Strategic Plan FY 2018 - 2022Every four years, HHS updates its Strategic Plan, which describes its work to address complex, multifaceted, and evolving health and human services issues. An agency strategic plan is one of three main elements required by the Government Performance and Results Act (GPRA) of 1993 (P.L. 103-62) and the GPRA Modernization Act of 2010 (P.L. 111-352). An agency strategic plan defines its mission, goals, and the means by which it will measure its progress in addressing specific national problems over a four-year period.For the period FY 2018 - 2022, HHS is publishing its Strategic Plan as a Web document, which will be updated periodically to reflect the Department’s strategies, actions, and progress toward its goals. The Web version of the Strategic Plan, rather than focusing on a static set of performance measures, provides priorities, accomplishments, and next steps that are tracked and updated frequently, reinforcing the Strategic Plan’s function as a living, vital document that serves a genuine management purpose. The Strategic Plan was last updated February 28, 2018.U.S. Department of Health and Human ServicesHHS_9b56aaae-2fed-11e1-8f79-be747a64ea2aAlex M. Azar IISecretary, Health and Human Services_dbad56c2-2413-11e8-8315-745665556326_dbad5b7c-2413-11e8-8315-745665556326HealthcareReform, Strengthen, and Modernize the Nation's Healthcare System_dbad5d8e-2413-11e8-8315-7456655563261U.S. Census BureauAccording to the U.S. Census Bureau, 91.2 percent of people carried health insurance coverage or received medical assistance for all or part of 2016. Although most people with health insurance coverage get that coverage through private plans (67.5 percent), such as employer-sponsored insurance or direct-purchase insurance, government-sponsored plans and medical assistance such as Medicare, Medicaid, Children's Health Insurance Program (CHIP), and military healthcare pay for health services for 37.3 percent of Americans.Federal GovernmentYet national health spending is expected to rise between 2017 and 2026, at an average rate of 5.5 percent per year, driven by growth in medical prices. Healthcare spending by Federal, State, Tribal, local, and territorial governments will be greater than that of private businesses, households, and other private payers due to growth in Medicare enrollment and continued government funding dedicated to subsidizing premiums for lower-income enrollees of health insurance exchanges under current law.State GovernmentsTribal GovernmentsLocal GovernmentsTerritorial GovernmentsOlder AmericansPer-person personal healthcare spending in 2012 was $18,988 for adults older than age 65, more than five times higher than the spending per child ($3,552). Compared with other Organisation for Economic Co-operation and Development (OECD) member countries, the United States ranks the highest in healthcare spending per capita, measured as a share of Gross Domestic Product (GDP). However, health outcomes do not always reflect this.American ChildrenOrganisation for Economic Co-operation and Development (OECD)ChildrenThe effort to improve healthcare quality and patient safety in many ways has been an American success story. Average life expectancy at birth - PDF has increased by nearly 30 years from the turn of the last century (47.3 years in 1900) to the beginning of this century (76.8 years in 2000). A child born in 2015 will live on average 78.8 years. However, preventable medical errors potentially take 200,000 or more American lives each year and cost the United States about $19.5 billion in additional medical costs and lost productivity from missed work.Rural AreasImproving access to healthcare is not just a matter of making it more affordable; services -- including specialized services -- are often not available within a person’s geographic area, or do not offer culturally responsive care, or are available only after delays. Inadequate access to healthcare can exacerbate health problems, increasing costs and preventing better health outcomes. For example, in 2014 - 2015, 17.3 percent of adults aged 18 to 64 had no usual source of healthcare. In 2016, only 84.7 percent of children age 2 to 17, and fewer than 65 percent of adults aged 18 and over, had a dental visit in the past year. And although 14 percent of Americans live in rural areas, only 9 percent of the Nation’s physicians practice there, despite the fact that rural residents are more likely than their urban counterparts to have higher rates of cigarette smoking, high blood pressure, and obesity.Healthcare WorkforceTo improve health in the United States, the Department is working to strengthen and expand the healthcare workforce. In 2010, the U.S. primary care workforce comprised nearly 295,000 primary care professionals, including more than 208,000 physicians, more than 55,000 nurse practitioners, and more than 30,000 physician assistants. Yet the United States lags behind more than 25 other countries in the number of doctors per capita, with only 2.6 physicians per 1,000 people. While the number of physician assistants is projected to grow by almost 72 percent by 2025, the growth rate may not provide a sufficient number of providers to address the projected primary care physician shortage.PhysiciansNurse PractitionersPhysician AssistantsDoctorsHHS DivisionsWithin HHS, the following divisions are working to reform, strengthen and modernize the Nation's healthcare system:Administration for Community Living (ACL)Agency for Healthcare Research and Quality (AHRQ)Centers for Disease Control and Prevention (CDC)Centers for Medicare & Medicaid Services (CMS)Food and Drug Administration (FDA)Health Resources and Services Administration (HRSA)Indian Health Service (IHS)Office for Civil Rights (OCR)Office of the National Coordinator for Health Information Technology (ONC)Substance Abuse and Mental Health Services Administration (SAMHSA)For a nation to thrive, its population must be healthy. Poor health reduces one’s ability to attend school, care for one’s family, or work. Without healthcare services—including physical, behavioral, and oral healthcare—to help improve health, Americans are at greater risk of poor health and human services outcomes. To improve the health of our Nation, the Department is working with its public and private partners to make healthcare affordable, high quality, and accessible for the people it serves. The Department also is making investments to strengthen and expand the healthcare workforce. This goal seeks to improve healthcare outcomes for all people across the lifespan, including the unborn, children, youth, adults, and older adults, across healthcare settings.AffordabilityPromote affordable healthcare, while balancing spending on premiums, deductibles, and out-of-pocket costs_dbad5ece-2413-11e8-8315-7456655563261.1AHRQCMSFDAPerformance Goals: * Reduce the average out-of-pocket share of prescription drug costs while in the Medicare Part D Prescription Drug Benefit coverage gap for non–Low-Income Subsidy Medicare beneficiaries who reach the gap and have no supplemental coverage in the gap * Increase the percentage of Medicare Fee-for-Service payments tied to alternative payment models. Affordability is a key component of accessible healthcare. For individuals and families, high costs of care create economic strain. Americans often have to choose between spending a higher proportion of wages on healthcare and paying for other household essentials. Without timely access to healthcare services, Americans risk worsening healthcare outcomes and higher costs. Yet for many, costs make healthcare out of reach. In 2016, the Federal Government accounted for 28 percent of healthcare spending; households, 28 percent; private businesses, 20 percent; and State and local governments, 17 percent. National Health Expenditure data show that growth in spending is due to expanded coverage and increased utilization of healthcare. HHS is committed to lowering healthcare costs for Americans to affordable levels and minimizing the burden of government healthcare spending. By increasing consumer information, offering lower-cost options and innovation in payment and service delivery models, and promoting preventive care and market competition, HHS is working with its partners to reduce the burden of higher healthcare costs. HHS is providing guidance, resources, and flexibility for States to enable them to construct competitive, affordable insurance options that best meet the needs of their citizens. Through the Quality Payment Program authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10), the Department has new ways to provide incentives to pay physicians and other practitioners for providing cost-effective, high-quality care to Medicare beneficiaries, and to provide incentives for physicians to participate in alternative payment models, which reward value over volume. HHS tests and evaluates alternative payment models that bring together private payers, healthcare providers, State partners, consumer groups, beneficiaries, and others. These models aim to reduce costs and improve the quality of care for beneficiaries, including those in at-risk populations. In 2016, data on 245.4 million people, representing 84 percent of the publicly and commercially insured population in the United States, revealed that 57 percent of healthcare spending occurred within some payment structure tied to quality, including care coordination, pay-for-performance, or shared savings. Data and evidence from these innovative models are used to inform State and Federal policymakers of the methodologies that work to reduce healthcare costs and improve quality.OptionsPromote higher-value and lower-cost healthcare options._dbad6194-2413-11e8-8315-7456655563261.1.1In 2016, the average household experienced increases in healthcare spending of 6.2 percent, primarily due to increased health insurance expenditures. Out-of-pocket spending grew 2.6 percent, physician and clinical services expenditures grew 6.3 percent, and prescription drug spending increased 9.0 percent. The Department is promoting higher-value and lower-cost healthcare options through the following strategies:Healthcare ProvidersPromote the use of high-quality, lower-cost healthcare providers, such as community health workers and community organizations, where appropriate_dbad63a6-2413-11e8-8315-745665556326Strategy 1.1.1.1Healthcare ProvidersCommunity Health WorkersCommunity OrganizationsSettingsPromote better coordination and efficiency in post-acute care by discharging patients to appropriate settings, including home and community-based services and skilled nursing facilities, using site-neutral payment rates_dbad650e-2413-11e8-8315-745665556326Strategy 1.1.1.2Home ServicesCommunity-Based ServicesSkilled Nursing FacilitiesPrescription DrugsPromote greater affordability of prescription drugs._dbad67ca-2413-11e8-8315-7456655563261.1.2Prescription drug spending growth is projected to grow an average of 6.3 percent per year through 2025. Spending growth is attributed to increased spending on new medicine, price growth for existing brand-name drugs, and fewer expensive drugs going off patent. The Department is working to promote greater affordability of prescription drugs through the following strategies:Access & CompetitionExpand access to high-quality, safe, affordable generic medicines by streamlining the generic drug application review process, enhancing the development and review of complex generic drug products, and otherwise facilitating entry of lower-cost alternatives, to increase competition in the market for prescription drugs_dbad6a22-2413-11e8-8315-745665556326Strategy 1.1.2.1Application ProcessStreamline the generic drug application review process._dbad6c66-2413-11e8-8315-745665556326Strategy 1.1.2.1.1Complex DrugsEnhance the development and review of complex generic drug products._dbad6fc2-2413-11e8-8315-745665556326Strategy 1.1.2.1.2AlternativesFacilitate entry of lower-cost alternatives_dbad7224-2413-11e8-8315-745665556326Strategy 1.1.2.1.3GenericsPromote the use and benefits of generics through beneficiary and partner educational campaigns aimed at helping those paying for the medications to better recognize the value they present_dbad73a0-2413-11e8-8315-745665556326Strategy 1.1.2.2Outpatient DrugsContinue to offer outpatient drugs to eligible healthcare organizations at reduced prices through the 340B Drug Pricing Program_dbad7684-2413-11e8-8315-745665556326Strategy 1.1.2.3OutpatientsHealthcare OrganizationsDataCollect, analyze, and apply data to improve access to affordable healthcare._dbad78a0-2413-11e8-8315-7456655563261.1.3From 2000 to 2015, national health expenditures increased from 13.3 percent to 17.8 percent of the U.S. Gross Domestic Product. Per capita expenditures rose from $4,857 to $9,990 per person. More than 16 percent of people under age 65 reported that their family spent more than 10 percent of total family income on health insurance premiums and out-of-pocket costs in 2014. The Department will continue to collect, analyze, and apply data to improve access to affordable healthcare through the following strategies:CostsProvide information on the prevalence, causes, and consequences of high healthcare financial costs, including social factors that exacerbate costs_92da00da-241d-11e8-a426-058f67556326Strategy 1.1.3.1Education & InformationPartner with States, community organizations, and the private and nonprofit sectors to educate Americans about their health insurance coverage options and how they can identify the best plan for themselves, and to provide information on how Americans can access and use their benefits_92da0a8a-241d-11e8-a426-058f67556326Strategy 1.1.3.2StatesCommunity OrganizationsPrivate SectorNonprofit SectorPremiums, Payments, Deductibles & MaximumsTrack trends in premiums, out-of-pocket payments, deductibles, and out-of-pocket maximums in health insurance plans_92da0f4e-241d-11e8-a426-058f67556326Strategy 1.1.3.3 Digital StrategiesEnhance digital strategies to empower consumers_92da117e-241d-11e8-a426-058f67556326Strategy 1.1.3.4Regulatory RequirementsExamine regulatory requirements that may differentially burden providers_92da16d8-241d-11e8-a426-058f67556326Strategy 1.1.3.5Preventive CarePromote preventive care to reduce future medical costs._dbad7a1c-2413-11e8-8315-7456655563261.1.4Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of every 10 deaths among Americans each year and account for 75 percent of the Nation’s health spending. The Department is working to promote preventive care to reduce future medical costs through several strategies: Note: Additional strategies on preventive care are in Strategic Objectives 2.1, 2.2, and 2.3.Prenatal, Maternal & Postpartum CareReduce the need for avoidable medical costs and improve health outcomes of pregnant women and newborns by increasing use of timely prenatal, maternal, and postpartum care_dbad7d0a-2413-11e8-8315-745665556326Strategy 1.1.4.1 Pregnant WomenNewbornsDiabetes & Cardiovascular DiseasePromote and implement lifestyle change interventions and intensive case management to reduce risk of diabetes and cardiovascular disease in high-risk individuals_dbad7f26-2413-11e8-8315-745665556326Strategy 1.1.4.2Chronic ConditionsProvide chronic care management services to patients with multiple chronic conditions, including comprehensive care management, a care plan, and care transitions_dbad80b6-2413-11e8-8315-745665556326Strategy 1.1.4.3Cost & ValueStrengthen consumer decision making and transparency about the cost and value of healthcare_dbad839a-2413-11e8-8315-7456655563261.1.5Healthcare ConsumersIn 2015, approximately 20.1 million people in the United States delayed medical care during the preceding year because of worry about the cost, and 14.2 million did not receive needed medical care because they could not afford it. The Department is working to strengthen informed consumer decision making and transparency about the cost and value of healthcare through the following strategies:Comparison & Decision-MakingEnhance comparison and decision-making tools, such as Hospital Compare and Nursing Home Compare, to help Americans make informed decisions about healthcare, including coverage options, providers, and treatments_dbad85c0-2413-11e8-8315-745665556326Strategy 1.1.5.1Spending, Services & SupportBuild out and broaden models, such as Medicaid's Self Directed Services, that allow beneficiaries the option of managing more of their healthcare dollars, services, and supports_dbad8750-2413-11e8-8315-745665556326Strategy 1.1.5.2MedicaidHealth LiteracySupport health literacy tools, such as Coverage to Care or the Person and Family Engagement Strategy, which focus on increasing health literacy and consumer connections to healthcare, as well as partnership efforts to promote understanding of health coverage, costs, and terminology, so that consumers can choose the most appropriate, affordable health plan to receive the healthcare services they need_dbad8a3e-2413-11e8-8315-745665556326Strategy 1.1.5.3Individual MarketStabilize the market, implement policies that increase the mix of younger and healthier consumers purchasing plans through the individual market, and reduce premium increases_dbad8c6e-2413-11e8-8315-745665556326Strategy 1.1.5.4Young AmericansHealthy AmericansEligibility & EnrollmentStreamline eligibility and enrollment processes for community supports so that all populations have access to the services they need_dbad8e08-2413-11e8-8315-745665556326Strategy 1.1.5.5Quality & ValueIncentivize healthcare quality and value-based care._dbad9114-2413-11e8-8315-7456655563261.1.6Value-based programs reward healthcare providers with incentive payments for the quality of care they provide. These programs seek to achieve better care for individuals, better health for populations, and lower costs overall. The Department is working to incentivize healthcare quality and value-based care through the following strategies: Note: Additional healthcare quality strategies are in Strategic Objective 1.2.Risk & DetectionPromote the application of proven clinical preventive services for high-impact risk factors and early-stage disease detection, through Federal guidelines, quality measurement, and partnerships with accrediting and other organizations_dbad93b2-2413-11e8-8315-745665556326Strategy 1.1.6.1Accrediting OrganizationsROIImprove return on investment of Federal and State spending by encouraging development of payment models that reward value over volume Incentivize better planning, coordination, and management of services across the continuum of care to improve outcomes for people with chronic conditions_dbad9556-2413-11e8-8315-745665556326Strategy 1.1.6.2ModelsBuild out and broaden models that improve quality and reduce costs_dbad984e-2413-11e8-8315-745665556326Strategy 1.1.6.3Options, Innovation & CompetitionExpand safe, high-quality healthcare options, and encourage innovation and competition_dbad9a92-2413-11e8-8315-7456655563261.2ACLAHRQCDCCMSHRSAOCRONCSAMHSAAcute Care HospitalsAmbulatory Surgical CentersDialysis CentersLong-Term Care FacilitiesPerformance Goals: * Increase the percentage of hospitals reporting implementation of antibiotic stewardship programs fully compliant with the CDC Core Elements of Hospital Antibiotic Stewardship Programs * Reduce the all-cause hospital readmission rate for Medicare-Medicaid enrollees * Meet the following patient safety goals: - Improve hospital patient safety by reducing preventable patient harms - Reduce the standardized infection ratio for central line–associated bloodstream infections in acute care hospitals - Reduce the standardized infection ratio for hospital-onset Clostridium difficile infections. Strengthening the Nation's healthcare system cannot be achieved without improving healthcare quality and safety for all Americans. The immediate consequences of poor quality and safety include healthcare-associated infections, adverse drug events, and antibiotic resistance. Healthcare safety is a national priority. When the Office of Inspector General examined - PDF the health records of hospital inpatients in 2008, it determined that hospital care contributed to the deaths of 15,000 Medicare beneficiaries each month. Healthcare-associated infections are infections people get while they are receiving medical treatment or undergoing surgery. At any given time, about 1 in 25 patients have an infection related to hospital care. Infections lead to the loss of tens of thousands of lives and cost the U.S. healthcare system billions of dollars each year. Adverse drug events -- injuries resulting from medical intervention related to a drug -- result in more than 3.5 million physician office visits, 1 million emergency department visits, and 125,000 hospital admissions each year. Antibiotic overuse has contributed to Clostridium difficile infections, the most common microbial cause of healthcare-associated infections, responsible for more than half a million infections and nearly 15,000 deaths in a single year. And each year in the United States, 2 million people become infected with antibiotic-resistant bacteria, directly resulting in the deaths of 23,000 people each year, as well as $20 billion in increased healthcare costs and $35 billion in lost productivity. Yet these consequences are preventable. Recognizing the unique challenges of different healthcare settings -- including acute care hospitals, ambulatory surgical centers, dialysis centers, and long-term care facilities -- HHS has developed specific strategies to reduce the incidence and impact of healthcare-associated infections in these settings. Through surveillance, antibiotic stewardship, diagnostic innovations, and research strategies, HHS is working to combat antibiotic-resistant bacteria. HHS also focuses on three key drug classes -- anticoagulants, diabetes, and opioids -- to prevent adverse drug events. HHS investments in prevention have yielded both human and economic benefits. From 2010 to 2014, efforts to reduce hospital-acquired conditions and infections have resulted in a decrease of 17 percent nationally, translating to 87,000 lives saved, $19.8 billion in unnecessary health costs averted, and 2.1 million instances of harm avoided.IncentivesIncentivize safe, high-quality care._dbad9c40-2413-11e8-8315-7456655563261.2.1Through the Quality Payment Program authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114–10), the Department has new ways to provide incentives to pay physicians and other practitioners for providing cost-effective, high-quality care to Medicare beneficiaries, and to provide incentives to physicians to participate in alternative payment models, which reward value over volume. Through these and other efforts, the Department is working to incentivize safe, high-quality care through the following strategies:Payment & DeliveryDevelop new payment and service delivery model concepts that aim to reduce healthcare costs by speeding the adoption of best practices, encouraging care coordination, and promoting evidence-based care, and expand opportunities for Medicare and Medicaid alternative payment models to incentivize value-based care options_dbad9f92-2413-11e8-8315-745665556326Strategy 1.2.1.1Preventive ServicesImprove provision of, and access to, appropriate preventive services for Medicare beneficiaries, through improved understanding of uptake of preventive benefits, particularly for those individuals who are high risk_dbada1e0-2413-11e8-8315-745665556326Strategy 1.2.1.2Medicare BeneficiariesMetricsStrengthen the development, implementation, and reporting of measures for reducing health disparities_dbada398-2413-11e8-8315-745665556326Strategy 1.2.1.3Quality VariationPromote research on how to recognize variation in quality of healthcare provision due to circumstances outside the control of the provider_dbada6f4-2413-11e8-8315-745665556326Strategy 1.2.1.4Safety & Adverse EventsImprove patient safety and prevent adverse events._dbada942-2413-11e8-8315-7456655563261.2.2PatientsThe Healthcare-Associated Infections Progress Report found that rates of central line-associated bloodstream infections declined 50 percent from 2008 to 2014, and rates of surgical site infections declined 17 percent, although the rate of catheter-associated urinary tract infections did not change. The 2016 National Healthcare Quality and Disparities Report, which tracks a broad range of patient safety indicators, found that about two-thirds of patient safety measures were improving. The Department continues to work to improve patient safety and prevent adverse events such as healthcare-associated infections and medication harms across the healthcare system through the following strategies:Research & InnovationSupport research and innovation to strengthen evidence-based recommendations_dbadab04-2413-11e8-8315-745665556326Strategy 1.2.2.1Gaps & RisksAddress quality gaps and safety risks for healthcare-associated conditions_dbadae6a-2413-11e8-8315-745665556326Strategy 1.2.2.2Infections & Antibiotic ResistanceDevelop improved methods and strategies to prevent healthcare-associated infections and combat antibiotic resistance_dbadb0c2-2413-11e8-8315-745665556326Strategy 1.2.2.3Tools, Training & ResourcesTranslate knowledge and evidence into practical tools, training, and other resources to accelerate progress to improve quality and patient safety_dbadb28e-2413-11e8-8315-745665556326Strategy 1.2.2.4Information TechnologyLeverage technology solutions to support safe, high-quality care._dbadb5ea-2413-11e8-8315-7456655563261.2.3The 21st Century Cures Act of 2016 (Pub. L. 114–255) provides the Department with authority to advance the interoperability and usability of health information technology. In 2015, 77.9 percent of office-based physicians had a certified electronic health record system. However, in 2015, only about one-third of physicians had electronically sent, received, integrated, or searched for patient health information with other providers, and only 8.7 percent had performed all four of these activities. In 2015, the Shared Nationwide Interoperability Roadmap was published to enhance the Nation’s health information technology infrastructure to support information sharing. The Department will work to leverage technology solutions to support safe, high-quality care through the following strategies:Clinical InformationAdvance interoperable clinical information flows so that patients, providers, payers, and others can efficiently send, receive, and analyze data across primary care, acute care, specialty care including behavioral healthcare, and post-acute care settings_dbadb84c-2413-11e8-8315-745665556326Strategy 1.2.3.1PatientsProvidersPayersTools & WorkflowsPromote implementation of understandable, functional health information technology tools to support provider and patient decision making, and to support workflows for healthcare providers._dbadba68-2413-11e8-8315-745665556326Strategy 1.2.3.2Healthcare ProvidersTeamsImplement team-based approaches to care._dbadbdec-2413-11e8-8315-7456655563261.2.4Healthcare TeamsTeam-based care is the provision of health services to individuals, families, and communities by at least two health providers who work collaboratively with patients and their caregivers to accomplish shared goals and achieve coordinated, high-quality care. The Department is working to implement team-based approaches to care through the following strategies:Innovation & EvidenceCollaborate with healthcare systems and community partners to facilitate the spread of evidence-based clinical practices and the appropriate incorporation of innovations that advance patient care_dbadc04e-2413-11e8-8315-745665556326Strategy 1.2.4.1Connections & TransitionsPromote and implement models that connect primary care, acute care, behavioral healthcare, and long-term services and supports, and that use health information technology effectively, to facilitate transitions between care settings, especially for dually eligible Medicare-Medicaid enrollees_dbadc22e-2413-11e8-8315-745665556326Strategy 1.2.4.2Medicare EnrolleesMedicaid EnrolleesBehavioral HealthImplement a collaborative model for behavioral health integration with primary care that is team driven, population focused, measurement guided, and evidence based._dbadc59e-2413-11e8-8315-745665556326Strategy 1.2.4.3Person-Centered CareEmpower patients, consumers, families, and other caregivers to facilitate the delivery and increase the use of person-centered care._dbadc80a-2413-11e8-8315-7456655563261.2.5PatientsConsumersFamiliesCaregiversPerson-centered care is an approach to service delivery that ensures that services are respectful of, and responsive to, the preferences, needs, and values of people and those who care for them. The Department is working to empower patients, consumers, families, and other caregivers to facilitate the delivery and increase the use of person-centered care through the following strategies:EngagementExpand the engagement of patients, families, and other caregivers in developing and implementing programs that improve the quality of care and increase access to services available to them_dbadc9ea-2413-11e8-8315-745665556326Strategy 1.2.5.1PatientsFamiliesCaregiversExperience & Outcome MetricsPromote the development, implementation, and use of experience and outcome measures, including patient-reported data and price transparency data, as appropriate, for use in quality reporting_dbadcd6e-2413-11e8-8315-745665556326Strategy 1.2.5.2Care PlanningSupport patient, consumer, and caregiver involvement in care planning, as appropriate, to ensure that care is person centered, responding to the needs and wishes of those being served, including their religious or conscience needs and wishes_dbadcfee-2413-11e8-8315-745665556326Strategy 1.2.5.3PatientsConsumersCaregiversDisparitiesReduce disparities in quality and safety._dbadd200-2413-11e8-8315-7456655563261.2.6While patient safety measures have been improving overall, disparities persist. For example, hospital readmissions for conditions like congestive heart failure and pneumonia are higher for people on Medicaid than for Medicare beneficiaries, yet adverse drug events in hospitals are higher among Medicare beneficiaries than for people on Medicaid. The Department is working to reduce disparities in quality and safety through the following strategies: Note: Additional strategies to strengthen the healthcare workforce are in Strategic Objective 1.4.Health Information TechnologyEnhance the use of health information technology among safety-net providers and community-based organizations to inform decision making, better engage people in their care, improve public health outcomes, and increase public health reporting_dbadd5a2-2413-11e8-8315-745665556326Strategy 1.2.6.1Safety-Net ProvidersCommunity-Based OrganizationsCulturally Appropriate CareEncourage and support a healthcare workforce that delivers culturally appropriate care, across all settings_dbadd80e-2413-11e8-8315-745665556326Strategy 1.2.6.2Healthcare WorkforcePerson-Centered CareIncrease capacity to provide person-centered care by promoting geriatric-competent, disability-competent, and culturally competent care through training programs that teach these concepts and require practicing them_dbadda02-2413-11e8-8315-745665556326Strategy 1.2.6.3Training & AssistancePromote technical training and assistance to disseminate promising practices around geriatric-competent, disability-competent, and culturally competent care_dbaddd90-2413-11e8-8315-745665556326Strategy 1.2.6.4Information Levels & FormatsProvide health information in culturally appropriate and health-literacy-appropriate levels, and in alternative formats, such as in languages other than English, to improve access to health information_dbade060-2413-11e8-8315-745665556326Strategy 1.2.6.5Risk FactorsConduct, fund, and apply research on the role of other risk factors and their impact on health, as appropriate, to improve health outcomes, including access, quality, and safety_dbade25e-2413-11e8-8315-745665556326Strategy 1.2.6.6DataCollect, analyze, and apply data to improve access to safe, high-quality healthcare._dbade632-2413-11e8-8315-7456655563261.2.7The two primary systems for tracking progress toward safe, high-quality healthcare are the National Healthcare Quality and Disparities Report, which directly tracks measures of healthcare quality, and Healthy People, which tracks measures of health. Both reports noted significant variation in the proportion of healthcare quality measures that were improving in relation to sex, race/ethnicity, socioeconomic status, disability status, and geographic location. The Department will continue to work to collect, analyze, and apply data to improve access to safe, high-quality healthcare through the following strategies:Evidence & ImprovementImprove quality in healthcare delivery by helping healthcare organizations apply evidence for continuous policy, process, and outcomes improvement, such as through Medicare's Quality Payment Program_dbade8bc-2413-11e8-8315-745665556326Strategy 1.2.7.1Healthcare OrganizationsMedicarePerformance DataExpand measurement and reporting of stratified performance data to identify health disparities, show gaps in access to safe, high-quality healthcare options, and enable quality improvement_dbadeac4-2413-11e8-8315-745665556326Strategy 1.2.7.2Access, Engagement & PracticesCollect additional data that will allow HHS to identify barriers to access, facilitate consumer engagement, and promote evidence-based practices, to improve access to physical and behavioral health services_dbadee84-2413-11e8-8315-745665556326Strategy 1.2.7.3Quality & DisparitiesMeasure and report on healthcare quality and disparities at the national, State, Tribal, local, territorial, and individual provider level to facilitate a more complete understanding of the factors that may influence healthcare quality and lead to improvements in the healthcare system_dbadf122-2413-11e8-8315-745665556326Strategy 1.2.7.4Health Care ProvidersCommunication & CoordinationSupport communication and coordination between public health practitioners and clinicians to improve use of data and increase use of evidence-based prevention strategies to address risk factors, and their underlying causes, for disease and health conditions, and implement rapid responses to address outbreaks of infectious disease_dbadf32a-2413-11e8-8315-745665556326Strategy 1.2.7.5Public Health PractitionersCliniciansAccess & OptionsImprove Americans' access to healthcare and expand choices of care and service options_dbadf6ea-2413-11e8-8315-7456655563261.3American IndiansSome populations, including American Indians and Alaska Natives, experience unique challenges when attempting to access care, due to factors such as inadequate supply of healthcare providers and geographic barriers.Alaska NativesTribal PopulationsFor Tribal populations, the Department plans and constructs healthcare facilities, youth regional treatment centers for substance abuse, small ambulatory care facilities, and other healthcare resources to eliminate geographic barriers that can prevent people from accessing care. In addition, the Department continues to be committed to implementing Executive Order 13166, Title VI of the Civil Rights Act of 1964, Sections 504 and 508 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, Section 1557 of the Patient Protection and Affordable Care Act to support access to care and prevent discriminatory practices, and authorities that protect religious freedom and the exercise of conscience rights.Uninsured PeopleIn 2014, 86.7 percent of people younger than age 65 had health insurance, including government and private coverage, and 76.4 percent of people had a usual primary care provider. However, more than 10 percent of all people were unable to obtain or delayed obtaining necessary medical care, dental care, or prescription medicines.WomenThe 2016 National Health Interview Survey reports that 4.4 percent of people failed to obtain medical care due to cost, with adult women more likely than adult men to have failed to obtain needed medical care due to cost.ACLCMSHRSAIEAIHSOCROGASAMHSAPerformance Goals: * Track the number of individuals who receive direct services through the Federal Office of Rural Health Policy Outreach grants, subject to the availability of resources * Improve patient and family engagement by improving shared decision making Increase telebehavioral health encounters nationally among American Indians and Alaska Natives. The Department defines access to health services as "the timely use of personal health services to achieve the best health outcomes." It involves gaining entry into the healthcare 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 healthcare provider. Efforts to improve access to care are not limited to physical healthcare. Improving access to behavioral and oral healthcare, including through innovative solutions that use health information technology, also is critical, especially for populations experiencing disparities in access. Lack of access to care presents a myriad of problems with both human and economic costs -- including clinically significant delays in care, increased complications, higher treatment costs, and increased hospitalizations. The Department pursues multiple approaches to address barriers to care... 