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INDIAN HEALTH SERVICE
GPRA & PART OVERVIEW
November 2008
10/8/2010 Indian Health Service 1
Emerging Trends in Federal
Accountability Requirements
Demonstrating results and a continuous commitment to
program improvement is the Administration’s mandate
Critical Performance Activities:
President’s Management Agenda Score Card
PART Evaluation of programs by OMB
Annual GPRA Performance Report in the Performance
Budget
HHS Performance Improvement Initiative (Quarterly
Reporting by Senior Executives to HHS)
IHS Director’s, Area Directors’ and Service Unit CEO
Performance Contracts
10/8/2010 Indian Health Service 2
GPRA Overview
• The Government Performance and Results Act
(GPRA)
• A Federal law requiring a data-supported audit trail from
appropriated dollars to activities and ultimately to customer
benefits or outcomes consistent with an agency’s mission
• Requires an annual performance plan, as well as an annual
report
• IHS-Fully implemented in 1997 with the 1999
budget submission
• Now widely recognized across I/T/U programs
as an important requirement for performance
improvement
10/8/2010 Indian Health Service 3
IHS GPRA Measure Categories
• Treatment: FY08 22 measures
• e.g., diabetes, cancer screening, oral health
• Prevention: FY08 12 measures
• e.g., immunizations, tobacco cessation intervention,
childhood weight control, etc.
• Treatment and Prevention clinical measures are
based on RPMS data and extracted by the Clinical
Reporting System (CRS)
• Capital Programming/ Infrastructure:
FY08 2 measures
10/8/2010 Indian Health Service 4
How Critical is GPRA Today?
• The PART performance assessment continues to be
heavily based on GPRA annual measures
• Elements of the Director’s performance contract with
the Secretary are based on GPRA annual measures
(6 measures in FY 2008): retinal eye exam; DM blood
pressure control; childhood immunizations; colorectal
cancer screening; influenza; mammography)
• Elements of the Area Directors’ performance
contracts with the IHS Director are based on GPRA
annual measures
• Service Unit Director/ CEO’s performance
assessment are increasingly based on GPRA annual
measures
10/8/2010 Indian Health Service 5
Re-organized GPRA Process
• The number of process measures has been reduced.
• CRS is serving an important role in quality improvement in a
growing number of local IHS and Tribal sites.
• A more formalized Performance Measures Steering
Committee has been formed to guide GPRA measure
development.
• GPRA Measure Leads will develop a 5 year plan for each measure.
• Prospective measure planning will eventually sync with National Budget
Formulation Meetings.
• Steering committee will have representation from I/T/U programs
• The Performance Achievement Team (PAT), as the overall
agency performance coordinating body, will be the approving
body for proposed GPRA measure changes.
10/8/2010 Indian Health Service 6
2008 - National Dashboard (IHS Direct/Tribal)
Non-CRS Measures 2008 2007 2006 2008 Target Results
YRTC Accreditation 91% 91% 100% 100% Not Met
IHS Direct Accreditation 100% 100% 100% 100% Met
Patient Safety a 94 sites 64 sites 3 Areas 74 sites Met
Scholarship Placements 61% 47% 37% 52% Met
Public Health Nursing b 415,945 427,700 Developed 449,085 Not Met
3 projects/
Injury Intervention c 11 Areas 12 Areas Implemented 11 Areas Met
Pending Pending Pending
Unintentional Injury Mortality (12/2012) Pending (12/2011) (12/2010) 94.8/100,000 (12/2012)
Suicide Surveillance 1598 1674 1603 1758 forms Not Met
Environmental Surveillance d 12 Areas 32 programs 20 programs 11 Areas Met
Sanitation Improvement 21,811 21,819 24,090 21,800 Met
Healthcare Facilities
Construction 0 projects 2 projects 3 projects 0 projects Met
a2006 measure was number of Areas with medical error reporting system; 2007 was to develop and deploy a patient safety measurement
system
b2006 measure was to develop data system to capture GPRA-related activities; 2007 was to set baseline of activities
c2006 measure was to implement web-based reporting; 2007 measure was to report projects via web-based system;
2008 measure is to administer a recognized occupant protection survey in 11 IHS Areas
d2006 and 2007 measure was number of programs using web-based automated system to report priorities;
