The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) both underwent a leadership change in 2021. Xavier Becerra was confirmed as HHS’ Secretary in March and Chiquita Brooks-LaSure as CMS’ Administrator in May.
CMS, an Operating Division of HHS, has oversight for what Brooks-LaSure calls “the three Ms”: Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA) Marketplaces. Enrollment in “the three Ms” runs at about 156.2 million lives (61.2 million Medicare as of 2020, 82.8 million Medicaid and CHIP as of May 2021, and 12.2 million Marketplace as of August 2021).
As you might imagine, it takes a lot of planning and coordination to define and achieve success with such large government healthcare programs! Between August and November 2021, both Secretary Becerra and Administrator Brooks-LaSure publicly shared their visions and objectives for the Department and Agencies they serve. This blog posting looks at what Becerra and Brooks-LaSure put forth. Table 1 offers a side-by-side review along with my interpretation and labeling of the major themes running through them. I close with the motivating words of Secretary Becerra.
Secretary Becerra released a draft of his “Strategic Plan for Fiscal Years 2022-2026” for HHS on October 7. His Strategic Plan and five Strategic Goals were available for comment until November 7 and have since been removed from the website. Table 1 captures the HHS Mission and Draft Strategic Goals as originally posted. HHS is required to have a Strategic Plan. It is updated every four years and “defines its mission, goals, objectives, and how it will measure its progress in addressing specific national problems over a four-year period.”
Administrator Brooks-LaSure laid out the Strategic Vision for CMS, and some early successes, in a September blog posting. “Everything we do at CMS should be aligned with one or more of six strategic pillars,” according to Brooks-LaSure.
There are several “Centers” that fall under the umbrella of CMS, two of which I have included in this posting: Center for Medicare and Medicaid Innovation (CMMI) and Center for Medicaid and Children’s Health Insurance Program Services (CMCS).
The Center for Medicare and Medicaid Innovation (CMMI) aims to create a more value-based system that reduces spending while preserving or enhancing quality of care. It has spent the last ten years testing “more than 50 alternative payment models that reward health care providers for delivering high-quality and cost-efficient care.”
CMMI recently went through a Strategy Refresh and published a Vision for the next 10 years along with five Strategic Objectives to guide the implementation of this vision. While its focus has primarily been on Medicare, its scope is broadening to include Medicaid, with an emphasis on value-based care. CMMI ambitiously set a target to have all Medicare Part A and B beneficiaries and most Medicaid beneficiaries in an accountable care model or provider relationship, respectively, by the end of the decade.
The Center for Medicaid and Children’s Health Insurance Program Services (CMCS) Deputy Administrator and Director Daniel Tsai, together with CMS’ Administrator Brooks-LaSure, published a blog in Health Affairs outlining the Strategic Vision and three focus areas for Medicaid and the Children’s Health Insurance Program (CHIP). As you might expect, they align with CMS and CMMI.
Each of the three focus areas for Medicaid and CHIP are expanded:
- Coverage and Access
- Protect Access to Coverage After the COVID-19 Continuous Coverage Requirement Ends
- Close the Coverage Gap
- Increase and Strengthen Eligibility and Enrollment
- Protect and Expand Access to Care
- Broaden Access to Home and Community Based Services (HCBS)
- Make Bold Investments in Equity
- Innovation and Whole-Person Care
- Establish Section 1115 Policy Principles and Criteria
- Bring Behavioral Health Care Up to Parity with Physical Health
This expansion adds a little clarity to what CMCS hopes to achieve, as well as the challenges. Let’s look at “Increase and Strengthen Eligibility and Enrollment” under Focus Area #1. According to the blog posting, accessing and maintaining coverage is the desired result. Too often this is undermined by “unnecessary administrative red tape.” “In 2018, roughly 17 percent of people who lost Medicaid or CHIP coverage (close to 3 million people) re-enrolled within three months.” This statistic speaks to individuals losing coverage who were eligible.
At Centauri Health Solutions, we see this scenario play out daily with the hospital patients and health plan members we work with. Our 37 years of experience working with the uninsured, along with our “Power to Solve” and “Passion to Serve” gives us the knowledge, skills, and dedication it takes to advocate for those who cannot advocate for themselves.
Remarks from HHS Secretary Becerra
The National Association of Medicaid Directors (NAMD) held their 2021 Fall Conference in November and heard from HHS Secretary Becerra. His remarks were encouraging and motivating. “At the end of the day, all of us are working toward the same goal: How do we get people the services they need?” said Becerra.
“Of course, our job today is not just to discuss the challenges we face during this pandemic, but also to articulate a vision for the future of Medicaid – the nation’s largest health insurer.
I tell my team never to be mild. I’m not mild. And I didn’t take this job to be “mild.” I took this job to be “game-changing.”
Our vision for Medicaid should be no exception.
Now what does that mean? In my mind, this means making coverage more accessible, more equitable, and more holistic to meet the needs of every possible family.”
“COVID-19 hasn’t just forced us to think outside the box. It’s thrown the box out the window. And we need to work together on creative and innovative solutions to get families the care they need.
Because that’s what our work is all about – not just programs, but people. Not just dollars, but dignity. Not just numbers and figures, but names and faces. They are counting on us to succeed.’
I like to tell folks: the Department of Health and Human Services is aptly named – you can’t separate health from humanity. If we lead with our humanity, there’s nothing we can’t do for the American people.” – HHS Secretary Becerra
Shanna Hanson, FHFMA, ACB
Manager, Business Knowledge
Centauri Health Solutions, Inc.