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. Strategies related to promoting affordability and strengthening the workforce are addressed in Strategic Objectives 1.1 and 1.4. This Strategic Objective focuses on how HHS, rather than instituting government mandates, is giving people more control over how they access care, through increasing the spectrum of consumer options and expanding competition among healthcare providers, including by removing barriers to participation in the healthcare sector for religious, faith-based, and other providers.ChoicesImprove consumer choices._dbadf988-2413-11e8-8315-7456655563261.3.1Healthcare ConsumersExecutive Order 13765, Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal, and Executive Order 13813, Promoting Healthcare Choice and Competition Across the United States, instituted policies intended to improve consumer choices. In support of these Executive orders, the Department will pursue the following activities:Costs & BurdensTo the maximum extent permitted by law, waive, defer, grant exemptions from, or delay implementation of any provision or requirement of the Patient Protection and Affordable Care Act that would impose a fiscal burden on any State or cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications_dbadfba4-2413-11e8-8315-745665556326Strategy 1.3.1.1StatesIndividualsFamiliesHealthcare ProvidersHealth InsurersPatientsRecipients of Healthcare ServicesPurchasers of Health InsuranceMakers of Medical DevicesMakers of Medical ProductsMakers of MedicationsLimited-Duration InsurancePropose regulations or revise guidance, consistent with law, to expand the availability of short-term, limited-duration insurance, which is exempt from certain Federal insurance mandates and regulations_dbadff96-2413-11e8-8315-745665556326Strategy 1.3.1.2ReimbursementsPropose regulations or revise guidance, to the extent permitted by law and supported by sound policy, to increase the usability of health reimbursement arrangements, to expand employers' ability to offer this option to their employees_dbae0248-2413-11e8-8315-745665556326Strategy 1.3.1.3EmployersEmployeesOptionsExpand healthcare coverage options._dbae0478-2413-11e8-8315-7456655563261.3.2The Department is committed to promoting access to high-quality, affordable healthcare for all Americans, increasing patient choices, and lowering premiums. A key component of current healthcare reform efforts emphasizes price transparency of all healthcare providers, allowing consumers to shop more easily for the best prices for their care. Consumers of healthcare should be able to choose the options that make the most sense for themselves, their families, and their budgets. The Department is working to expand healthcare coverage options through the following strategies:Medicare Advantage & Part DExpand plan choice in the Medicare Advantage and Part D Prescription Drug programs by reducing administrative, regulatory, and operational burdens, while protecting the integrity and soundness of these programs_dbae08a6-2413-11e8-8315-745665556326Strategy 1.3.2.1Medicare EnrolleesNew & Innovative ProductsPromote patient access to new and innovative medical products by conducting timely, patient-centered reviews for coverage_dbae0b6c-2413-11e8-8315-745665556326Strategy 1.3.2.2Coverage DecisionsMake information regarding coverage decisions publicly available where possible_dbae0db0-2413-11e8-8315-745665556326Strategy 1.3.2.3Physical & Behavioral CareImprove access of Medicare-Medicaid dual enrollees to fully integrated physical and behavioral care options, such as Medicare-Medicaid Plans, Programs of All-Inclusive Care for the Elderly (PACE), and dual-eligible Special Needs Plans, designed to address the unique healthcare needs of dual-eligible individuals_dbae1198-2413-11e8-8315-745665556326Strategy 1.3.2.4Medicare EnrolleesMedicaid EnrolleesEmploymentAllow State Medicaid programs to promote employment, to help improve health outcomes among recipients of medical assistance_dbae145e-2413-11e8-8315-745665556326Strategy 1.3.2.4State Medicaid ProgramsAlzheimer's Disease & DementiasEnhance care quality and efficiency by exploring the effectiveness of new models of care and advancing coordinated and integrated health and long-term services and supports for people living with Alzheimer's disease and related dementias_dbae16a2-2413-11e8-8315-745665556326Strategy 1.3.2.5Understanding & DecisionsImprove consumer understanding of healthcare options and consumer-directed healthcare decisions._dbae1a8a-2413-11e8-8315-7456655563261.3.3Healthcare ConsumersHealthcare reform will focus on improving quality and affordable care for all Americans. The Department is committed to strengthening consumers’ informed healthcare decision making through cost-quality comparisons and tools to reduce individual and overall costs in healthcare. The Department is pursuing the following strategies to improve consumer understanding of healthcare options and consumer-directed healthcare decisions:Care & Insurance OptionsPromote information and assistance that is accessible, transparent, and provided in understandable formats to ensure that care and insurance options meet consumers' needs_dbae1d5a-2413-11e8-8315-745665556326Strategy 1.3.3.1Mental Health & AddictionCollaborate across Federal agencies and stakeholders to ensure effective and coordinated implementation and enforcement of mental health and addiction parity laws_dbae1f9e-2413-11e8-8315-745665556326Strategy 1.3.3.2Payment & Service DeliveryExpand the use of innovative payment and service delivery models, including those to encourage patients to use high-value clinical services and optimize medication use based upon their specific healthcare needs_dbae23ae-2413-11e8-8315-745665556326Strategy 1.3.3.3Benefits, Fraud & AbuseProvide information through partners and trusted intermediaries, including Tribes and faith-based and other community organizations, on how to access and use benefits and avoid fraud or abuse_dbae267e-2413-11e8-8315-745665556326Strategy 1.3.3.4TribesFaith-Based OrganizationsCommunity OrganizationsOptionsDesign healthcare options that are responsive to consumer demands, while removing barriers to participation for faith-based and other community-based providers._dbae28cc-2413-11e8-8315-7456655563261.3.4Faith-Based ProvidersCommunity-Based ProvidersEvidence supports policies of increasing consumer engagement and public awareness as solutions to reducing healthcare costs, but much remains to be done. Americans may be willing to price-shop, but their priorities for maintaining a preferred provider and the challenges of coordinating care across many providers must continue to be studied for their impact on healthcare reform. The Department is designing healthcare options that are responsive to consumer demands, while removing barriers to participation for faith-based and other community-based providers, through the following strategies:Global PartnersEngage with global partners to learn about effective healthcare models and best practices that could be used domestically for the benefit of the American people_dbae2cd2-2413-11e8-8315-745665556326Strategy 1.3.4.1Ideas, Strategies & Best PracticesSeek ideas, strategies, and best practices from the private sector, Tribes, and faith-based and community organizations that can be introduced to Department-administered programs, to meet evolving consumer needs_dbae2ff2-2413-11e8-8315-745665556326Strategy 1.3.4.2Private SectorTribesFaith-Based OrganizationsCommunity OrganizationsDisparitiesReduce disparities in access to healthcare._dbae324a-2413-11e8-8315-7456655563261.3.5Despite the Nations advancements in health and medicine, care is still not equally available and accessible across communities, populations, socioeconomic groups, and ethnicities. Disparities in access to, use of, and quality of care can lead to disparities in health outcomes. For example, American Indians and Alaska Natives born today have a life expectancy that is 4.4 years less than that of the average U.S. population. The Department is working to reduce disparities in access to healthcare through the following strategies:Person-Centered CareAssess person-centered models of care, including patient-centered medical home recognition and care integration, and support the adoption and evolution of such models that reduce expenditures and improve quality_dbae3678-2413-11e8-8315-745665556326Strategy 1.3.5.1Enrollment, Retention & ProvidersSimplify enrollment, eliminate barriers to retention, and address shortages of healthcare providers who accept Medicare or Medicaid and providers who offer specialized care_dbae3966-2413-11e8-8315-745665556326Strategy 1.3.5.2Medicare ProvidersMedicaid ProvidersSpecialized Care ProvidersCoverage OptionsProvide consumers more options to shop for coverage in the individual insurance market_dbae3d3a-2413-11e8-8315-745665556326Strategy 1.3.5.3Healthcare ConsumersHealthcare AccessProvide resources and tools to providers and plans to encourage implementation of activities and strategies to help improve healthcare access_dbae4186-2413-11e8-8315-745665556326Strategy 1.3.5.4Chronic DiseaseIncrease access to preventive services, home and community-based services and social supports, and care management in areas and populations with high chronic disease burdens_dbae4488-2413-11e8-8315-745665556326Strategy 1.3.5.5Women's HealthIncrease access to preventive services to support women's health, including adaptive mammography equipment in clinics, prenatal/pregnancy care and supports, and lactation accommodations and other breastfeeding supports_dbae46ea-2413-11e8-8315-745665556326Strategy 1.3.5.6WomenHealthy PregnancyPromote healthy pregnancy by protecting unborn children from harm through proven strategies such as receipt of adequate prenatal care and the identification and treatment of diabetes and hypertension_dbae4b4a-2413-11e8-8315-745665556326Strategy 1.3.5.7Unborn ChildrenIndividuals & Populations at RiskIdentify individuals and populations at risk for limited healthcare access and assist them to access health services, including prevention, screening, linkages to care, clinical treatment, and relevant support services, including through mobilization of Tribes and faith-based and community organizations_dbae4e6a-2413-11e8-8315-745665556326Strategy 1.3.5.8Individuals at RiskPopulations at RiskPeople with DisabilitiesRemove barriers to inclusion and accessibility for people with disabilities in acute care, post-acute care, and community-based settings_dbae50d6-2413-11e8-8315-745665556326Strategy 1.3.5.9People with DisabilitiesWorkforceStrengthen and expand the healthcare workforce to meet Americas diverse needs_dbae55ae-2413-11e8-8315-7456655563261.4CDCCMSHRSAIHSOCRSAMHSAPerformance Goals: Support field strength of the National Health Service Corps through scholarship and loan repayment agreements. Whether people access healthcare in a doctor’s office, in a health center, in a pharmacy, at home, or through a mobile device, they depend on a qualified, competent, responsive workforce to deliver high-quality care. Yet population growth and the aging U.S. population, among other factors, are generating increasing demand for physicians, with demand among the older population expected to grow substantially. From 2014 to 2025, the U.S. population age 65 and older is expected to grow 41 percent, compared with 8.6 percent for the population as a whole and 5 percent for those younger than age 18. Because the elderly have higher healthcare use per capita, compared with younger populations, the increase in demand for healthcare services for older adults is projected to be much greater than the increase in demand for pediatric healthcare. The U.S. Health Workforce Chartbook estimated that more than 14 million individuals -- 10 percent of the Nation's workforce -- worked for the healthcare sector in 2010. The largest health occupation groups were registered nurses; nursing, psychiatric, and home health aides; personal care aides; physicians; medical assistants and other healthcare support occupations; and licensed practical and licensed vocational nurses. Employment in healthcare occupations is projected to grow 19 percent from 2016 to 2026 much faster than the average for all occupations, because of the aging population and increased access to health insurance and medical assistance. HHS regularly produces reports projecting growth or deficits in the supply and demand of various occupations in the healthcare workforce. At a national level, by 2025, demand is expected to exceed supply for several critical health professions, including primary care practitioners, geriatricians, dentists, and behavioral health providers, including psychiatrists, mental health and substance abuse social workers, mental health and substance use disorder counselors, and marriage and family therapists. At a State level, the picture is more complex, with some States projected to experience greater deficits in certain healthcare occupations. For example, rural areas experience greater shortages in the oral and behavioral health workforces. HHS works in close partnership with academic institutions, advisory committees, research centers, and primary care offices. These collaborations help HHS make informed decisions on policy and program planning to strengthen and expand the workforce.DataCollect, analyze, and apply data to understand opportunities to strengthen the healthcare workforce._dbae58ce-2413-11e8-8315-7456655563261.4.1Healthcare WorkforceThe Department provides detailed information on 35 healthcare occupations and occupational groupings, describing variations in age, demographics, work settings, and geographic distribution of the healthcare workforce. The Department will collect, analyze, and apply data to understand opportunities to strengthen the healthcare workforce through the following strategies:Characteristics, Gaps, Needs & TrendsConduct monitoring, occupational forecasting, data collection and analysis, and general research on the healthcare workforce to identify the characteristics, gaps, needs, and trends, and determine where to target resources to strengthen the workforce_dbae5b44-2413-11e8-8315-745665556326Strategy 1.4.1.1Ambulatory CareCollect data on ambulatory care services in hospital emergency and outpatient departments and ambulatory surgery locations, to estimate the number of physicians needed to provide care_dbae5fb8-2413-11e8-8315-745665556326Strategy 1.4.1.2PhysiciansHospital Emergency DepartmentsOutpatient DepartmentsAmbulatory Surgery LocationsProfessional DevelopmentSupport professional development of the workforce._dbae62ce-2413-11e8-8315-7456655563261.4.2Healthcare WorkforceTraining, fellowships, and other opportunities not only strengthen the healthcare workforce, help them learn new skills, and advance their careers, but also result in better care. The Department is supporting professional development of the workforce through the following strategies:Safety & Scientific KnowledgeIncrease awareness and promote use of clinical decision support and patient-provider communication tools, and share evidence-based practices and training opportunities to provide safety and scientific knowledge to the workforce_dbae6558-2413-11e8-8315-745665556326Strategy 1.4.2.1Health OccupationsExpand and transform the healthcare workforce through the training and engagement of emerging health occupations, such as community health workers and promotores de salud, and community partners to enhance the provision of culturally, linguistically, and disability-appropriate services, and increase workforce diversity_dbae69cc-2413-11e8-8315-745665556326Strategy 1.4.2.2Healthcare WorkforceCommunity Health WorkersPromotores de SaludCommunity PartnersClinical TrainingTransform clinical training environments to develop a healthcare workforce that maximizes patient, family, and caregiver engagement and improves health outcomes for older adults by integrating geriatrics and primary care_dbae6cec-2413-11e8-8315-745665556326Strategy 1.4.2.3Competency TrainingIncrease access to quality trainings for public health workers that address cross-cutting competencies_dbae6f76-2413-11e8-8315-745665556326Strategy 1.4.2.4Public Health WorkersProvider ShortagesReduce provider shortages in underserved and rural communities._dbae73ea-2413-11e8-8315-7456655563261.4.3Underserved CommunitiesRural CommunitiesThroughout the United States, some geographic areas, populations, and facilities have too few primary care, dental, and mental health providers and services, and are classified as Health Professional Shortage Areas. The Department is working to reduce provider shortages in underserved and rural communities through the following strategies:Primary Care & Behavioral Health ProvidersSupport the training, recruitment, placement, and retention of primary care providers and behavioral health providers in underserved and rural communities through scholarships, student loan repayment, local recruitment, externships, and other incentives_dbae770a-2413-11e8-8315-745665556326Strategy 1.4.3.1Primary Care ProvidersBehavioral Health ProvidersUnderserved CommunitiesRural CommunitiesIncentivesIncentivize healthcare providers to work in underserved and rural areas, including Tribal communities_dbae7994-2413-11e8-8315-745665556326Strategy 1.4.3.2Healthcare ProvidersUnderserved AreasRural AreasTribal CommunitiesMental DisordersAssist primary care practices in integrating services for mental disorders, including substance use disorders, to expand access in underserved and rural communities_dbae7e58-2413-11e8-8315-745665556326Strategy 1.4.3.3Primary Care PracticesUnderserved CommunitiesRural CommunitiesBehavioral & Oral Health ServicesImprove access to behavioral and oral health services in underserved and rural communities by supporting the recruitment, placement, and retention of behavioral health, dental health, and primary care providers to address workforce shortages, reduce disparities, and ensure an equitable workforce distribution_dbae8182-2413-11e8-8315-745665556326Strategy 1.4.3.4Behavioral Health ProvidersDental Care ProvidersPrimary Care ProvidersTelehealth & TechnologyUse telehealth and technology solutions to increase access to and improve quality of care in rural and underserved areas, including for American Indians and Alaska Natives_dbae8420-2413-11e8-8315-745665556326Strategy 1.4.3.5Rural AreasUnderserved AreasAmerican IndiansAlaska NativesReligious FreedomSupport religious freedom and ensure removal of barriers to participation in healthcare for healthcare providers with religious beliefs or moral convictions_dbae889e-2413-11e8-8315-7456655563261.4.4Healthcare ProvidersExecutive Order 13798, Promoting Free Speech and Religious Liberty, instituted a policy that protects the freedom of Americans and their organizations to exercise religion and participate fully in civic life without undue interference by the Federal Government. In addition, there are long-standing laws, applicable to HHS and its programs, which protect the religious liberty and conscience rights of healthcare providers and others. In support of religious freedom, and to ensure removal of barriers to participation in healthcare for healthcare providers with religious beliefs or moral convictions, the Department will pursue the following activities:Laws, Regulations & AuthoritiesVigorously enforce laws, regulations, and other authorities protecting religious freedom and conscience in HHS-funded, HHS-regulated, HHS-conducted, and/or HHS-administered programs or activities, and engage in related outreach_dbae8bdc-2413-11e8-8315-745665556326Strategy 1.4.4.1Barriers & BurdensIdentify and remove undue barriers to, or burdens imposed on, the exercise of religious beliefs and/or moral convictions by persons or organizations partnering with or served by HHS, and affirmatively accommodate such beliefs and convictions, to ensure full and active engagement of persons of faith or moral conviction and of faith-based organizations in the work of HHS_dbae8e84-2413-11e8-8315-745665556326Strategy 1.4.4.2Faith-Based OrganizationsPersons of FaithParticipationPromote equal and nondiscriminatory participation by persons of faith or moral conviction and by faith-based organizations in HHS-funded, HHS-regulated, HHS-conducted, and/or HHS-administered programs or activities, including through outreach, education, and capacity building_dbae9334-2413-11e8-8315-745665556326Strategy 1.4.4.3Faith-Based OrganizationsPersons of FaithHealth ProtectionProtect the Health of Americans Where They Live, Learn, Work, and Play_92da1994-241d-11e8-a426-058f675563262HHS DivisionsWithin HHS, the following divisions are working to achieve this goal:Administration for Children and Families (ACF) Administration for Community Living (ACL)Agency for Healthcare Research and Quality (AHRQ)Agency for Toxic Substances and Disease Registry (ATSDR)Centers for Disease Control and Prevention (CDC)Centers for Medicare & Medicaid Services (CMS)Food and Drug Administration (FDA)Health Resources and Services Administration (HRSA)Indian Health Service (IHS)National Institutes of Health (NIH)Office for Civil Rights (OCR)Office of the Assistant Secretary for Administration (ASA)Office of the Assistant Secretary for Health (OASH)Office of the Assistant Secretary for Preparedness and Response (ASPR)Office of the Assistant Secretary for Public Affairs (ASPA)Office of Global Affairs (OGA)Office of Intergovernmental and External Affairs (IEA)Office of Security and Strategic Information (OSSI)Substance Abuse and Mental Health Services Administration (SAMHSA)Healthy living involves more than avoiding risky behavior and disease; health and wellness improve with healthful eating, regular physical activity, preventive care, and positive relationships. Yet in 2015, 30 percent of adults did not engage in any leisure-time physical activity, and from 2011 to 2014 only 28.9 percent of adults had a healthy weight. The Department invests in health promotion and wellness activities, including health literacy, to help Americans take control over their health. Beyond ensuring Americans have the resources they need to make healthier living choices, health promotion efforts also involve focusing on environmental health and reducing the burden caused by disease and other conditions. Nine of the 10 leading causes of death in 2015 were caused by communicable and chronic disease—heart disease, cancer, chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide. Together, these causes of death accounted for an estimated 74 percent of the 2.6 million deaths recorded in 2015. In some cases, Americans may have multiple chronic conditions at the same time, creating functional limitations and increasing the risk of mortality. Approximately one in four Americans has multiple chronic conditions. In addition to chronic conditions, the Department is working to prevent, treat, and control communicable diseases that pose a threat to the health of Americans. Although rates of new infections of HIV have declined for the last decade, nearly 40,000 people were diagnosed with HIV in 2015. New infections of hepatitis A, as well as acute hepatitis B and hepatitis C and chronic hepatitis B, increased in 2015. Most recently, the Nation has witnessed the emergence and outbreak of communicable diseases including severe acute respiratory syndrome (SARS), pandemic influenza A (H1N1), Ebola, and Zika virus. Millions of adolescents and adults across the Nation are affected by mental and substance use disorders. In 2016, an estimated 44.7 million adults, or 18.3 percent of all adults in the United States aged 18 or older, had a mental illness. Of those 44.7 million adults, an estimated 10.4 million were diagnosed with a serious mental illness. In 2016, approximately 20.1 million people in the United States aged 12 or older had a substance use disorder related to alcohol or illicit drug usage. Of 176.6 million alcohol users, an estimated 17 million have an alcohol use disorder, and excessive alcohol use is responsible for 88,000 deaths each year. The Surgeon General’s Report on Alcohol, Drugs, and Health highlights the important health and social problems associated with alcohol and drug misuse in the United States. The most common substance use disorder among illicit drug users involved marijuana and prescription pain relief medication. The issue of co-occurring mental illness and substance use disorders is also a public health concern. In 2016, an estimated 7.9 million adults aged 18 or older had co-occurring mental and substance use disorders. In 2017, large parts of the United States saw public health emergencies caused by natural disasters, including Hurricanes Harvey, Irma, Maria, and Nate, affecting several southeastern States and territories, and wildfires in California. In addition to natural disasters, the Nation also saw adverse health effects of recent outbreaks of Ebola and Zika virus, calling for raised awareness and actions from both domestic and international partners. Preparing for and addressing the immediate and persisting health impacts that stem from natural disasters, naturally occurring diseases and illnesses, and chemical, biological, radiological, or nuclear agents is critical to securing and maintaining a healthy population. The Department works every day to improve public health. This work is achieved through strategic partnerships with State, Tribal, local, territorial, and nongovernmental organizations within the United States. Partnerships, including with Tribes and faith-based and community organizations, are critical to promoting healthy living and addressing factors that influence the health of Americans. In addition, the Department actively provides leadership and expertise in global health diplomacy to contribute to a safer, healthier world. Through relationships with other Federal agencies and departments, multilateral organizations, foreign governments, ministries of health, civil society groups, and the private sector, the Department creates and maintains the pathways to apply expertise globally, learn from overseas counterparts, and advance policies that protect and promote health within our borders and worldwide.ChoicesEmpower people to make informed choices for healthier living_92da1c96-241d-11e8-a426-058f675563262.1ACFATSDRCDCFDAHRSAIHSNIHOASHOCROGASAMHSAHealth promotion and wellness activities involve providing information and education to motivate individuals, families, and communities to adopt healthy behaviors, which ultimately can improve overall public health. However, the lack of access to and understanding of health information can lead people to make uninformed decisions and engage in risky behavior. Inadequate health literacy can lead Americans to make uninformed health choices and engage in behavior that can put their health at risk, such as smoking tobacco. More than 16 million people have at least one disease caused by smoking. The total economic cost of smoking is more than $300 billion per year, including $170 billion in direct medical care for adults and more than $156 billion in lost productivity. Poor nutrition is another health outcome that affects the lives of Americans due to inadequate health education and lack of exposure to nutrition information. The typical American diet exceeds the recommended levels of or limits on calories from solid fats and added sugars, refined grains, sodium, and saturated fat. Additionally, the typical American intake of vegetables, fruits, whole grains, dairy products, and oils is less than is recommended. In the United States, an estimated 80 percent of people do not meet national physical activity recommendations for aerobic exercise and muscle strengthening. Estimates show that about 45 percent of adults in the United States do not engage in sufficient physical activity to achieve health benefits. The level of inadequate physical activity - PDF amounts to an estimated $117 billion in healthcare costs to Americans. Physical inactivity and the resulting health impacts are often due to a lack of health literacy and to health information that is not easy to use or understand. By supporting healthy choices and expanding access to healthier living supports, HHS is helping to curb threats to public health, promote a healthier population, and avoid the economic and human costs of poor health. HHS is working with partners, including faith-based and community organizations, to help people and communities take steps to identify and address priority health issues. The Department supports a series of programs and initiatives aimed