CMS Strategy: The Road Forward 2013-2017Every four years, the Department of Health and Human Services (HHS) updates its strategic plan as required by the Government Performance and Results Act (GPRA) of 1993 (Public Law 103–62) and the GPRA Modernization Act (GPRA-MA) of 2010 (PL 111-352). HHS’ plan defines its mission, goals, and the means by which it will measure its progress in addressing mission-related challenges. This CMS Strategy directly aligns with the HHS plan (Appendix #1). As we refine our Strategy over time, we will align to and draw upon the various planning efforts at work throughout the federal government. This alignment helps ensure that the CMS Strategy reflects the most current priorities and best available thinking, while also providing a coordinated implementation approach that ensures the Strategy is put into action. We are not simply "implementing the plan" but rather "managing our Strategy". We will work together, across component lines, to devise better ways of doing business and understand how our current initiatives contribute to attaining our goals, as well as what new things we can do to make measureable progress. We will hold ourselves accountable for our Strategy's success and will make refinements over time.Centers for Medicare & Medicaid ServicesCMS_d032122e-9f23-11df-9a83-7f707a64ea2aTBDMarilyn TavennerAdministratorAndrew SlavittPrincipal Deputy AdministratorTim LoveChief Operating OfficerJennifer BoulangerChief of StaffPatrick Conway, M.D.Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer... a high quality health care system that ensures better care, access to coverage and improved health. _5caf6c52-52f2-11e4-ac0b-f56979920db9To strengthen and modernize the nation's health care system to provide access to high quality care and improved health at lower cost. _5caf6f0e-52f2-11e4-ac0b-f56979920db9People FirstCMS puts first the best interest of the people it serves and the employees who faithfully serve them.Public ServiceCMS takes pride in its unique and privileged role in the health care of the nation.IntegrityCMS holds itself to the highest standards of honesty and ethical behavior.AccountabilityCMS earns trust by being responsible for the outcomes of its actions.TeamworkCMS fosters unconditional teamwork and regards every employee in CMS as valuable and willing to help each other. CMS strives to fully cooperate with our partners in the private sector.InnovationCMS encourages finding and testing new ideas.ExcellenceCMS is committed to strengthening its organizational culture of striving for excellence with regard to its products and services, as well as how CMS conducts business.RespectCMS treats all stakeholders and one another with the utmost respect and professionalism.Continuous ImprovementCMS strives to continually refine its processes, systems and services in the pursuit of excellence.Care & CostsBetter Care and Lower Costs_5caf7030-52f2-11e4-ac0b-f56979920db91TBDBeneficiaries receive high quality, coordinated, effective, efficient care. As a result, health care costs are reduced. Quality Improve Quality Care _5caf7134-52f2-11e4-ac0b-f56979920db9 1.1 TBD Harm Reduction Care is made safer by reducing harm caused in the delivery of care. TBD Engagement Patients and families are engaged as informed, empowered partners in their care. TBD Communication & Coordination Communication and care coordination across providers and health care facilities improves, leading to better health care quality at lower costs. TBD Mortalicy Leading causes of mortality are reduced and prevented. TBD Outcome Improvement A population-based approach to health care and preventive services improves health outcomes for all populations and helps individuals achieve their highest health-related quality of life. TBD Best Practices Best practices are promoted and disseminated in communities. TBD Electronic Records The meaningful use of electronic health records results in better care, better coordination, and lower costs. TBD Affordability Quality care is affordable for individuals, families, employers and governments. TBD Outcomes & Reporting Patient outcomes are improved and reporting burden is reduced through strengthened alignment of quality measures and associated payment and public reporting programs with the National Quality Strategy. TBD Coordination Integrated care models allow physicians and other providers to come together in new ways to better coordinate care. TBD Accessibility Accessibility to quality long term supports for individuals with disabilities and older adults achieve greater community integration. Caregiving Informal caregivers can effectively provide valuable support to their family. Incentives Value-based payment ensures providers are incentivized to provide high-quality, efficient care. Provider Supply Adequate