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Office of Performance Review


Performance Review Protocol is the framework for our work (Grantee, Community, ... On average, 2 to 4 members per review team ... – PowerPoint PPT presentation

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Title: Office of Performance Review

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

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

Office of Performance Review (OPR)
10 Regional Divisions 1 Sub-Division in Puerto
OPR Core Functions
  • Performance Reviews
  • State/Community Strategic Partnership Sessions
  • Track State and Regional Trends
  • Policy and grantee feedback to HRSA
  • Technical Assistance

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

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

OPR Underlying Assumptions
  • Most grantees are performing well
  • Performance first ? systems support/underlie
  • 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
  • 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

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

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

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

  • 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

  • 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 /
  • Begin to develop contributing and restricting

On-Site Visit
  • Identify the factors contributing and restricting
  • 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

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
  • 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

Action Plan
  • Critical driver of performance improvement
  • Action Plan development is a collaborative
  • 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

Post-Site Visit
  • Develop the Performance Report
  • Performance Improvement Options (2 to 3 per
  • 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)

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
  • 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

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
  • Outstanding program outcomes - to share with the
    larger HRSA grantee community

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

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

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.

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.


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.

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.

Barrio Comprehensive Family Health Center, Inc.
  • 2004 and 2008 Restricting Factors
  • Undocumented women and late prenatal care entry
  • Fear of pregnancy disclosure, particularly for
  • Socioeconomic factors and health literacy.

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.

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.

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

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.

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
  • 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)

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.

HRSA/OPR Web Sites
  • CY 2009 Review Schedule
  • http//
  • OPR Protocol
  • http//

HRSA/OPR Web Sites
  • Performance Review Tutorial
  • http//
  • Action Plan Template
  • http//

HRSA/OPR Web Sites
  • Online Training Modules for BPHC Clinical
  • Useful for 2008 UDS reporting and OPR
    performance review preparation
  • http//

Questions, Comments or Concerns
  • Thank You!
  • Lynda Marquardt
  • Dallas Regional Division
  • 214/767-3091
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