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  • Writer's pictureOzzie Paez

CMS IS RESHAPING MEDICARE AND HEALTHCARE BY EXTENSION

Updated: May 13, 2023

I led a presentation this week on how strategic initiatives from the Centers for Medicare and Medicaid Services (CMS) and Medicare will impact patients, providers, and other stakeholders. These include moving nearly all 60 million Medicare subscribers into value-based care. CMS is working with States to similarly move millions of Medicaid and CHIP subscribers into value-based programs. The losers are fee-for-service models long criticized as expensive and unresponsive to patient needs.

CMS is reshaping quality standards to increase patient influence by including Patient Outcomes and Patient Satisfaction as core metrics. Quality measures will support healthcare equity by applying common standards to underserved populations in urban centers and rural communities. Quality will in turn affect provider ranking and compensation. New tools will make it easier for patients to consider care quality and patient satisfaction in selecting their preferred providers. CMS hopes that these innovations will incentivize providers by transforming patients into more discerning consumers of healthcare services.


CMS and Medicare are also promoting high-quality, 100% digital measurements and metrics, increased data interoperability, and secured global access to electronic health information. These efforts are intended to improve continuity of care and coordination of care as patients are moved across departments and providers. The intent is for digital health information to seamlessly follow patients as they transition through care delivery systems.


CMS is supporting and benchmarking its programs through quality initiatives that include Meaningful Measures 2.0. It will take advantage of digital data to leverage advanced analytics and artificial intelligence in its performance and program assessments. CMS’s ambitious strategy and programs should move healthcare towards the goals and aims defined by the National Academy of Medicine’s STEEP (healthcare that is Safe, Timely, Efficient, Equitable, and Patient-Centered) and the Center for Healthcare Improvement’s Quintuple AIM Framework (Better Patient Outcomes, Improved Patient Satisfaction, Lower Costs, Clinician Well-Being, and Healthcare Equity).


Many providers will face challenges in innovating and aligning their practices, operations, and business models to meet CMS goals and deadlines. Seven years (2030) is a short time given their breadth and depth. Innovative technologies and business model innovations can help providers jump-start their efforts. Pilot programs are valuable options for beginning the process. Reach out to find out more: ozzie@oprhealth.com.

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