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Suggested Citation:"Appendix A: Statement of Task." National Research Council. 2012. Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services. Washington, DC: The National Academies Press. doi: 10.17226/13281.
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A

Statement of Task

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

Suggested Citation:"Appendix A: Statement of Task." National Research Council. 2012. Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services. Washington, DC: The National Academies Press. doi: 10.17226/13281.
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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.

Suggested Citation:"Appendix A: Statement of Task." National Research Council. 2012. Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services. Washington, DC: The National Academies Press. doi: 10.17226/13281.
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Page 127
Suggested Citation:"Appendix A: Statement of Task." National Research Council. 2012. Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services. Washington, DC: The National Academies Press. doi: 10.17226/13281.
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Page 128
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The Centers for Medicare and Medicaid Services (CMS) is the agency in the Department of Health and Human Services responsible for providing health coverage for seniors and people with disabilities, for limited-income individuals and families, and for children--totaling almost 100 million beneficiaries. The agency's core mission was established more than four decades ago with a mandate to focus on the prompt payment of claims, which now total more than 1.2 billion annually. With CMS's mission expanding from its original focus on prompt claims payment come new requirements for the agency's information technology (IT) systems.

Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services reviews CMS plans for its IT capabilities in light of these challenges and to make recommendations to CMS on how its business processes, practices, and information systems can best be developed to meet today's and tomorrow's demands. The report's recommendations and conclusions offered cluster around the following themes: (1) the need for a comprehensive strategic technology plan; (2) the application of an appropriate metamethodology to guide an iterative, incremental, and phased transition of business and information systems; (3) the criticality of IT to high-level strategic planning and its implications for CMS's internal organization and culture; and (4) the increasing importance of data and analytical efforts to stakeholders inside and outside CMS. Given the complexity of CMS's IT systems, there will be no simple solution.

Although external contractors and advisory organizations will play important roles, CMS needs to assert well-informed technical and strategic leadership. The report argues that the only way for CMS to succeed in these efforts is for the agency, with its stakeholders and Congress, to recognize resolutely that action must be taken, to begin the needed cultural and organizational transformations, and to develop the appropriate internal expertise to lead the initiative with a comprehensive, incremental, iterative, and integrated approach that effectively and strategically integrates business requirements and IT capabilities.

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