The country's largest health insurer, and one of its most powerful sources of evidence.
CMS runs Medicare, Medicaid, and the Health Insurance Marketplace, covering more Americans than at any point in its history. Its data and payment experiments are among the most powerful evidence tools in government.
CMS tests new payment models faster than it can rigorously evaluate them, lets evidence-conditional coverage drift toward permanent without the evidence it was meant to produce, and runs data systems built for payment that the country now leans on for research.
Require CMMI to publish its evaluation plan before a model launches, and bar an unregistered launch from expansion until it's fixed.
Separate the people who design and run CMMI models from the people who evaluate them.
Document how CMMI's evaluation findings translate into the Office of the Actuary's cost certifications.
Set clear thresholds for when evidence-conditional coverage ends, with a five-year sunset unless it is affirmatively renewed.
Establish federal funding to generate the evidence Medicare needs when no manufacturer has a reason to pay for the study.
Make the long-standing CMS-AHRQ partnership operational, with AHRQ assessing treatments Medicare is deciding whether to cover.
Bring Medicare Advantage encounter data up to research quality, with authority to enforce the standards.
Standardize researcher access to Medicaid data and improve its quality and comparability.