at improving nutrition; increasing physical activity; reducing environmental hazards; increasing access to preventive services; and reducing the use of tobacco, alcohol, and illicit drugs and prescription drug abuse. These outcomes are achieved through culturally competent and linguistically appropriate health education, services, and supports made possible through strategic partnerships.TobaccoReduce tobacco-related death and disease._92da2358-241d-11e8-a426-058f675563262.1.1Smoking is the leading cause of preventable death, responsible for more than 480,000 deaths per year in the United States. If smoking continues at the current rate among U.S. youth, 5.6 million of today’s Americans younger than 18 years of age are expected to die from a smoking-related illness. The Department is working to reduce tobacco-related death and disease through the following strategies:Health EffectsReduce the negative health effects of tobacco use by implementing a comprehensive approach that includes regulating the manufacturing, marketing, and distribution of tobacco products; assisting States to implement proven tobacco-control programs; discouraging people from starting to use tobacco products; and educating parents on the potential harm to their children if the parents smoke_92da275e-241d-11e8-a426-058f67556326Strategy 2.1.1.1RegulationRegulate the manufacturing, marketing, and distribution of tobacco products._3cce7130-248b-11e8-b521-8c21bde01b74Strategy 2.1.1.1.1AssistanceAssist States to implement proven tobacco-control programs._3cce7c84-248b-11e8-b521-8c21bde01b74Strategy 2.1.1.1.2StatesDiscouragementDiscourage people from starting to use tobacco products._3cce8576-248b-11e8-b521-8c21bde01b74Strategy 2.1.1.1.3EducationEducate parents on the potential harm to their children if the parents smoke._3cce907a-248b-11e8-b521-8c21bde01b74Strategy 2.1.1.1.4CessationReduce the harm caused by tobacco use by educating tobacco users on the availability of smoking cessation programs_92da2a88-241d-11e8-a426-058f67556326Strategy 2.1.1.2 Underage AccessReduce underage access to tobacco products by ensuring tobacco is not sold to individuals younger than age 18_92da319a-241d-11e8-a426-058f67556326Strategy 2.1.1.3 Nutrition & ActivityPromote better nutrition and physical activity._92da3640-241d-11e8-a426-058f675563262.1.2More than one-third of adults in the United States were obese in 2011–2014. For youth aged 2 to 19 years, the prevalence of obesity is about 17 percent, affecting 12.7 million children and adolescents. In that same period, all States had more than 20 percent of adults with obesity. Around $117 billion in healthcare costs are associated with inadequate physical activity. The Department is promoting better nutrition and physical activity through the following strategies:Food Labeling & Nutrition InformationEnhance understanding of how consumers notice, understand, and act on food labeling and nutrition information, including nutrition facts labels, nutrition product claims, and dietary recommendations_92da396a-241d-11e8-a426-058f67556326Strategy 2.1.2.1ObesityDecrease prevalence of obesity by encouraging breastfeeding, promoting healthful food and beverage consumption, and promoting increased physical activity_92da3ffa-241d-11e8-a426-058f67556326Strategy 2.1.2.2 Behaviors & Chronic DiseasesReduce chronic diseases and related health behaviors that impact older adults and people with disabilities by adapting and implementing evidence-based programs and policies, such as implementing nutrition standards and guidelines_92da43ec-241d-11e8-a426-058f67556326Strategy 2.1.2.3Health EducationIncrease access to health education services, including opportunities to learn about the importance of healthful eating and physical activity_92da4720-241d-11e8-a426-058f67556326Strategy 2.1.2.4Wellness, Activity, Literacy & NutritionForm public-private partnerships to promote health in academic and religious institutions, such as wellness workshops, physical activity, health literacy, and nutritional excellence programs_92da4dd8-241d-11e8-a426-058f67556326Strategy 2.1.2.5Nutrition EducationIncrease collaboration with stakeholders, including industry, consumer, and public health groups, to enhance consumer nutrition education directed toward age and demographic groups with specific needs_92da51ca-241d-11e8-a426-058f67556326Strategy 2.1.2.6Oral HealthPromote oral health._92da54fe-241d-11e8-a426-058f675563262.1.3In 2013 - 2014, more than 14 percent of children had untreated dental decay in their primary or permanent teeth, and only 43.1 percent of children, adolescents, and adults had used the oral healthcare system in the last year. The Department is working to promote oral health through the following strategies:Oral Health LiteracyStrengthen oral health literacy, and integrate oral health awareness into clinics, early childhood settings, and social service agencies_92da5be8-241d-11e8-a426-058f67556326Strategy 2.1.3.1Oral CarePromote dental screenings and preventive oral care for children and adolescent_92da6048-241d-11e8-a426-058f67556326Strategy 2.1.3.2InformationEnsure people have the information they need to make healthier living choices._92da6390-241d-11e8-a426-058f675563262.1.4Health services should be delivered in ways that are easy to understand and that improve health, longevity, and quality of life. The Department is working to ensure people have the information they need to make healthier living choices through the following strategies:Language & FormatsCommunicate culturally competent and linguistically appropriate messages in plain language, as well as in accessible formats for persons with disabilities, using approaches that leverage new and emerging communications and appropriate messengers, including faith-based and other community organizations_92da6a20-241d-11e8-a426-058f67556326Strategy 2.1.4.1UnderstandingSupport programs and build partnerships with organizations (including faith-based and community organizations) that build the health literacy skills of disadvantaged and at-risk populations, and promote proven methods of checking understanding to ensure individuals understand health and prevention information, recommendations, and risk and benefit tradeoffs_92da6e26-241d-11e8-a426-058f67556326Strategy 2.1.4.2Tools & ResourcesEncourage providers to communicate effectively with patients, families, and caregivers by offering tools and resources to assist discussions centered around care and healthier living_92da7178-241d-11e8-a426-058f67556326Strategy 2.1.4.3Environmental HazardsSupport development of tools that provide information about potential environmental hazards in the natural and built environments_92da7812-241d-11e8-a426-058f67556326Strategy 2.1.4.4Education, Training & QualityDevelop tools and resources that improve health department and healthcare setting efficiency in providing education, training, and quality assurance for screening, treatment, services, and prevention messages_92da7c68-241d-11e8-a426-058f67556326Strategy 2.1.4.5ChoicesPartner with private organizations, including Tribes and faith-based and community organizations, to develop and implement programs to help people make healthy life choices_92da7fc4-241d-11e8-a426-058f67556326Strategy 2.1.4.6 BehaviorsIncrease awareness of the importance of healthy lifestyle behaviors among patients and caregivers to reduce risk of chronic conditions and other illnesses_92da86e0-241d-11e8-a426-058f67556326Strategy 2.1.4.7InformationEnsure people have the information they need to make healthier living choices._92da8afa-241d-11e8-a426-058f675563262.1.5Health services should be delivered in ways that are easy to understand and that improve health, longevity, and quality of life. The Department is working to ensure people have the information they need to make healthier living choices through the following strategies:Language & FormatsCommunicate culturally competent and linguistically appropriate messages in plain language, as well as in accessible formats for persons with disabilities, using approaches that leverage new and emerging communications and appropriate messengers, including faith-based and other community organizations_92da8e4c-241d-11e8-a426-058f67556326Strategy 2.1.5.1Health LiteracySupport programs and build partnerships with organizations (including faith-based and community organizations) that build the health literacy skills of disadvantaged and at-risk populations, and promote proven methods of checking understanding to ensure individuals understand health and prevention information, recommendations, and risk and benefit tradeoffs_92da95c2-241d-11e8-a426-058f67556326Strategy 2.1.5.2Tools & ResourcesEncourage providers to communicate effectively with patients, families, and caregivers by offering tools and resources to assist discussions centered around care and healthier living_92da9a9a-241d-11e8-a426-058f67556326Strategy 2.1.5.3Environmental HazardsSupport development of tools that provide information about potential environmental hazards in the natural and built environments_92da9e32-241d-11e8-a426-058f67556326Strategy 2.1.5.4Screening, Treatment & PreventionDevelop tools and resources that improve health department and healthcare setting efficiency in providing education, training, and quality assurance for screening, treatment, services, and prevention messages_92daa526-241d-11e8-a426-058f67556326Strategy 2.1.5.5ChoicesPartner with private organizations, including Tribes and faith-based and community organizations, to develop and implement programs to help people make healthy life choices_92daa9ae-241d-11e8-a426-058f67556326Strategy 2.1.5.6BehaviorsIncrease awareness of the importance of healthy lifestyle behaviors among patients and caregivers to reduce risk of chronic conditions and other illnesses_92daad1e-241d-11e8-a426-058f67556326Strategy 2.1.5.7Diseases & ConditionsPrevent, treat, and control communicable diseases and chronic conditions_92dab4f8-241d-11e8-a426-058f675563262.2ACLASPAASPRCDCCMS FDAHRSAIHSNIHOASHOGASAMHSAPerformance Goals: * Increase the percentage of Ryan White HIV/AIDS Program clients who are receiving HIV medical care and have had at least one viral load test demonstrating suppression of the virus * Increase the percentage of adults aged 18 years and older who are vaccinated annually against seasonal influenza * Continue advanced research and development initiatives for more effective influenza vaccines and the development of safe, broad-spectrum therapeutics for use in seriously ill and/or hospitalized patients, including pediatric patients. Communicable diseases and chronic conditions affect the lives of millions of Americans every day. The emergence and spread of infectious diseases -- such as HIV/AIDS, hepatitis, tuberculosis, measles, and human papillomavirus (HPV) -- can quickly threaten the stability of public health for communities and place whole populations at risk. The rise of globalization and ease of travel also has made it easier for domestic and international outbreaks -- such as recent outbreaks of measles, pandemic influenza A (H1N1), Ebola, Zika, and chikungunya -- to create public health challenges. Moreover, the prevalence of chronic conditions -- such as diabetes, heart disease, stroke, and cancer -- in the United States continues to contribute to the daily struggles of Americans. The occurrence of multiple chronic conditions also exacerbates the adverse health impacts and healthcare costs associated with chronic conditions and their associated health risks. In 2014, an estimated 17.8 million visits to physician offices were due to infectious and parasitic diseases. More than 1.1 million people in the United States are infected with HIV; estimated lifetime treatment costs are more than $400,000 per person living with HIV. Viral hepatitis affects approximately 4.4 million people - PDF, and curing hepatitis C costs between $45,000 and $94,000 per person. Up to 13 million Americans are infected with the bacteria that cause tuberculosis; multiple drug resistant tuberculosis can cost between $134,000 and $430,000 to treat. Many Americans are negatively affected by the high costs associated with chronic conditions. According to 2010 Medical Expenditure Panel Survey (MEPS) data, an estimated 86 percent of annual healthcare expenditures are for individuals who have at least one chronic condition. In the 40 years leading up to 2015, heart disease and cancer remained the top two leading causes of death. In 2015, heart disease and cancer alone accounted for an estimated 45 percent of the 2.7 million deaths recorded that year. However, in recent years, data have shown a decrease - PDF in death rates from cardiovascular disease, stroke, and cancer, which can be attributed to increased efforts in prevention, early detection, treatment, and care. The prevention and management of communicable diseases require strategic coordination, collaboration, and mobilization of resources among governmental and nongovernmental partners within and outside of the United States. Similarly, managing chronic conditions requires support for affected individuals, families, caregivers, health professionals, and service providers. HHS programs and initiatives focus on promoting partnerships, educating the public, improving vaccine development and uptake, advancing early detection and prevention methods, and enhancing surveillance and response capacity.Antibiotic ResistanceReduce the emergence and spread of antibiotic-resistant infections._3cce9606-248b-11e8-b521-8c21bde01b742.2.1Antibiotic-resistant infections are a major health and economic burden for the United States. Patients who survive antibiotic-resistant infections usually require significantly longer hospitalizations, more medical visits, and a lengthier recuperation and experience a higher incidence of long-term disability. The Department has made significant progress in combating antibiotic-resistant infections and in conducting research and development to discover new antibiotics, diagnostics, therapeutics, and vaccines. The Department is working to reduce the emergence and spread of antibiotic-resistant infections through the following strategies:Surveillance, Detection & ResponseIncrease surveillance, early-detection methods (e.g., the use of point-of-care diagnostics), and response capacity, in order to reduce the domestic and international emergence and spread of antibiotic-resistant infections_3cce9c0a-248b-11e8-b521-8c21bde01b74Strategy 2.2.1.1TreatmentExpand the study of low-cost, readily available treatment regimens that limit the emergence of drug resistance, by identifying new antibiotic classes and agents, screening existing products, and combining new or existing compounds to treat drug-resistant infections_3ccea592-248b-11e8-b521-8c21bde01b74Strategy 2.2.1.2ResearchAdvance preclinical and clinical research to accelerate the translation of promising antibiotic products into safe and effective treatment regimens_3cceaba0-248b-11e8-b521-8c21bde01b74Strategy 2.2.1.3Appropriate UsageFoster improvements in the appropriate use of antibiotics by improving prescribing practices and promoting antibiotic stewardship across all healthcare settings and in all veterinary settings_3cceb1a4-248b-11e8-b521-8c21bde01b74Strategy 2.2.1.4Clinical TestingExpand the development and clinical testing of potential vaccines to prevent infections by drug-resistant pathogens_3ccebb0e-248b-11e8-b521-8c21bde01b74Strategy 2.2.1.5Collaboration & CapacityImprove international collaboration and capacities for antibiotic resistance prevention, surveillance, and control and for antibiotic research and development_3ccec0d6-248b-11e8-b521-8c21bde01b74Strategy 2.2.1.6Infectious DiseasesPrevent and control infectious diseases._3ccec6d0-248b-11e8-b521-8c21bde01b742.2.2Infectious diseases are a major health and economic burden for the United States. Each year in the United States, on average, 5 to 20 percent of the U.S. population gets the flu, a vaccine-preventable illness. Tens of thousands are hospitalized, and thousands die from flu-related illness, resulting in an estimated $10.4 billion a year in direct medical expenses and an additional $16.3 billion in lost earnings annually. The Department will work to prevent and control infectious diseases such as influenza through the following strategies:Discovery & ImplementationIncrease research on vaccine discovery and implementation science on best approaches for enhancing dissemination and uptake of effective vaccines domestically and internationally_3cced044-248b-11e8-b521-8c21bde01b74Strategy 2.2.2.1VaccinesMobilize resources to support the development, testing, and preparation of vaccines_3cced67a-248b-11e8-b521-8c21bde01b74Strategy 2.2.2.2InterventionsImplement effective and coordinated public health and healthcare interventions to detect, prevent, and control environmental, person-to-person, and zoonotic transmission of infectious diseases in the United States and globally_3ccedc6a-248b-11e8-b521-8c21bde01b74Strategy 2.2.2.3OutbreaksRespond to outbreaks of infectious diseases to identify their cause, limit their spread, and identify strategies for preventing future outbreaks_3ccee5de-248b-11e8-b521-8c21bde01b74Strategy 2.2.2.4Food SafetySupport food safety._3cceecaa-248b-11e8-b521-8c21bde01b742.2.3While the American food supply is among the safest in the world, an estimated 48 million cases of foodborne illness occur annually -- the equivalent of sickening 1 in 6 Americans each year. Each year, these illnesses result in an estimated 128,000 hospitalizations and 3,000 deaths. The Department will work to support food safety through the following strategies:StandardsWork with stakeholders, including food facilities, manufacturers, farmers, and distributors, to implement science-based preventive control standards for domestic and imported foods_3ccef380-248b-11e8-b521-8c21bde01b74Strategy 2.2.3.1Communications, Outreach & ResearchIncrease consumer-based communications, outreach, and research on measures to improve consumer behaviors and practices related to food safety_3ccefeac-248b-11e8-b521-8c21bde01b74Strategy 2.2.3.2Research, Analysis & EvaluationIncrease research, data analysis, and systematic evaluation to improve the effectiveness of food safety education in changing unsafe consumer food handling behaviors_3ccf0546-248b-11e8-b521-8c21bde01b74Strategy 2.2.3.3Detection & TreatmentSupport early detection and treatment of communicable and chronic diseases._3ccf0c26-248b-11e8-b521-8c21bde01b742.2.4The percentage of adults aged 18 years and over with hypertension who have their blood pressure under control increased by 42 percent between 2001–2004 and 2011–2014, from 35.5 percent to 50.3 percent. In 2010, 58.2 percent of adults aged 50 to 75 years received a colorectal cancer screening, 72.6 percent of women aged 50 to 74 years reported recent mammography, and 80.7 percent of women aged 21 to 65 years reported a recent Pap test (age-adjusted). The Department will work to support early detection and treatment of communicable and chronic diseases through the following strategies: Note: Additional strategies on mental health and substance use are in Strategic Objective 2.3.PreventionSupport access to preventive services including immunizations and screenings, especially for high-risk, high-need populations_3ccf16e4-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.1 ScreeningSupport screening for tobacco use, alcohol misuse, substance use disorder, and obesity, and offer counseling and treatment as appropriate_3ccf1d92-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.2Chronic ConditionsImprove early detection and treatment of people with multiple chronic conditions, such as heart disease, asthma, diabetes, kidney disease, cancer, chronic pain, and dementia_3ccf24b8-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.3HIV Suppression & PreventionImprove HIV viral suppression and prevention by increasing engagement and re-engagement activities for screening, treatment, care, and support services_3ccf2f80-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.4HIV ProgramsImplement HIV programs, including prevention, testing, treatment, and retention interventions, provide technical assistance, and conduct research in support of the President's Emergency Plan for AIDS Relief_3ccf3642-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.5HepatitisIncrease access to hepatitis B and hepatitis C screening, treatment, and care for people with hepatitis B or hepatitis C infection_3ccf3d18-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.6 Medical ProductsSupport the development of new, safe, and effective medical products, including drugs, vaccines, and devices, for the treatment of communicable diseases and chronic conditions_3ccf4858-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.7Opioids & Other DrugsPrevent the spread of infectious diseases among persons who inject opioids or other drugs by supporting implementation of effective, comprehensive community- and school-based interventions that reduce the infectious risks associated with injection of opioids and other drugs, increase screening and treatment for bloodborne pathogens, and provide access to effective treatment of substance use disorders_3ccf4e5c-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.8Triage & ScreeningImprove triage and screening for the prevention of communicable diseases and the future development of chronic diseases in children through annual health screenings and age-appropriate immunizations for children_3ccf5474-248b-11e8-b521-8c21bde01b74Strategy 2.2.4.9InterventionsSupport chronic disease management interventions._3ccf5e42-248b-11e8-b521-8c21bde01b742.2.5Chronic disease management interventions, which involve coordinated healthcare services and communications for populations with conditions in which patient self-care is important, have been clearly shown to improve health outcomes in patients with such diverse conditions as diabetes, heart failure, chronic obstructive pulmonary disease, hypertension, anxiety, and depression. The 2017 National Diabetes Statistics Report estimated that 9.4 percent of the U.S. population had diabetes, with the highest rates among American Indians and Alaska Natives. The Department will work to support chronic disease management interventions through the following strategies:Planning, Coordination & ManagementImprove planning, coordination, and management of services to better meet the needs of people with complex healthcare needs and chronic health conditions_3ccf6432-248b-11e8-b521-8c21bde01b74Strategy 2.2.5.1Self-ManagementExpand participation by older adults and adults with disabilities in self-management education interventions_3ccf6a4a-248b-11e8-b521-8c21bde01b74Strategy 2.2.5.2Mental & Substance Use DisordersReduce the impact of mental and substance use disorders through prevention, early intervention, treatment, and recovery support_92daba0c-241d-11e8-a426-058f675563262.3ACFACLAHRQCDCCMSFDAHRSAIEAIHSOCRSAMHSAPerformance Goals: * Meet the following opioid-related goals: - Reduce the age-adjusted annual rate of overdose deaths involving prescription opioids per 100,000 population among States funded through the Prescription Drug Overdose Prevention for States program - Increase the number of persons receiving outpatient medication-assisted treatment for opioid use disorder from a substance use disorder treatment facility - Increase the availability of electronic clinical decision support tools related to safe pain management and opioid prescribing - By 2020, evaluate the efficacy of new or refined interventions to treat opioid use disorders * Meet the following goals related to mental illness: - Increase the percentage of youth ages 12 to 17 who experienced major depressive episodes in the past year receiving mental health services - Increase the percentage of adults with serious mental illness receiving mental health services -- Mental illness and substance abuse create health risks and place a heavy burden on affected individuals and their families. Substance use disorders arise from the recurring use of alcohol and/or drugs, which lead to clinically and functionally significant impairments. Mental disorders are health conditions that involve significant changes in thinking, emotion, and/or behavior and lead to distress and/or problems functioning in social, work, or family activities. Mental and substance use disorders are illnesses that impact people’s ability to go about their daily lives in family, social, and professional settings and place individuals at risk of additional health problems. Mental illness and substance abuse have a known impact on public health. In 2016, an estimated 20.1 million people - PDF aged 12 or older in the United States had a substance use disorder related to alcohol consumption or illicit drug use in the previous year. In 2016, approximately 2 million people had an opioid use disorder - PDF. The number of deaths related to overdose involving opioids, including prescription opioids and heroin, has quadrupled since 1999. The recent increase in deaths appears to be largely a result of use of heroin and synthetic opioids. Between 2015 and 2016 alone, the death rate from synthetic opioids other than methadone, including fentanyl, increased by 100 percent, and the death rate from heroin increased by 19.5 percent. In 2016, one in five American adults experienced a mental illness - PDF, and 13 percent of adolescents met criteria for depression - PDF. The number of emergency department visits that involved mental disorders as the primary diagnosis was approximately 5 million in 2014. In 2014, suicide ranked as the 10th leading cause of death. In the same year, suicide deaths reached 13.4 deaths per 100,000 people. Records show that rates of suicide have steadily increased since the baseline year of 2007 in the United States. HHS works closely with Federal, State, Tribal, local, territorial, and community partners and stakeholders, including faith-based and community organizations, to help identify and address mental health problems and substance use disorders. The Department invests in programs and interventions focused on prevention, screening, and early detection of serious mental illness and substance abuse, including those related to opioid abuse. Other HHS activities involve improving the provision of comprehensive, coordinated, and evidence-based community recovery supports for affected individuals and improving access to treatment options. Continuing to advance research and work in these areas raises awareness and facilitates the adoption of best practices across communities to minimize the negative health impacts caused by mental and substance use disorders.Mental Illness & Substance AbuseExpand prevention, screening, and early identification of serious mental illness and substance abuse._3ccf7454-248b-11e8-b521-8c21bde01b742.3.1The National Survey on Drug Use and Health recently found that, while serious mental illness among age groups 26 and older has remained constant for nearly a decade, the prevalence of serious mental illness, depression, and suicidal thoughts has increased among young adults in recent years. In 2016, approximately 20.1 million people aged 12 or older had a substance use disorder. The Department is expanding prevention, screening, and early identification of serious mental illness and substance abuse through the following strategies:OpioidsApply a public health approach for preventing opioid misuse, opioid addiction, and opioid overdose deaths including through promoting safer prescribing practices_3ccf7a6c-248b-11e8-b521-8c21bde01b74Strategy 2.3.1.1Recognition, Screening & IdentificationEducate and empower individuals and communities, including partnerships with Tribes and faith-based and community organizations, to recognize the signs of serious mental illness and substance abuse to encourage screening and identification of such problems_3ccf80a2-248b-11e8-b521-8c21bde01b74Strategy 2.3.1.2ScreeningEnsure early screening of children and youth to identify those with or at risk for serious emotional disturbance or substance use disorders, and expand access to integrated mental health or substance use disorder services_3ccf8aca-248b-11e8-b521-8c21bde01b74Strategy 2.3.1.3ChildrenYouthDepression, Suicide Risk, Substance Use, Dementia & Other DisordersIncrease screening for depression, suicide risk, substance use, dementia, and other behavioral disorders in schools, emergency departments, and inpatient and outpatient settings_3ccf91dc-248b-11e8-b521-8c21bde01b74Strategy 2.3.1.4SchoolsEmergency DepartmentsInpatient SettingsOutpatient SettingsScreening & InterventionEncourage healthcare providers' use of screening and brief intervention approaches for alcohol, opioid, and other substance use disorders to reduce consequences of risky behavior, including effects of harmful substance use in pregnancy_3ccf989e-248b-11e8-b521-8c21bde01b74Strategy 2.3.1.5Healthcare ProvidersSubstance MisuseSupport adoption of other evidence-based prevention strategies, including environmental strategies and community capacity/mobilization strategies, to prevent substance misuse and substance use disorders_3ccfa2c6-248b-11e8-b521-8c21bde01b74Strategy 2.3.1.6SuicidesPrevent suicides and suicide attempts by expanding evidence-based approaches for adults and youth and helping State, Tribal, local, and territorial governments and communities take advantage of the best available evidence to prevent suicide_3ccfa94c-248b-11e8-b521-8c21bde01b74Strategy 2.3.1.7Care & TreatmentImprove access to high-quality care and treatment for mental and substance use disorders._3ccfafaa-248b-11e8-b521-8c21bde01b742.3.2In 2016, an estimated 21 million people aged 12 or older needed substance use treatment, but only 3.8 million people received treatment. Of the 3.1 million adolescents with a major depressive episode in the same year, only 1.2 million received treatment. Similarly, of the 16.2 million adults with a major depressive episode in the same year, only 10.6 million received treatment. The Department seeks to improve access to high-quality care and treatment for mental and substance use disorders through the following strategies: Note: Additional behavioral healthcare quality strategies are in Strategic Objective 1.2.Care ContinuumSupport the integration of the full continuum of behavioral healthcare and primary care and medical systems, and increase the capacity of the specialty behavioral health systems to ensure that the physical health needs of the people they serve are met_3ccfb9e6-248b-11e8-b521-8c21bde01b74Strategy 2.3.2.1Child & Family SupportProvide integrated child and family supports to parents/guardians with addiction to support healthy child development and preservation of families_3ccfc0a8-248b-11e8-b521-8c21bde01b74Strategy 2.3.2.2FamiliesChildrenMental Illness, Addition & DepressionImprove adoption and continued refinement of selected evidence-based practices for serious mental illness, medication-assisted treatment for alcohol and opioid addiction, and effective use of psychotherapy and antidepressant medication for depression_3ccfc710-248b-11e8-b521-8c21bde01b74Strategy 2.3.2.3MedicationsImprove access to medications that reverse opioid overdose and prevent death_3ccfd156-248b-11e8-b521-8c21bde01b74Strategy 2.3.2.4TreatmentSupport efforts to increase engagement in treatment following an opioid overdose_3ccfdc00-248b-11e8-b521-8c21bde01b74Strategy 2.3.2.5Clinician TrainingStrengthen clinician training on evidence-based practices related to pain management and the prevention and treatment of opioid use disorders to inform clinical management decisions for patients, including effects of opioid use in pregnancy_3ccfe330-248b-11e8-b521-8c21bde01b74Strategy 2.3.2.6CliniciansMental Illness & Substance Use DisordersImprove access to recovery support for people with serious mental illness and substance use disorders_3ccfedf8-248b-11e8-b521-8c21bde01b742.3.3Recovery support is provided through treatment, services, and community-based programs by behavioral healthcare providers, peer providers, family members, friends and social networks, Tribes, and people with experience in recovery. The Department will employ the following strategies to improve access to recovery support for people with serious mental illness and substance use disorders:Peer Providers & ParaprofessionalsWork with States to encourage the training, certification, and supervision of peer providers and paraprofessionals_3ccff550-248b-11e8-b521-8c21bde01b74Strategy 2.3.3.1StatesPeer ProvidersParaprofessionalsHousing, Employment & EducationEncourage broad adoption of evidence-based recovery housing, supported housing, supported employment, and supported education programs_3ccffcb2-248b-11e8-b521-8c21bde01b74Strategy 2.3.3.2Recovery SupportEngage individuals and communities, including faith-based and community organizations, to provide social and community recovery support_3cd00810-248b-11e8-b521-8c21bde01b74Strategy 