CMS teams up with 37 states for Medicaid, CHIP quality metrics initiative
The Centers for Medicare & Medicaid Services (CMS) is looking to redefine how Medicaid and the Children’s Health Insurance Program (CHIP) measure quality outcomes, partnering with 37 states that will help to reshape the future of the government insurance initiatives.
In an announcement on Friday, CMS said it and the "founding group” of states will be looking at how Medicaid and CHIP can drive meaningful improvements to chronic disease management, illness prevention and behavioral health, three of the largest pain points in terms of both patient health outcomes and cost.
The agency added that it is looking to eliminate the paperwork burden faced by states, looking for ways that success can be measured in other ways that more accurately reflect the health and wellbeing of those covered by the programs.
“We are shifting the focus from paperwork and process to real accountability for what matters: health outcomes,” CMS Deputy Administrator Stephanie Carlton said. “We are encouraged at this level of commitment from states, and we are ready to get to work with them to implement this vision.”
CMS added that the call for change was spurred by a 2026 analysis it conducted on 42 state Medicaid and CHIP programs, where it discovered that roughly 260 quality metrics existed, linked to 450 reporting requirements developed to show the managed care programs were working.
However, as CMS Administrator Mehmet Oz, MD, noted, the reporting was tantamount to ensuring that “boxes are checked” rather than whether patients are getting healthier, something he hopes a new framework can address.
“We should judge success by what matters — preventing disease, managing chronic conditions, and improving patients’ health,” Oz added.
These variations in state reporting habits also make it difficult for CMS to make direct comparisons on quality, given that each state is ostensibly setting its own bar. One of the goals of this initiative is for states to agree on more uniform and evidence-based definitions of quality outcomes.
Four guiding principles
As part of their participation in what is being called the Investing in Health Outcomes program, the 37 states will be required to adhere to a guiding set of four rules, as they rework the way they measure the success of Medicaid and CHIP.
These include:
- Prioritizing health outcomes over process, with a focus on prevention, chronic disease management, and behavioral health.
- Streamlining quality measure inventories to reduce burden without sacrificing accountability.
- Using real-time data to advance digital quality measurement, as opposed to medical claims data and chart abstraction.
- Aligning financial goals with outcomes-focused patient care measures.
CMS said it will be hosting workshops later this year to monitor the ongoing shift, allowing state Medicaid agencies a chance to share best practices.
For more, read the full announcement by clicking here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.