Care Management

Performance Budget Submission for Congressional Justification

This statement summarizes budget information submitted to Congress by the Agency for Healthcare Research and Quality (AHRQ).

Care Management

Long-term Goal: Increase the delivery of evidence-based treatments for acute and chronic conditions, through research and research syntheses; development of tools; identification of effective implementation strategies; and promotion of effective policies.

MeasureFYTargetResult
By 2010, we will:
  • Increase by 15% the proportion of patients with diabetes, coronary heart disease (including acute myocardial infarction) and asthma who receive effective treatments.
  • Reduce disparities in effective care delivered to different populations (Developmental).
  • Increase the proportion of patients with chronic conditions such as diabetes and asthma who practice self-care (Developmental).
  • Increase the proportion of clinicians who have access to evidence-based tools to guide treatment decisions (Developmental).

Outcome

2008Complete 6 reports through the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) research network to address research gaps in treatment of chronic diseaseDec-08
2007Complete 2 reports under The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Section 1013 to inform pharmacy benefits relevant to chronic disease. Establish survey measures for patient self-management of chronic disease.Dec-07
2006Begin interventions through partnerships with Federal and State agencies, professional societies, plans, and purchasers.Completed
2005Develop partnerships with 2-4 large delivery systems (States, health plans, purchasers) to improve outcomes and reduce disparities for 1 to 3 specific chronic diseases.Completed
Synthesize evidence on interventions, burden of disease, gaps in care and costs; agree on outcome measures to be tracked.Completed
Establish trends in National Quality Report categories.Completed
2004Report on progress in core measure set in National Quality Report and National Disparities ReportCompleted
 
Identify private sector data to be used in future reportsCompleted
Synthesize evidence on interventions for improving diabetes and hypertension care.Completed
2003N/A1N/A1

Data Source: National Health Care Quality Report (NHQR); National Healthcare Disparities Report (NHDR); RFC Healthplan Disparities Collaboratives; Effective Healthcare Program reports.

Data Validation: Measures in the NHQR and NHDR are based on validated surveys conducted by Department of Health & Human Services (HHS) Agencies including the Agency for Healthcare Research and Quality (AHRQ and Centers for Disease Control and Prevention (CDC) and private partners such as the National Committee for Quality Assurance (NCQA).

Cross Reference: SG 1/5; HP2010-3/4/5/12/13/14/16/21/24; 500-Day Plan—Transform the Healthcare System; Advance Medical Research

1. New measure developed FY 2004.

The long-term goal of the Care Management Portfolio is to improve care and reduce disparities for common chronic conditions such as diabetes, asthma, and heart disease. In 2006, the AHRQ Portfolio Team supported information on effective interventions for practices and health systems to improve care; worked in partnership with health plans and States to improve the care they deliver; and identified changes in the health care system that will make it easier to deliver effective chronic illness care, such as evidence-based decision support, population data management, and support for patient self-management.

In 2006, the NHQR and NHDR reported that care for chronic diseases is improving as some disparities in care are narrowing. At the same time, important gaps in care and disparities in care remain, and some disparities are worsening, especially those affecting for Hispanic patients. Two important AHRQ initiatives continued to mature in 2006. The Health Disparities Collaboratives, involving 9 health plans serving over 73 million members, has developed information on existing disparities within healthplans and has moved plans to developing interventions to address these disparities. An initiative with 6 state Medicaid programs begun in 2005 (with assistance of an additional 2 states as faulty) is adding 6 additional states in 2006 to assist them in their efforts to improve the quality of chronic disease care delivered under primary care case management.

Two new "knowledge translation" initiatives were launched in 2006 to address asthma and diabetes. AHRQ is working with 6 state coalitions to improve asthma care and is working with health systems to improve diabetes care in Latino women. By working with States and plans to develop rigorous evaluations of their efforts, we will help develop new data sources to track improvements in care for diabetes in health plans and public programs. We will release and disseminate two new Best Practices reports on interventions to improve asthma care and interventions to improve care coordination in fall 2006. Under section 1013 of the Medicare Modernization Act, we have released the first three of a series of reports on the comparative effectiveness of different treatments or diagnostic interventions for chronic conditions. Reports on care for depression, diabetes, osteoporosis, and arthritis are scheduled for release by the end of 2006.