2.3.3.3IndividualsCommunitiesFaith-Based OrganizationsCommunity OrganizationsCareImprove access to a full evidence-based continuum of care for people with mental illness and addiction, including medication-assisted treatment, follow-up from inpatient and residential care, and recovery supports, with a focus on opioid use disorder and serious mental illness_3cd00fae-248b-11e8-b521-8c21bde01b74Strategy 2.3.3.4People with Mental IllnessPeople with AddictionCapacity & CollaborationBuild capacity and promote collaboration among States, Tribes, territories, and communities._3cd01738-248b-11e8-b521-8c21bde01b742.3.4StatesTribesTerritoriesCommunitiesThe Department values its strong partnerships with external groups to respond to stakeholder needs, and supports investments to build the expertise, infrastructure, and other capacity to reduce the impact of mental health and substance use disorders. The Department is working to build capacity and promote collaboration among States, Tribes, territories, and communities through the following strategies:CapacityImprove community capacity to provide comprehensive, coordinated, and evidence-based supports for people with serious mental illness, addiction, and serious emotional disturbances with a focus on reducing crises and use of emergency services, hospitalization, and involvement with the criminal justice system_3cd023e0-248b-11e8-b521-8c21bde01b74Strategy 2.3.4.1CommunitiesCollaborationImprove collaboration with Federal and non-Federal stakeholders to promote the health and independence of older adults with or at risk for behavioral health conditions including mental illness, substance use disorders, and suicide_3cd02b24-248b-11e8-b521-8c21bde01b74Strategy 2.3.4.2RelationshipsFoster and strengthen relationships with national, regional, and local coalitions, including with Tribes and faith-based and community partners, to encourage their full and robust involvement in addressing the opioid crisis by providing accurate, up-to-date information regarding health and human service activities, resources, and subject matter expertise_3cd03344-248b-11e8-b521-8c21bde01b74Strategy 2.3.4.3National CoalitionsRegional CoalitionsLocal CoalitionsTribesFaith-Based PartnersCommunity PartnersTechnology & InnovationLeverage technology and innovative solutions to improve access to and quality of behavioral healthcare_3cd03ede-248b-11e8-b521-8c21bde01b742.3.5As described in Strategic Goal 1: Reform, Strengthen, and Modernize the Nation's Healthcare System, accessing high-quality behavioral healthcare providers in rural or underserved communities can be challenging. The Department is working to leverage technology and innovative solutions, such as telehealth, electronic health records, and health information exchange, to improve access to and quality of behavioral healthcare through the following strategies:Decision SupportDevelop, test, and disseminate clinical decision supports through electronic health records to use evidence-based mental health and substance use disorder guidelines for preventing and treating mental health and substance use disorders and increase access to appropriate behavioral care services_3cd04668-248b-11e8-b521-8c21bde01b74Strategy 2.3.5.1Information ExchangeIncrease the use of health information exchange to improve the coordination and integration of care, including by increasing the number of behavioral health providers using interoperable electronic health records and by addressing confidentiality policy barriers to health information exchange_3cd04d16-248b-11e8-b521-8c21bde01b74Strategy 2.3.5.2BarriersAddress the barriers, real or perceived, under the Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191) and 42 CFR Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records, to the appropriate sharing of mental health and substance use disorder information_3cd05770-248b-11e8-b521-8c21bde01b74Strategy 2.3.5.3AccessImprove access to mental health and substance abuse care for rural and underserved populations, including American Indians and Alaska Natives, by supporting care through telehealth services through regulation and policy clarification and refinement; collaboration with States; and technical assistance, training, and funding opportunities_3cd05eb4-248b-11e8-b521-8c21bde01b74Strategy 2.3.5.4EmergenciesPrepare for and respond to public health emergencies._92dabdf4-241d-11e8-a426-058f675563262.4ACFACLASAASPAASPRCDCCMSFDAHRSAIEAIHSNIHOASHOCROGAOSSISAMHSAPerformance Goals: * Increase the percentage of CDC-funded Public Health Emergency Preparedness State and local public health agencies that can convene, within 60 minutes of notification, a team of trained staff that can make decisions about appropriate response and interaction with partners * Increase the number of new licensed medical countermeasures within the Biomedical Advanced Research and Development Authority. -- The health of Americans during public health emergencies and other incidents depends on the effectiveness of preparedness, mitigation, response and recovery efforts. Threats in an increasingly interconnected, complex, and dangerous world include naturally emerging infectious diseases; frequent and severe weather events; state and nonstate actors that have access to chemical, biological, radiological, or nuclear agents; nonstate actors who commit acts of mass violence; and cyber attacks on healthcare systems and infrastructure. HHS provides strong leadership by setting the strategic direction to improve preparedness, mitigation, response, and recovery capabilities, such as through the National Health Security Strategy and the National Biodefense Strategy. HHS, as the coordinator of Emergency Support Function 8 (ESF 8) and the Health and Social Services Recovery Support Function, works with other departments to establish, evaluate, and conduct preparedness, mitigation, response, and recovery activities to support efforts by States, Tribes, localities, and territories. HHS leads the Federal public health and medical response to emergencies and incidents conducted in accordance with the ESF 8 (Public Health and Medical Services) annex of the National Response Framework and the Health and Social Services annex of the National Disaster Recovery Framework. HHS is working to ensure that a national disaster healthcare system is integrated within the healthcare delivery infrastructure—hospitals, emergency medical services, emergency management, and public health agencies—to provide safe and effective healthcare during emergencies and other disasters. In addition, National Disaster Medical System teams and the U.S. Public Health Service Commissioned Corps complement non-Federal efforts during incidents. HHS supports local Medical Reserve Corps units, which supplement the capacity of States, Tribes, localities, and territories. Through direct services and partnerships with State, Tribal, local, and territorial governments, with faith-based and community organizations, and with the private sector, HHS works to strengthen the Nation’s emergency preparedness, response, and recovery efforts. HHS is engaged in the research, development, and procurement of medical countermeasures, including vaccines, drugs, therapies, and diagnostic tools. HHS collaborates with others to ensure that the appropriate number of safe and effective medical countermeasures are developed and stockpiled and can be easily distributed and used to save lives during an incident. HHS invests in building the capacity of other countries to detect, prevent, and respond to incidents -- thus providing early warning to or reducing the impact to the United States. The international public health professionals trained by the Global Disease Detection Operations Center monitor 30 to 40 public health events each day, and can deploy within 24 hours of learning about an outbreak.Preparedness & ResponsePromote emergency preparedness and improve response capacity._3cd065d0-248b-11e8-b521-8c21bde01b742.4.1Federal statutes, Presidential directives, and strategies set the Nation’s approach to preparing for threats and hazards that pose the greatest risk to the security of the United States. National preparedness is a shared responsibility of the government and nongovernmental sectors, as well as individuals. The Department promotes emergency preparedness and improves response capacity through the following strategies:ExpertiseProvide subject expertise and tools to State, Tribal, local, and territorial governments, health systems and facilities, and faith-based and community organizations, to strengthen their capabilities to provide continuous, safe, and effective healthcare, public health, and social services in the aftermath of disasters and through the recovery period, including when such care or services may need to be delivered in alternate settings or by alternate mechanisms_3cd07098-248b-11e8-b521-8c21bde01b74Strategy 2.4.1.1State GovernmentsTribal GovernmentsLocal GovernmentsTerritorial GovernmentsHealth SystemsHealth FacilitiesFaith-Based OrganizationsCommunity OrganizationsDataDevelop and implement data-driven approaches that prioritize resources and technical support for underprepared geographical regions and communities to maximize preparedness across the Nation_3cd0775a-248b-11e8-b521-8c21bde01b74Strategy 2.4.1.2Situational AwarenessExpand the use and availability of public health and healthcare emergency response situational awareness tools, including investments in new systems and technologies that support rapid risk assessment, decision making, resource coordination across many levels, and monitoring of the effectiveness of interventions_3cd07e08-248b-11e8-b521-8c21bde01b74Strategy 2.4.1.3Medical CountermeasuresDetermine appropriate type and quantities of medical countermeasures, ensure timely access to medical countermeasures during response, and maximize effective utilization of medical countermeasures through clinical guidance and public health communications_3cd088da-248b-11e8-b521-8c21bde01b74Strategy 2.4.1.4PlanningAssess preparedness to plan for the timely access to and capacity to use medical countermeasures during disasters and other public health emergencies, and establish requirements based on estimated response needs, capacity to use, and desired characteristics of medical countermeasures to protect the public_3cd08f60-248b-11e8-b521-8c21bde01b74Strategy 2.4.1.5Response & RecoverySupports timely, coordinated, and effective response and recovery activities._3cd09618-248b-11e8-b521-8c21bde01b742.4.2The Secretary, through the National Response Framework, leads and coordinates the Federal public health and medical response and provides supplemental support to States, Tribes, localities, and territories that are responding to incidents. The Department supports timely, coordinated, and effective response and recovery activities through the following strategies:Risk ReductionPromote effective disaster risk reduction strategies to mitigate the adverse physical and behavioral health impacts of disasters and public health emergencies_3cd0a090-248b-11e8-b521-8c21bde01b74Strategy 2.4.2.1Information, Coordination & ResearchRespond rapidly to limit the impacts of incidents by gathering, analyzing, and disseminating information; coordinating requests for public health and medical services with partners; executing response operations and risk communication plans; and conducting research to inform current and future incident responses_3cd0a77a-248b-11e8-b521-8c21bde01b74Strategy 2.4.2.2At-Risk PopulationsEnsure that the needs of at-risk populations and those with access and functional needs are met during incidents, through integrated and informed preparedness, response, and recovery activities at the Federal, State, Tribal, local, and territorial levels of government_3cd0ae32-248b-11e8-b521-8c21bde01b74Strategy 2.4.2.3At-Risk PopulationsPlanningProvide tools and guidance to interagency, intergovernmental, Tribal, and faith-based and community organizations to improve the Nation's planning, to ensure timely human services response to incidents_3cd0b8b4-248b-11e8-b521-8c21bde01b74Strategy 2.4.2.4Interagency OrganizationsIntergovernmental OrganizationsTribal OrganizationsFaith-Based OrganizationsCommunity OrganizationsCollaboration, Communication & CoordinationImprove collaboration, communication, and coordination with partners._3cd0bf4e-248b-11e8-b521-8c21bde01b742.4.3Public health emergencies are not confined by geographic borders; response efforts often must engage various States, Tribal governments, localities, or territories. Response efforts must be undertaken in coordination with critical partners, such as hospitals, schools, houses of worship and faith-based organizations, and individual citizens. The Department is working to improve collaboration, communication, and coordination with partners through the following strategies:Communication & MediaProvide accurate and timely public health communication and media support to non-Federal stakeholders and leaders, as well as deployed HHS leaders and teams_3cd0c61a-248b-11e8-b521-8c21bde01b74Strategy 2.4.3.1MediaDecision SupportImprove decision support at all levels through active collaboration with State, Tribal, local, and territorial partners to share human health, environmental, zoonotic health, and other relevant information to improve situational awareness_3cd0d100-248b-11e8-b521-8c21bde01b74Strategy 2.4.3.2Healthcare CoalitionsBuild resilient healthcare coalitions that integrate efforts of healthcare facilities, emergency medical services, emergency management, and public health agencies_3cd0d7a4-248b-11e8-b521-8c21bde01b74Strategy 2.4.3.3Healthcare CoalitionsCommunication, Response & Recovery PlansJointly develop, exercise, and maintain coordinated risk communication, response, and recovery plans among governments and nongovernmental partners_3cd0defc-248b-11e8-b521-8c21bde01b74Strategy 2.4.3.4PartnershipsFormalize strategic partnerships to better ensure that medical countermeasure products and policies that guide their safe and effective use can be implemented effectively during an incident_3cd0ec8a-248b-11e8-b521-8c21bde01b74Strategy 2.4.3.5WorkforceStrengthen and protect the emergency preparedness and response workforce._3cd0f644-248b-11e8-b521-8c21bde01b742.4.4Emergency Preparedness WorkforceEmergency Response WorkforceNational Disaster Medical SystemU.S. Public Health Service Commissioned CorpsMedical Reserve CorpsVolunteer Health ProfessionalsMental Health WorkersHuman Service WorkersNongovernmental Organizationsincluding faith-based and community organizationsThe emergency preparedness and response workforce includes, but is not limited to, those engaged through the National Disaster Medical System, the U.S. Public Health Service Commissioned Corps, the Medical Reserve Corps, volunteer health professionals, mental health and human service workers, and nongovernmental organizations (including faith-based and community organizations). The Department is strengthening and protecting the emergency preparedness and response workforce through the following strategies:Hazardous ExposuresReduce illness and injury due to hazardous exposures in first responders, emergency managers, and public health, healthcare and human services providers, through health and safety training, education, and medical countermeasures_3cd1015c-248b-11e8-b521-8c21bde01b74Strategy 2.4.4.1First RespondersEmergency ManagersPublic Health ProvidersHealthcare ProvidersHuman Services ProvidersTrainingTrain the HHS workforce, and support the training of other partners, to strengthen the health response to incidents and protect communities from domestic and global threats_3cd10d96-248b-11e8-b521-8c21bde01b74Strategy 2.4.4.2HHS WorkforcePublic Health ProfessionalsReview the U.S. Public Health Service Commissioned Corps structure and modernize how HHS employs public health professionals and responds to public health emergencies_3cd11534-248b-11e8-b521-8c21bde01b74Strategy 2.4.4.3U.S. Public Health Service Commissioned CorpsPublic Health ProfessionalsWorkforce GapsCoordinate with human resources to help fill hard-to-fill assignments, bridge critical workforce gaps, and respond to public health and medical emergencies_3cd11d72-248b-11e8-b521-8c21bde01b74Strategy 2.4.4.4Individuals with Functional & Access NeedsIncrease capacity of emergency managers; healthcare, public health, and human services providers; and faith-based and community organizations to address needs of at-risk individuals with functional and access needs during incident preparedness, response, mitigation, and recovery_3cd129b6-248b-11e8-b521-8c21bde01b74Strategy 2.4.4.5Individuals with Functional & Access NeedsEmergency ManagersHealthcare ProvidersPublic Health ProvidersHuman Services ProvidersFaith-Based OrganizationsCommunity OrganizationsDiverse PopulationsDevelop cultural and linguistic competency to allow public health officials and emergency managers to better meet the needs of diverse populations and improve the quality of services and health outcomes during and after a disaster_3cd1315e-248b-11e8-b521-8c21bde01b74Strategy 2.4.4.6Diverse PopulationsPublic Health OfficialsEmergency ManagersGlobal HealthAdvance global health security._3cd13960-248b-11e8-b521-8c21bde01b742.4.5HHS is working with other Federal departments, foreign governments, and multilateral organizations to create a world safe and secure from public health threats. The Department is working to advance global health security as a national priority through the following strategies:Information, Communication & ResponseRespond rapidly to limit the impacts of incidents by using and sharing incident information, coordinating communications with international partners, and conducting response operations, risk communication, and research to respond to emerging and re-emerging diseases; chemical, biological, radiological, and nuclear agents; and other threats to health security_3cd14626-248b-11e8-b521-8c21bde01b74Strategy 2.4.5.1PreparednessEnhance international preparedness activities at the national, regional, and global levels to identify gaps, build capacity, and track progress to prevent, detect, and respond to health threats, respecting cultural differences and the inherent dignity of persons from conception to natural death_3cd14cf2-248b-11e8-b521-8c21bde01b74Strategy 2.4.5.2Products & BehaviorsPromote and support, where appropriate, the development, deployment, and use of medical products to prevent, mitigate, or treat adverse health effects in response to a global public health emergency, as well as the development, understanding, and use of behaviors or actions that people and communities can take to help slow the spread of disease or limit the impact of threat agents in response to a public health emergency_3cd153f0-248b-11e8-b521-8c21bde01b74Strategy 2.4.5.3ProgramsCollaborate with, and provide leadership to, international programs and initiatives to strengthen global preparedness and response to public health and medical emergencies_3cd162e6-248b-11e8-b521-8c21bde01b74Strategy 2.4.5.4PlansFurther develop, exercise, and update plans for responding to global threats that have the potential to impact national health security_3cd16a70-248b-11e8-b521-8c21bde01b74Strategy 2.4.5.5Well-BeingStrengthen the Economic and Social Well-Being of Americans Across the Lifespan_3cd171aa-248b-11e8-b521-8c21bde01b743AmericansAdministration for Children and Families (ACF)Administration for Community Living (ACL)Centers for Disease Control and Prevention (CDC)Centers for Medicare & Medicaid Services (CMS)Health Resources and Services Administration (HRSA)Indian Health Service (IHS)Office of the Assistant Secretary for Health (OASH)Substance Abuse and Mental Health Services Administration (SAMHSA)Poverty, unemployment, family disruptions, aging, and disability can threaten independence and self-sufficiency and increase Americans’ need for safety-net programs. Violence and preventable injuries threaten the security and social stability of the American people. HHS is committed to supporting the social and economic well-being of all Americans, including those individuals and populations who are at high risk of social and economic challenges. A core component of the HHS mission is the dedication to serve all Americans from conception to natural death, including those individuals and families who face or who are at high risk of economic and social well-being challenges. According to the U.S. Census Bureau, the official poverty rate in 2016 was 12.7 percent, down 0.8 percentage points from 13.5 percent in 2015. Both the percentage of the U.S. population in poverty and the unemployment rate have declined in the last three years. According to the U.S. Department of Labor’s Bureau of Labor Statistics, in 2017 the monthly unemployment rate averaged 4.4 percent, down from 4.9 percent in 2016. However, some Americans still experience challenges. According to the 2016 Annual Homeless Assessment Report - PDF, on a single night in 2016, nearly 550,000 people were experiencing homelessness in the United States. Additionally, in 2011, 4.8 million formerly incarcerated individuals were under community supervision. Many individuals returning to the community after serving time experience challenges due to limitations on their eligibility for access to public housing, employment, and healthcare. Job training and social supports are imperative for ensuring that these individuals are able to reintegrate into their communities. Both unintentional injuries and those caused by acts of violence are among the top 15 causes of death for Americans. Nearly 200,000 people in the United States die every year from injuries and violence related to preventable events such as drug overdoses, falls, drowning, and self-harm. Even when people do not die from injuries and violence, many experience long-term effects. Survivors often face lifelong mental, physical, and financial problems. In 2014, 26.9 million people were treated in an emergency department for injuries, and 2.5 million people were hospitalized. In 2013, costs associated with fatal injuries totaled $214 billion, while nonfatal injuries resulted in $457 billion in costs. The Department’s effort to support all Americans includes empowering families to encourage positive child and youth development. Financial and emotional support can encourage children and youth to continue education and make healthier decisions. In 2010, 71 percent of children younger than 18 were reported to be living with at least one parent who was employed full-time, year round. In 2014, 79.3 percent of adolescents age 12 to 17 surveyed said they had an adult in their lives with whom they can discuss serious problems, up from 78.2 percent in 2013. Over the past 15 years, there has been significant improvement in the teen birth rate. The teen birth rate declined by 63 percent between 1990 and 2015 and is now at a record low. In 1990, the teen birth rate was 60 births per 1,000 teenage girls. By 2015, the rate had dropped to 22 births per 1,000 teenage girls. Some subpopulations are at high risk of poor economic and social outcomes. In 2015, 35 percent of single-parent families had incomes below the poverty line, compared with 8 percent of married couples with children. Over the past decade, the percentage of children in single-parent families has increased from 32 percent to 35 percent, although the percentage has remained stable since 2011. Additionally, the more than 400,000 children who live in foster homes face a complex set of challenges. Older foster youth who age out of foster care are at a higher risk of teen pregnancy, employment instability, and homelessness. Older Americans and Americans with disabilities also face a number of obstacles. Over the past 10 years, the population 65 and over increased by 30 percent from 36.6 million in 2005 to 47.8 million in 2015, and this age group is projected to more than double to 98 million in 2060. More than 4.2 million older adults lived below the poverty line in 2015. At least 90 percent of older adults receiving help with daily activities receive some form of unpaid care, and about two-thirds receive only unpaid care. Almost 12 percent of working-age adults in the United States have some type of disability. Of these adults, 51 percent had a mobility disability, and 38.3 percent had a cognitive disability. Working-age adults with disabilities are more likely to live in poverty, have less than a high school education, and be unemployed. Self-Sufficiency, Responsibility & OpportunityEncourage self-sufficiency and personal responsibility, and eliminate barriers to economic opportunity_3cd17c90-248b-11e8-b521-8c21bde01b743.1ACFACLCMsPerformance Goals: * Increase the percentage of adult TANF recipients and former recipients who are newly employed * Increase the percentage of refugees who are self-sufficient (not dependent on any cash assistance) within the first 6 months after arrival -- Strong, economically stable individuals, families, and communities are integral components of a strong America. Many Americans currently experience or are at risk for economic and social instability. The social and health impacts of poverty can include reduced access to nutritious food; fewer educational opportunities and poor educational outcomes; a lack of access to safe and stable housing; increased risk of poor health outcomes including obesity and heart disease; and difficulty obtaining work opportunities. In 2016, a family of three was considered to be living in poverty if they earn less than $19,105 per year. According to the Census Bureau, the poverty rate in 2016 was 12.7 percent, with 40.6 million people living in poverty; this number was down 0.8 percentage points from 2015. For most demographic groups, the number of people in poverty decreased from 2015, with adults older than 65 the only population group experiencing an increase in the number of people living in poverty. By providing opportunities for work and work supports, the Department is dedicated to improving the education, skills, health, and resources of low-income individuals and families to help them expand their productivity, achieve economic independence, and enhance their economic and health outcomes. To reach this goal, the Department coordinates safety-net programs across the Federal Government; State, local, Tribal, and territorial governments; and faith-based and community organizations. One of the Department’s primary programs for families in need is the Temporary Assistance for Needy Families (TANF) program. TANF provides States with block grants to design and operate programs that help needy families reach self-sufficiency, with a focus on preparing parents for work. The Department coordinates with the U.S. Departments of Labor and Education to implement the Workforce Innovation and Opportunity Act, which is designed to help young job seekers and people with disabilities access employment education, training, and support services and match employers with skilled workers.Education, Training & WorkInvest in education, training, and work._4c92c2cc-24e7-11e8-9c9b-7e20c2e01b743.1.1In March 2017, nearly 2.5 million people across all 50 States, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands received cash assistance from TANF programs. The Department invests in education, training, work, and work supports through the following strategies: Note: Additional strategies on supporting independence for people with disabilities are in Strategic Objective 3.4.EmploymentInvest in evidence-informed practices that enable low-income adults, unemployed noncustodial parents, youth, and individuals with disabilities to prepare for, acquire, and sustain employment, including for fast-growing professions in healthcare_4c92da3c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.1.1Low-Income AdultsUnemployed Noncustodial ParentsYouthIndividuals with DisabilitiesWork ParticipationStrengthen the required work participation rate standards for States receiving TANF funds, and provide guidance and technical assistance to State TANF programs to engage adult cash assistance recipients who have the capacity to work in work activities_4c92ebc6-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.1.2StatesStability & SupportPromote innovation in the TANF program to advance the objective of helping families in need find stability and support through the employment and economic independence of adult participants and the healthy development of children whose families receive assistance_4c930070-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.1.3RefugeesIntegrate refugees entering the country into American society and connect them with wraparound services and resources, using faith-based and community organizations, to provide economic opportunity and success_4c930c1e-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.1.4RefugeesAssistive TechnologyProvide assistive technology equipment to people with disabilities, allowing them more self-sufficiency and eliminating barriers to their economic opportunity_4c9318b2-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.1.5People with DisabilitiesPeople with DisabilitiesIncrease the number of employed people with disabilities by encouraging and assisting integration into the greater community's workforce_4c932bd6-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.1.6People with DisabilitiesLow-Income PopulationsReform human services programs to assist low-income populations._4c933586-24e7-11e8-9c9b-7e20c2e01b743.1.2Low-Income PopulationsAlthough the number of people in poverty is shrinking, in 2016, 40.6 million people lived below the poverty line, with 32 percent of these people under the age of 18. The Department is working to reform human services programs to assist low-income populations through the following strategies:Safety-Net ProgramsFoster coordination and innovation across safety-net programs, including faith-based and community organizations, to help individuals and families in need to become self-sufficient and end dependency through employment and growth in habits of personal responsibility_4c934116-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.2.1Transitional ServicesIncrease access to comprehensive services as part of short-term, transitional public welfare services in partnership with other Federal agencies and faith-based and community organizations, including programs to promote social and economic self-sufficiency for American Indians and Alaska Natives_4c935570-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.2.2Federal AgenciesFaith-Based OrganizationsCommunity OrganizationsAmerican IndiansAlaska NativesFormerly Incarcerated IndividualsSupport formerly incarcerated individuals in obtaining and maintaining employment, developing habits of personal responsibility, reconnecting with their children and families, paying child support, and avoiding recidivism_4c935fca-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.2.3Formerly Incarcerated IndividualsEconomic IndependenceBecome a center of excellence in the research and practice of facilitating rapid and sustained economic independence for diverse at-risk populations_4c936b46-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.2.4At-Risk PopulationsPersonal Responsibility, Education, Employability & RelationshipsSupport youth as they transition to adulthood by assisting them to develop habits of personal responsibility, to obtain an education, to strengthen employability skills, and to establish and maintain positive, healthy relationships (including through evidence-based or evidence-informed healthy marriage and relationship education)_4c937bb8-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.2.5YouthHomelessnessReduce the incidence of homelessness._4c938518-24e7-11e8-9c9b-7e20c2e01b743.1.3The Department participates in the U.S. Interagency Council on Homelessness, which coordinates the Federal response to homelessness by partnering with 19 Federal agencies, State and local governments, advocates, service providers, and people experiencing homelessness, with a goal of ending all homelessness in America. The Department is working with its partners to reduce the incidence of homelessness through the following strategies:Emergy ShelterTest and invest in models, including emergency shelter and Housing First, to support homeless domestic violence survivors_4c938f2c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.3.1Domestic Violence SurvivorsRunaway & Homeless YouthStrengthen programs for runaway and homeless youth that provide outreach, crisis intervention, shelter, counseling, family reunification, and aftercare services_4c939d6e-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.1.3.2Runaway YouthHomeless YouthInjuries & ViolenceSafeguard the public against preventable injuries and violence or their results_3cd18370-248b-11e8-b521-8c21bde01b743.2ACFACLCDCIHSOASHSAMHSAPerformance Goals: * Increase the percentage of domestic violence program clients who have a safety plan * Decrease the percentage of children with substantiated or indicated reports of maltreatment that have a repeated substantiated or indicated report of maltreatment within 6 months * Increase intimate partner (domestic) violence screening among American Indian and Alaska Native females -- Injuries and violence affect all Americans regardless of an individual’s age, race, or economic status. Preventable injuries and violence -- such as falls, homicide stemming from domestic violence, and gang violence -- kill more Americans ages 1 to 44 than any other cause, including cancer, HIV, or the flu. Hospitalizations, emergency room visits, and lost productivity caused by injuries and violence cost Americans billions of dollars annually. Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. The Department supports multiple trauma-informed care initiatives to integrate a trauma-informed approach into health, behavioral health, and related systems, to reduce the harmful effects of trauma and violence on individuals, families, and communities. In 2015, the age-adjusted rate of unintentional injuries (43.2 per 100,000) increased 6.7 percent from the rate in 2014. The largest subcomponent of injury mortality is poisoning, with a rate 1.5 times greater than that of motor vehicle traffic deaths. In 2015, the age-adjusted rate of drug overdose deaths was more than 2.5 times the rate in 1999. The pattern of drugs involved in drug overdose deaths also has changed in recent years. In 2010, 29 percent of drug overdose deaths involved natural and semisynthetic opioids, and 12 percent involved methadone. In 2015, the percentage of drug overdose deaths involving these drugs decreased to 24 percent and 6 percent, respectively. In contrast, drug overdose deaths involving heroin increased from 8 percent in 2010 to 25 percent in 2015. Increases also were seen in drug overdose deaths involving synthetic opioids other than methadone, from 8 percent in 2010 to 18 percent in 2015. In 2014, according to the National Center for Health Statistics National Vital Statistics System, nearly 200,000 people died of injuries, including poisoning, resulting in a mortality rate of 62.6 per 100,000. In that same year, 39.5 million (126.3 per 1,000) medically attended injury and poisoning episodes occurred in the United States. In 2013, 1.4 million emergency department visits were due to assault alone. In 2014, 33,594 people died from all firearm-related injuries. In 2013, these issues cost the United States an estimated $671 billion in medical care and lost productivity.PracticesIdentify and disseminate evidence-based practices to reduce injuries and violence._4c93a61a-24e7-11e8-9c9b-7e20c2e01b743.2.1HHS funds 23 State health departments through the Core State Violence and Injury Prevention Program (Core SVIPP), which helps States implement, evaluate, and disseminate strategies that address the most pressing injury and violence issues, including child abuse and neglect, traumatic brain injury, domestic violence, and sexual violence. Core SVIPP aims to decrease injury- and violence-related morbidity and mortality and increase sustainability of injury prevention programs and practices. The Department also is working to identify and disseminate evidence-based practices to reduce injuries and violence through the following strategies:Abuse InterventionExpand knowledge about important abuse intervention models to enhance evidence-based services for older adults and adults with disabilities_4c93b024-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.1.1Older AdultsAdults with DisabilitiesChildren & Youth SafetyDisseminate evidence-based strategies to keep children and youth safe from violence and injuries -- including child maltreatment, unintentional poisoning, drowning, fires and burns, and infant suffocation_4c93befc-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.1.2ChildrenYouthInfantsFoster CareEnsure more children safely avoid foster care placement by encouraging the availability of effective, accessible family support services to address the issues families face, including the opioid crisis_4c93c80c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.1.3ChildrenFamily Support ServicesServicesFund services to support those who have been impacted by injuries and violence._4c93d202-24e7-11e8-9c9b-7e20c2e01b743.2.2Homicide is the third leading cause of death for young people ages 15 to 24, with more than 4,000 young people dying by homicide each year. One in four women, and one in nine men, were victims of sexual violence, physical violence, or stalking by an intimate partner, resulting in injury, fear, and a concern for their safety. The Department funds services to support those who have been impacted by injuries and violence, including through the following strategies:Centers of ExcellenceFund National Centers of Excellence in Youth Violence Prevention to better understand youth violence, implement and evaluate programs to prevent violence, and promote safe and supportive environments_4c93e008-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.2.1Emergency SheltersProvide support for emergency shelters and related assistance for victims of family violence_4c93f462-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.2.2Victims of Family ViolenceAbuse, Neglect & ExploitationPrevent abuse, neglect, and exploitation for older Americans._4c940024-24e7-11e8-9c9b-7e20c2e01b743.2.3Older AmericansAn estimated 1 in 10 older adults will be a victim of elder maltreatment. The Department works to prevent abuse, neglect, and exploitation for older Americans through the following strategies: Note: Additional strategies to support older adults are in Strategic Objective 3.4.Elder JusticeCoordinate elder justice activities within HHS and across the Federal Government through the Elder Justice Coordinating Council_4c94112c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.3.1Elder Justice Coordinating CouncilLong-Term Care FacilitiesFoster the health, safety, rights, and welfare of individuals who live in long-term care facilities through promoting person-centered quality care, monitoring, and ombudsman programs_4c941a3c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.3.2Long-Term Care FacilitiesResources & EducationImprove access to resources and education to help local communities identify and responding to elder abuse, neglect, and exploitation_4c94254a-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.3.3Older AmericansMaltreatmentEnhance knowledge about preventing elder maltreatment, through research_4c9433b4-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.3.4Protective ServicesStrengthen adult protective services' timely and effectively responses to older adults who are maltreated through practice guidelines, data collection and reporting, and technical assistance_4c943db4-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.3.5Adult Protective ServicesPartnershipsExpand partnerships with Federal, State, Tribal, local, and territorial government entities and other stakeholders to reduce injuries and violence_4c9447dc-24e7-11e8-9c9b-7e20c2e01b743.2.4Federal Government EntitiesState Government EntitiesTribal Government EntitiesLocal Government EntitiesTerritorial Government EntitiesThe Department works across the Federal Government, and with States, territories, Tribes, and faith-based and community organizations, to address injuries and violence -- monitoring accidental and violence-related injuries, supporting research on the factors that put people at risk, creating and evaluating preventative programs, helping partners plan and implement programs, and conducting research on the effective adoption and dissemination of these strategies. The Department is working to expand partnerships with Federal, State, Tribal, local, and territorial government entities and other stakeholders to reduce injuries and violence through the following strategies:Pregnant WomenProtect women from harmful exposures before, during, and after pregnancy, such as from domestic violence, tobacco exposure, and alcohol, opioid, and other harmful substance use, and improve outcomes for newborns and pregnant women_4c9456b4-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.4.1Pregnant WomenNewbornsDomestic & Dating ViolenceExpand interagency partnerships and systems to train healthcare and human service providers to assess for domestic and dating violence and do brief interventions to link victims to safety and support services, including through faith-based and community organizations_4c946064-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.4.2Healthcare ProvidersHuman Service ProvidersFaith-Based OrganizationsCommunity OrganizationsBullying & Dating ViolenceExpand bullying prevention and youth dating violence prevention partnerships with Federal, State, Tribal, local, territorial, and nongovernmental stakeholders to support safety and well-being_4c946a96-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.4.3Federal StakeholdersState StakeholdersTribal StakeholdersLocal StakeholdersTerritorial StakeholdersNongovernmental StakeholdersGangsExpand and strengthen partnerships with Federal, State, local, Tribal, and territorial partners, including faith-based and community organizations, on gang prevention programs as well as investing in youth mentoring and coaching, counseling, and life skills and workforce training_4c947900-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.4.4Federal PartnersState PartnersLocal PartnersTribal PartnersTerritorial PartnersFaith-Based OrganizationsCommunity OrganizationsHuman TraffickingAssess and increase the capacity of medical and behavioral health practitioners, nonprofits, faith-based and community organizations, licensed social workers, child welfare professionals, housing authorities, and public health agencies to provide comprehensive and survivor-informed services for victims of human trafficking_4c9481de-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.4.5Medical PractitionersBehavioral Health PractitionersNonprofitsFaith-Based OrganizationsCommunity OrganizationsLicensed Social WorkersChild Welfare ProfessionalsHousing AuthoritiesPublic Health AgenciesChild Welfare SystemImprove services to children and families in the child welfare system as a result of parental or caretaker opioid or other substance use disorder, including through faith-based and community organizations_4c948d14-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.4.6ChildrenFamiliesCultural CompetenceEnhance the cultural competence of the workforce in the delivery of social services to children, youth, and families through research, technical assistance, and training_4c949ba6-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.4.7 DataCollect, analyze, and report national data on the incidence and consequences of injuries and violence_4c94a57e-24e7-11e8-9c9b-7e20c2e01b743.2.5Nearly 192,000 people die from violence and injuries each year -- nearly 1 person every 3 minutes. The Department is working to collect, analyze, and report national data on the incidence and consequences of injuries and violence through the following strategies: Note: Additional surveillance strategies are in Strategic Objective 4.1.Healthcare Use & CostAssess healthcare use and costs associated with violence and unintentional injury, including patient safety events that occur in healthcare settings, to inform actions to prevent injury and violence and describe the return on investment of public health action_4c94b014-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.5.1MonitoringDevelop and enhance timely, coordinated data systems to monitor injuries and violence by using expanded surveillance, innovative methods, and new technology, to inform and evaluate national and State prevention activities_4c94c16c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.5.2Child MaltreatmentAddress gaps in data on prevalence and risk factors for child maltreatment_4c94ca9a-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.2.5.3ChildrenFamilies & ChildrenSupport strong families and healthy marriage, and prepare children and youth for healthy, productive lives_3cd18a6e-248b-11e8-b521-8c21bde01b743.3FamiliesChildrenACFACLCDCHRSAIHSOASHSAMHSAPerformance Goals: * Reduce the proportion of Head Start preschool grantees receiving a score in the low range on any of the three domains on the basis of the Classroom Assessment Scoring System (CLASS: Pre-K) * Reduce the proportion of children and adolescents ages 2 through 19 who are obese * Maintain the proportion of youth living in safe and appropriate settings after exiting ACF-funded Transitional Living Program services * Increase the number of participants in ACF-funded healthy marriage and relationship education services -- Families are the cornerstone of America's social fabric. A strong family can lead to many positive outcomes for the health, social, and economic status of both adults and children. People live longer, have less stress, and are more financially stable in a healthy family environment where both parents are present, share the responsibility of the household, and raise the children. Additionally, in these households, children tend to be healthier, both mentally and physically, and are better able to have their fundamental needs met. The Department supports healthy families and youth development through collaborations across the Federal Government and with States, territories, community partners, Tribal governments, and faith-based organizations. Head Start - PDF served 1.1 million children from birth to age 5 and pregnant women in 2015–2016, and approximately 1.4 million children per month received child care assistance in 2015. Recommendations for best practices for early child development are shared with partners across the country. Transitions from youth to adulthood are supported through the promotion of strength-based approaches, multisector engagement, and youth engagement efforts. Through programs like the Healthy Marriage and Relationship Education Grant Program, the Department funds organizations (including faith-based and community organizations) across the country to provide comprehensive healthy relationship and marriage education services, as well as job and career advancement activities to promote economic stability and overall improved family well-being. Children with involved fathers are more likely to perform well in school, have healthy self-esteem, and display empathy and pro-social behavior, compared with children who have uninvolved fathers. The New Pathways for Fathers and Families funds organizations across the United States to provide responsible-fatherhood activities that strengthen positive father-child engagement, improve employment and economic mobility, and improve relationships (including couple and coparenting) and marriage. The Department also supports reentry efforts for incarcerated fathers. Approximately 1.7 million State and Federal inmates are fathers of minor children. The impacts of incarceration affect the lives and well-being of their children and families. The Responsible Fatherhood Opportunities for Reentry and Mobility program funds grants that are specifically tailored to the needs of fathers transitioning from incarceration to their families and communities. Grants help fathers stabilize their lives, establish or reconnect with their children and families, develop habits of personal responsibility, obtain employment, and achieve economic mobility.ChildrenSupport the healthy development and well-being of children._4c94d670-24e7-11e8-9c9b-7e20c2e01b743.3.1ChildrenIn 2016, the United States was home to 73.6 million children, a number that is projected to grow to 74.5 million by 2022 and 76 million by 2029. The Department supports the healthy development and well-being of children through the following strategies:Healthy DevelopmetnPromote healthy development in young children to avoid behavioral challenges, support school readiness and learning, and offer parents of young children access to evidence-based, culturally appropriate parenting education and supports_4c94e66a-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.1.1Young ChildrenParentsQualityImprove the quality of care and education settings through effective professional development, coaching, monitoring for health and safety, provision of comprehensive services, and other training and technical assistance in order to promote positive teacher-child interactions and support children's skill development in all domains, including language, early literacy, numeracy, cognitive, and social-emotional development_4c94efa2-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.1.2TeachersChildrenLanguage DevelopmentTo achieve optimal brain development for all children, identify and promote effective approaches for early language development to integrate them into existing programs that reach young children, and leverage partnerships (including with faith-based and community organizations) to encourage broad implementation_4c94fa74-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.1.3 Young ChildrenFaith-Based OrganizationsCommunity OrganizationsActivity, Play, Nutrition & ContactPromote increased physical activity and active play, improved nutrition, reduced screen time, and increased interpersonal contact with and between children in child care and early childhood development programs_4c9508fc-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.1.4ChildrenChild Care ProgramsEarly Childhood ProgramsEarly Care & EducationImprove access to high-quality early care and education opportunities for young children by improving the quality of existing early care and education settings, including those offered by Tribes and faith-based and community initiatives, and building the supply of high-quality options for families_4c951216-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.1.5Young ChildrenEarly Care SettingsEducation SettingsTribesFaith-Based InitiativesCommunity InitiativesChildren with DisabilitiesRemove barriers to inclusion and accessibility to early child care and education for children with disabilities_4c951e8c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.1.6Children with DisabilitiesPrograms & ServicesReduce barriers to child and family participation in early childhood programs and services_4c953084-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.1.7ChildrenFamiliesEarly Childhood SettingsProvide effective training and technical assistance to help parents and families have greater involvement with teachers, educators, and caregivers to improve the quality of early childhood settings_4c953b92-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.1.8Early Childhood SettingsParentsFamiliesTeachersEducatorsCaregiversAdolescents & Young AdultsSupport the healthy development and well-being of adolescents and young adults_4c95486c-24e7-11e8-9c9b-7e20c2e01b743.3.2AdolescentsYoung AdultsThrough the Interagency Working Group on Youth Programs, the Department collaborates with other Federal departments and agencies to support at-risk youth through adolescence and young adulthood. The Department supports the healthy development and well-being of adolescents and young adults through the following strategies:Youth TransitionsSupport successful youth transitions to adulthood by strengthening relationship and employability skills and the development of habits of personal responsibility_4c955898-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.2.1 YouthRelationshipsHelp youth establish and maintain positive, healthy relationships, including connections with peers and caring adults, through demonstration programs and evidence-based or evidence-informed programs (including programs that provide healthy marriage and relationship education), including programs provided by faith-based and community organizations_4c95627a-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.2.2 YouthPeersCaring AdultsMental IllnessInvest in training to support adults in detecting and responding to mental illness in children and youth, including encouraging adolescents and their families to seek treatment_4c956d24-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.2.3AdultsChildrenYouthMorbidity, Mortality & Risk BehaviorsPrevent and reduce morbidity, mortality, and key risk behaviors among youth by supporting schools and communities to improve youth skills through sound health education and connection to needed services, and promoting school environments that protect and nurture youth to avoid risk and make positive life choices_4c957e5e-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.2.4 YouthSchoolsCommunitiesFoster CareSupport efforts to place children in foster care with extended birth family and support these kinship caregivers_4c9588c2-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.2.5 ChildrenExtended Birth FamiliesKinship CaregiversAdoptive FamiliesPromote efforts to recruit, train, and support adoptive families for children and youth whose birth parents and relatives cannot or will not safely care for them_4c959380-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.2.6ChildrenAdoptive FamiliesFoster CareSupport efforts to ensure the well-being of children in foster care and those who age out of foster care without a family_4c95a320-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.2.7Healthy DecisionsProvide adolescents with information and support to make healthy decisions regarding their health and well-being, including risk avoidance and establishment of positive life choices_4c95ac62-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.2.8AdolescentsParents, Guardians & CaregiversSupport parents, guardians, and caregivers._4c95b70c-24e7-11e8-9c9b-7e20c2e01b743.3.3ParentsGuardiansCaregiversWhile most children live with two parents, the Census Bureau estimates that 23 million children live in households with only one parent or no parent at all. The Department supports parents, guardians, and caregivers through the following strategies:ParentingImprove opportunities for parent participation in an evidence-based parenting curriculum or mentoring programs to improve parenting skills and lead to better learning and development outcomes for children and marital and family stability_4c95ca26-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.3.1ParentsFamiliesChild Development & ParentingSupport efforts, including through Tribes and faith-based and community organizations, to educate parents and caregivers about healthy child development, effective parenting practices, and specific developmental and health concerns faced by their children_4c95d386-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.3.2TribesFaith-Based OrganizationsCommunity OrganizationsParentsCaregiversFatherhoodSupport and engage fathers in innovative program models across agencies to better integrate them into their families' life_4c95de3a-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.3.3FathersFamiliesParental Mental Health & Substance AbuseSupport families with young children by addressing parental mental health or substance abuse_4c95ee20-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.3.4ParentsYoung ChildrenMarriages & RelationshipsDevelop and implement local and national dissemination strategies to communicate the value of healthy marriages and relationships, and of the success sequence, which recommends completing education, obtaining employment, and getting married before a first or subsequent child, across all socioeconomic demographics_4c95f78a-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.3.5Services & HealthIntegrate human services and health supports to support the well-being of children, youth, and families._4c9602b6-24e7-11e8-9c9b-7e20c2e01b743.3.4The Department recognizes that other risk factors like poverty, food insecurity, and housing instability can negatively impact health, and is working to integrate human services and health supports to support the well-being of children, youth, and families through the following strategies:Preventive & Primary HealthcareEnsure more young children become up to date on all age-appropriate preventive and primary healthcare, including sensory and developmental screening, with appropriate referral and intervention_4c96133c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.4.1Young ChildrenService AccessPromote interagency Federal, State, and local coordination, including through Tribes and faith-based and community organizations, to facilitate families' access to services and help them navigate systems of care across the full spectrum of family needs, including housing, education and training, healthcare, child care, social services, and economic supports_4c961ce2-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.4.2Risks & ChoicesIntegrate age- and developmentally appropriate strategies into programs designed to help all youth avoid risk and make better choices_4c9627c8-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.4.3YouthPediatric CareIntegrate trauma-informed, family-focused behavioral health services with pediatric primary care_4c96381c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.3.4.4Older Adults, People with Disabilities & CaregiversMaximize the independence, well-being, and health of older adults, people with disabilities, and their families and caregivers_3cd19590-248b-11e8-b521-8c21bde01b743.4Older AdultsPeople with DisabilitiesCaregiversACFACLCDCCMSHRSAIHSOASHSAMHSAOlder adults and people with disabilities face a complex set of difficulties. About one in every seven, or 14.9 percent, of the population is an older American - PDF. Approximately 12 percent of working-age adults in the United States have some type of disability. Of these adults, 51 percent had a mobility disability, and 38.3 percent had a cognitive disability. Older people and people with disabilities often rely on other people to fulfill fundamental needs and complete daily tasks. In order to facilitate adequate care and maximize independence, older adults and people with disabilities of all ages should be able to live where they choose, with the people they choose, and with the ability to participate fully in their communities. To support older adults, people with disabilities, and the system of friends, family, and community members that support them, the Department collaborates across the Federal Government, with States, Tribes, and territories, and with faith-based and community organizations. Aging and Disability Resource Centers provide a gateway to a broad range of services and supports for older adults and people with disabilities. Centers for Independent Living are community-based centers that offer services to empower and enable people with disabilities to stay in their communities. Every State and territory has an Assistive Technology Act program that can help people find, try, and obtain assistive technology devices and services. Assistive technology includes resources ranging from "low tech" helping tools -- like utensils with big handles -- to higher-tech solutions like talking computers. The Department also supports caregivers of older Americans and Americans living with disabilities. At least 90 percent of older adults receiving help with daily activities receive some form of unpaid care, and about two-thirds receive only unpaid care. In 2011, an estimated 18 million unpaid caregivers provided 1.3 billion hours of care on a monthly basis to Medicare beneficiaries age 65 and over. Strategies relating to supporting the healthcare needs of older adults and people with disabilities can be found in Strategic Goal 1: Reform, Strengthen, and Modernize the Nation's Healthcare System and Strategic Goal 2: Protect the Health of Americans Where They Live, Learn, Work, and Play. This Strategic Objective focuses on human services -- efforts to support the economic and social well-being of these populations.Community LivingStrengthen supports for community living._4c9641f4-24e7-11e8-9c9b-7e20c2e01b743.4.1Stable housing is foundational to good health and well-being. Accessible, affordable housing is essential to community integration and aging-in-place. For some older adults and people with disabilities, additional assistance is required to support community living. The Department works to strengthen supports for community living through the following strategies:Livable CommunitiesSupport age- and dementia-friendly livable communities to improve quality of life for older adults, families, caregivers, people with disabilities, and the larger community_4c964e4c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.1.1 Older AdultsFamiliesCaregiversPeople with DisabilitiesIndependencePromote independence of older adults and people with disabilities through improved collaboration, including with Tribes and faith-based and community organizations, to ensure opportunities to live and receive services in the community_4c966616-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.1.2Older AdultsPeople with DisabilitiesInclusion & AccessibilityFoster culture change through inclusion and accessibility for children and adults with disabilities and older adults by removing physical and other barriers_4c967386-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.1.3Children with DisabilitiesAdults with DisabilitiesOlder AdultsProgramsSupport programs for people with disabilities and older adults that help protect them from all forms of abuse, including physical, mental, emotional, and financial abuse, and help ensure their ability to exercise their rights to make choices, contribute to their communities, and live independently_4c968402-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.1.4People with DisabilitiesOlder AdultsRelationshipsSupport focused technical assistance to States aimed at forging stronger relationships between State Medicaid agencies, State housing finance agencies, and private partners including faith-based and community organizations with the goal of expanding community-living capacity in States_4c969410-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.1.5State Medicaid AgenciesState Housing Finance AgenciesPrivate PartnersFaith-Based OrganizationsCommunity OrganizationsCare Continuum, Transitions & Coordinationsupport choice across the care continuum, as well as improved care transitions and care coordination._4c969dc0-24e7-11e8-9c9b-7e20c2e01b743.4.2In Olmstead v. L.C., the Supreme Court affirmed that under the Americans with Disabilities Act, people with disabilities cannot be unnecessarily segregated and must receive services in the most integrated setting appropriate for their needs. Federal and State efforts following this landmark decision have increased community participation and independence of people with disabilities and older Americans who are living in communities, including those who have transitioned from nursing homes and other institutions. The Department is working to support choice across the care continuum, as well as improved care transitions and care coordination, through the following strategies:CollaborationPromote collaboration among Federal, State, Tribal, local, territorial, and private-sector partners that serve older adults, people with disabilities, and their families and caregivers to improve access to a full range of healthcare services, and home and community-based services_4c96ab08-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.2.1Older AdultsPeople with DisabilitiesCaregiversTransitionsPursue initiatives and programs to provide support to older adults, people with disabilities, and their families and caregivers as individuals move between the settings that best address their unique needs_4c96bdaa-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.2.2Older AdultsPeople with DisabilitiesCaregiversPlansIncrease the proportion of youth with disabilities who have plans in place for transitioning from pediatric to adult care_4c96c782-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.2.3Youth with DisabilitiesLong-Term Services & SupportsImprove quality and availability of long-term services and supports, including home and community-based services (HCBS)_4c96d2f4-24e7-11e8-9c9b-7e20c2e01b743.4.3Community-Based Services (HCBS)Approximately 20 percent of older Americans receive assistance with their care needs. Medicaid is the largest source of support for long-term services and supports, with an estimated $131.4 billion annually expended at the Federal and State levels. The Department is working to improve quality and availability of long-term services and supports, including home and community-based services (HCBS), through the following strategies:Performance MeasuresSupport the development of a core set of performance measures for HCBS that can provide data that can be used in quality and outcome measurement and reporting_4c96e384-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.3.1Delivery