provider supply in needed areas is supported. Consumer Protection Strengthen Consumer Protections _5caf726a-52f2-11e4-ac0b-f56979920db9 1.2 TBD Partnerships Partnerships among issuers, consumers, the community, and state-based insurance oversight activities strengthen consumer protections against private insurance abuses. TBD Consumer Protections Consumer protections in the private marketplace promote transparency into issuers' business operations and increases their accountability that result in cost savings for enrollees. TBD Payments Improve Payment Models _5caf7382-52f2-11e4-ac0b-f56979920db9 1.3 TBD Incentives Patient/provider incentives for better outcomes and more efficient care align payment with performance and provide new incentives that encourage care coordination, high quality, and efficient care delivery. Value-based payment ensures providers are incentivized to provide high-quality, efficient care. TBD Accuracy & Timeliness Claims processing accuracy and timeliness of payments to providers and States, through the use of electronic reporting tools and transparency; assure appropriate provision of care and services, and reduce the administrative burden for providers and States, while decreasing Agency administrative costs. TBD Prevention & Population HealthAll Americans are healthier and their care is less costly because of improved health status resulting from use of preventive benefits and necessary health services. _5caf7472-52f2-11e4-ac0b-f56979920db92TBD Benefits Improve Preventive Health Benefits _5caf759e-52f2-11e4-ac0b-f56979920db9 2.1 TBD Evidence Basis Use of evidence-based preventive services and primary care keeps individuals healthy, improves population health, and avoids adverse outcomes. CMS uses the latest scientific evidence to determine coverage. TBD Prevention Use of lifesaving/cost-saving preventive benefits increases; including screenings and tests (e.g., blood pressure, diabetes, immunizations) and home- and community-based services. TBD Disparities Disparities in the use of preventive benefits, community-based services, outreach, and education are identified and reduced. TBD CoverageExpanded Health Care Coverage_5caf76a2-52f2-11e4-ac0b-f56979920db93TBDAll Americans have access to affordable health insurance options that protect them from financial hardship and ensure quality health care coverage. Expansion Expand Coverage _5caf77b0-52f2-11e4-ac0b-f56979920db9 3.1 TBD Support Support to States as they create affordable insurance marketplaces reduce the number of uninsured and help ensure eligible individuals receive needed assistance. TBD Guidance, Resources & Flexibility Guidance, resources and flexibility for States enable them to construct competitive insurance marketplaces that best meet the needs of their citizens. TBD ExcellenceEnterprise Excellence_5caf78e6-52f2-11e4-ac0b-f56979920db94TBDWe will have achieved "Enterprise Excellence" when CMS' high quality, diverse workforce develops, supports and utilizes innovative strategies, tools and processes, and collaborates effectively with its partners and agents to reach its goals. Program Integrity Strengthen Program Integrity _5caf79f4-52f2-11e4-ac0b-f56979920db9 4.1 TBD Financial Accountability Federal and state oversight of Medicaid expenditures improves financial accountability. TBD Prevention & Detection Coordination and collaboration with law enforcement in order to achieve law enforcement buy-in and support for CMS' new approach away from "pay and chase" and towards prevention and detection. TBD Enrollment processes Enrollment processes are refined, inappropriate payments are identified, and detection of bad actors is enhanced. TBD Policy Levers & Mechanisms Policy levers and all available mechanisms to combat fraud, waste, and abuse are considered early in regulation development and policy changes. TBD Risk Management Risk management improves proactive stance with consistent and effective program oversight across the range of CMS' programs. TBD Compliance & Oversight Compliance and oversight activities strengthen enforcement. TBD Screening A more targeted screening process improves prevention of fraud, waste and abuse. TBD Risk & ROI Risk is managed and strategic investments provide high impact and rate of return. TBD Auditing Audit processes are improved resulting in reduced audit frequency inconsistencies. TBD Program Data Program data is integrated, better aligned, and used for decision-making. TBD Partnerships Partnerships with States on implementing health care delivery reform and increasing access to health care coverage are enhanced. TBD Financial Information Decision makers and other key staff have necessary access to financial information related to Agency resources creating a more accountable, reliable, and transparent CMS. TBD Program Integrity CMS