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Effectiveness—Data Development

Long-term Goal: Achieve wider access to effective health care services and reduce health care costs.

MeasureFYTargetResult
Increase the number of partners contributing data to the Healthcare Cost & Utilization Project (HCUP) databases by 5% above FY 2000 baseline

Output

2008Increase the number of partners contributing outpatient data to the HCUP databasesDec-08
2007Increase the number of partners contributing outpatient data to the HCUP databasesDec-07
2006Increase the number of partners contributing outpatient data to the HCUP databases# of outpatient databases increased to 21 AS and 17 ED
2005Increase the number of partners contributing outpatient data to the HCUP databasesAdded 5 new outpatient databases
20045% increase over FY 00 baseline36 States as data partners
2003Increase the number of partners33 States as data partners
Insurance Component tables will be available within 6 months of collection

Output

20086 monthsDec-08
20076 monthsDec-07
20066 months6 months
20057 months6 months
20047 months6 months
20037 months7 months
Medical Expenditure Panel Survey (MEPS) Use and Demographic
Files will be available 12 months after final data collection

Output

200811 monthsDec-08
200711 monthsDec-07
200611 months11 months
200511 months11 months
200412 months12 months
200315 months15 months
Full Year Expenditure Data will be available within 12 months of end of data collection

Output

200812 monthsDec-08
200712 monthsDec-07
200612 months12 months
200512 months12 months
200412 months12 months
200318 months18 months
Increase the number of topical areas included in the MEPS Tables Compendia

Output

2008Add State Quality TablesDec-08
2007Add FY Insurance TablesDec-07
2006Add State TablesCompleted Jul-06
2005Add Access TablesCompleted Sep-05
2004Add Quality TablesCompleted Sep-04
2003N/A1N/A1
Increase the number of MEPS Data Users

Output

2008Exceed baseline standardDec-08
2007Exceed baseline standardDec-07
2006Exceed baseline standard14,809 HC/IC
net hits

19,989 HC/IC
Tables Compendia
hits

33 Data Center
Projects worked on

2005Meet baseline standard11,600 HC/IC hits

16,200 Tables Compendia hits

14 active data center projects

2004Establish baseline on:
  • # of Web hits on MEPS-net IC/HC
  • # of Web hits on MEPS-HC Tables Compendia
  • # of data center projects worked on
Completed:

13,101 HC/IC Net
15,900 Tables Compendia

10 active data center projects

2003N/A1N/A1

Percent reductions in time will occur for the Point-in-time, Utilization and Expenditure Files with the goal of production taking no more than 12 months following data collection

Efficiency Measure
Output

2008Re-establish baseline for the release of the 2007 point in time and use filesDec-08
2007Implement Computer Assisted Personal Interviewing (CAPI) process for the MEPSDec-07
2006Implement pretest of CAPI process for the MEPSCompleted Jun-06
2005N/A2N/A2
2004N/A2N/A2
2003N/A2N/A2

Data Source: MEPS Web site; HCUP database and Quality Indicators (QI) Project Officers

Data Validation: MEPS Web site; HCUP database and QI Project Officers

Cross Reference: SG-4/5; HP2010-23; 500-Day Plan—Transform the Healthcare System; Advance Medical Research

1. New measure developed FY 2004
2. New efficiency measure developed FY 2006 for PARTed program

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Effectiveness—Data Development

Long-term Goal: Assure that providers and consumers/patients use beneficial and timely health care information to make informed decisions/choices.