Models & FlexibilitySupport innovative delivery system models and program flexibilities that include HCBS to improve quality, accessibility, and affordability in Medicare and Medicaid_4c96ed0c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.3.2Person-Centered CareConsider new person-centered models of care in Medicare and Medicaid that provide an integrated approach to addressing individuals' medical, behavioral, long-term services and supports, and other needs to maintain health, well-being, and independence_4c96fd60-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.3.3MedicareMedicaidPersons with DementiaIdentify opportunities to accelerate the development, evaluation, translation, implementation, and scaling up of comprehensive care, services, and supports for persons with dementia, families, and other caregivers_4c970fee-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.3.4Persons with DementiaCaregiversLong-Term Services & SupportAssist States in strengthening and developing high-performing long-term services and supports systems that focus on the person, provide streamlined access, and empower individuals to participate in community living_4c971a70-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.3.5StatesDisaster & Emergency PreparednessEducate and improve the awareness of HCBS providers of the need to integrate the access and functional needs of older adults and people with disabilities into disaster and public health emergency preparedness, response, mitigation, and recovery_4c97272c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.3.6HCBS ProvidersOlder AdultsPeople with DisabilitiesAlzheimer's Disease & DementiasAddress Alzheimer's disease and related dementias._4c97374e-24e7-11e8-9c9b-7e20c2e01b743.4.4Alzheimer’s disease (AD) is an irreversible, progressive brain disease that affects as many as 5.3 million Americans. The prevalence of people with AD doubles for every 5-year interval beyond age 65. Without a preventive treatment or cure, the significant growth in the population over age 85 that is estimated to occur between 2015 and 2050 (from 6.3 million to 19 million) suggests a substantial increase in the number of people with AD. The Department is working to address Alzheimer’s disease and related dementias through the following strategies: Note: Additional strategies on preventive care are in Strategic Objectives 1.3 and 4.3.Education, Training & SupportExpand supports for people with Alzheimer's disease and related dementias and their families through culturally sensitive education, training, and support; assessing housing and other needs; and assisting families in planning for future care needs_4c9741d0-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.4.1People with Alzheimer's DiseasePeople with DementiasDiagnosis & Clinical ManagementEnhance public awareness and engagement to reduce misperceptions about diagnosis and clinical management_4c974d42-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.4.2DataImprove data to track the burden of Alzheimer's disease and related dementias, identify and monitor trends in associated risk factors, and assist with understanding health disparities_4c975d8c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.4.3CaregiversStrengthen supports for caregivers._4c97673c-24e7-11e8-9c9b-7e20c2e01b743.4.5CaregiversCaregivers provide care to people of all ages who live in residential or institutional settings. Caregiving can be both paid and unpaid; a 2009 survey found that approximately 25 percent of adults reported providing care to a person with a long-term illness or disability in the past 30 days. The Department is working to strengthen supports for caregivers through the following strategies:SupportProvide support for unpaid family caregivers, to maximize the health and well-being of the caregivers and the people for whom they provide care_4c977402-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.5.1Unpaid Family CaregiversCommunity SupportEducate and empower community supports, such as faith-based and community organizations, for providing support of all types for caregivers_4c978384-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.5.2Faith-Based OrganizationsCommunity OrganizationsResearch Gaps & FindingsIdentify research gaps in caregiving, and optimize sharing of research findings_4c978d48-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.5.3Caregiver ResourcesImprove access to educational and community-based resources that caregivers can use to maintain and/or increase their health and well-being_4c979b80-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.4.5.4CaregiversService DisparitiesReduce disparities in services for older adults and people with disabilities._4c97ab0c-24e7-11e8-9c9b-7e20c2e01b743.5.6Older AdultsPeople with DisabilitiesFor people with complex health needs, such as older adults and people with disabilities, accessing high-quality and affordable care -- healthcare, as well as assistance for daily living -- can be challenging. Geographic disparities, as well as economic constraints, can limit the number and quality of available options. The Department is working to reduce disparities in services for older adults and people with disabilities through the following strategies:RightsEnsure that individual rights are protected and addressed through enforcement of mental health and substance use parity laws, Olmstead, Americans with Disabilities Act, and other protections_4c97b584-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.5.6.1Care PlanningInclude culturally appropriate, person- and family-centered care planning in Federal social and healthcare services for older adults and persons with disabilities to protect individual choice and address a person's current and future economic resources, including advance care planning needs_4c97c218-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.5.6.2Monitoring & ReportingMonitor, using existing data sources, the status of the health, well-being, and independence of older adults and people with disabilities, and improve reporting on these populations_4c97d1b8-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.5.6.3Older AdultsPeople with DisabilitiesWorkforceStrengthen the workforce providing services to people 65 years old and older._4c97db68-24e7-11e8-9c9b-7e20c2e01b743.5.7Older AmericansThe number of people 65 years old and older is expected to double between 2000 and 2030. Providing high-quality services to this growing population requires a high-quality workforce. The Department seeks to strengthen the workforce through the following strategies:EducationEducate the healthcare and service professional workforce on the concerns of a geriatric population to ensure awareness of the unique challenges and issues of older adults_4c97e6da-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.5.7.1 CompetencyImprove and increase competency in the healthcare and direct service workforce in person-centered approaches and cultural competency_4c97f652-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.5.7.2 Healthcare WorkforceDirect Service WorkforceTraining & CapacityStrengthen the training and capacity of healthcare providers to recognize, assess, refer, connect, and engage caregivers_4c98000c-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.5.7.3 Healthcare ProvidersCaregiversPartnershipsStrengthen partnerships between academia, health delivery systems, Tribes, and faith-based and community organizations to educate and train the workforce to provide high-quality, culturally competent care_4c980cdc-24e7-11e8-9c9b-7e20c2e01b74Strategy 3.5.7.4AcademiaHealth Delivery SystemsTribesFaith-Based OrganizationsCommunity OrganizationsScienceFoster Sound, Sustained Advances in the Sciences_3cd19c7a-248b-11e8-b521-8c21bde01b744Administration for Children and Families (ACF)Administration for Community Living (ACL)Agency for Healthcare Research and Quality (AHRQ)Centers for Disease Control and Prevention (CDC)Centers for Medicare & Medicaid Services (CMS)Food and Drug Administration (FDA)Health Resources and Services Administration (HRSA)National Institutes of Health (NIH)Office for Civil Rights (OCR)Office of Global Affairs (OGA)Office of the Assistant Secretary for Health (OASH)Office of the Assistant Secretary for Preparedness and Response (ASPR)Substance Abuse and Mental Health Services Administration (SAMHSA)According to a recent study, the United States makes about 44 percent of the total global biomedical research investments worldwide. Together with foundations, charities, private industry, and State, Tribal, local, and territorial governments, the Department’s scientific investments seek to unlock mysteries to improve health and well-being; reduce the burden of death, disease, and disability; and extend and improve quality of life. These scientific investments are to be conducted consistent with the understanding that all human life is valuable and that the human subjects protection regulations apply to all human beings from conception to natural death.Making better decisions in health, public health, and human services often depends on data obtained through surveillance, epidemiology, and laboratory services—at the Federal, State, Tribal, local, and territorial levels. HHS efforts in this area help to track and trace disease outbreaks, connect the data to tell a more complete story of public health issues, and facilitate speedier responses to threats to health and well-being.Success in this domain starts with our scientific workforce. To date, 153 NIH-supported researchers have received Nobel Prizes for their achievements. HHS strives to expand the capacity of the research workforce, and equip them with the tools to make the discoveries of tomorrow.The NIH’s Human Genome Project—completed under budget and 2 years ahead of schedule—has led to the discovery of more than 1,800 disease genes and is sparking the development of more powerful, preventive, personalized medical interventions. Basic science and applied research investments—whether intramural or extramural—seek solutions to the health, public health, and human services challenges articulated throughout this Strategic Plan.To be truly effective, these discoveries must be shared, adopted, scaled up, and implemented with fidelity. HHS is working to promote evidence-informed practices in the health, public health, and human services domains. As a steward of the public trust, HHS has a responsibility to promote approaches that will improve health and well-being.Surveillance, Epidemiology & LabsImprove surveillance, epidemiology, and laboratory services_3cd1a378-248b-11e8-b521-8c21bde01b744.1ASPRCDCCMSFDANIHOCROGASAMHSAPerformance Goals:* Increase the percentage of laboratory reports on reportable conditions that are received through electronic means nationally* Increase the percentage of notifiable disease messages transmitted in HL7 format to improve the quality and streamline the transmission of established surveillance data* Increase the number of people for whom the FDA is able to evaluate product safety through the Mini-Sentinel/Sentinel system--In an increasingly interconnected world, public health threats can quickly escalate from an isolated incident to a regional or even global emergency. A flu outbreak in one State can quickly spread to multiple States -- keeping children out of school and adults away from work, and threatening the lives of the very young and very old. Rapid changes in public health patterns -- such as the growth in opioid use and overdose -- can strain the resources and capacity of first responders, health systems, and communities.Identifying and mitigating urgent and persistent threats to public health depends on the quality of surveillance, epidemiology, and laboratory services—at the Federal, State, and local levels as well as with U.S. territories, Tribes, and international partners. Public health surveillance data, applied epidemiology, and laboratory best practices can guide better decision making to target interventions more responsibly, and ultimately improve health.The Department is dedicated to conducting and funding scientific research that leads to evidence-based, high-quality care and responsive interventions to mitigate health crises. Data and information from surveillance, epidemiology, and laboratory services can aid in the prevention and early intervention of foodborne illnesses, such as listeria and norovirus, and infectious disease outbreaks, such as Zika and Ebola. To achieve this objective, the Department is working to facilitate information exchange to identify risks quickly and efficiently, strengthen the quality and safety of our Nation’s laboratories, and strengthen the alignment of surveillance, epidemiology, and laboratory services.As response rates to surveys fall and primary data collection costs increase, the need to use and leverage new sources of data for public health surveillance becomes critical. Within the Department, efforts are underway to use electronic health records for infectious disease surveillance and to facilitate coding of causes of death on death certificates. At the National Center for Health Statistics, linkages between survey data, mortality data, hospital administrative data, electronic health records, Medicare data, and housing data have been created and should greatly expand public health surveillance opportunities. In addition, HL7 Continuity of Care Document specifications have been published to facilitate the submission of standardized electronic health information to the National Health Care Surveys, enhancing their usability for surveillance.OutcomesApply surveillance data and epidemiological findings to improve outcomes._c21f70c0-257e-11e8-8fea-35c5c4e01b744.1.1The value of data, as articulated by the HHS Data Council, is its relevance, timeliness, availability when needed, and distinctive contributions. The Department will apply surveillance data and epidemiological findings to improve outcomes through the following strategies:Data StandardsEstablish data standards and, as appropriate, ensure that Federally conducted or supported healthcare or public health programs, activities, or surveys collect and report data in five specific demographic categories: race, ethnicity, sex, primary language, and disability status_c21f8d3a-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.1.1American Indians & Alaska NativesEngage with American Indians/Alaska Natives to explore opportunities to improve data collection efforts_c21fa2ac-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.1.2American IndiansAlaska NativesPopulation HealthCollect, analyze, and report granular or disaggregated data to support population health_c21fbc10-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.1.3Health & Human ServicesApply surveillance data and epidemiological findings to improve health, public health, and human services._c21fca48-257e-11e8-8fea-35c5c4e01b744.1.2In addition to these more general strategies with applicability across settings, the Department will apply surveillance data and epidemiological findings to improve health, public health, and human services through the following strategies:YouthPromote use of youth-focused surveillance and data collection to inform school and community actions that improve the health of adolescents_c21fdc72-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.1YouthAdolescentsSchoolsCommunitiesMedical ProductsIdentify and assess adverse events related to the use of regulated human and animal medical products, including the development and more effective use of large nationally representative database systems, electronic health records, common data models, and natural language processing_c21ff46e-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.2FoodImplement advanced laboratory, epidemiologic, and environmental methods across Federal and State agencies to identify, investigate, and stop foodborne outbreaks sooner and prevent future illness by identifying and addressing gaps in the food safety system_c220036e-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.3InfluenzaEnhance domestic and global capacity for influenza surveillance to ensure rapid detection and reporting of cases or outbreaks of influenza viruses that have pandemic potential and to monitor trends in seasonal influenza epidemiology_c22015a2-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.4OpioidsStrengthen understanding of the opioid crisis through better public health surveillance to inform clinical management decisions for patients, including effects of opioid use in pregnancy and neonatal abstinence syndrome_c2202cd6-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.5Behavioral DisparitiesAnalyze data on behavioral health disparities to increase understanding of factors contributing to disparities, identify disadvantaged and at-risk populations, assess trends, and inform policy and program development_c2203ac8-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.6Disadvantaged PopulationsAt-Risk PopulationsEmergenciesSupport a data-driven approach to emergency preparedness, response, and recovery_c2204c7a-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.7Injury & ViolenceAssess healthcare use and costs associated with violence and unintentional injury, including patient safety events that occur in healthcare settings_c2206660-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.8MonitoringDevelop and enhance timely, coordinated data systems to monitor injuries and violence by using expanded surveillance, innovative methods, and new technology to inform and evaluate national and State prevention activities_c2207434-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.2.9StatesData & InformationFacilitate better information sharing, exchange, and alignment of data._c2208ab4-257e-11e8-8fea-35c5c4e01b744.1.3Improving data's value also involves integrating data from two or more sources such as surveys, administrative and claims data, public health surveillance data, and clinical data. The Department is working to facilitate better information sharing, exchange, and alignment of data through the following strategies:Data CollectionImprove data collection methodologies and systems for enhancing real-time and local data collection in order to minimize local burden, and improve timeliness, reliability, and comparability of the data, allowing for local public health and healthcare providers to use data for decision making and response mobilization_c220a3d2-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.3.1Public Health ProvidersHealthcare ProvidersInformation ExchangeImplement information technology solutions that support timely information exchange among local, State, international, and Federal agencies, healthcare facilities, and laboratories while ensuring that these systems minimize threats to information security_c220b26e-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.3.2Local AgenciesInternational AgenciesInternational AgenciesFederal AgenciesHealthcare FacilitiesLaboratoriesInfectious & Chronic DiseaseModernize domestic and international infectious and chronic disease surveillance systems to improve system interoperability and enable more rapid reporting, data exchange, and use to drive timely public health and medical action and response_c220c42a-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.3.3InnovationPromote new and innovative methods to rapidly collect, store, standardize, share, and analyze data across all levels of government, and with nongovernmental partners, to improve situational awareness and public health surveillance before, during, and after public health and medical emergencies_c220dc30-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.3.4Data Collection StrategyConsistent with any limitations on the use or disclosure of such data, develop and implement a Department-wide data collection strategy to strengthen the capacity of HHS resources; promote synergy across systems; assure efficiencies, quality, utility, and timeliness; and address high-priority data gaps_c220ea40-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.3.5Quality & SafetyPromote and protect laboratory quality and safety._c220fc42-257e-11e8-8fea-35c5c4e01b744.1.4LaboratoriesAcross the Department, laboratories house efforts to find the cures to disease; detect infectious organisms, foodborne outbreaks, and biosecurity threats; screen for genetic and health risks; and identify environmental hazards. Ensuring that laboratories follow safe practices and meet high standards of quality is essential to preserve the integrity of these essential resources. The Department works to promote and protect laboratory quality and safety through the following strategies:Note: Additional strategies to strengthen the scientific workforce and infrastructure are in Strategic Objective 4.2.Professional DevelopmentProvide ongoing professional development opportunities to help the laboratory-based workforce remain on the cutting edge of relevant scientific and technological advancements_c2211470-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.4.1Laboratory WorkforceTrainingEnsure training for laboratory personnel and management, and promote employee safety, security, and occupational health through laboratory evaluations and inspections_c2212366-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.4.2Laboratory PersonnelLaboratory ManagersQuality & Safety StandardsReview standards for laboratory quality and strengthen guidance to increase patient and laboratory safety_c221372a-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.4.3CapacityEnhance and sustain national and international laboratory capacity to manage samples, conduct research, and analyze and report test results that leads to the development of interventions associated with disease detection and surveillance_c221502a-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.4.4TechnologiesSupport the development, implementation, and evaluation of new laboratory technologies (such as telemedicine, metagenomics, next-generation sequencing), and their use for emerging infectious diseases, antimicrobial resistance, food safety, pharmaceutical safety, chronic disease risk factors, and environmental biomonitoring_c2215e1c-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.4.5Microbiology LaboratoriesDevelop reporting guidelines for microbiology laboratories, based upon Federal, State, and local requirements, to improve surveillance of antimicrobial resistance_c2216fa6-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.4.6Microbiology LaboratoriesRegulatory ComplianceLeverage expertise of clinical and public health laboratory partners on improving regulatory compliance to ensure quality laboratory testing operations during emergency response efforts_c2218798-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.4.7Clinical PartnersPublic Health Laboratory PartnersAlignmentStrengthen the alignment of surveillance, epidemiology, and laboratory services to improve health outcomes._c221956c-257e-11e8-8fea-35c5c4e01b744.1.5Effective surveillance systems not only serve as an early warning system for threats to public health; when aligned with epidemiological and laboratory services, they can investigate and confirm outbreaks to facilitate a speedier response. The Department is strengthening the alignment of surveillance, epidemiology, and laboratory services to improve health outcomes through the following strategies:Epidemiological DataDevelop innovative solutions for conducting population health monitoring, risk assessments, and analysis of epidemiological data to improve our understanding of health risk factors and the effectiveness of health interventions_c221a7be-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.5.1PartnershipsFoster State, Federal, and international partnerships to improve surveillance and laboratory capacity across the continuum of care to identify and control threats to public health and health security, including infectious disease threats, healthcare-associated infections, antimicrobial-resistant pathogens, and environmental health hazards_c221c12c-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.5.2InterventionsSupport the private and secure collection, maintenance, analysis, and sharing of information to improve surveillance and expand the evidence base for high-quality care and rapid interventions, through Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104–191) rules and guidance_c221cf6e-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.5.3Data Science & Information SystemsEnhance domestic and international information systems (e.g., data linkage, shared services, data standards) and apply modern data science methods to provide timely, high-quality, and actionable data for early outbreak detection, rapid response to public health threats, programmatic planning, and targeted interventions for populations at risk_c221e382-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.5.4OutcomesImprove health and behavioral health outcomes for children and their parents by using surveillance data to build epidemiological capacity in States and counties to identify high-need issues and particular areas of risk, and then responding with appropriate evidence-based interventions and policy development_c221fc50-257e-11e8-8fea-35c5c4e01b74Strategy 4.1.5.5ChildrenParentsWorkforce & InfrastructureExpand the capacity of the scientific workforce and infrastructure to support innovative research_3cd1ae40-248b-11e8-b521-8c21bde01b744.2Scientific WorkforceAHRQCDCFDANIHOASHOGASAMHSAPerformance Goals:* By 2021, develop, validate, and/or disseminate three to five new research tools or technologies that enable better understanding of brain function at the cellular and/or circuit level* Increase the percentage of scientists retained at the FDA after completing fellowship or traineeship programs--Tomorrow's scientific breakthroughs depend on a highly trained and ethical scientific workforce, working in facilities and with tools that foster innovation. Efforts to expand the capacity of the scientific workforce and infrastructure can better prepare the Nation for global health emergencies, extend the reach and impact of scientific investigations, and contribute to research of national or global significance.Through various initiatives and programs, HHS recruits and trains students, recent graduates, and other professionals to conduct rigorous and reproducible research. HHS provides research training and career development opportunities to ensure that highly trained investigators will be available across the range of scientific disciplines necessary to address the Nation’s biomedical and scientific research needs.HHS invests in Federal statistical units responsible for national surveys that provide reliable, timely, and policy-relevant information for policymakers and researchers. HHS also invests in strengthening the research infrastructure, ensuring that research facilities are constructed, modernized, and equipped with state-of-the-art tools and resources to support the scientific community.A critical component of this objective is HHS leadership in protecting the rights, welfare, and well-being of human subjects involved in research, and in investigating unethical behavior and misconduct in research. These human subjects protections apply to all human beings, from conception to natural death. Through the Federal Policy for the Protection of Human Subjects (The Common Rule, 45 CFR Part 46, Subpart A), the Department describes Institutional Review Boards, informed consent processes, and Assurances of Compliance, as well as additional protections for biomedical and behavioral research involving pregnant women, human fetuses, neonates, prisoners, and children (45 CFR Part 46, Subparts B–D).Scientific integrity is a priority for the Department. Divisions responsible for research have developed policies and procedures to ensure the highest degree of scientific integrity in the research HHS conducts, funds, and supports -- to ensure that our research is credible and worthy of the public’s confidence.Recruitment, Training & RetentionRecruit, train, and retain a scientific workforce responsive to future demands._c2220b50-257e-11e8-8fea-35c5c4e01b744.2.1Scientific WorkforceThe Department recognizes that our ability to develop the breakthroughs of tomorrow depends on our ability to recruit the next generation into careers in science, technology, engineering, and math today. The Department is recruiting, training, and retaining a scientific workforce responsive to future demands through the following strategies:Recruitment & TrainingSupport fellowships and other training programs in academic, industry, and government settings to help recruit and train early-career scientists, laboratory scientists, public health scientists, and survey statisticians_c2221dca-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.1.1Early-Career ScientistsLaboratory ScientistsPublic Health ScientistsSurvey StatisticiansTraining & Career DevelopmentProvide research training and career development opportunities to ensure that a diverse pool of highly trained investigators will be prepared for and available across the range of scientific disciplines necessary to address the Nation's biomedical and scientific research needs_c22236ac-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.1.2InvestigatorsScientific Workforce DevelopmentImplement and evaluate the effectiveness of scientific workforce development programs, including training and formal mentorship of new scientists, including data scientists, to guide and support staff performance and professional development and to improve the sustainability and quality of workforce programs_c2224516-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.1.3Scientific WorkforceTraining & FellowshipsConduct joint fellowship programs and other training programs targeted to researchers and regulatory reviewers to provide multidisciplinary training across the interrelated areas of basic and translational science_c2225718-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.1.4Systems & PoliciesEnsure administrative systems and policies are aligned with anticipated workforce needs to support comprehensive capacity building and consistent quality improvement programs_c2226f3c-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.1.5Ethics & ResponsibilitiesPromote ethical and responsible research._c2227cfc-257e-11e8-8fea-35c5c4e01b744.2.2Guidelines for ethical and responsible research consider the boundaries between biomedical and behavioral research and the accepted and routine practice of medicine, risk-benefit criteria, appropriate guidelines for selection of human subjects for participation, and informed consent. The Department promotes ethical and responsible research through the following strategies:Peer ReviewsAssess peer review practices and provide the workforce with best practices for peer review_c2228f94-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.2.1Human SubjectsImprove human subjects protection, and enforcement of human subjects protection regulations and other laws governing research, especially with respect to research involving human embryos or embryonic stem cells/tissue, fetal tissue, genetic engineering and manipulation of the germ cell, and the creation of chimeras_c222a86c-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.2.2Human SubjectsGuidance & ToolsProvide guidance and tools, including required trainings, to ensure that researchers are able to conduct research ethically, safely, securely, and responsibly_c222b708-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.2.3Rigor, Transparency & ReproducibilityImprove the methodological rigor, transparency, and reproducibility of federally funded research and surveys to strengthen public confidence in federally supported research and survey findings_c222c900-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.2.4InnovationCollaborate with the broader research community to strengthen innovation._c222e278-257e-11e8-8fea-35c5c4e01b744.2.3Research CommunityApproximately 84 percent of the NIH budget is dedicated to supporting more than 300,000 members of the research workforce in the extramural biomedical, behavioral, and social science research communities. The Department collaborates with the broader research community to strengthen innovation through the following strategies:Interactions & CollaborationFacilitate interactions with domestic and international partners to promote basic science and research/educational collaborations and to engage in innovative joint research projects_c222f1b4-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.3.1 CulturePromote a culture of responsible data sharing, openness, and collaboration to better engage with academia and the private sector, consistent with applicable privacy and security