Office of Performance Review

1

• Office of Performance Review
• TACHC Presentation
• Lynda Marquardt, M.S.W.
• October 28, 2008

2
Office of Performance Review (OPR)

• U.S. Department of Health and Human Services
  (HHS)
• Health Resources and Services Administration
  (HRSA)
• Office of Performance Review (OPR)
• Regional Division VI - Dallas

3
Office of Performance Review (OPR)
10 Regional Divisions 1 Sub-Division in Puerto
Rico
4
OPR Core Functions

• Performance Reviews
• State/Community Strategic Partnership Sessions
• Track State and Regional Trends
• Policy and grantee feedback to HRSA
• Technical Assistance

5
Purpose of Performance Reviews

• To improve the Performance of HRSA funded
  programs
• Provide direct feedback to the agency about the
  impact of HRSA policies on program implementation
  and performance

6
Performance Review Components

• Measure program performance
• Analyze the contributing and restricting factors
  impacting performance, including HRSA policies
• Identify effective strategies and partnerships to
  improve program performance

7
OPR Underlying Assumptions

• Most grantees are performing well
• Performance first ? systems support/underlie
  performance
• Many solutions to issues/problems exist within an
  organization, and/or
• Can be achieved through partnerships with others
• Working in collaboration with grantees and other
  HRSA staff will produce better outcomes and
  results
• Performance Review Protocol is the framework for
  our work (Grantee, Community, and State Reviews)
• Day-to-day grantee responsibility remains with
  the Headquarters HRSA project officers and grants
  officers

8
Performance Review Benefits

• Focus on performance
• One performance review ? all grants reviewed at
  the same time
• Low cost/no cost improvement options and
  technical assistance to support grantees efforts
  to improve performance
• Opportunity to provide feedback on HRSA policies,
  including surveys on OPR performance

9
Phases of Performance Review

• Scheduling of Performance Reviews
• Each OPR regional division receives a list of
  HRSA grantees
• For each review, the OPR regional division
  identifies the review team members
• On average, 2 to 4 members per review team
• OPR staff serve as the review team lead
  consultants provide additional substantive
  expertise as necessary

10
Performance Review Components
Performance Report (Post-Site)
Performance Analysis (On-Site)
Performance Review Measures/Goals / Objectives
(Pre-Site)
Action Plan (Pre-site, On-site, Post-Site)
11
Review Designations Category 1

• Includes health delivery activities and training
  programs with measurable data.
• Reviews generally
• focus on the selected performance review measures
  
• assess program performance by looking at
  performance measures
• analyzes the factors impacting performance, and
• identifies effective strategies and partnerships
  to improve performance

12
Pre-Site

• Review the program documents
• Conference calls to identify key issues
• Identify the population served by each program
• Specify the program services/resources provided
• Identify the current program performance measures
  and Program reporting requirements

13
Pre-Site

• Select with grantee the Performance Review
  Measures / Goals / Objectives (3 to 5)
• Determine
• What is the grantees progress towards this
  Measure / Goal / Objective
• Is there or what is the gap between current and
  desired progress towards the Measure / Goal /
  Objective?
• Begin to develop contributing and restricting
  factors

14
On-Site Visit

• Identify the factors contributing and restricting
  performance
• Internal systems and processes
• External issues, including HRSA policies
• Partnerships critical for most outcome measures
• Two to four contributing factors and two to four
  restricting factors
• Determine which are the most important to address
  to improve performance on each goal /objective
• Begin to develop Performance Improvement Options
• Average 2 to 3 day site visit

15
Key Area Discussion

• Discussion regarding the implementation of the
  grant program that are not directly aligned with
  the measure may surface and should be discussed
• The discussion may include
• broader internal systems issues
• external issues, including HRSA policies
• identification of cross-cutting factors
• significant accomplishments and best/promising
  practices
• The purpose of the discussion is to
• broaden HRSAs understanding of the grantee and
  the grant program
• enhance HRSAs understanding of the challenges
  and opportunities the grantee faces in achieving
  its mission

16
Action Plan

• Critical driver of performance improvement
• Action Plan development is a collaborative
  process
• Discussion of the Action Plan will begin
  pre-site, brainstormed while on-site, and
  completed post-site.
• Include only the top 3-5 Action Items and should
  be completed within the project period
• Also include Technical Assistance Proposal
• Must be in support of Action Plan

17
Post-Site Visit

• Develop the Performance Report
• Performance Improvement Options (2 to 3 per
  goal/objective)
• No cost/low cost options
• Evidence-based strategies
• Partnerships
• Requirement issues (if necessary)
• Share the Performance Draft Report with the
  grantee, project officer(s), and other
  appropriate HRSA staff for feedback and comments
  (4 weeks from onsite)

18
Post-Site Visit

• Grantee Draft Action Plan and comments on the
  Draft Report (6 weeks from onsite)
• Review the grantees Action Plan submission and
  provide feedback, as appropriate
• Final Report sent to Grantee (6 to 9 weeks from
  onsite)
• Grantee submits final Action Plan (6 to 9 weeks)
• Final Report and Action Plan uploaded to EHB (9
  weeks from onsite)
• Follow-up will be transitioned to the Project
  Officer and integrated into routine monitoring