MeasureFYTargetResult
By 2010, at least 5 organizations will use HCUP databases, products, or tools to improve health care quality for their constituencies by 5%, as defined by AHRQ Quality Indicators (QIs)

Outcome

20083 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least 2 of them will develop and implement an intervention based on the QIsDec-08
Impact will be observed in one new organization after the development and implementation of an intervention based on the QIsDec-08
20073 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least one will develop and implement an intervention based on the QIsDec-07
Impact will be observed in at least one new organization after the development and implementation of an intervention based on the QIsDec-07
20063 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least one will develop and implement an intervention based on the QIsCompleted
  • Org for Economic Cooperation & Dev.
  • Connecticut Office of Health Care Access.
  • Dallas-Fort Worth Hospital Council.
  • Canada's Public Reports.
Impact will be observed in at least one new organization after the development and implementation of an intervention based on the QIs

Completed
Colorado Health and Hospital Association

20052 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least 1 will develop and implement an intervention based on the QIs4 implementations
20042 new organizations will use HCUP/QIs to assess potential areas of quality improvement, and at least 1 will develop and implement an intervention based on the QIsCompleted
20032 organizations will use HCUP/QIs to assess potential areas of quality improvementCompleted
By 2008, Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data will be more easily available to the user community, and the number of consumers who use information from CAHPS® to make choices about their healthcare will increase by 20%.

(FY 2002 Baseline 100 Million)

Outcome

2008Place a pediatric version of the CAHPS® Clinician/Group Survey and related reporting tools in the public domainDec-08
Increase 42% over baseline 
2007Place a CAHPS® questionnaire for consumer assessment of home health quality and related reporting tools in the public domainDec-07

Place a CAHPS® questionnaire for consumer assessment of assisted living quality and related reporting tools in the public domain

Dec-07

Place a CAHPS® questionnaire for assessments of quality of care by persons with mobility impairments and related reporting tools in the public domain

Dec-07
Increase 40% over baseline 
2006Produce CAHPS® module for consumer assessment of Individual Clinician/Group Practice quality
  • CAHPS® Clinician & Group Adult Survey.
  • CAHPS® Clinician & Group Child Survey.
  • CAHPS® Clinical & Group Specialty Survey.
Produce CAHPS® module for consumer assessment of Medicare prescription drug programs—MMA requiredCAHPS® Module Medicare Prescription Drug Program
Produce CAHPS® module for cancer patients assessments of their careCAHPS® for cancer patients not funded by AHRQ. The National Cancer Institute (NCI) is doing some work on this effort.
Increase over baseline138 Million
2005Produce CAHPS® questionnaire for consumer assessment of dialysis facility qualityCompleted
ICH-CAHPS® survey on AHRQ Web site
Establish baseline for number of hospitals collecting HCAHPS dataCompleted
3,000 Hospitals
Increase over baseline number of people with access to CAHPS® data135 Million
2004Produce a CAHPS® questionnaire for consumer assessment of hospital qualityCompleted
H-CAHPS
Increase over baseline number of people with access to CAHPS® data130 Million*
2003Produce a CAHPS® module for consumer assessments of care received in nursing home settingsCompleted
NHCAHPS Resident Survey
Increase over baseline number of people with access to CAHPS® data123 Million*
2002Obtain baseline number of people with access to CAHPS® data.Completed
100 Million*

Data Source: HCUP and QI Project Officers; CAHPS®; National CAHPS® Benchmarking Database (NCBD).

Data Validation: Personal communication; Tracking Medicare and Medicaid beneficiaries and NCQA accredited commercial health plan members covered by health plans that use CAHPS®. Prior to placing surveys and related reporting products in the public domain a rigorous development, testing and vetting process with stakeholders is followed. Once, deemed ready, based on scientific evidence and potential user feedback, the tools are released for broad use. Following release of the tools technical assistance is provided to users. The overall process enhances the likely adoption of the tools

Cross Reference: SG-2/3/4/5/6/7/8; HP2010-23; HHS Objectives: Transform the Healthcare System; Advance Medical Research; Emphasize Healthy Living; Prevention of Disease, Illness and Disability.

*People are in plans that use CAHPS® data.

MEPS—Efficiency

The MEPS is part of AHRQ's Efficiency strategic plan goal area and the Data Development Portfolio. A significant factor that reduces the efficiency of our modern-day health care system is waste caused by systems that do things that don't improve care, processes that could be designed to do things better and systems that fail to do things that would assure more effective treatment. AHRQ's investments include efforts to develop ways to:

  1. Measure and report on the efficiency of systems, procedures, and processes.
  2. Assess the scope, nature, and impact of waste in health care systems.
  3. Design techniques, methods, and technology to improve treatment outcomes and reduce associated costs.