requirements_c22304b0-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.3.2AcademiaPrivate SectorFacilities & InfrastructureStrengthen core facilities and infrastructure capacity._c2231d38-257e-11e8-8fea-35c5c4e01b744.2.4Core facilities are centralized shared resources that provide access to instruments, technologies, services, expert consultation, and other services to scientific and clinical investigators. The Department is strengthening core facilities and infrastructure capacity through the following strategies:FacilitiesLeverage facilities as shared resources, which provide investigators access to advanced technologies through cutting-edge instrumentation operated by appropriately trained staff_c2232bc0-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.4.1InvestigatorsToolsEnsure that the scientific research workforce has access to modern tools, including resources for data science and scientific computing_c2233dfe-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.4.2Scientific Research WorkforceModernization & ImprovementSupport modernization and improvements of research facilities through alterations, renovations, and new equipment purchases_c223571c-257e-11e8-8fea-35c5c4e01b74Strategy 4.2.4.3Basic ScienceAdvance basic science knowledge and conduct applied prevention and treatment research to improve health and development._c223657c-257e-11e8-8fea-35c5c4e01b744.3ACLAHRQCDCFDANIHOASHPerformance Goals:* By 2023, develop, optimize, and evaluate the effectiveness of nano-enabled immunotherapy (nano-immunotherapy) for one cancer type* By 2022, evaluate the safety and effectiveness of one to three long-acting strategies for the prevention of HIV* By 2020, identify risk and protective alleles that lead to one novel therapeutic approach, drug target, or pathway to prevention for late-onset Alzheimer’s disease-- The impact of scientific discoveries cannot be underestimated. Research-related gains in average life expectancy between 1970 and 2000 have an economic value of $3.2 trillion dollars per year. A $1.00 increase in public basic research stimulates an additional $8.38 of industry research and development investment after 8 years.Basic science and applied prevention and treatment research are critical not just to the American economy, but to quality of life. Infant mortality has dropped by more than 75 percent since 1960. For children born in 2009, childhood vaccinations are expected to save $13.5 billion in direct healthcare costs over the course of their lifetimes. The death rate from unintentional injuries - PDF has decreased almost 40 percent since 1969. And a 20-year-old HIV - PDF-positive adult receiving treatment to suppress the virus can expect to live into their early 70s—nearly as long as someone without HIV.For nearly every Strategic Objective in this Strategic Plan, HHS is conducting, supporting, or funding research to expand our knowledge about how to achieve positive outcomes—to improve health and well-being and extend quality of life. Partnerships with the private sector, academia, and governments at the Federal, State, Tribal, local, and international levels are critical to success in this objective.HHS conducts, funds, and supports a broad and diverse portfolio of biomedical research in a range of scientific disciplines, including basic and translational research, to augment scientific opportunities and innovation for public health needs. HHS works to strengthen basic and applied science and treatment pipelines to assess potential health threats and bolster the fundamental science knowledge in these risk areas to expedite the development of therapies. As described in Strategic Objective 4.2, Expand the capacity of the scientific workforce and infrastructure to support innovative research, research is conducted ethically and responsibly.Causes of DeathReduce the incidence of the leading causes of death._c2237b16-257e-11e8-8fea-35c5c4e01b744.3.1Heart disease, cancer, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer's disease, diabetes, influenza and pneumonia, kidney diseases, and suicide were the 10 leading causes of death in 2016. The Department is working to reduce the incidence of the leading causes of death through the following research strategies:Risk FactorsDiscern risk factors and mechanisms underlying the leading causes of death to accelerate applied and preventive research solutions_c223960a-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.1.1Studies, Reporting & TestingSupport research to prevent the leading causes of death in adults by improving the quality and specificity of reporting causes of death, developing systematic studies, and testing interventions to determine and prevent the actual causes of death_c223a4e2-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.1.2Clinical Preventive ServicesDevelop and test methods to increase adoption by primary care providers of recommendations from the U.S. Preventive Services Task Force for clinical preventive services that address the leading and actual causes of death_c223b892-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.1.3Primary Care ProvidersU.S. Preventive Services Task ForceInterventionsAssess the 5-year health outcomes and adverse events of preventive interventions that target the actual and leading causes of death, to assist the U.S. Preventive Services Task Force in providing evidence-informed recommendations_c223d1d8-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.1.4U.S. Preventive Services Task ForceAccess, Safety & QualityInvest in research to promote access, patient safety, and healthcare quality._c223e038-257e-11e8-8fea-35c5c4e01b744.3.2PatientsStrategic Objective 1.2, Expand safe, high-quality healthcare options, and encourage innovation and competition, describes the Department’s efforts to improve patient safety and healthcare quality, including within healthcare settings. Strategic Objective 1.3, Improve Americans' access to healthcare and expand choices of care and service options, describes how the Department works to connect the people HHS serves to quality options. To build knowledge about effective approaches, the Department is investing in research to promote access, patient safety, and healthcare quality through the following strategies:Medical Product DevelopmentFacilitate patient-focused medical product development to inform regulatory decision making_c223f33e-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.1DataConduct and support data collection, research, and evaluations to support healthcare safety, delivery, quality, efficiency, and effectiveness for all populations, including those experiencing healthcare disparities_c2240d06-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.2Lifestyle, Environment & iologyConduct research that takes into account individual differences in lifestyle, environment, and biology, to determine new pathways for preventing and treating disease_c2241b70-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.3Personalized MedicineFoster and capitalize on advances in personalized medicine to accelerate health research and medical breakthroughs, enabling individualized prevention, treatment, and care for all people and addressing unmet medical needs_c2242f3e-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.4InsuranceSupport research to provide evidence on how to ensure access to affordable, physical, oral, vision, behavioral, and mental health insurance coverage for children and adults_c2244e88-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.5ChildrenAdultsMedical ProductsConduct research to facilitate development and availability of innovative, safe, and efficacious human and animal medical products, including development of regulatory science_c2246490-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.6Risk FactorsConduct, fund, and apply research on the role of other risk factors and their impact on health access, quality, and safety_c2247a84-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.7Outcome AssessmentFacilitate the development and qualification of clinical outcome assessment tools to measure clinical benefit in medical product development_c224955a-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.8Medical Product DevelopersPharmaceutical TechnologySupport and facilitate the adoption of innovative pharmaceutical technology to modernize product development and manufacturing, ensuring the consistent supply of high-quality medicine for patients_c224a446-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.9Quality, Access, Disparities & RisksProduce and promote healthcare delivery methods and interventions that improve care quality, promote healthcare access, reduce disparities, and address other risk factors among populations at risk for poor health outcomes_c224b756-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.10Alzheimer's Disease & DementiasExpand our understanding of the causes of, treatments for, and prevention of Alzheimer's disease and related dementias, including accelerating efforts to identify early and presymptomatic stages and translating findings into medical practice and public health programs_c224d2f4-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.2.11Healthcare ProvidersInvest in research on strengthening and supporting healthcare providers._c224e2da-257e-11e8-8fea-35c5c4e01b744.3.3Healthcare ProvidersStrategic Objective 1.4, Strengthen and expand the healthcare workforce to meet America's diverse needs, describes the Department's efforts to recruit, retain, and train the healthcare workforce. To build our knowledge, the Department is investing in research on strengthening and supporting healthcare providers through the following strategies:Clinical DecisionsEvaluate the adoption, implementation, and impact of clinical decision support systems, and evidence-based guidelines on clinical and community preventive services and treatments to improve both behavioral and physical health and well-being_c224f8c4-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.3.1Shared Decision MakingFund research on shared decision making to support healthcare providers' efforts to deliver healthcare services that empower patients, families, and caregivers to implement lifestyle behavior modification aimed at better health and healthcare outcomes_c22516a6-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.3.2Healthcare ProvidersPatientsFamiliesCaregiversService Delivery ProfessionalsFund applied research, development, training, and sharing of information and products to improve knowledge and practice of service delivery professionals who are supporting disadvantaged and at-risk populations_c2252628-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.3.3Service Delivery ProfessionalsSystems of CareConduct research and disseminate findings on systems of care and strategies such as team-based care, enhanced communication, and improvements in technology that reduce burden and burnout of healthcare professionals and that create healthy workplaces_c22538ac-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.3.4Systems of CareHealth & WellnessInvest in research to promote health and wellness._c22550c6-257e-11e8-8fea-35c5c4e01b744.3.4Strategic Objective 2.1, Empower people to make informed choices for healthier living, describes the Department’s efforts to promote health and wellness in the public. To expand our knowledge base, the Department is investing in research to promote health and wellness through the following strategies:Behavior ChangeInvest in research and education on behavior change methods, such as effective stress management, proper nutrition, and regular exercise_c2255fda-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.4.1Childhood ObesityAccelerate research and national efforts to implement solutions at the individual, family and community level, including through partnerships with Tribes and faith-based and community organizations, to reduce childhood obesity, including focusing on the pregnancy period to age five in terms of the etiology and interventions_c2257326-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.4.2ChildrenTribesFaith-Based OrganizationsCommunity OrganizationsCommunicable DiseasesInvest in research to prevent, treat, and control chronic conditions and communicable diseases._c2258c94-257e-11e8-8fea-35c5c4e01b744.3.5Strategic Objective 2.2, Prevent, treat, and control communicable diseases and chronic conditions, describes the Department’s efforts to promote public health on the ground. To develop our understanding about best practices and build the evidence base, the Department is investing in research to prevent, treat, and control chronic conditions and communicable diseases through the following strategies:Infectious DiseasesSupport basic science and applied prevention and treatment research on approaches to reduce the global burden of infectious diseases such as HIV, viral hepatitis, tuberculosis, malaria, and neglected tropical diseases_c2259afe-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.5.1Enteric & Respiratory DiseasesSupport basic and applied research to prevent and treat enteric and respiratory diseases_c225ae54-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.5.2VaccinesConduct basic science and applied research and disseminate findings to maximize the use of age-appropriate vaccines to minimize the burden of preventable diseases across the lifespan_c225c8bc-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.5.3Prevention, Detection & InvestigationDevelop and assess improved methods for rapidly detecting and investigating disease outbreaks and developing new preventive and therapeutic strategies_c225d7f8-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.5.4High-Impact InterventionsDevelop, evaluate, and implement high-impact public health interventions domestically and internationally, and advance policies to increase community and individual engagement in infectious disease prevention efforts_c225ec2a-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.5.5Social & Behavioral InterventionsInvest in research on the use of specific social and behavioral interventions to prevent, treat, and control communicable and chronic conditions_c2260750-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.5.6Vector-Borne DiseasesIdentify, develop, and evaluate effective prevention and control practices for Lyme and other vector-borne diseases_c22616a0-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.5.7Behavioral HealthInvest in research to improve behavioral health._c226294c-257e-11e8-8fea-35c5c4e01b744.3.6Strategic Objective 2.3, Reduce the impact of mental and substance use disorders through prevention, early intervention, treatment, and recovery support, describes the Department’s direct supports related to mental health and substance abuse. To expand the knowledge base, the Department is investing in research to improve behavioral health through the following strategies:Modifiable Risk FactorsConduct applied research to identify the most effective health and community-based system interventions that address the modifiable risk factors for prescription opioid misuse, heroin initiation, and opioid use disorder and overdose_c2264332-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.6.1Genomics & ProteomicsFoster integration of behavioral and social science research into research involving acceptability and understanding of genomics and proteomics, to accelerate time-to-trial as well as improve study designs_c2265228-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.6.2Public Health EmergenciesDevelop the knowledge to support evidence-based interventions for public health emergencies._c22665ba-257e-11e8-8fea-35c5c4e01b744.3.7Strategic Objective 2.4, Prepare for and respond to public health emergencies, articulates the Department’s emergency preparedness and response activities. The Department is developing the knowledge to support evidence-based interventions for public health emergencies through the following strategies:Strategies, Interventions & EvaluationsEnhance the portfolio of strategies, interventions, and evaluations to prevent and respond to public health emergencies_c22682f2-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.7.1Preparedness & CountermeasuresAccelerate research on novel therapeutics, vaccines, rapid diagnostics, and behavioral interventions to expand evidence-based biomedical countermeasures and preparedness strategies_c226924c-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.7.2Research & EvaluationInvest in research and evaluation to strengthen human services programs._c226a638-257e-11e8-8fea-35c5c4e01b744.3.8The Strategic Objectives in Strategic Goal 3: Strengthen the Economic and Social Well-Being of Americans Across the Lifespan describe the Department’s efforts to provide high-quality, evidence-based human services programs. The Department is investing in research and evaluation to strengthen human services programs through the following strategies:FamiliesDevelop evidence on policies and practices that support stable, economically secure families, with a focus on TANF, employment, education and training, behavioral science, and safety-net research_c226c0be-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.8.1Prevention StrategiesInvest in rigorous research and evaluation to identify effective violence and injury prevention strategies, and support the adoption of evidence-based practices to address these issues_c226d0fe-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.8.2Domestic ViolenceInvest in rigorous research on and evaluation of domestic violence programs_c226e436-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.8.3Domestic Violence ProgramsInterventionsInvest in research on individual and community-wide interventions and approaches for children, youth, and adults who have experienced adverse childhood experiences, to learn what trauma-informed programs and services demonstrate positive effects_c226fee4-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.8.4ChildrenYouthAdultsChildrenConduct applied research and disseminate findings to maximize use of evidence-based strategies to improve the well-being of children at all stages of development, youth, and families_c2270e20-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.8.5ChildrenYouthFamiliesHousingSupport research and test approaches to effective housing with services for people with disabilities and older adults aimed at maximizing independence, choice, and health_c22721da-257e-11e8-8fea-35c5c4e01b74Strategy 4.3.8.6 People with DisabilitiesOlder AdultsDissemination, Implementation & EvalutationLeverage translational research, dissemination and implementation science, and evaluation investments to support adoption of evidence-informed practices_3cd1bcaa-248b-11e8-b521-8c21bde01b744.4ACFACLAHRQCDCFDAHRSANIHOASHSAMHSAPerformance Goals:* Increase the percentage of Community-Based Child Abuse Prevention total funding that supports evidence-based and evidence-informed child abuse prevention programs and practices* By 2020, develop and test the effectiveness of two strategies for translating cancer knowledge, clinical interventions, or behavioral interventions to underserved communities in community-based clinical settings-- Translational research, dissemination and implementation science, and evaluation investments help to ensure that critical knowledge from basic and applied research finds its way into practice in clinical, public health, and community settings.Translational research, dissemination, and implementation science help increase understanding about how best to support knowledge, adoption, and faithful implementation of best practices in the community. Selecting and adopting evidence-based approaches to tackle health, public health, and human services challenges can be a complex undertaking. HHS programs balance requirements to implement high-quality programs with fidelity, while acknowledging the unique needs of specific individuals or target populations, recognizing differences in program and community settings and resources, and respecting linguistic or cultural differences. Understanding threats to successful implementation of a promising practice can help the Department prevent and mitigate those risks early.Evaluation and evidence can support the Department’s efforts to improve program performance by applying existing evidence about what works, generating new knowledge, and using experimentation and innovation to test new approaches to program delivery. HHS is committed to integrating evidence into policy, planning, budget, operational, and management decision making. HHS funds multiple types of evaluation and evidence-generating activities; these activities may examine how well a program is implemented, whether it achieves intended outcomes, the overall impact of a program, or all three. Results of these types of activities may be used to plan programs, assess program performance, understand how to improve a program, and inform policy decisions.Populations at RiskImprove programs for populations at risk for poor health and well-being outcomes._c2273d00-257e-11e8-8fea-35c5c4e01b744.4.1Populations at RiskNumerous factors affect whether an intervention will have a positive health, public health, or human services outcome on individuals or targeted populations, including the selected model of the intervention, the population served, and the fidelity of implementation. The Department works to improve programs for populations at risk for poor health and well-being outcomes through the following strategies:Access & OutcomesAssess evidence-based practices and service delivery system improvements to increase access to services and improve outcomes for disproportionately affected populations_c2274d0e-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.1.1Disproportionately Affected PopulationsSettingsSupport research conducted in a variety of settings and populations, to improve the quality and utility of evidence generated from HHS investments and the impact of those investments on a broad range of outcomes_c2276078-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.1.2Multifaceted StrategiesEvaluate multifaceted strategies to apply evidence-based interventions to reach disproportionately affected populations and reduce health disparities_c2277c66-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.1.3Disproportionately Affected PopulationsBehavioral Health DisparitiesAnalyze data on behavioral health disparities to increase understanding of factors contributing to disparities, identify disadvantaged and at-risk populations, assess trends, and inform policy and program development_c2278cec-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.1.4Disadvantaged PopulationsAt-Risk PopulationsInterventionsDisseminate knowledge about evidence-based interventions._c227a024-257e-11e8-8fea-35c5c4e01b744.4.2Dissemination is the intentional, strategic distribution of information and intervention materials to a specific public health or clinical practice audience. HHS is working to disseminate knowledge about evidence-based interventions through a number of strategies:Evidence-Based PracticesIncrease dissemination and implementation of evidence-based practices and provide training and technical assistance to stakeholders to improve outcomes_c227bbd6-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.2.1EffectivenessSystematically review current evidence on the effectiveness of programs and policy, and disseminate findings in easily accessible formats to practitioners and decision-makers_c227ccde-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.2.2Outcome ResearchDisseminate patient-centered outcome research findings to health professionals and organizations that deliver healthcare_c227e1e2-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.2.3Efficiency & EffectivenessInvest in programs to determine their efficiency and effectiveness._c227ffa6-257e-11e8-8fea-35c5c4e01b744.4.3Evaluation involves the systematic collection of information about the activities, characteristics, and outcomes of programs to make judgments about a program, improve program effectiveness, and/or inform decisions about future program development. HHS invests in programs to determine their efficiency and effectiveness through several strategies, including the following:Learning AgendasEncourage the use of learning agendas or other tools to prioritize critical questions that generate evidence to guide decision making and continuous learning, including short- and long-term questions that build a portfolio of evidence about what works for whom_c22810ea-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.3.1Learning, Coordination & CollaborationFoster a culture of learning through opportunities for coordination and collaboration within and across HHS and with external partners_c22824cc-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.3.2ImprovementsIdentify improvements to existing evidence-based programs and policies to share broadly with local communities for public health impact_c22840ce-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.3.3Evidence & PoliciesPromote the use of common evidence standards, principles and practices for evaluation, and policies that support rigorous, relevant, transparent, independent, and ethical evidence-building activities_c228510e-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.3.4Uptake, Adoption & ImplementationSupport the uptake, adoption, and implementation of evidence-based interventions_c22864dc-257e-11e8-8fea-35c5c4e01b744.4.4Implementation science is the study of methods to promote the integration of research findings and evidence into healthcare policy and practice. HHS is working to support the uptake, adoption, and implementation of evidence-based interventions through a number of strategies:Engagement, Adaptation & CustomizationEngage healthcare, public health, and human service system research networks to study and support local adaptation or customization of evidence-based practices_c22880ac-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.4.1Healthcare Research NetworksPublic Health Research NetworksHuman Service System Research Networks Tools & Technical AssistanceDevelop and disseminate tools and provide technical assistance that supports adoption and implementation of evidence-based practices to improve access to high-quality public health, healthcare, and human services_c2289056-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.4.2Knowledge TranslationSupport knowledge translation capacity and practice to ensure that knowledge generated by grantees and others working in the field is used or adopted by its intended users_c228a424-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.4.3GranteesChangeAccelerate change._c228be8c-257e-11e8-8fea-35c5c4e01b744.4.5Facilitating the adoption of evidence-based solutions into practice requires active engagement of change agents and innovators across health, public health, and human services domains. The Department works to accelerate change through the following strategies:Processes & ObstaclesPromote innovative approaches to translating research into interventions that improve health and well-being, by modernizing processes and removing obstacles to bring more effective practices to more people more quickly_c228ce86-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.5.1Platforms for InteractionLeverage cutting-edge science to support product development strategies, regulatory evaluation, and implementation science by establishing platforms for interaction with academic institutions, other government agencies and their investments, and industry_c228e1e6-257e-11e8-8fea-35c5c4e01b74Strategy 4.4.5.2Academic InstitutionsGovernment AgenciesManagement & StewardshipPromote Effective and Efficient Management and Stewardship_3cd1c790-248b-11e8-b521-8c21bde01b745HHS DivisionsAll operating divisions and staff divisions within HHS are committed to achieving this goal, with the Office of the Assistant Secretary for Financial Resources (ASFR), the Office of the Assistant Secretary for Administration (ASA), the Office of the Chief Technology Officer (CTO), the Office of the General Counsel (OGC), and the Office of Security and Strategic Information (OSSI) playing key roles.Office of the Assistant Secretary for Financial Resources (ASFR)Office of the Assistant Secretary for Administration (ASA)Office of the Chief Technology Officer (CTO)Office of the General Counsel (OGC)Office of Security and Strategic Information (OSSI)This Strategic Goal describes efforts to act as responsible stewards of the financial resources the American taxpayers and Congress entrust to the Department, to support and cultivate top talent, to develop robust and responsive information management systems, and to create a safe and secure environment for human, digital, and physical assets.HHS is responsible for almost a quarter of Federal outlays and administers more grant dollars than all other Federal agencies combined. Ensuring the integrity of direct payments, grants, contracts, and other financial transactions requires strong business processes, effective risk management, and a financial management workforce with the expertise to comply with legislative mandates, including the Federal Managers’ Financial Integrity Act of 1982 (Pub. L. 97–255), the Federal Funding Accountability and Transparency Act of 2006 - PDF (Pub. L. 109–282), and the Improper Payments Elimination and Recovery Improvement Act of 2012 (Pub. L. 112–248).More than 91,000 permanent and temporary employees serve the public through the Department, providing direct clinical care, serving as emergency responders, researching cures, working with grantees to improve outcomes, and performing other critical functions. Half of the Department’s employees work in Washington, DC, with others serving in States and territories, on Tribal lands, and around the globe. Through a new Federal Human Capital Framework, the Federal Workforce Priorities Report, and annual Human Capital Review sessions with the Office of Personnel Management, required by 5 CFR Part 250, Subpart B, Strategic Human Capital Management, HHS will work to identify and implement strategies to strengthen its workforce.The information technology landscape has changed significantly in this century. How we collect and consume information, how we purchase resources, and even how we interact with each other has been revolutionized by technology—and will continue to evolve and change. The Department’s information technology investments focus on accessible, user-friendly design and promote business efficiencies, and also must comply with Office of Management and Budget (OMB) guidance and legislative mandates, such as the Federal Information Security Modernization Act (Pub. L. 113–283).Finally, to accomplish the HHS mission, its staff, data, and infrastructure must be safe and secure. The Department is working to safeguard assets against threats and hazards, whether internal or external, unintentional or malicious, natural or manmade. Securing staff, software, and systems is guided by specific supports, such as Homeland Security Presidential Directive 12, and standards, measurements, and testing promoted by the National Institute of Standards and Technology.Financial ManagementEnsure responsible financial management_3cd1ce66-248b-11e8-b521-8c21bde01b745.1Performance Goals:* Meet the following goals related to improper payments:- Reduce the percentage of improper payments made under the Medicare Fee-for-Service Program- Reduce the improper payment rate in the Medicaid Program- Reduce the improper payment rate in the Children’s Health Insurance Program- Reduce the percentage of improper payments made under Medicare Part C, the Medicare Advantage Program- Reduce the percentage of improper payments made under the Part D Prescription Drug Program--Responsible financial management is the Department's foundation for meeting its commitment to making sure taxpayer dollars are spent wisely. Strong, modern financial systems and practices and targeted investments improve accountability, reporting, and decision making, which can lead to cost savings and efficiencies that improve how the Department manages its public funds. Program integrity is a priority.In 2016, the Department awarded $1.0 trillion in grants, contracts, loans, and other financial assistance, including Medicare and Medicaid. State, Tribal, local, and territorial governments, and educational, cultural, faith-based, and community organizations, received $481.9 billion in HHS-funded grants. Large and small vendors were awarded $24.7 billion in contracts. Effectively managing these funds presents a range of challenges in preventing fraud and abuse, preventing misuse of funds by grantees, streamlining acquisition planning and procurement, and dealing with the root causes of improper payments. While not all improper payments are the result of intentional