Organizational Excellence—Organizational Support

Develop Efficient And Responsive Business Processes

Strategic Management of Human Capital

Measure	FY	Target	Result
By FY 2007, Get to Green on the President's Management Agency Initiatives Get to Green on Strategic Management of Human Capital Initiative Output	2008	Develop core competencies for selected Agency staff and develop strategies for implementation	Dec-08
	2007	Implement Department of Health & Human Services (HHS) Performance Management Program	Dec-07
	2006	Assess core competency and leadership models	Completed
		Identify strategies to infuse new talent into Agency programs	Completed
	2005	Reduce mission support positions by 11 Full Time Equivalents (FTEs)	Completed Reduced 11 FTEs
		Fully Implement cascade performance management system	Completed
	2004	Develop a plan to recruit new or train existing staff to acquire skills necessary to fill identified gaps. Continue to identify gaps in agency skills and abilities. Continue to integrate competency models into organizational processes	Completed
	2003	Identify gaps in agency skills and abilities. Integrate competency models into organizational processes. Finalize the identification of technical competencies. Engage a consultant to evaluate options and develop a plan for vertically & horizontally collapsing organizations. Continue to reduce organizational levels.	Completed

Data Source: Departmental quarterly updates on President's Management Agenda (PMA) activities as well as submissions for budget justifications.

Data Validation: Performance Plans serve as the data validation for the "cascading" process from the Director, Agency for Healthcare Research and Quality (AHRQ) throughout the entire Agency workforce. The Agency successfully reduced the number of mission support positions by 11 Full Time Equivalents (FTEs) by the end of FY 2005. Positions eliminated include: Senior Advisor, GS-0301-15, Center for Outcomes and Evidence (COE); Information Technology (IT) Specialist, GS-2210-14, Office of Performance Accountability, Resources, and Technology (OPART); Planning and Development Officer, GS-0301-15, OPART; Staff Assistant, GS-0303-09, OPART; Secretary, GS-0318-06, COE; Office Automation Assistant, GS-0326-05, COE; Office Automation Assistant, GS-0326-05, OPART. AHRQ was also granted a waiver for six positions deemed mission-support but due to the nature of the work, have been moved to the mission-critical designations. With the seven positions eliminated and the six waivers, we exceed our target for 2005.

Cross Reference: SG-8.

In FY 2003, AHRQ conducted eleven streamlined competitive sourcing studies in the functional areas of accounting, visual information, program/management analysis, information technology, and program assistance. The performance decision for each of these studies was in favor of the agency. In FY 2004, AHRQ conducted a streamlined (with MEO) competitive sourcing study in the functional area of secretarial/program assistance. This study encompassed 20 FTEs and the performance decision made was for the agency, which utilized a Most Efficient Organization (MEO). The Most Efficient Organization is in the process of being staffed and implemented.

As part of the President's Management Agenda and the Department's 20 Management Objectives, AHRQ submitted a succession plan in the Spring of 2005 which addressed issues such as infusion of new talent and developing and validating competencies for mission critical occupational series. Additionally, AHRQ revised its list of mission critical occupations (a total of six) and has developed competencies/skill levels for three occupational series and completed a gap analysis and action plan to address deficiencies for one of the series. Efforts continue to develop competencies and skill levels for the other three occupational series.

AHRQ is also working to implement the HHS Performance Management Program. The Agency is scheduled to migrate to this new system by March 31, 2006, and will serve as the Department's Beta site with the Office of Personnel Management to identify best practices and possible deficiencies. AHRQ has laid out a timeline for the implementation including management and employee briefings, online training, as well as technical assistance in the development of plans.

Organizational Support—Improve Financial Management

Measure	FY	Target	Result
Maintain a low risk improper payment risk status Output	2008	Complete all requirement related to OMB revised Circular A-123, and begin to update internal controls following AHRQ's conversion to UFMS.	Dec-08
	2007	Continue to participate in Department A-123 internal control efforts related to improper payments, and begin to implement the requirements of OMB revised Circular A-123.	Dec-07
		Continue to examine and refine internal controls to address preventing improper payments, including assessing controls over financial reporting.	Dec-07
	2006	Participate in Department A-123 Internal Control efforts related to improper payments, define and begin to assess controls over financial reporting to address the requirements of OMB revised Circular A-123, and attend A-123 training.	Completed
		Continue to examine and refine internal controls to address preventing improper payments, including assessing controls over financial reporting	Completed
	2005	Update AHRQ Improper Payment Risk Assessment	Completed
		Increase awareness of risk management within AHRQ	Completed
	2004	Develop initial AHRQ Improper Payment Risk Assessment	Completed initial AHRQ Improper Payment Risk Assessment and submitted to HHS
	2003	N/A1	N/A

Data Source: CORE, IMPAC II, Payment Management System, SAS 70 Reviews, and A-133 audits.

