Program Support

Performance Budget Submission for Congressional Justification

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

Program Support

Authorizing Legislation: Federal funds pursuant to Title IX and Section 927(c) of the Public Health Service Act (PHSA).

 FY 2006
Enacted
FY 2007
Appropriation
FY 2008
Estimate
FY 2008 Request
+/- FY 2007
TotalBudget Authority000$ -
Public Health Service (PHS) Evaluation$ 2,700,000$ 2,700,000$ 2,700,000$ -
Full Time Equivalents (FTEs)2222220

A. Statement of the Budget

A total of $2,700,000 is provided at the level for Program Support, the same level as the FY 2007 Continuing Resolution level. These funds are directly related to the Agency for Healthcare Research and Quality's (AHRQ) work on the President's Management Agenda.

B. Program Description

This activity supports the overall direction and management of the AHRQ. This includes the formulation of policies and program objectives; and administrative management and services activities.

C. Performance Analysis

AHRQ has instituted a systematic approach to addressing and implementing the President's Management Agenda. The five government-wide agenda reforms—Strategic Management of Human Capital; Competitive Sourcing; Improve Financial Performance; Budget and Performance Integration; and Expanding Electronic Government are teamed with other program reforms with which the Department has been charged. In a realignment announced in May 2003, the AHRQ Director created a new organizational entity—an Office of Performance, Accountability, Resources and Technology—to better manage the Agency's progress against these reforms as well as other management initiatives that cross-cut Agency components.

Program Support

Performance GoalResultsContext
Get to Green on Budget and Performance Integration Initiative as part of the Presidential Management Agenda.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.In continuing AHRQ's commitment to budget and performance integration, we reorganized the management structure. This new structure aligns those who are responsible for budget formulation, execution, and providing services and guidance in all aspects of financial management with those who are responsible for planning, performance measurement, and evaluation. These functions are now within one office.

Current and future efforts include continuing the development of a software application that maps each AHRQ-funded activity to the portfolio structure and associated performance. This is a work in progress and we look forward to sharing our success as we continue this journey.

Finally, AHRQ completed comprehensive program assessments of five key programs within the Agency. Over the next few years, the Agency will perform assessments of the balance of our programs and focus on fully integrating financial management of these programs with their performance.

Strategic Management of Human Capital

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 Department of Health & Human Services' (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.

Improve Financial Performance

Financial accountability is a cornerstone of the "Improved Financial Performance" initiative of the President's Management Agenda. 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.

Expanding Electronic Government

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

  1. Government Paperwork Elimination Act (GPEA).
  2. Security.
  3. Full participation in 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 information technology (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.

Budget and Performance Integration

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 (CAHPS®); and, 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.

D. Rationale for the FY 2008 Request

The FY 2008 Request for Program Support is maintained at the FY 2007 Continuing Resolution level. These funds will support the overall direction and management of the AHRQ. This includes the formulation of policies and program objectives; and administrative management and services activities.

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Current as of February 2007
Internet Citation: Program Support: Performance Budget Submission for Congressional Justification. February 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/cpi/about/mission/budget/2008/prog08.html