activity to defraud the government, any improper payment reduces public confidence in the Department’s ability to manage its programs.HHS is addressing these and other challenges that come from managing the diverse portfolio of financial agreements, systems, and reporting requirements across its 11 agencies and other offices. The Department is a member of the Healthcare Fraud Prevention Partnership, a voluntary public-private partnership between the Federal Government, State agencies, law enforcement, private health insurance plans, and healthcare anti-fraud associations, to prevent and detect healthcare fraud. HHS works with other Federal agencies to promote and implement practices, including shared services, to simplify the acquisition process and to improve performance and increase savings. As a member of the Chief Financial Officers Council, the Department engages with other Federal departments and agencies to share best practices in consolidating and modernizing financial systems, improving the quality of financial information, and complying with legislation affecting financial operations and organizations. The Department met new governmentwide standards to exchange and report financial information and share its spending data with the public.Leading and implementing these efforts are staff working in the Department's financial management, acquisition, and grants workforce who need to keep up with changing demands. Auditing and acquisitions are mission-critical occupations, and grants management is a mission-critical competency. The Department will expand its training and development efforts to close the skill and knowledge gaps in these positions and strengthen the competencies of all HHS staff with responsibilities that impact the Department's fiscal stewardship.StreamliningStreamline business processes._c228fd98-257e-11e8-8fea-35c5c4e01b745.1.1Each year, the Department publishes its Agency Financial Report, which shares its progress in modernizing financial systems to strengthen system security, reliability, and availability. Among the Department's efforts to streamline business processes are the following strategies:Quality ImprovementUse quality improvement principles to review key business processes, and identify opportunities to reduce risk and improve outcomes in areas such as financial management, grant management, and acquisitions_c2290e46-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.1.1RecordingReduce inconsistent recording and incomplete financial data and, thus, reduce efforts required to perform data cleanup and data transformation_c22922aa-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.1.2Trust & StewarshipPreserve public trust and stewardship of taxpayer funding by ensuring effective internal controls and efficient operating policies and procedures are in place that can result in an unqualified audit opinion with no material weaknesses_c2293f38-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.1.3Risk anagementPromote effective and efficient risk management across HHS and its programs._c2294f96-257e-11e8-8fea-35c5c4e01b745.1.2OMB Circular A-11 and OMB Circular A-123, Management’s Responsibility for Enterprise Risk Management and Internal Control, charge Federal agencies with implementing an enterprise risk management approach to address significant risks, improve mission delivery, and prioritize corrective actions. The Department promotes effective and efficient risk management across HHS and its programs through the following strategies:Risk AssessmentsConduct and use risk assessments within an enterprise risk management framework to improve information sharing and leadership decision making, resulting in risk-informed strategy execution and program implementation_c229636e-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.2.1PartnershipsUse public-private partnerships to prevent and detect fraud and other inappropriate payments across the healthcare industry by sharing fraud-related information and data, promoting best practices, and educating partners_c2297f02-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.2.2Medicare & MedicaidProtect Medicare and Medicaid through prevention and detection of fraud, waste, abuse, and improper payments_c22992c6-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.2.3Private ExpendituresManage the costs associated with governmental imposition of private expenditures through implementation of Executive Order 13771 of January 30, 2017, Reducing Regulation and Controlling Regulatory Costs, by ensuring that, consistent with the Administrative Procedure Act and as informed by the terms of the Executive Order and associated guidance, as appropriate, for every one new regulation issued, at least two prior regulations are identified for elimination, and the cost of planned regulations are managed through a budgeting process_c229a96e-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.2.4WorkforceStrengthen the financial management, acquisition, and grants workforce_c229c8ae-257e-11e8-8fea-35c5c4e01b745.1.3In a Federal department responsible for the administration of more than a trillion taxpayer dollars, the financial management workforce needs to have the skills and competencies to maximize and leverage the Department’s financial resources. The Department is strengthening the financial management, acquisition, and grants workforce through the following strategies:Note: Additional strategies on strengthening the workforce are in Strategic Objective 5.2.Knowledge GapsReduce knowledge gaps within the financial management, acquisition, and grants workforce by supporting hiring, training, and development programs to strengthen competencies_c229da4c-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.3.1Training & Knowledge TransferSupport knowledge transfer programs and training strategies so that the financial management, acquisition, and grants workforce can respond to challenges and changing demands across the enterprise_c229ee9c-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.3.2Knowledge TransferDevelop a financial management, acquisition, and grants workforce that uses cross-functional and knowledge transfer training programs to respond to challenges and changing demands across the HHS enterprise_c22a0e22-257e-11e8-8fea-35c5c4e01b74Strategy 5.1.3.3Human CapitalManage human capital to achieve the HHS mission_3cd1d578-248b-11e8-b521-8c21bde01b745.2HHS EmployeesPerformance Goals:* Increase HHS employee engagement through the Federal Employee Viewpoint Survey* Decrease the cycle time to hire new employees--As the Department looks to FY 2022 and beyond, it imagines all the achievements that can be reached when workforce performance is heightened, efficiencies achieved, and accountability strengthened. The Department must continue to create a flexible and agile workforce that responds and adapts to change: change in technology, change in society, change in expectations, and change in scientific findings. HHS needs the leaders of tomorrow today. To this end, the Department will build a world-class Federal management team and a workforce ready to collaborate with colleagues within the Department, among other Federal departments, and outside the Federal Government, to seek change that improves and enhances the health and well-being of Americans.The HHS workforce comprises more than 91,000 permanent and temporary employees, serving in every region of the United States, including Tribal communities and the U.S. territories, and 66 countries around the world. To achieve its mission, HHS will need to recruit, hire, and retain a qualified, talented, diverse, and inclusive workforce. As the majority of HHS staff nears retirement eligibility, human resources offices throughout the Department help HHS components to hire the best talent from all segments of society and strengthen succession planning, to ensure the Department can continue to support mission-critical functions.Management will need to help build and maintain the workforce in a way that retains current knowledge, anticipates advances in medicine and technology, and prepares internal staff for future leadership positions. To fulfill the Department’s mission, there is a need to recruit, hire, and retain talent with STEM (science, technology, engineering, and math) skills. Targeted recruitment efforts will become more important as mission-critical positions are vacated. Competition from private industry for new employees will continue to be a challenge in recruitment efforts.An improved and engaged workforce is enhanced by a world-class management team. HHS will strengthen its management team by providing the tools, training, skill development, and empowerment needed to encourage its workforce to work to its highest potential, accountable for its efficiency and effectiveness toward meeting the HHS mission. To keep abreast of advances and lead change in these fields, HHS will continue to bring together the best expertise and talent -- to serve the American people the best way possible.WorkforceBuild a high-quality workforce to respond to current and emerging demands._c22a202e-257e-11e8-8fea-35c5c4e01b745.2.1HHS WorkforceAmong large agencies, HHS was ranked the second "Best Place to Work" in 2017. The Department is working to build a high-quality workforce to respond to current and emerging demands through the following strategies:RecruitmentDeploy creative and strategic recruitment strategies to target talent to fill mission-critical occupations_c22a35be-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.1.1QualificationsRecruit and retain the most qualified candidates to best meet the needs of the populations served by the Department_c22a53d2-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.1.2Efficiency & EffectivenessIncrease the efficiency and effectiveness of recruitment efforts by partnering with hiring managers and leveraging data to make informed decisions regarding recruitment and retention strategies_c22a648a-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.1.3Flexibilities & IncentivesUse existing flexibilities and pursue new retention incentives to ensure HHS retains the highest caliber workforce_c22a79ca-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.1.4Workforce PlanningImprove workforce planning efforts by integrating succession management activities into efforts to retain employees and manage knowledge transfer within governmentwide and agency-specific mission-critical occupations and other shortfall areas_c22a9982-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.1.5Employee DevelopmentAdvance employee development by increasing opportunities for cross-training activities, developmental and rotational assignments, mentoring and coaching, and other cross-functional activities_c22aab0c-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.1.6Development OpportunitiesCreate and implement development opportunities to provide staff with the leadership, technical, and behavioral skills to succeed in their current and future positions in Federal service_c22abdae-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.1.7Employee ContributionsMaximize opportunities for employees to contribute to mission success._c22adbd6-257e-11e8-8fea-35c5c4e01b745.2.2HHS EmployeesIn 2017, the Department ranked second among large agencies in employee engagement, according to the Federal Employee Viewpoint Survey. The Department is maximizing opportunities for employees to contribute to mission success through the following strategies:Diversity & InclusionDeploy diversity and inclusion activities to create an environment where people feel valued and can effectively contribute their talents to the mission_c22aecac-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.2.1Workforce CompositionDeploy legally permissible strategies to achieve workforce composition goals, including efforts to increase the Veteran workforce and to increase the number of employees with targeted disabilities_c22b00fc-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.2.2VeteransEmployees with DisabilitiesFeedback & Best PracticesUse employee feedback and best practices from across the Federal Government to identify and develop strategies to act on employee input and increase employee engagement, such as brown-bag lunches, midcycle surveys, improved analytics, and action guides_c22b2762-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.2.3EngagementIncrease employee engagement, participation in the Federal Employee Viewpoint Survey, and belief that results will be used to improve the organization, by helping managers devise strategies to increase employee engagement and scores around belief in action_c22b3fea-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.2.4Performance & AccountabilityStrengthen performance and accountability._c22b5782-257e-11e8-8fea-35c5c4e01b745.2.3OMB Memorandum M-17-22, Comprehensive Plan for Reforming the Federal Government and Reducing the Federal Civilian Workforce, charged all Federal agencies with ensuring that supervisors and managers are held accountable for managing employee performance and conduct. The Department is strengthening performance and accountability through the following strategies:Supervisory TrainingConduct supervisory training sessions to ensure supervisors are aware of the tools available to engage employees, recognize performance, and strengthen accountability_c22b756e-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.3.1HHS SupervisorsRewards & RecognitionEnhance and promote reward and recognition tools available throughout HHS_c22b8720-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.3.2Performance ManagementStrengthen the performance management process, including better ensuring critical elements are directly linked to the work being performed_c22b9b20-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.3.3Human CapitalLeverage technology to support human capital management._c22bb966-257e-11e8-8fea-35c5c4e01b745.2.4The Department is working to build better, stronger, integrated systems that will save hundreds of hours of labor and bring human resources data, tools, and services into the 21st century. The Department works to leverage technology to support human capital management through the following strategies:IT ToolsDeploy new and enhanced information technology tools to strengthen the human capital management program at HHS, to reduce administrative burdens, strengthen the human capital program, and improve reporting capabilities as well as promote uniformity and data transparency, appropriate controls, and enterprise-wide analysis to strengthen decision making_c22bca46-257e-11e8-8fea-35c5c4e01b74Strategy 5.2.4.1Information TechnologyOptimize information technology investments to improve process efficiency and enable innovation to advance program mission goals_3cd1e0a4-248b-11e8-b521-8c21bde01b745.3Performance Goals:* Increase the percentage of systems with an Authority to Operate (ATO)* Improve the score to an "A" in each of the FITARA-related Scorecard Metrics, per GAO and the House Oversight and Government Reform Committee-- New technology is changing how Americans, businesses, governments, and other organizations expect the Federal Government to manage and deliver services. These individuals and entities expect the same innovation, speed, and quality when they interact with HHS. The right technology investments can help reduce costs as the Department becomes more agile and responsive in an environment of rapid change.HHS information technology investments help achieve the Department's mission by acquiring and managing the technology infrastructure and systems for its healthcare and human services programs and mission-support programs. From externally facing websites like HHS.gov to internal applications that manage programs and resources, HHS needs information technology solutions to be modernized, secure, and responsive to customer demands.The HHS Information Technology Strategic Plan 2017 - 2020 and the HHS Implementation Plan for the Federal Information Technology Acquisition Reform Act (FITARA) guide information technology decision making across the Department. The Department’s current modernization investments include cloud computing, data center consolidation and improvements, information technology portfolio reviews, shared services, and a digital strategy that makes it easier to access information using HHS websites and tools. HHS is working to increase partnerships with industry, academia, and other organizations to leverage their technology expertise as well.Planning and managing information technology investments is a challenge. HHS will upgrade its legacy systems, increase interoperability to allow systems to exchange information and use the information to make better decisions, and improve the management of its information technology investments to ensure quality service delivery. For example, through the HHS Strategic Plan for Data Center Optimization, the Department is working to reduce costs on infrastructure, curtail excessive energy usage, leverage cloud-based technologies, and minimize or eliminate security risks.Through its participation on the Chief Information Officers (CIO) Council, the Department engages with other Federal departments and agencies to implement information resource management objectives described in the E-Government Act of 2002 (Pub. L. 107-347), the Government Paperwork Elimination Act (Pub. L. 105-277), the Paperwork Reduction Act of 1980 (Pub. L. 96-511), and the Information Technology Management Reform Act of 1996 (Pub. L. 104-106). The Department also has established clear lines of authority among the Office of the Chief Information Officer and CIOs in each of its operating divisions, to ensure shared and transparent responsibility for information technology investments, and more effective management of the information technology portfolio.Customer ExperienceProvide easily understandable, easily accessible information technology solutions._c22bdd6a-257e-11e8-8fea-35c5c4e01b745.3.1User-centered design in information technology involves understanding who will be using a resource, what they need, what they value, and their abilities and limitations. The Department’s externally facing information technology solutions help States look for early warning data on infectious disease outbreaks, such as flu; share information about health insurance coverage options with older adults and the general population; and provide research data to universities and colleges with which the Department is collaborating to find the cures of the future. The Department is working to provide easily understandable, easily accessible information technology solutions, to improve the customer experience, through the following strategies:User-Centered DesignPromote adoption of user-centered design for information technology services targeted to the American public_c22bfc3c-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.1.1SystemsBuild multiuse and interconnected systems that are intuitive, usable, and accessible_c22c0d44-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.1.2Internal CommunicationsImprove internal communications, including through unified communications technology, to integrate email, voice mail, and other systems, so that staff may access these work supports regardless of division or work location_c22c2220-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.1.3ModernizationModernize information technology systems._c22c3f9e-257e-11e8-8fea-35c5c4e01b745.3.2About 40 percent of the systems of record at HHS are "legacy" information technology, meaning they are no longer supported by their manufacturers. The Department is working to modernize information technology systems to reduce the risk associated with unsupported or end-of-life systems by identifying opportunities to modernize, decommission, or replace legacy systems, through the following strategies:Best PracticesCapitalize on and leverage best practices from divisions within HHS and the private sector to develop enterprise-wide information technology solutions, while minimizing custom application development, maximizing collaboration, and reducing cost_c22c50a6-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.2.1Computing ServicesSupport the capability of high-performance computing services, such as sharing large data sets between research institutions, to deliver parallel processing for running advanced application programs efficiently, reliably, and quickly_c22c647e-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.2.2Assets & ServicesImprove acquisition of information technology assets and services._c22c818e-257e-11e8-8fea-35c5c4e01b745.3.3Informed by FITARA and the Making Electronic Government Accountable By Yielding Tangible Efficiencies (MEGABYTE) Act of 2016 (Pub. L. 114-210), as well as by OMB M-16-12, Category Management Policy 16-1, Improving the Acquisition and Management of Common Information Technology: Software Licensing, the Department is working to improve acquisition of information technology assets and services through the following strategies:PurchasingImplement cost-efficient and effective purchasing of software and services that serve as a bridge between operating systems, databases, and applications_c22c9214-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.3.1Acquisition ProcessesAlign acquisition processes, including those required by the Federal Acquisition Regulation and internal policies, with information technology business models and practices, to remove barriers for purchasing responsive technology in a timely manner to meet ongoing and urgent business needs_c22ca664-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.3.2WorkforceStrengthen the information technology workforce._c22cc400-257e-11e8-8fea-35c5c4e01b745.3.4Information Technology WorkforceCompeting with the private sector is a perennial challenge to recruiting and retaining top talent in the government sphere. The Department is working to strengthen the information technology workforce through the following strategies:Note: Additional strategies on strengthening the workforce are in Strategic Objective 5.2.Management & PlanningSupport ongoing management and planning to optimize use of technology expertise and resources, properly align staffing and responsibilities, and maximize resources_c22cd422-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.4.1TrainingImplement skills-based workforce training for technology practitioners who design, manage, operate, and support information technology investments_c22ce912-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.4.2Technology PractitionersDecision MakingOptimize HHS capacity for data-driven decision making._c22d04e2-257e-11e8-8fea-35c5c4e01b745.3.5Through the HHS Data Council, operating divisions and staff divisions from across the Department promote a coordinated strategy on data issues, by supporting strong data collection, analysis, and dissemination systems and by collaborating with other health and human services entities on common data interests. But data collected by the Department also include data related to business and operational functions. The Department is optimizing HHS capacity for data-driven decision making through the following strategies:InteroperabilityImprove system interoperability to allow efficient data sharing; strengthen detection and surveillance of regulated products; reduce risks in manufacturing, production, and distribution of regulated products; and increase regulatory science capacity to effectively evaluate products_c22d157c-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.5.1DataImprove the capture, use, and management of operational and administrative data, including financial management and human capital management systems, by establishing formal processes, rules, and templates to control data sharing and protect sensitive information_c22d2760-257e-11e8-8fea-35c5c4e01b74Strategy 5.3.5.2Human, Physical & Digital AssetsProtect the safety and integrity of our human, physical, and digital assets_3cd1e784-248b-11e8-b521-8c21bde01b745.4Performance Goals:* Decrease the percentage of susceptibility among personnel to phishing* Increase the number of days since last major incident of personally identifiable information breach-- Through dedicated personnel, the vigilance of all of our employees, and physical and technological investments, the Department actively works to protect the safety and integrity of its personnel and the people served through HHS programs.Threats to the people working in and served by the programs, facilities, and systems prevent the Department from focusing on its mission. Breaches of information technology systems can compromise electronic health records and privacy, and cause physical and financial harms to patients and financial harm to people and organizations that do business with HHS. In response to the increased threats to Federal information technology systems and cybersecurity attacks, Federal agencies are responsible for developing an information security program and managing cybersecurity risks for their networks and information technology infrastructure. HHS has implemented plans and processes to address different security incidents, from improper use to web attacks; continue operations during emergencies; and provide training to HHS staff and contractors.Protecting the privacy of personally identifiable information—such as birthdates and Social Security numbers—and securing Federal information systems and critical infrastructure are challenges for Federal agencies. HHS is working to improve how it protects the security and privacy of electronic health information and to consistently address controls that prevent unauthorized use and unauthorized changes to information system resources, monitor building and access control systems, and ensure that all HHS staff and contractors are vetted properly and understand cybersecurity risks. Keeping personal information safe increases trust and confidence in HHS and its information and reporting systems.Yet providing security for HHS involves more than preventing breaches or cybersecurity attacks. The Department’s operating divisions and staff divisions participate in efforts to preserve physical security; personnel security and suitability; security awareness; information security, including the safeguarding of sensitive and classified material; and security and threat assessments. In addition, the Department has established a network of scientific, public health, and security professionals internally, as well as points of contact in other agencies, in the intelligence community, and in the Information Sharing Environment Council. The Department has specialized staff to provide policy direction to facilitate the identification of potential vulnerabilities or threats to security, conduct analyses of potential or identified risks to security and safety, and work with agencies to develop methods to address them.Safety, Security & IntegrityIdentify, assess, remediate, and monitor risks to safety, security, and integrity._c22d4498-257e-11e8-8fea-35c5c4e01b745.4.1Strategic Goal 5: Promote Effective and Efficient Management and Stewardship has described our efforts to promote integrity in our financial management systems, strengthen our human capital, and optimize our information technology investments. Protecting these assets and mitigating threats to these systems require an enterprise-wide approach. The Department is working to identify, assess, remediate, and monitor risks to safety, security, and integrity through the following strategies:Risk ManagementAdvance an enterprise-wide risk management approach that continually provides situational awareness of HHS's risk posture by effectively identifying, assessing, remediating, and monitoring risks_c22d54ba-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.1.1Safety & SecurityEstablish enterprise-wide safety and security models that incorporate best practices from other Federal agencies_c22d6770-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.1.2CybersecurityProtect information technology systems, data, and sensitive information, and prevents, detects, mitigates, and responds to cybersecurity events._c22d8444-257e-11e8-8fea-35c5c4e01b745.4.2The Federal Information Security Modernization Act (Pub. L. 113–283) and the HHS Information Technology Strategic Plan guide the Department’s efforts to protect data and electronic data systems from threats, including those from state actors, hackers, and internal threats. The Department protects information technology systems, data, and sensitive information, and prevents, detects, mitigates, and responds to cybersecurity events, through the following strategies:Data Access & SecurityMaximize enterprise-level data access and security for stakeholders while ensuring data integrity and privacy in support of streamlined program flexibilities, accountability, and information exchange_c22d94ac-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.2.1AuthenticationEnsure stronger authentication of privileged users to support application security_c22da938-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.2.2Privileged UsersIntelligenceImprove the sharing of intelligence with Federal and private-sector partners to improve situational awareness and reduce cyberthreats_c22dc260-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.2.3Data Access & UsabilityMaximize data access and usability to internal and external users while protecting data confidentiality, integrity, and availability, including beneficiary privacy_c22dd304-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.2.4IntegrationPromote integration of electronic data systems to increase efficiency and minimize redundancy while maintaining appropriate standards for identity management and the protection of personally identifiable information (PII) and protected health information (PHI)_c22de768-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.2.5Risk ManagementUse a priority-based risk management approach that focuses on the protection of sensitive data, including PII and PHI data sets, High Value Assets, and mission-essential systems_c22e0432-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.2.6Continuity of OperationsExecute essential functions, even in the event of an emergency, while protecting the safety of the HHS workforce._c22e118e-257e-11e8-8fea-35c5c4e01b745.4.3Through Federal Continuity Directives 1 and 2, the Federal Emergency Management Agency mandates that the executive branch prepare a Continuity of Operations Plan to be implemented in the event of service disruptions affecting any facility. The Department will execute essential functions, even in the event of an emergency, while protecting the safety of the HHS workforce, by employing the following strategies:Essential FunctionsPromote and ensure the execution of essential Federal functions, while providing for the safety and well-being of employees during emergency situations, including continuity of operations and emergency evacuations, and ensure that all safety and emergency plans take into consideration the varying needs of the HHS workforce_c22e2688-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.3.1Continuity PlansReview and update continuity plans and procedures to ensure the safety of our workforce while taking advantage of available technologies, increasing efficiency, and minimizing duplication of efforts_c22e47d0-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.3.2Information SecurityIntegrate information security with emergency preparedness efforts, to prepare for broad-scale cyberattacks or security breaches, and proactively engage with stakeholders on best practices in protecting the health of cyberspace_c22e56b2-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.3.3HSPD 12Protect HHS facilities, information, and infrastructure through implementation of HSPD 12._c22e654e-257e-11e8-8fea-35c5c4e01b745.4.4Homeland Security Presidential Directive (HSPD) 12 establishes a requirement for all Federal agencies to create and use a governmentwide secure and reliable form of identification for their Federal employees and contractors (a personal identity verification credential). The Department is working to protect HHS facilities, information, and infrastructure through implementation of HSPD 12, as well as the following strategies:InfrastructureStrengthen physical, organizational, and functional infrastructure to maximize HHS's ability to meet increased demands_c22e859c-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.4.1Best PracticesImplement best practices in identity and access management to enforce appropriate levels of protection of HHS-owned physical and logical assets and to ensure only authorized users are given access to resources and information_c22e9500-257e-11e8-8fea-35c5c4e01b74Strategy 5.4.4.22018-02-282022-09-302018-03-11OwenAmburOwen.Ambur@verizon.net