HCUP—Efficiency

The long term goal for efficiency is to achieve wider access to effective health care services and reduce health care costs. HCUP has set a goal that by 2010, at least 5 organizations will use HCUP databases, products or tools to improve health care quality for their constituencies by 5%, as defined by AHRQ Quality Indicators. By increasing the number of organizations using HCUP and the Quality Indicator tools, we support the overall program goal by expanding to add new states that will improve national and regional representation and by expanding the number of Partners that contribute ambulatory surgery and emergency department data. AHRQ added Arkansas to HCUP this year. AHRQ also added two new ambulatory surgery databases (Iowa, Michigan) and two new emergency department databases (Iowa, New Jersey). They were selected based on the diversity—in terms of geographic representation and population ethnicity—they bring to the project, along with data quality performance and their ability to facilitate timely processing of data. Currently, 38 statewide data organizations participate in HCUP.

HCUP—Effectiveness

The long term goal for effectiveness is to assure that providers and consumers/patients use beneficial and timely health care information to make informed decisions/choices. The examples provided below demonstrate the progress made in achieving information dissemination that is being used to implement interventions aimed at making better informed decisions and choices.

2006 Examples of Organizations using HCUP/QIs to assess quality improvement and implement an intervention: 3 new users are the: Employer Health Care Alliance Cooperative of Wisconsin, Florida Agency for Health Care Administration (AHCA); and Massachusetts Department of Health and Human Services.

  1. The Employer Health Care Alliance Cooperative of Wisconsin used the AHRQ Quality Indicators to produce a hospital level Quality Report to improve health care quality for its members.
  2. The Florida AHCA used the Quality Indicators to produce a publicly reported hospital level Quality Report to improve health care quality.
  3. Massachusetts Department of Health and Human Services used the Quality Indicators to produce a publicly reported hospital level Quality Report to improve health care quality.

CAHPS—Effectiveness

The long-term goal is to ensure that providers and consumers/patients use beneficial and timely health care information to make informed choices/decisions. CAHPS® has set a goal of ensuring that patient experience of care data will be more readily available to consumers by 2008 in order to help them make choices among competing providers in the marketplace on the basis of quality. By moving to create surveys for a range of providers beyond the widely used CAHPS® health plan surveys, including hospitals, nursing homes, and dialysis facilities, CAHPS® is rapidly expanding the capacity to collect data that can be utilized to make more informed choices by the purchasers who contract with and the consumers who visit these providers.

The CAHPS® program also directly addresses patient-centeredness, one of the six aims for the health care system espoused by the Institute of Medicine in its 2001 report, Crossing the Quality Chasm. Data generated by the implementation of CAHPS® surveys by the Medicare and Medicaid programs, NCQA accredited commercial health plans, and states populates several of the measures included in the annual National Healthcare Quality and Disparity Reports, mandated by Congress. In addition, Medicare and other CAHPS® sponsors regularly produce public reports of CAHPS® data. AHRQ is working with the Centers for Medicare & Medicaid Services (CMS) in the design of the Web site on which HCAHPS data will be published. It is also working with a number of states to collect HCAHPS data and make it available for a variety of audiences including consumers, hospitals, health plans and employers. AHRQ also continues to work with Medicaid agencies to collect CAHPS® Health Plan data, prepare benchmarks and make the data available to a variety of audiences.

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Cost, Organization, and Socio-Economics

Long-term Goal: By 2010, in at least 5 cases, public or private health care policymakers and decisionmakers will have used AHRQ findings or tools in the area of:

MeasureFYTargetResult
System and delivery improvement, payment and purchasers, and/or market forces to make decisions designed to improve quality, effectiveness, and/or efficiency of health care by 5%.
Outcome

Financing, access, costs, and coverage to make decisions designed to improve the efficiency of the U.S. health care system while maintaining or improving quality, and/or improving access to care or reducing any existing disparities.

