With technology in virtually every place that care is provided, the Centers for Medicare & Medicaid Services (CMS) is in the process of ending Meaningful Use and moving to "a new regime culminating with [the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)]," said Andy Slavitt, CMS acting director, speaking at the 34th Annual J.P. Morgan Healthcare Conference in San Francisco. More details will come in the next few months, Slavitt said, but CMS will move away from rewarding providers for the use of technology to care for patients.   CMS also aims to level the technology playing field for startups and new entrants. APIs will help move away from the lock placed on data by early system and allow for apps, analytic tools and connected technologies. "We are deadly serious about interoperability. Technology companies that look for ways to pratice data blocking will not be tolerated."  Medicaid is another significant item on the punch list, he said. Over the last two plus years, over 13 million people gained the security of Medicaid or CHIP coverage. "We are equally focused on rapidly modernizing Medicaid so it works as well or better than any insurance program." CMS is working state by state on plans to improve incentives. CMS' priority this year is to attract new innovative companies to invest in the Medicaid IT space. "Investing in the future of Medicaid is one of the single best opportunities in healthcare. First, it's big. The opportunity for innovation and differentiation is large." To encourage new entracts in this area, CMS has taken several steps. It permanently extended the 90 percent federal match for investments in Medicaid systems. Overall, CMS’ annual investment in state Medicaid IT is more than $5 billion, enabling states to modernize their Medicaid IT systems to best meet their program, providers’ and beneficiaries’ needs. CMS and states are prepared to invest in innovative solutions. CMS' new regulations require that states evolve their legacy Medicaid IT systems to leverage reusable solutions, and to practice industry-proven IT methods such as use of modularity, reuse, shared services (including Software-as-a-Service) by fundamentally shifting the financial incentives away from custom development. This opens opportunity to smaller vendors to develop focused solutions for use across multiple states or to introduce solutions from comparable sectors such as commercial insurance or large provider systems. "We believe this approach will expedite states’ IT timelines, decrease overall costs, and ignite adoption of advanced technology solutions." To help the technology community enter this solution space, CMS also created a one-stop-shop set of resources to begin the work. Slavitt's talk coincided with the launch of a new Medicaid program resource that will help private sector companies identify opportunities to participate in this market. Vendors can find links to states’ Medicaid procurement websites and to any open state Medicaid IT Requests for Proposals. Building upon the final regulation and new state procurement webpage, CMS will also be issuing a series of state guidance documents, initiating a new certification process for Medicaid system modules, and issuing a request for information (RFI) that will ask the broader IT vendor community how we can best position our investments coupled with states’ technology needs and break out of the same old solutions.   The final significant item for CMS this year is the health and long-term stability of healthcare marketplaces. The marketplaces are still in their early stages. Consumers are getting educated and plans are experimenting with the right products and network design. "We want to meet today's needs but we need to pay attention to needed adjustments as the marketplace matures." Slavitt discussed the experienced team at work studying the data and meeting with all the market participants. "The focus is simple--they must be attractive to health plans, the offerings need to be attractive to consumers so they come and shop and they need a predictive set of underwriting and other tools to keep the risk pool stable and balanced."