PERFORMANCE PLAN AND REPORT EXECUTIVE SUMMARY Background The Government Performance and Results Act (GPRA) of 1993 requires Federal agencies to prepare: 5-year Strategic Plans setting out long-term goals and objectives; Annual Performance Plans (APPs) which link the Strategic Plan with the annual budget request by committing to short-term performance goals; and Annual Performance Reports (APRs) explaining and documenting how effective the Agency's actions have been in achieving these goals. This APP for the Centers for Medicare & Medicaid Services (CMS), formerly known as the Health Care Financing Administration (HCFA) sets out specific performance goals for the Agency for Fiscal Year (FY) 2003. It builds on previous APPs submitted to Congress and contains many enhancements. The CMS's APP complements and supports the Agency's FY 2003 budget, and is integral to it. In this APR, CMS is reporting on Agency performance for its FY 2001 GPRA goals. The CMS Annual Performance Plan is divided by budget category as a means of integrating budget and performance. The GPRA goals identified under each budget category reflect CMS's overall management vision and are representative of its vital activities to perform its mission. Thus, the APP does not reflect every activity and challenge encountered by CMS. Using a representative approach is consistent with guidance from GAO based on the nature of the Agency's work. In 2001 The President's Management Plan announced several reform initiatives with the primary objectives of making the Government more citizen-centered, resultsoriented, and market-based. In response to the President's five management objectives, CMS developed initiatives to vigorously move the Agency forward with a focus on five primary objectives: integrating budget and performance; enhancing strategic management of human capital; increasing competitive sourcing; improving financial performance; and expanding electronic government. The CMS's initiatives include process reengineering efforts, improved methods of working and management initiatives that will enable the Agency to effectively implement its Strategic Plan and long-term goals and objectives. For example, one of our strategies to expand electronic government makes use of technology-based learning, also known as computer based training, to educate our workforce on systems security issues, among many other subjects. This method enhances productivity because it allows the employee flexibility in scheduling so that training can be completed according to the employee's schedule and/or during "downtimes." It also provides a way for the employee to refer back to familiar training tools if necessary. PERFORMANCE PLAN AND REPORT Summary of Plan and Report An improvement in this year's plan is the addition of the goal write ups for those goals that are no longer carried in the plan but for which data continues to be included in the reports. We have also included reference numbers for each goal in the reference column of the reporting charts. For goals appearing in the reporting chart but no longer carried in the plan, we have included an additional 2 digit number indicating the last year the goal was included in the plan. We have included a chart in Appendix A.2 that summarizes the evolution of our Plan since FY 1999. The chart indicates the year(s) in which each goal was included and also tracks the performance of the goal in each GPRA reporting year. The CMS's total number of FY 2003 goals is 37. We carried over the majority of the goals in the FY 2002 plan, with new targets appropriate for FY 2003. We will be reporting on the status of 33 FY 2001 performance goals. Consistent with the President's Management Plan, CMS has adopted three new goals to the FY 2003 plan to reflect our efforts to improve our management structure, to strengthen and maintain a diverse workforce, and to restructure the Agency to be more citizen-focused. Through workforce planning efforts, CMS identified broad competency areas that need to be targeted for skill and knowledge gap reduction. One of the identified areas to be targeted is management and leadership. To address this, CMS has developed a Leadership and Management Development Strategy (LMDS) to strengthen and increase the effectiveness of the Agency's leadership. There is a strong business case for our goal to strengthen and maintain diversity at all levels of CMS, resulting in a workforce that mirrors the diverse population we serve thus improving our effectiveness. Our new goal to make CMS more citizen-focused emphasizes improved organizational efficiency. These goals, along with the Workforce Planing goal, will enable CMS and the Department of Health and Human Services (HHS) to effectively implement its Strategic Plan and long-term goals and objectives through a more effective work force. We have embarked on a National Media Campaign, which will help beneficiaries and their caregivers become active and informed participants in their health care decisions. In the Fall of 2001, we implemented a number of new and expanded services to make it easier than ever for Medicare beneficiaries to learn about their choices. These included expanded phone service availability for 1-800-MEDICARE, expanded web-based capabilities to help consumers compare health plan choices, and a publicity campaign on the new choices and new ways to get information. These strategies support a number of our GPRA goals in this Annual Performance Plan. The use of performance measures to improve health care quality in the Medicaid program has been primarily undertaken by State Medicaid agencies. At the national level, we do not have information on health care quality for the majority of Medicaid beneficiaries receiving care in non-institutional settings. Therefore, CMS is beginning to work with States to jointly explore a strategy for State and Federal use of PERFORMANCE PLAN AND REPORT performance measures that will improve health care delivery and quality for Medicaid and SCHIP populations using reliable and valid performance measures; this effort is reflected in a new FY 2003 goal. The CMS's FY 2003 plan reflects our continued efforts to strengthen our coordination with other organizations and to enhance data verification and validation. With respect to data issues, CMS has been careful to cite and describe data sources for each individual goal, as well as particular data concerns or limitations. Data issues are explored further in the Appendix, Section A.1. The CMS continues to increase coordination with States in the performance plan process. State Medicaid agencies are directly involved in carrying out the goals for decreasing the number of uninsured children; assisting States in conducting Medicaid payment accuracy studies, linking Medicare and Medicaid data; and increasing rates of immunization for Medicaid children. Consistent with GPRA principles, CMS has focused on identifying a set of meaningful, outcome-oriented performance goals that speak to fundamental program purposes and to the Agency's role as steward of taxpayer dollars. The Agency is confident that performance measurement under GPRA will substantially improve CMS's programmatic and administrative performance. Each goal is outlined with targets for each fiscal year. Some goal targets are labeled “developmental" goals. We include these goals in our plan to show our commitment to certain priorities while acknowledging the challenges of developing a specific, measurable goal. Performance measurement results will provide a wealth of information about the success of CMS's programs and activities. In fact, CMS is already beginning to use performance information to identify opportunities for improvement and to shape its programs. The use of GPRA goals also provides a method of clear communication of CMS's programmatic objectives to our partners, such as national professional organizations. Performance data are extremely useful in shaping policy and management choices in both the short and long term. We look forward to the challenges posed by our performance goals and are optimistic about our ability to meet them. PERFORMANCE PLAN AND REPORT PART 1 - INTRODUCTION: AGENCY CONTEXT FOR PERFORMANCE 1.1 AGENCY MISSION AND LONG-TERM GOALS The CMS's mission is to assure the health care security of our beneficiaries. Our Strategic Plan, developed in conjunction with the Strategic Plan of the Department of Health and Human Services, outlines our goals for achieving this mission over the next several years. The CMS's internal strategic planning process (begun in 1994), the HHS Strategic Plan, the enactment of GPRA, and other HHS and government-wide programs have all emphasized the themes of accountability, stewardship and a renewed focus on the customer. For CMS, this has resulted in a strengthened Agency commitment to beneficiaries as the ultimate focus of all CMS activities, expenditures, and policies. In 1999, CMS released an updated Strategic Plan to the Congress and the public, which renews the Agency's commitment to meeting beneficiary needs (Exhibit 1). Our FY 2003 performance goals will track our progress toward achieving our Strategic Plan goals outlined in Appendix Section A.3. We explicitly link our FY 2003 performance goals to the Department of Health and Human Services' Strategic Plan goals in Appendix Section A.3. |