Impact Pediatric Health | Innovation Pain Points for CMS
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Innovation Pain Points for CMS

The Centers for Medicare & Medicaid Services (CMS) is working to build a health care delivery system that’s better, smarter and healthier – a system that delivers improved care, spends healthcare dollars more wisely, and one that makes our communities healthier.

For more details about the aims, foundational principles, programs and initiatives visit the CMS Quality Strategy overview and website.

Quality Strategy Goals:

SAFETY & REDUCTION OF HARM

Healthcare-related errors harm millions of Americans each year and add billions of dollars to healthcare costs.

We’re seeking innovative solutions that: improve support for a culture of safety, reduce inappropriate and unnecessary care that can lead to harm and/or prevent or minimize harm in all settings.

PERSON & FAMILY ENGAGEMENT

Studies have found that person-centered care models improve quality of care and health outcomes, engage people more actively in their healthcare, and can reduce costs and disparities in care.

We’re seeking innovative solutions that: ensure all care delivery incorporates person and family preferences, improve experience of care for persons and families and/or promote self-management.

COMMUNICATION & COORDINATION OF CARE

Poor coordination of healthcare can result in harms to health care patients and increase costs.

Most healthcare payment systems pay for volume over value, and do not foster coordination of care or understanding of patient preferences

Rewarding providers for doing more, rather than for working together, compromises the ability to achieve the best outcomes for individuals and communities.

We’re seeking innovative solutions that: reduce admissions and readmissions, embed best practices to enable successful transitions between all settings of care and/or enable effective healthcare system navigation.

PREVENTION & TREATMENT OF CHRONIC DISEASE

Chronic conditions last a year or more and require ongoing medical attention and/or limit activities of daily living. More than 133 million Americans report at least one chronic condition, while many have multiple chronic conditions (MCC)—two or more chronic conditions that affect a person at the same time.

Increased spending on chronic conditions among Medicare beneficiaries is a key factor driving the overall increase in spending in the traditional Medicare program.

We’re seeking innovative solutions that: increase appropriate use of screening and prevention services, strengthen interventions to prevent heart attacks and strokes. improve quality of care for people with multiple chronic conditions, improve behavioral health (BH) access and quality care, and/or improve perinatal outcomes.

HEALTHY LIVING

Many factors influence health and wellbeing, including individual behavior, access to health services, and the environments where people live.

Efforts to improve lives through access to appropriate healthcare rely on deploying evidence-based. interventions and strong partnerships among local healthcare providers, public health professionals, community and social service agencies, and individuals.

We’re seeking innovative solutions that: partner with and support federal, state, and local public health improvement efforts, improve access within communities to best practices of healthy living, promote evidence-based community interventions to prevent and treat chronic disease, and/or increase use of community-based social services and HCBS.

AFFORDABLE CARE

Despite the decrease in the growth rate of spending, the cost of medical care remains unacceptably high.

Higher costs lead to underutilization of appropriate care and services, greater financial burden on the sickest and most vulnerable, and increased burden on providers and payers.

We’re seeking innovative solutions that: develop and implement payment systems that reward value over volume and/or use cost analysis data to Inform payment policies