19
Post-Performance Review

• Overall, OPR will also document key performance
  findings and provide recommendations on these
  findings in the Performance Review Bi-annual
  Trends Report, focusing on
• Key environmental trends/issues (regional, state,
  local) and policy issues (including HRSA
  policies) impacting program implementation and/or
  performance
• Outstanding program outcomes - to share with the
  larger HRSA grantee community

20
OPR Internal Performance Measurement

• Grantee will receive a satisfaction survey
• Provide input regarding the OPR Performance
  Review Process and HRSA/OPR team
• Source CFI Survey via e-mail to grantee

21
Barrio Comprehensive Family Health Center, Inc.

• Common performance measure identified for 2004
  and 2008 performance reviews
• Percentage of Pregnant Women Beginning Prenatal
  Care by the End of the First Trimester
• In 2004, the measure was chosen by the grantee
  and review team because

22
Barrio Comprehensive Family Health Center, Inc.

• Prenatal care (1) is critical in achieving
  healthy pregnancy outcomes and
• (2) helps reduce perinatal illness, disability,
  death and financial burden by allowing providers
  to better manage chronic conditions and
  pregnancy-related risks.

23
Barrio Comprehensive Family Health Center, Inc.

• The measure was chosen for the 2008 performance
  review to
• (1) measure program performance since 2004 and
• (2) determine identified strategy effectiveness
  to increase the percentage of pregnant women
  entering early prenatal care.

24

25
Barrio Comprehensive Family Health Center, Inc.

• Performance Trend
• Early prenatal care entry rates declined 7 from
  2001-2003 stabilized in 2003-2005 increased 4
  in 2005-2006 and improved 3 in 2006-2007.
• Despite consistent increases since 2005, the
  rate remains below grantee and Healthy People
  2010 objectives.

26
Barrio Comprehensive Family Health Center, Inc.

• 2004 and 2008 Contributing Factors
• Dedicated womens health location
• Stable professional provider/program staff and
• Improved patient flow process.

27
Barrio Comprehensive Family Health Center, Inc.

• 2004 and 2008 Restricting Factors
• Undocumented women and late prenatal care entry
• Fear of pregnancy disclosure, particularly for
  adolescents
• Socioeconomic factors and health literacy.

28
Barrio Comprehensive Family Health Center, Inc.

• 2004 Performance Improvement Options (PIO)
• Identify and strengthen national, state and local
  perinatal partnerships and
• Expand state Medicaid eligibility access.
• The grantee leadership team developed and
• initiated strategic planning activities to
• address these PIO.

29
Barrio Comprehensive Family Health Center, Inc.

• Strategic planning activities included
• Collaborative partnerships with the March of
  Dimes, San Antonio Healthy Start and the San
  Antonio Independent School District established
  and increased perinatal health education,
  outreach resources and opportunities.

30
Barrio Comprehensive Family Health Center, Inc.

• To further increase performance, the 2008 review
  team recommended
• Expanded academic partnerships
• Recruit/retain female health providers
• Explore opportunities to incorporate lay health
  workers to expand perinatal outreach and
  education initiatives

31
Barrio Comprehensive Family Health Center, Inc.

• Medicaid expansion was achieved by providing
  onsite eligibility work space in two service
  sites. The service expansion
• (1) ensured eligible women and families Medicaid
  insurance access and (2) reduced patient
  financial concerns.

32
Barrio Comprehensive Family Health Center, Inc.

• Pursue plans for radio and television public
  service announcements to promote public awareness
  and emphasize the importance of early prenatal
  care
• Update grantee Website to (1) add links to
  downloadable health education and resources on
  early prenatal care, diet, folic acid, and
  chronic disease care and (2)

33
Barrio Comprehensive Family Health Center, Inc.

• Increase community awareness about dental
  services available for pregnant women and
• Initiate contact with the state Title V program
  to learn more about the Youth Risk Behavior
  Surveillance System and adolescent pregnancy
  prevention activities.

34
HRSA/OPR Web Sites

• CY 2009 Review Schedule
• http//www.hrsa.gov/performancereview/schedule09.
  htm
• OPR Protocol
• http//www.hrsa.gov/performancereview/protocol.ht
  m

35
HRSA/OPR Web Sites

• Performance Review Tutorial
• http//www.hrsa.gov/performancereview/tutorial/
• Action Plan Template
• http//www.hrsa.gov/performancereview/actionplant
  emplate.htm

36
HRSA/OPR Web Sites

• Online Training Modules for BPHC Clinical
  Measures
• Useful for 2008 UDS reporting and OPR
  performance review preparation
• http//www.bphcdata.net/html/bphctraining.html

37
Questions, Comments or Concerns

• Thank You!
• Lynda Marquardt
• HRSA/OPR
• Dallas Regional Division
• 214/767-3091
• lmarquardt_at_hrsa.gov