Oct, 02 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program

Seema Verma
Administrator, Centers for Medicare & Medicaid Services

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program

Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion. The program is often the first or second largest line item in state budgets. Just recently, CMS’ independent Office of the Actuary released their Medicaid financial report, confirming what we have already known for quite some time – that our healthcare spending, particularly in Medicaid – is forecast to continue growing, averaging 5.7% annually over the next 10 years to reach over $1 trillion by 2026.

Yet as program costs have continued to rise, we have failed to deliver a level of transparency and accountability for achieving positive outcomes commiserate with our significant investment. But this is finally beginning to change. Over the last several years, CMS has collaborated with states to improve how we collect and use data to modernize and measure the Medicaid and CHIP program. Through strong data and systems, CMS and states can drive toward better health outcomes and improve program integrity, performance, and financial management in Medicaid and CHIP. These efforts will provide the foundation that enables CMS to deliver on its commitment to usher in a new era of Medicaid centered on state flexibility, stronger accountability, and improved program integrity.

As one example, CMS has worked with stakeholders to identify two core sets of health care quality measures that can be used to assess the quality of health care provided to children and adults enrolled in Medicaid and CHIP.  These core sets are tools states can use to monitor and improve the quality of health care provided to Medicaid and CHIP enrollees. Under statute, state reporting on these measure sets is voluntary. In the future, we aim to increase the number of states reporting on a uniform set of measures and to support states in using these measures to drive quality improvement for the beneficiaries they serve. And ultimately, this move toward greater transparency will start an important conversation about how and when states should be held accountable for the outcomes their programs produce.

Last week, we released the latest Federal Fiscal Year 2017 quality measurement data from the Medicaid and CHIP Child and Adult Core Sets that states have voluntarily reported to CMS. We greatly appreciate the work our state partners have endured to report these measures. CMS recognizes that quality reporting can present a significant administrative burden for both states and providers, and has taken steps to reduce this burden through our Meaningful Measures initiative.  In the future, we hope to leverage existing and more automated data reporting systems to generate these Medicaid measures on behalf of states, thereby reducing reporting burden while also improving data consistency, comparability, and comprehensiveness.  

States have worked with CMS over the last few years to modernize the way in which administrative data is collected by moving from the Medicaid Statistical Information System (MSIS) to the Transformed-MSIS (T-MSIS).  T-MSIS modernizes and enhances the way states submit operational data about beneficiaries, providers, claims, and encounters.  It is the foundation of a national analytic data infrastructure to support programmatic and policy improvements and program integrity efforts and will help advance reporting on outcomes. It also enhances the ability to identify potential fraud and improve program efficiency.

I am pleased to say that all states, the District of Columbia, and Puerto Rico are now successfully submitting T-MSIS data, marking a significant and exciting milestone in the history of the Medicaid program.

With these data in hand, we are shifting our efforts to continuous data quality review and improvement--a collaboration we will sustain with states. CMS’ ongoing goal is to use advanced analytics and other innovative solutions to both improve T-MSIS data and maximize its potential for performance measurement, health care quality improvement, and program integrity, all while reducing state reporting burden.   

I appreciate our continued partnership with states. Programs as important as Medicaid and CHIP require robust, timely, and accurate data in order to ensure the highest financial and program performance, support policy analysis and ongoing improvement, identify potential fraud or waste, and enable data-driven decision making.  

We are committed to collaborating with states on improving their data submissions.

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