FY 2023 Annual Performance Plan and Report - Strategic Goal 3: Objective 3.3

Fiscal Year 2023
Released March, 2022

Topics on this page: Objective 3.3: Expand access to high-quality services and resources for older adults and people with disabilities, and their caregivers to support increased independence and quality of life | Objective 3.3 Table of Related Performance Measures

Objective 3.3: Expand access to high-quality services and resources for older adults and people with disabilities, and their caregivers to support increased independence and quality of life

HHS is investing in several strategies to expand access to high-quality services and resources for older adults, people with disabilities, and their caregivers.  HHS enhances system capacity to develop processes, policies, and supports that are person centered and provide quality care for older adults and individuals with disabilities across settings, including home and community-based settings.  HHS ensures the availability and equitable access and delivery of evidence-based interventions that focus on research, prevention, treatment, and care to older adults and individuals with disabilities.  HHS also supports development and implementation activities to better understand and address the needs of all caregivers across the age and disability spectrum.

The Office of the Secretary leads this objective.  The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, AHRQ, ASPE, CDC, CMS, IHS, NIH, OASH, and OGA.  The narrative below provides a brief summary of any past work towards these objectives and strategies planned to improve or maintain performance on these objectives.

Objective 3.3 Table of Related Performance Measures

This measure is atypical as a decline indicates improved performance.  FY 2013 through 2016 performance indicates a slight increase in difficulties faced by caregivers.  In FY 2015, aging network efforts resulted in a nearly three-percentage point improvement in caregivers reporting difficulties obtaining services.  Although the target was not met that fiscal year and the rate increased slightly in 2016, the reduction to around 31% in 2017 has held steady and is a sign of improvement.  ACL will continue to provide states with technical assistance and work with complementary programs such as Lifespan Respite and Alzheimer’s Disease Supportive Services programs to advance system improvements to enhance and strengthen caregiver supports.  This measure is calculated using data from the 2020 National Survey of Older Americans Act Participants.  The survey was not conducted in 2021 due to the COVID-19 Pandemic.  ACL anticipated receiving a result of approximately 31% which is a 3-year weighted average.

Under the Developmental Disabilities Assistance and the Bill of Rights Act of 2000 (DD Act), each state and territory has a Developmental Disabilities Protection and Advocacy (P&A) program designated by the state’s governor.  The DD Act and other authorizing statutes give the P&A the authority to advocate for the rights of individuals with disabilities.  The DD Act states that each P&A has the authority to “pursue legal, administrative, and other appropriate remedies or approaches to ensure the protection of, and advocacy for, the rights of such individuals within the State."42 U.S.C.  15043  P&As provide a range of legal services and use a range of remedies, including self-advocacy assistance, negotiation, investigation, and litigation, to advocate for traditionally unserved or underserved individuals with developmental disabilities.  P&A authorities are critical to preventing abuse and neglect of people with disabilities and safeguarding individuals’ right to live with dignity and self-determination.

In FY 2020, Administration on Disabilities program staff continued to work with ACL’s Office of Performance and Evaluation to develop or improve logic models and performance measures for this program.  ACL staff are piloting methods for collecting data and working on developing standard methods for analyzing the data to identify trends and results.

Recent projections indicate that arthritis prevalence and arthritis-associated limitations are increasing and confirm that arthritis remains a top cause of morbidity, work limitations, and compromised quality of life.  Arthritis affects more than 58.5 million adults, almost 60% of whom are working aged adults (< 65) and is projected to affect 78.4 million adults by 2040.  There is good evidence that physical activity can reduce joint pain, improve function, and halt or delay physical disability among adults with arthritis, but physical activity levels are lower for adults with arthritis than adults without arthritis.  Adults with arthritis are more likely to engage in physical activity and self-management education programs when recommended by a health care provider.  This strategy and an emphasis on provider recommendations are reflected in CDC’s new state arthritis program and will be reflected in other, future activities of the arthritis program.

A new arthritis program state cooperative agreement began in FY 2018.  This has given the program an opportunity to begin work with 13 states on innovative activities.  The BRFSS 2019 age-adjusted pooled estimate for the 13 funded states serves as a baseline for the program performance measure and indicates 70% of adults with arthritis reported being counseled about the benefits of physical activity for managing arthritis by a health care provider that year.