Data Validation: The Department concurred with AHRQ's assessment that the Agency's programs are at low risk for incurring improper payments.

Cross Reference: SG-8.

¹New measure developed FY 2004.

Financial accountability is a cornerstone of the "Improved Financial Performance" initiative of the President's Management Agenda (PMA). Federal managers continue to experience growing pressures from their executive leaders, Congress, the public, and their customers to achieve more under the programs they manage. To that end, this initiative asks agencies to evaluate their financial management capabilities to ascertain if sufficient internal controls are in place to safeguard against the misuse of federal funds, and to ensure that these controls provide the accountability required to make certain funds are spent as intended.

The Federal managers Financial Integrity Act of 1982 (FMFIA) and the Office of Management and Budget (OMB) Circular A-123 Internal control Systems establish the requirements for internal control in federal agencies. Circular A-123 was revised in 2004 to include a detailed process that agency management must follow to document, assess, test, and report on the effectiveness of internal controls over financial reporting. This process includes establishing an effective control environment by identifying the risks that need to be mitigated to prevent improper payments. AHRQ will use its Improper Payment Risk Assessment as one of the sources to identify the business processes that will assessed under A-123 and determine the adequacy of Agency internal controls.

Organizational Support—Information Technology & E-Government

Measure	FY	Target	Result
Get to Green on Information Technology and E-Government Expanded E-government Increase IT Organizational Capability Output	2008	Extend PMO operations and concepts to AHRQ IT investments	Dec-08
	2007	Develop fully integrated Project Management Office with standardized processes and artifacts	Dec-07
	2006	Work towards level 3 maturity in Enterprise Architecture, as directed by HHS	Completed
		Fully implement integrated Enterprise Architecture, Capital Planning, and investment review processes	Completed
	2005	Fully implement integrated Enterprise Architecture, Capital Planning, and investment review processes	Completed
	2004	Complete implementation of the control review cycle. Implement the evaluation cycle. Integrate capital planning processes with enterprise architecture processes.	Completed
	2003	Implement the planning cycle Implement the select review cycle Initiate efforts for the control review cycle	Completed
Improve IT Security/Privacy Outcome	2008	Certify and accredit all level 3 information systems.	Dec-08
	2008	Review and update security program to reflect current guidance and mandates.	Dec-08
	2007	Certify and accredit all Level 2 Information systems	Dec-07
		Begin implementation of Public Key Infrastructure with applications	Dec-07
	2006	Perform required testing to insure maintenance of security level	Completed
	2005	Fully integrate security approach, enterprise architecture, and capital planning process	Completed
	2004	Continue/refine risk assessments on AHRQ's second tier systems Implement the business continuity and contingency program plans Develop authentication program plan	Completed
	2003	Finalize initial risk assessments on AHRQ's mission critical systems Implement incident response plans and procedures Develop network security plans Develop anti-virus program plan	Completed
Establish IT Enterprise Architecture Outcome	2008	Implement Level 3 EA plan and comply with EA activity as defined by HHS.	Dec-08
	2007	Complete Level 3 EA plan	Dec-07
	2006	Work toward Level 3 maturity in Enterprise Architecture as defined by HHS	Completed
	2005	Use enterprise architecture to derive gains in business value and improve performance related to Agency mission	Completed
	2004	Refine view of baseline architecture and technical architecture Develop the target architecture Create the migration plan Integrate enterprise architecture processes with capital planning processes	Completed
	2003	Continue to carry out business process assessments of key business lines Establish enterprise architecture governance Develop the baseline architecture Develop the technical reference model Establish technical standards Implement general desktop and network upgrades to reflect the technical architecture	Completed

Data Source: Green on PMA compliance.

Data Validation: Green on PMA compliance and complies with departmental standards.

Cross Reference: SG-8.

AHRQ's major activities regarding the integration and implementation of the PMA through e-Government technologies within the Agency include:

1. Government Paperwork Elimination Act (GPEA).
2. Security.
3. Full participation in Department of Health & Human Services (HHS) PMA activities that intersect with the mission of the Agency.

These activities continue to result in efficiencies in time and improvement in quality.

