FY 2020 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

Accessing health services 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.

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 Table of Related Performance Measures

FORHP Outreach grants focus on improving access to care in rural communities through the work of community coalitions and partnerships. These grants often focus on disease prevention and health promotion, but can also support expansion of services such as primary care, mental and behavioral health care, and oral health services. Over 700,000 people received direct services supported through Outreach grants in FY 2017. In FY 2019 and 2020, FORHP will continue to fund non-categorical grants that allow rural communities to respond to health care challenges and issues unique to rural areas.

Congress created the Shared Savings Program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare FFS beneficiaries and reduce unnecessary costs. Similarly, Congress designed the Merit-based Incentive Payment System (MIPS) to tie Medicare payments to clinicians to quality and cost efficient care, to drive improvement in care processes and health outcomes, and to increase the use of health care information. The purpose of this performance goal is to help assess an important component of patient experience of care with their provider. 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 final results reported are representative of the survey results from the Shared Decision Making Summary Survey Measure (SSM), which is collected and reported through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for Physician Quality Reporting programs, the Merit-Based Incentive Program, and the CAHPS for Accountable Care Organizations (ACOs) Survey administered by ACOs participating in the Medicare Shared Savings Program. The SSM is the percentage of patients who gave positive responses on experience in sharing decision making with providers on topics related to medications, procedures, and information sharing. A higher score indicates a better experience with shared decision making. 

CMS set the CY 2017 target for this goal at 76 percent, which is between the 80th and 90th percentiles for all Shared Savings Program ACOs that used the CY 2015 Shared Savings Program quality measure benchmarks. The mean performance on this measure was 75.40 percent in CY 2016 and was 75.85 percent in CY 2017.

Because the agency implemented a revised shortened version of the survey in CY 2018 for both ACOs and MIPS, the CY 2018 performance period was a developmental year. CMS plans to re-establish the baseline for this goal based on the results from the new survey for CY 2018, which is expected to be available to CMS in April 2019. In addition, CMS intends to provide targets for CY 2019, CY 2020, and CY 2021 when the new survey scores are available.

IHS 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 2018 target was 11,600, and the FY 2018 result was a total of 13,204 encounters. IHS exceeded its FY 2018 target by 14 percent. From FY 2013 to FY 2018, results for this measure increased by 79 percent. In FY 2019 and 2020, IHS will continue to expand access to care through telehealth behavioral services.