takes a proactive and integrated approach to Agency program integrity activities. TBD Business Operations Transform Business Operations _5caf7b02-52f2-11e4-ac0b-f56979920db9 4.2 TBD Participation & Coverage Application of the conditions of participation and conditions for coverage and the survey and certification process promotes high quality care and safety, and reduces provider burden and operational costs. By routinely reviewing all regulatory requirements and survey guidance to incorporate changes in practice, we reduce unnecessary burden that does not contribute to improved health for beneficiaries. TBD State Proposals Processes for reviewing and approving state proposals accelerate and simplify to expand access to Medicaid and establish health care marketplaces. This results in the timely negotiation, approval, and implementation of state plan amendments, state health care delivery reform initiatives, and other state-federal administrative activities. Modern technology and business process redesign ensures that timeliness goals are met, and that structured data on program design is available to CMS and our state partners. TBD Culture Culture of lean production and the continuous improvement of our operations and operating processes decrease the cost of production. TBD Waste, Risk, Continuity & Timeliness Enterprise operations, performance reliability, resilience and accountability minimize waste, mitigate risk, optimize resources, assure continuity, and deliver timely response. TBD Acquisition Planning Agency acquisition planning allows CMS to prioritize investments, and better define requirements, to identify opportunities for strategic sourcing that leverages the Agency’s buying power, and ensures delivery of better and more cost effective programmatic results and outcomes for our beneficiaries and for taxpayers. TBD Regulatory Burden Regulatory burden decreases by reducing unnecessary, obsolete, or burdensome regulations, simplifying requirements of the public and private sectors, and enhancing net benefits of the regulations. TBD Administrative Simplification Administrative simplification activities align with other e-health and business initiatives in order to streamline interactions among health plans, providers, and other entities through standardized, real-time transactional automation; resulting in the integration of clinical and claims information and reductions in provider burden. TBD Efficiency & Agility Efficiency and agility of "shared" and common support services promote timely access, transparency and communication, and improve service quality. The development of enterprise shared services, reduces costly redundancies and increases our effectiveness. TBD Financial Information Accountable, reliable, accessible, and transparent financial information aids decision makers in the day-to-day management of CMS programs. TBD Delivery & Payment The understanding of new delivery system and payment models support choice and person-centered care and services and allow CMS to quickly integrate new programs. TBD Consumer Information Health care information available to consumers is understandable, culturally and linguistically-appropriate and comprehensive. Health information assists consumers in making informed decisions about finding health care coverage that best meets their needs. TBD Monitoring & Reporting Stakeholders can obtain insight on the Medicare, Medicaid, CHIP, and Health Insurance Marketplace programs through modernized monitoring and reporting. TBD Engagement & Partnerships Engagement with other public and private sector entities promote collaborative partnerships that enhance policy, operations, and other enterprise interests and initiatives. Partnerships extend the reach and impact of many programs aimed to improve the health and wellness of Americans. TBD Internal Communication & Collaboration Internal CMS employees benefit from enhanced communication and opportunities for collaboration. TBD Recruitment & Professional Development Recruitment, staff support, and skill development provide the resources, competencies and opportunities for a diverse staff to work to their fullest potential in a supportive work environment that achieves the overall mission. TBD Employee Wellness An environment which supports employee wellness improves staff morale and productivity. Retention and productivity are improved by addressing opportunities for improvement such as those identified in the Employee Viewpoint Survey. TBD Investments Investments in information systems expands the CMS knowledge base. TBD Technologies New innovative technologies are adopted that enhance the availability, quality and delivery of information. TBD Infrastructure & Technology Infrastructure and technology improvements enhance interoperability and promote evidence-based