The future targets were set to be consistent with an outcome measure in CDC’s  State Public Health Approaches to Addressing Arthritis Notice of Funding Opportunity.  A 1% increase over 5 years for this outcome measure was reasonable given the scope of work required and the award amount per state.

CDC protects people and prevents complications of blood disorders by reducing the prevalence of inhibitors among hemophilia patients and increasing the proportion of very young hemophilia patients receiving early prophylaxis treatment.  Through Community Counts, CDC collects data on health issues and medical complications for people living with bleeding disorders, incorporates screening for inhibitors, and monitors treatment use, including prophylaxis, to facilitate best practices that help prevent or eradicate complicated, costly, and debilitating health conditions.

Approximately 15-20% of people with hemophilia develop an inhibitor, a condition where the body stops accepting the factor treatment product (which helps the blood clot properly) as a normal part of blood.  The body treats the “factor” as a foreign substance and mounts an immune system response to destroy it with an inhibitor.  When people develop inhibitors, treatments to prevent and stop bleeding episodes are less effective.  Special treatment is required until the body stops making inhibitors, which can increase hospitalizations, compromise physical function, and exceed $1,000,000 a year for a single patient.

Discovering an inhibitor as soon as possible helps improve outcomes and reduce costs.  Although hemophilia care providers widely accept that development of an inhibitor is a serious issue, routine screening for inhibitors is not current practice for local laboratories because of the high cost and the inability to perform the proper tests.

In FY 2020, the prevalence of hemophilia treatment inhibitors was 5.1% which surpassed the FY 2020 target by eight percent.  The continued decrease in inhibitor prevalence demonstrates marked improvement for the population's management of complications, and preliminary results for FY 2021 are trending similarly.

In FY 2021, AHRQ continued to provide ongoing scientific, administrative and dissemination support to the U.S. Preventive Services Task Force (USPSTF).  The Task Force makes evidence-based recommendations about clinical preventive services to improve the health of all Americans (e.g., by improving quality of life and prolonging life).  By supporting the work of the USPSTF, AHRQ helps to identify appropriate clinical preventive services for adults, disseminate clinical preventive services recommendations, and develop methods for understanding prevention in adults.

For several years, AHRQ has invested in creating a national measure of the receipt of appropriate clinical preventive services by adults (measure 2.3.7).  A necessary first step in creating quality improvement within health care is measurement and reporting.  Without the ability to know where HHS is and the direction HHS is heading, it is difficult to improve quality.  This measure will allow AHRQ to assess where improvements are needed most in the uptake of clinical preventive services.  It will help AHRQ support the USPSTF by targeting its recommendations and dissemination efforts to the populations and preventive services of greatest need.  Thus, making sure the right people get the right clinical preventive services, in the right interval.  The data from this measure can also identify gaps in the receipt of preventive services and therefore inform the Department’s and the public health sector’s prevention strategies.

AHRQ now has a validated final survey to collect data on the receipt of appropriate clinical preventive services among adults (the Preventive Services Self-Administered Questionnaire (PSAQ) in the AHRQ Medical Expenditure Panel Survey (MEPS)).  The survey was fielded in a pilot test in 2015.  It is a self-administered questionnaire that will be included as part of the standard MEPS starting in 2018.  Additional years of data will allow for AHRQ to track and compare receipt of high priority, appropriate clinical preventive services over time.

The panel design of the survey, which features several rounds of interviewing covering two full calendar years, makes it possible to determine how changes in respondents' health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related.  Once data is collected, it is reviewed for accuracy and prepared to release to the public. 

In FY 2021, AHRQ continued to analyze the FY 2018/2019 data.  It also continued collecting the FY 2020/2021 data.

In FY 2022, AHRQ anticipates completing analysis of the FY 2018/2019 data.  It also anticipates the FY 2020/2021 preventive items data will become available, and data collection for the FY 2022/2023 will begin.

In FY 2023, AHRQ anticipates it will begin analysis of the FY 2020/2021 data, and continue data collection for the FY 2022/2023 data.