AHRQ's current activities include:

• Ongoing development of policies and procedures that link AHRQ's IT initiatives directly to the mission and performance goals of the Agency. Our governance structure ensures that all IT initiatives are not undertaken without the consent and approval of AHRQ Senior Management and prioritized based upon the strategic goals of the agency.
• Ensure AHRQ's IT initiatives are aligned with departmental and agency enterprise architectures. Utilizing HHS defined Federal Health Architecture (FHA) and HHS Enterprise Architectures, AHRQ ensures that all internal and contracted application initiatives are consistent with the technologies and standards adopted by HHS. This uniformity improves application integration (leveraging of existing systems) as well as reducing cost and development time.
• Provide quality customer service and operations support to AHRQ's centers, offices and outside stakeholders. This objective entails providing uniform tools, methods, processes and standards to ensure all projects and programs are effectively managed utilizing industry best practices. These practices include Presidential Management Intern (PMI) (Project Management Body of Knowledge [PMBOK], Earned Value Management [EVM}), Rational Unified Process (RUP) (Software Development Life Cycle [SDLC]), Capital Planning and Investment Control (CPIC), and Enterprise Architecture (EA). These practices have appreciably improved AHRQ's ability to satisfy project objectives to include cost and schedule.
• Ensure the protection of all AHRQ data, commiserate with legislation and directives. AHRQ has modified the systems development life-cycle to ensure that security is addressed throughout each project phase. Additionally, AHRQ is in the process of Certifying and Accrediting all Tier 3 systems to ensure compliance with National Institute of Standards and Technology (NIST) directives and guidance.

Organizational Support—Budget & Performance Integration

Measure	FY	Target	Result
Get to Green on Budget and Performance Integration Initiative Output	2008	Continue implementation of software within the portfolios of work	Dec-08
	2007	Begin implementation of software within the portfolios of work to help facilitate budget and performance integration	Dec-07
		Conduct additional internal Program Assessment Rating Tool (PART) reviews by strategic goal areas	Dec-07
	2006	Planning system—Continue to implement additional phases	Completed
		Conduct additional internal PART reviews	Conducted additional internal reviews
		Design and pilot software for facilitating budget and performance integration	Visual Performance Suite software designed and piloted
	2005	Planning System—Implement additional phases Conduct additional internal PART reviews	Completed
	2004	Planning System—Implement phase for tracking budget and performance Conduct additional PART reviews	Completed
	2003	Develop and test planning system that links budget and performance Conduct additional internal PART reviews	Completed

Data Source: PARTWeb Web site and AHRQ Planning System.

Data Validation: AHRQ Internal share directory site, logic models.

Cross Reference: SG-8.

General program direction and budget and performance integration is accomplished through the collaboration of the Office of the Director and the offices and centers that have programmatic responsibility for portions of the Agency's research portfolio.

As a result of the increased emphasis on strategic planning, the Agency has shifted from a focus on output and process measurement to a focus on outcome measures. These outcome measures are being developed to cascade down from our strategic goal areas of safety/quality, effectiveness, efficiency and organizational excellence. Portfolios of work (combinations of activities that make up the bulk of our investments) support the achievement of our highest-level outcomes. Current and future efforts will include the development of a software application that maps each AHRQ funded activity to the portfolio structure and associated performance.

Finally, AHRQ completed comprehensive program assessments on five key programs within the Agency:

• The Medical Expenditure Panel Survey (MEPS).
• The Healthcare Cost and Utilization Project (HCUP).
• The Consumer Assessment of Healthcare Plans Survey (CAHPSP®).
• The Patient Safety program.

The Pharmaceutical Outcomes Portfolio was the latest program to undergo a PART review. These reviews provide the basis for the Agency to move forward in more closely linking high quality outcomes with associated costs of programs. Over the next few years, the Agency will focus on fully integrating financial management of these programs with their performance.

Summary of Performance Targets and Results

FY	Total Measures in Plan	Results Reported		Targets
		Number	%	Met	Not Met		% Met
					Total	Improved
2003	47	47	100	47	0		100
2004	50	49	98	49	11		100
2005	47	47	100	47	0		100
2006	412	403	98%	40	14	15	100
2007	416
2008	416

1. Performance measure not met due to program refunding.

2. Total Measures in Plan are reduced by five to reflect:

1. Patient Safety (-1)
   • Inaccurate reporting of an annual measure as a long-term measure
2. Health Information Technology (-1)
   • Hospitals using Computerized Order Entry (CPOE) by 10%
     (retiring measure that has met and exceeded its target)
3. Care Management (-3)
   • Three developmental measures with no established baselines

3. Represents the # of measures that currently have data available for FY 2006.

4. Quality/Safety of Patient Safety efficiency measure data will not be available until September 2009.

5. The target for Pharmaceutical Outcomes congestive heart failure hospital readmission rates measure was changed from 20% in 2014 to 30%. The rational to support this change is the average age among the 65-85 year old population is increasing; therefore, it is necessary to risk adjust the 2014 target by raising the 2014 target from a readmission rate of 20% to 30%. This target adjustment has been accepted and approved and is published on the PARTWeb.