decisions made by public stakeholders, researchers, state officials and others using enterprise data, analytics, and information products. TBD Data Standardization & Integration Data standardization and integration effectively improves care coordination, performance, transparency, and knowledge discovery. TBD Systems, Tools & Data The CMS Workforce has systems, tools and data to perform at the highest levels. TBD StrategyEffectively manage our Strategy._5caf7c42-52f2-11e4-ac0b-f56979920db94.3TBDWe will know that we are making progress in effectively managing our Strategy when we see several things occurring: DataUse data to gauge our progress._5caf7d96-52f2-11e4-ac0b-f56979920db94.3.1TBDWe are able to manage our performance by effectively using data to gauge our progress. As part of the movement toward a performance-based and results-oriented environment, the Government Performance and Results Act (GPRA) requires Federal agencies to set strategic goals and objectives, measure performance, and report their accomplishments. CMS must excel at thinking strategically and taking appropriate action to effectively manage its many mission-critical activities. As an Agency, we must use performance metrics that are measureable, usable and actionable to ensure that resources are directed towards priorities, operational risks are identified, and employees are held accountable for meeting strategic goals. The Administration, Congress, public, and health care industry expect CMS to be accountable for the efficient and effective administration and oversight of its programs. As such, we are planning a comprehensive Agency-wide process to define, capture and report on performance outcomes and project milestones associated with the Strategy's activities. For example, an executive-level dashboard will be developed to report at-a-glance information on the status of CMS' key performance accomplishments and challenges, provide timely and relevant information to decision makers, reduce reporting burden on program staff, and enable them to make mid-course adjustments to the Strategy. CMS understands that managers and employees must be engaged to foster a culture of accountability. Our new performance management framework will align the Agency’s progress on its strategic goals and objectives to the performance commitments of senior executives responsible for moving particular priorities forward. These expectations will cascade to the performance plans of managers and employees. This new framework will help support CMS as it evolves into a more nimble, performance-focused organization that can effectively and efficiently respond to the changing demands and expectations of its stakeholders. Strategic AlignmentAll Agency strategic plans are coordinated and integrated, and staff at all levels of the organization align their work to the CMS Strategy._5caf7ec2-52f2-11e4-ac0b-f56979920db94.3.2TBDVarious Agency strategic plans are coordinated and integrated; staff at all levels of the organization align their work to the CMS Strategy. Progress will be realized when independent strategic and action plans across all levels of the organization are consistently aligned with the CMS Strategy. In most cases, strategic plans for the Centers, Offices, Consortia and other components will "cascade" from the CMS Strategy. This means that each component's vision, mission and strategy supports the Agency’s Strategy and day-to-day work provides individuals with a clear understanding of how their efforts fit into the CMS Strategy. A clear understanding of the Agency goals and objectives will meaningfully guide staff 's decisions on a day-to-day basis. By aligning to strategic objectives, the organization can better focus efforts on long-term results and accomplishments, instead of short-term milestones and task completion. Transparency, Participation & Collaboration Create mechanisms for the public to contribute their ideas and harness the energy and expertise both inside and outside the government to achieve our goals._5caf800c-52f2-11e4-ac0b-f56979920db94.3.3TBDWe are "open" -- transparent, participatory and collaborative -- with internal and external partners and stakeholders. Having a defined Strategy will enable us to be open with our internal and external partners in meaningful ways. By inviting and using meaningful input across the Agency and with our partners and stakeholders our Strategy will be enhanced and we will have greater opportunities for success. We will continually strive to create mechanisms for the public to contribute their ideas, and harness the energy and expertise both inside and outside the government to achieve our goals.2013-03-312017-09-302014-10-13http://www.cms.gov/About-CMS/Agency-Information/CMS-Strategy/Downloads/CMS-Strategy.pdfOwenAmburOwen.Ambur@verizon.net