that it met or exceeded its target for nearly 90 percent of the goals for which it had data. Delays in reporting performance data were attributed to time lags in data collection, analysis, and reporting by states. It plans to have final data for most performance goals later in 2001. SAMHSA did not report strategies for achieving several planned goals. Thus, while it cited measurable targets and time frames for achieving its prevention and treatment programs, it omitted details about how these programs will attain their targets.
   
• Planned outcome: Public has prompt access to safe and effective medical drugs and devices. The Food and Drug Administration's (FDA) performance report and plan indicate that it has made significant progress in achieving this outcome. In last year's assessment, we reported that performance data were unavailable for the majority of FDA's goals. In contrast, the fiscal year 2000 performance report provides outcome data on nearly all goals, and FDA reported that it met or exceeded most of its targets. FDA's strategies for achieving this outcome are clear and reasonable. When FDA did not meet a goal, it generally provided an explanation and discussed strategies for improving future performance, including human capital strategies.

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