The Centers for Medicare and Medicaid Services (CMS) face enormous challenges related to their information systems. They must meet challenging day-to-day operational requirements and make frequent adjustments to their business processes, code, databases, and systems in response to changing statutory, regulatory, and policy requirements. Increasingly, their core mission is expanding from one focused on prompt claims payment to one that is more broadly involved in improving health care quality and efficiency. And all of this is being done with old, and arguably antiquated, information technology even as CMS is increasingly engaged in efforts to modernize the nation’s health care information technology.
An ad hoc committee will conduct a study that will, in the foregoing context, lay out a forward-looking vision for the Centers for Medicare and Medicaid Services, taking account of CMS’s mission, business processes, and information technology requirements. It will review the current state of CMS’s technical infrastructure and systems architecture and current plans for its evolution, and make recommendations to CMS on modernizing its business processes, practices, and information systems to meet today’s and tomorrow’s demands, including how to build in the flexibility to cope with changing requirements. The study will anticipate ever-broadening mandates for CMS to deal with data on outcomes, performance, and clinical procedures—perhaps even extending to electronic health records themselves—and requirements for interacting directly with beneficiaries, both to manage claims and to manage health. It will also
consider the financial and human resources necessary to implement this modernization.
The study will take place in 2 phases. The first phase, drawing largely on a workshop (centered on the current CMS landscape and emerging strategy to match its information technology to changing mission requirements), will result in an interim report to be issued 6-9 months after the project start. The second phase, drawing on the workshop and additional briefings, site visits, and committee deliberations, will result in a final report to be issued by the end of the project.