NHHCIA NCC Financial Performance Measures

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Native Hawaiian Health Care Systems (NHHCS) Sample Required and Optional Financial Performance Measures
The Financial Performance Measures forms below are for reference only. Starting with the Required and Optional Financial Performance Measures Forms submitted with the FY 2024 limited competition application, add two new rows (as seen in red in the table below) to provide numeric data to date and a narrative explanation of progress in relation to the goal. Do not edit any information previously included in the FY 2024 form. In your progress report, you must include all Required Financial Performance Measures and any Optional Financial Performance Measures that you included in your FY 20XX limited competition application. 


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
NATIVE HAWAIIAN HEALTH CARE SYSTEM
Required Financial Performance Measures
FOR HRSA USE ONLY 

Grant Number
Application Tracking Number 

 
 
1. Required Focus Area – NHHCIA Program Grant Cost Per Total Patient (Grant Costs) 	 
Performance Measure 
Ratio of total NHHCIA grant funds per patient served in the measurement calendar year
Is this Performance Measure Applicable to your Organization? 
Yes 
Target Goal Description 

Numerator Description 
Total NHHCIA grants drawn down for the period from January 1 to December 31 of the measurement calendar year
Denominator Description 
Total number of patients
Baseline Data 
Baseline Year: 
Measure Type:  
Numerator:  
Denominator:  
Calculated Baseline:  
Numeric Progress to Date
Provide recent data to demonstrate ongoing progress toward goal.
Narrative Progress Since August 1, XXXX
Provide a narrative description to explain recent data provided. 
Projected Data (by End of Period of Performance) 
 
Data Source & Methodology 
 
Key Factor and Major Planned Action #1 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Key Factor and Major Planned Action #2 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Key Factor and Major Planned Action #3 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Comments 
 
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Health Resources and Services Administration
NATIVE HAWAIIAN HEALTH CARE SYSTEM
Optional Financial Performance Measures 
(Must report on at least one)
FOR HRSA USE ONLY 

Grant Number
Application Tracking Number 

 
 
2. Optional Focus Area – Total Cost Per Total Patient (Costs)
Performance Measure 
Ratio of total cost per patient served in the measurement calendar year
Is this Performance Measure Applicable to your Organization? 
[_] Yes [_] No 
Target Goal Description 

Numerator Description 
Total accrued cost before donations and after allocation of overhead 
Denominator Description 
Total number of patients 
Baseline Data 
Baseline Year: 
Measure Type:  
Numerator:  
Denominator:  
Calculated Baseline:  
Numeric Progress Since August 1, XXXX
Provide recent data to demonstrate ongoing progress toward goal.
Narrative Progress Since August 1, XXXX
Provide a narrative description to explain recent data provided.
Projected Data (by End of Period of Performance) 
 
Data Source & Methodology 
 
Key Factor and Major Planned Action #1 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Key Factor and Major Planned Action #2 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Key Factor and Major Planned Action #3 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Comments 
 
3. Optional Focus Area – Medical Cost Per Medical Visit (Cost) 
Performance Measure 
Ratio of total medical cost per medical visit 
in the measurement calendar year
Is this Performance Measure Applicable to your Organization? 
[_] Yes [_] No 
Target Goal Description 

Numerator Description 
Total accrued medical staff and other 
medical cost after allocation of overhead, 
excluding lab and x-ray cost
Denominator Description 
Medical visits, excluding nurse visits
Baseline Data 
Baseline Year: 
Measure Type:  
Numerator:  
Denominator:  
Calculated Baseline:  
Numeric Progress Since August 1, XXXX
Provide recent data to demonstrate ongoing progress toward goal.
Narrative Progress Since August 1, XXXX
Provide a narrative description to explain recent data provided.
Projected Data (by End of Period of Performance) 
 
Data Source & Methodology 
 
Key Factor and Major Planned Action #1 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Key Factor and Major Planned Action #2 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Key Factor and Major Planned Action #3 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Comments 
 


4. Optional Focus Area – Financial Viability 
Performance Measure 
Non-Federal Matching Funds as a percentage of matching funds included in the total project budget
Is this Performance Measure Applicable to your Organization? 
[_] Yes [_] No 
Target Goal Description 

Numerator Description 
Non-Federal Matching Funds 
Denominator Description 
Total Budget 
Baseline Data 
Baseline Year: 
Measure Type:  
Numerator:  
Denominator:  
Calculated Baseline:  
Numeric Progress Since August 1, XXXX
Provide recent data to demonstrate ongoing progress toward goal.
Narrative Progress Since August 1, XXXX
Provide a narrative description to explain recent data provided.
Projected Data (by End of Period of Performance) 
 
Data Source & Methodology 
 
Key Factor and Major Planned Action #1 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Key Factor and Major Planned Action #2 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Key Factor and Major Planned Action #3 
Key Factor Type: [_] Contributing [_] Restricting 
Key Factor Description: 
Major Planned Action Description: 
Comments 
 
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