If it weren't for the Affordable Care Act (ACA), the government would not have had the framework and authority to help support the movement toward accountable care organizations, said Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services (CMS) in a Thursday keynote.
Tavenner said CMS is making a big effort to align all of its quality measures into a coherent system. "When we move forward, it won't be so much about the number of measures, but the quality of the measures and how they work across the system," she said, adding that, "there is a lot of work to do."
CMS is now focusing on working with providers who provide care to dually enrolled beneficiaries in both the Medicaid and Medicare programs. "The current system is a bit fragmented," she said, and the goal is to have a more seamless system. CMS would like to align the quality measures for both, and currently has some pilots running across several states in that effort. "We've been accused of moving at lightening speed," she said. "I've never heard that about CMS before, so I'll take that one."
Tavenner said fraud is at the top of the priority list. "I continue to be amazed at the number of fraudsters after a large pot of government money," she said. CMS is trying to move away from the "pay and chase" methods to predictive modeling to find fraud early on. She said the government is starting to see some results of that effort this year.
For its part, CMS is working to lower its administrative costs through simplification. "We are concerned about bending the cost curve," said Tavenner, adding that millions of baby boomers joining the Medicare program is only going to make that all the more important.
[See also: CMS announces new ACO initiatives.]
"The last two-and-a-half years has been an incredible journey," Tavenner said. "It's interesting to see dialogue move from 'change is needed' to 'what type of change is needed?'"