6. Data are not yet available for FYs 2007 and 2008.

Changes and Improvements over Previous Years

AHRQ continues to align its measures and portfolios to the Agency's strategic goals as well as supporting departmental initiatives and goals. We anticipate revisiting our officially PARTed Patient Safety measures to best determine how the strategic goals of the portfolio will best capture the new Patient Safety legislation. We will continue the iterative process of developing and refining outcome measures to support our research agenda, reviewing the proposed outcomes with the Executive Management members and other key AHRQ staff, and incorporating these into our budget documents. Major improvements include approval of efficiency measures for the Data Development and Quality/Safety of Patient Care portfolios. We anticipate further changes and improvements during FY 2008 as measures are reviewed, finalized, and accepted by the Agency.

Portfolio of Work	FY 2007/FY 2008 Measure Improvements
Quality/Safety of Patient Care*	Approval of new efficiency measure Total measures reduced by 1
Health Information Technology Portfolio*	Measures remained the same
Data Development Portfolio	Measures remained the same
Care Management Portfolio*	Total measures reduced by 3 1 established measure 3 developmental measures
Prevention Portfolio	Measures remained the same
Cost, Organization and Socio-Economics Portfolio	Measures remained the same
Pharmaceutical Outcomes Portfolio	Measures remained the same
Training Portfolio	Measures remained the same
Bioterrorism Portfolio	Measures remained the same
Organizational Support	Measures remained the same

*See Summary of Measures

PART Summary Table Calendar Years (CY) 2002-2007

CY 2002 PARTs	FY 2007 President's Budget	FY 2008 Request	FY 2008 +/- FY 2007	Narrative Rating
Data Collection and Dissemination	$65	$63	-$2	Moderately Effective
Patient Safety	$84	$94	+$10	Adequate
Pharmaceutical Outcomes	$26	$26	$0	Moderately Effective

AHRQ is in the process of conducting internal PART reviews on the balance of our programs. Information resulting from these reviews will be included in future iterations of the budget.

Data Collection and Dissemination

This program collects data on the cost (Medical Expenditure Panel Survey), use (Healthcare Cost and Utilization Project), and the quality of health care in the United States and develops and surveys beneficiaries regarding their health care plans (Consumer Assessment of Health Plans). In CY 2002 and CY 2003, the portfolio was given additional funding due to performance-based improvements coming from the PART. This funding supports efforts to ensure continued collection and availability of national health care cost, use, and quality data. This support was not provided in subsequent years.

Although the cost of the survey does not increase in FY 2007, an additional $1,940,000 in technical support is provided within the HCQO budget activity for the MEPS program. These funds will support a portion of the incremental funding needed to operationalize the transition in MEPS to a windows based computer assisted personal interview (CAPI) system ($1,100,000) and to facilitate linkages between the MEPS Insurance Component and the MEPS Household Component ($840,000) that enhance analytical capacity. This support is one year only and is not included in the FY 2008 Request of $55.3 million.

Patient Safety

Patient safety research is a vital component to AHRQ's continuing efforts to make improvements in the safety and quality of care. The FY 2008 Request is $93.9 million, an increase of $9.9 million from the FY 2007 Continuing Resolution level. The FY 2008 Request includes new and continuation support for the Ambulatory Patient Safety Program. AHRQ's Ambulatory Patient Safety program is comprised of research and implementation activities aimed at improving the quality, safety, efficiency and effectiveness of ambulatory care, with a special focus on the primary care setting.

In addition, the FY 2008 Request includes $15,000,000 in new research contract and interagency agreement (IAA) support for the Personalized Health Care Initiative. This initiative builds on our investments and progress in genomic science, molecular medicine and health information technology. It supports our drive for health care transparency (especially by identifying effective, high quality care), and it undertakes pioneering work in the utilization of health IT for linking clinical care with research progress.

Pharmaceutical Outcomes

In FY 2005, AHRQ requested $26 million for this portfolio, including $15 million in funds for the Effective Healthcare Program, authorized by Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. These funds continue into FY 2007 and 2008. These funds support a series of state-of-the-science studies that review existing scientific information on which drugs work best, for which patients, and under what circumstances.

This portfolio also includes funding for the Centers of Excellence for Research and Therapeutics (CERTs) program. These grants are a vital funding component of this portfolio. The CERTs currently consist of eleven research centers and a Coordinating Center. The CERTs receive funds from both public and private sources with AHRQ providing core financial support. The CERTs seek to develop new and effective ways to improve the use of therapeutics throughout the nation's healthcare system.

Return to Contents
Proceed to Next Section

Current as of February 2007

---

Internet Citation:

Performance Detail. From: Justification for Budget Estimates for Appropriations Committees, Fiscal Year 2008, February 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/cj2008/cjperf08.htm

---