2008 measure is to establish a baseline of common environmental risk factors in communities in 11 IHS Areas
10/8/2010 Indian Health Service 8 Nov-08
Summary of Percentage Met for CRS and
Non-CRS Measures
• FY 2002 78%
• FY 2003 76%
• FY 2004 72%
• FY 2005 83%
• FY 2006 76%
• FY 2007 79%
• FY 2008 81%
10/8/2010 Indian Health Service 9
The New Federal Program Report Card:
Program Assessment Rating Tool
Overview of PART:
• A uniform series of evaluation questions
intended to identify a program’s strengths and
weaknesses from its purpose and design to
what it accomplishes
• Allows for comparison between similar types of
programs government-wide
• Intended to inform budget and management
decisions
• Results based on GPRA annual measures and
strategic plan long-term goals with emphasis on
outcomes – they need to be “ambitious”
10/8/2010 Indian Health Service 10
Overview of PART - continued
Evaluates program effectiveness in four areas:
• Purpose/Design (20%)
• Strategic Planning (10%)
• Program Management (20%)
• Program Results (50%)
PART Ratings
• Effective 85-100
• Moderately Effective 70-84
• Adequate 50-69
• Ineffective 0-49
• Results Not Demonstrated
10/8/2010 Indian Health Service 11
IHS PART’d Programs
FY 2004 PARTs
Federally Administered Programs Moderately Effective (77%)
Sanitation Facilities Construction Moderately Effective (80%)
FY 2005 PARTs
Urban Indian Health Program Adequate (69%)
Resource and Patient Management System Effective (88%)
FY 2006 PART
Health Care Facilities Construction
Effective (92%)
FY 2007 PART
Tribally Operated Programs Adequate (69%)
FY 2008 PART
No new PART’d Programs Biannual improvement plans for each PARTd
program
FY 2009 PART
Sanitation Facilities Construction Program Moderately Effective (83%)
FY 2010 PART
No new PART’d Programs Biannual improvement plans for each PARTd
10/8/2010 Indian Health Service program 12
PART Measure Changes & Improvement
Actions for – FY 2008, Fall Update
• Flurry of activity before the change in
Administration
• Efficiency Measure changes
• SFC
• RPMS
• HCFC
• New PART Measures
• Urban Indian Health Programs
• RPMS
• Improvement Actions for Fall update
10/8/2010 Indian Health Service 13
PART Facts
• FY 2006 – OMB determined that all major
programs within the agency had been PARTed –
so no PART occurred in 2006.
• PART requirements for all previously PARTed
programs– bi-annual update of performance
improvement plans & annual performance
measure reporting.
• Measure approval & Target negotiations required
for each measure
• FY 2010 Issues
• Presumption: new administration will determine if there will be a
PART (or not).
10/8/2010 Indian Health Service 14
Agency Performance & Accountability
Requirements
• Performance and Accountability Report (PAR)
• Originally linked to Federal Manager’s Financial Integrity Act of 1982
• Agencies report on financial management
• Linked to audits or full accounting on how agency spends taxpayer dollars
• Morphed into the (HHS) Citizen’s Report (Retinopathy, BP Control, CRC)
• President’s Management Agenda (PMA)
• OMB/HHS score agencies on how well they are addressing or improving
government-wide management deficiencies on a quarterly basis
• Focuses on specific management areas (including Performance)
• Performance Improvement Initiative (PII)
• HHS Response to OMB’s poor rating of the Department’s
Budget/Performance Integration efforts
• Require quarterly meeting between IHS high level leadership and HHS
exec staff
10/8/2010 Indian Health Service 15
Summary
IHS Performance Management Today:
• Shift from supplying information to using information and the updated
IHS Strategic Plan as a roadmap for decision-making and performance
improvement
• Accountable cascading of performance & results is here to stay & will
likely increase
• Executive Performance Contracts; National Awards; Area Awards
• Performance must be linked to funding levels
• Appropriations
• GPRA and PART are now intertwined and viewed as inseparable
components of agency accountability
• The change in Administration will not likely impact GPRA reporting, but
the impact on PART reporting is unknown at this time.
10/8/2010 Indian Health Service 16
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