Health Line of Business Revised Health Domains January 26, 2005 Outcomes / Domains have been revised

1 Health Domains Access to Care –Focuses on the access to appropriate care Population Health and Consumer Safety –Assesses health indicators and consumer products as a means to protect and promote the health of the general population Health Care Administration –Assures that federal health care resources are expended effectively to ensure quality, safety, and efficiency Health Care Delivery Services –Provides and supports the delivery of health care to its beneficiaries Health Care Research and Practitioner Education –Fosters advancements in health discovery and knowledge

2 Access to Care Focuses on the access to appropriate care Examples: –Streamlining efforts to receive care –Ensuring care is appropriate in terms of type of care, intensity of care, and location of care –Providing seamless access to health knowledge through a myriad of beneficiary touch points –Ensuring availability of care –Enrolling providers –Performing eligibility determination, enrollment, scheduling of appointments and resources, and managing patient movement –Ensuring referral to appropriate health-related programs Outcome: A successful implementation will result in the population’s timely receipt of the right guidance to the right care at the right location.

3 Population Health and Consumer Safety Assesses health indicators and consumer products as a means to protect and promote the health of the general population Examples: –Monitoring of health, health planning, and health management of humans, animals, animal products, and plants –Tracking the spread of diseases (epidemiology) and pests –Facilitating wellness, population monitoring, health promotion, disease and injury prevention, and chronic disease management activities –Predicting the trends in population health –Evaluating the overall state of the environment and effects on human health status –Inspecting and evaluating consumer products, drugs, and foods to assess the potential risks and dangers –Evaluating and capturing emerging health threats and risks to the general population –Educating the consumer and the general population –Supporting disease registries, e.g., cancer, hepatitis C, SCI, and immunology Outcome: A successful implementation will use surveillance and monitoring results to inform decisions that will improve health outcomes and quality of life for the general population

4 Health Care Administration Assures that federal health care resources are expended effectively to ensure quality, safety, and efficiency Examples: –Managing health care quality, performance, and safety –Purchasing health care –Operationalizing payment methodologies –Managing cost, workload, utilization, and fraud and abuse efforts –Identifying trends (e.g., demographics) and estimating costs –Defining benefit packages and policies –Conducting oversight and control functions –Sustaining beneficiary satisfaction –Managing resources strategically –Contracting for provider and supplier participation –Improving operational efficiencies significantly –Assuring regulatory and accreditation compliance –Managing use and disclosure of patient information (to be applied across all domains) Outcome: A successful implementation will dedicate federal health care resources in a manner to ensure efficiency/cost-effectiveness, improve patient satisfaction and health status, and optimize fiscal stewardship.

5 Health Care Delivery Services Provides and supports the delivery of health care to its beneficiaries Examples: –Assessing health status –Planning health services –Delivering the continuum of care (including ancillary and allied health services) –Managing clinical information and documentation –Coordinating with business partners and integrating health services –Ensuring quality of services –Ensuring care and continuity during national emergencies Outcome: A successful implementation will be individual patient optimal health outcomes that result from informed clinical practice, an emphasis on patient-specific quality of care, and an increased focus on health promotion.

6 Health Care Research and Practitioner Education Fosters advancements in health discovery and knowledge Examples: –Developing new strategies for diagnosing, treating, and preventing diseases –Promoting health knowledge advancement and innovation and enabling the dissemination of medical research results –Protecting and improving health –Identifying new means for delivery of services, methods, decision models, and practices –Making strides in quality improvement –Conducting biomedical, behavioral, and rehabilitation research –Conducting and managing clinical trials –Managing research quality, performance, and subject safety –Providing for practitioner education Outcome: A successful implementation will accelerate medical discovery, improve dissemination of evidence-based medicine and provide for practitioner education as critical elements of improving people’s health.

7 Outcomes across the Federal Health Enterprise Access to Care: A successful implementation will result in the population’s timely receipt of the right guidance to the right care at the right location. Population Health and Consumer Safety: A successful implementation will use surveillance and monitoring results to inform decisions that will improve health outcomes and quality of life for the general population. Health Care Administration: A successful implementation will dedicate federal health care resources in a manner to ensure efficiency/cost- effectiveness, improve patient satisfaction and health status, and optimize fiscal stewardship. Health Care Research and Practitioner Education: A successful implementation will accelerate medical discovery, improve dissemination of evidence-based medicine and provide for practitioner education as critical elements of improving people’s health. Health Care Delivery Services: A successful implementation will be individual patient optimal health outcomes that result from informed clinical practice, an emphasis on patient-specific quality of care, and an increased focus on health promotion.