Outcome

2008Develop one set of efficiency measures stakeholders have prioritized from the evaluationDec-08
Conduct a conference for policymakers and other health care decisionmakers on actionable research findings from the MEPS on issues related to financing, access, costs, and public and private health insurance coverage.Dec-08
Conduct or support 15 new projects on research related to coverage, delivery, payment, purchasing or market forces that are disseminated to health care policymakers and healthcare decisionmakers.Dec-08
Conduct or support 15 new research projects related to financing, access, costs, or coverage with the findings to be disseminated to health care policymakers.Dec-08
2007Develop an evaluation of efficiency measures, including a useful applied taxonomy, an evaluation of the current published measures and a broad assessment of use.Dec-07
Conduct or support 15 new projects on research related to financing, access, costs, coverage, delivery, payment, purchasing of market forces that are disseminated to health care policymakers and healthcare decisionmakers.Dec-07
2006Develop and enhance mechanisms to disseminate and assist with implementation of findings to health care public policymakers,systems leadership, purchasers/employers, and health services researchers.Completed
Held conference to present research findings to policymakers
Conduct or support 15 new projects on research related to financing, access, costs, or coverage that is disseminated to health care policymakers.Completed
2005Conduct or support 12 new projects related to system and delivery improvement, payment and purchasers, and/or market forces.Completed
Conduct or support 15 new projects related to financing, access, cost, or coverage.Completed
Complete a synthesis of research in a significant area or system and delivery improvement, payment and purchasers, and/or market forces.Completed
Complete a synthesis of research in a significant area of financing, access, cost, or coverage.Completed
2004Develop a data warehouse and vocabulary server to process patient safety event dataCompleted
2003N/A1N/A

Data Source: Publications, intramural plans for the Center for Financing, Access and Cost Trends (CFACT) and Center for Delivery, Organization, and Markets (CDOM), grants management tracking of funded projects, and tracking of all deliverables by the Integrated Delivery System Research Network (IDSRN) project officer.

Data Validation: The CFACT and CDOM intramural plans are maintained and reviewed by senior staff. Grants are monitored by project staff, and the IDSRN has a senior project officer.

Cross Reference: SG-1/5; HP2010-17; 500-Day Plan–Transform the Healthcare System; Advance Medical Research

1. New measure developed FY 2004

The Cost, Organization and Socio-Economics Portfolio implements particular sections of AHRQ's reauthorizing legislation, most particularly those that relate to:

  • Research on health care costs, efficiency, utilization, and access.
  • The ways in which health care services are organized, delivered, and financed and the interaction and impact of these factors on the quality of patient care.
  • Health care productivity, efficiency, and market forces.
  • Analyses of MEPS and HCUP.

The mission of the portfolio is to provide public and private policymakers with the information they need to make improvements in the organization and financing of the U.S. health care system. Research conducted and supported by AHRQ has been used in the development and implementation of numerous public and private initiatives in recent years, including the design and implementation of the State Children's Health Insurance Program (SCHIP) program, estimates of the impact of the Medicare Modernization Act on health care costs, state initiatives to address the problems of the uninsured, and private efforts to incorporate quality measures into payment schemes. AHRQ will continue to develop and disseminate this type of critical information for policymakers in 2007.

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Training

Long-term Goal: By 2010, enhance capacity to conduct and translate HSR by:

MeasureFYTargetResult
Increase the number of individuals who receive career development support by 30%

Outcome

2008Make 10 new awardsDec-08
2007Increase by 15% from FY 2004Dec-07
2006Increase by 10% from FY 200415 new grants awarded
2005Increase by 5% from FY 20042 new awards (Career development budget was reprogrammed in FY 2005)
2004Support 40 career development grants49
2003Establish baseline40
Improve geographic diversity by increasing the number of States by 5 that have the capacity to undertake health services research (HSR)

Increase the number of institutions serving predominantly minority populations by 5 that have the capacity to undertake HSR

Output

2008Issue new grant announcementDec-08
2007Support at least 2 new programsJun-08
2006Issue new announcement11 new awards were issued
2005Support at least 3 institutions in new states and at least 1 new predominantly minority serving institutionNo new awards due to reprogramming of FY 2005 Building Research Infrastructure and Capacity (BRIC) funds
2004Baseline—support 6 institutions in new states and 9 predominantly minority-serving institutionsCompleted
2003N/A1N/A
Support 5 institutional programs that develop HSR curricula to address safety/quality, effectiveness, and efficiency

Output

2008Support at least 2 new projects relating curricula to applications of research to policy or health care practiceDec-08
2007Support at least one new projectDec-07
2006Issue announcementPresentation at annual meeting of Academy Health and AHRQ National Research Service Awards (NRSA) Trainee Conference, followed by journal publication
2005Support 1 pilot project leading to development of cultural competencies in HSR doctoral trainingCompleted 2 projects: small pilot feasibility study and related conference "HSR Competencies for Doctoral Training"
2004N/AN/A
2003N/AN/A
2003N/AN/A

Data Source: IMPAC II

Data Validation: AHRQ budget data management system used to keep annual track of spending relative to budget allotment

Cross Reference: SG-1/5; HP2010-23; 500-Day Plan–Advance Medical Research

1. New measure developed FY 2004

The Training Portfolio's mission is to continue to foster the growth, dissemination, and translation of the field and science of Health Services Research to achieve AHRQ's mission and address Departmental priorities geared toward the transformation of health care. Special attention will be paid to:

  • Individuals: Foster the growth of the next generation of researchers and knowledgeable users or research.
  • Diversity: Foster the institutional and individual diversity in the field of health services research.
  • Science: Foster the development of an integrated science of health services research and refine its foundation.

Throughout its research training portfolio, AHRQ seeks to address its three main research goals, focusing on enhancing efficiency, patient quality/safety, and effectiveness, as well as addressing AHRQ's priority populations.

New activities in developing the science of HSR were launched in FY 2005 with the completion of a feasibility study and related conference on the development of core competencies for doctoral training. FY 2006 activities in this area continued to impact this portfolio goal by broadly disseminating findings from the conference, soliciting feedback from key stakeholders and developing a plan to further refine and garner support for adoption of core competencies across training programs that educate and grow the next generation of health services researchers. The core competencies emphasize evolving needs in health service research, in conjunction with traditional emphases placed on interdisciplinary training, and intense exposure to sophisticated research design and analytic method and knowledge of the health care system and health policy. Included among the evolving needs are translating research into practice and policy and the ability to communicate research results to scientists as well as users of research (e.g., policy makers, clinicians, consumers, payors). It is anticipated that these core competencies will then be used by programs as they develop learning objectives and future curricula and by AHRQ as it prepares to design responsive, applied future initiatives in training.

FY 2007 and FY 2008 activities are expected to build on activities begun in FY 2006 to find ways to integrate quality improvement into research training. A series of conversations with training program directors in FY 2006 will lead to concrete next steps to be undertaken, including such projects as: sharing of curricula and resources, development of theoretical and methodological papers to advance the science of quality improvement, and the formation of partnerships between academia and users of research such as Quality Improvement Organizations (QIOs), HCUP partners, and health plans.

Grants awards in FY 2006 that related to the goal of increasing diversity included four new awards to increase the geographic diversity of states conducting health services research and three new awards to institutions serving predominantly minority populations. These grants were awarded to institutions in Arkansas, Georgia, Nebraska, North Dakota, North Carolina, Texas, and West Virginia. In addition, approximately three more new awards may be made in these programs in FY 2006 commensurate with grant budget. Projects supported through the programs address Departmental and Agency priorities including use of hand-held information technologies to support primary care decisionmaking, reductions in health disparities, and pharmaceutical outcomes research. All focus upon priority populations, including rural and frontier health care, disparities, and aging and long-term care. Plans are under development to launch an evaluation of these programs beginning in FY 2007. A revised program announcement is planned for FY 2008.

It is anticipated that in FY 2007 and FY 2008, AHRQ will continue to support new career development and research infrastructure grants to emerging institutions, which will further the mission of AHRQ by focusing on key priorities such as patient safety, health care quality, management of multiple chronic conditions and translating research into policy and practice as well as on new research foci as they emerge. New, highly targeted announcements, specifically tailored to AHRQ's evolving agenda, will be issued in FY 2007, in conjunction with the development of highly targeted dissertation and fellowship announcements.

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Current as of February 2007
Internet Citation: Care Management: Performance Budget Submission for Congressional Justification. February 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/mission/budget/2008/perf08c.html