This week four years ago, I was working for the Centers for Medicare and Medicaid Services, helping lead the national Medicaid program. The Affordable Care Act was hitting its stride. The number of uninsured people was at a historic low. The rate of people being readmitted to hospitals soon after being discharged was coming down.
But costs were unsustainably rising, health care providers were burning out, and the opioid crisis was spiraling out of control.
We were ready to tackle these issues under President Hillary Clinton, but President Donald Trump surprised us.
During the Trump administration, Seema Verma, who headed CMS, pushed for ineffective Medicaid work requirements, defunded ACA health insurance exchanges, and sidelined senior staff whose expertise conflicted with her ideology.
Under President Joe Biden, I am confident that the next CMS administrator will not have disdain for the department she or he runs. Here’s what I would advise the next administrator to do during her or his first 100 days — based on what I learned while working at CMS and investing in health care since then — to begin undoing unscientific policies, instituting new ones based on evidence, and building a more resilient organization.
Reaffirm the vision of the Quadruple Aim
As an investor, I spend most of my time serving on boards and advising companies and nonprofits, which range from early startups to Fortune 500 firms. CMS is a bigger ship with a smaller rudder than most of my portfolio companies, but the same change management best practices apply.
Business management guru Jim Collins says the foundation of organizational strategy is having a clear vision, sticking to what the organization is uniquely capable of doing, and focusing on the sustainability engine, the financing model that keeps the organization afloat.
The vision for CMS is inculcated in the much-amended Social Security Act of 1935, constraining each administrator’s scope for setting their vision, hence the tiny tiller. Given the organization’s legislative underpinnings, the visions expressed in the strategy slide decks of politically divergent Andy Slavitt, the administrator of CMS under President Obama from March 2015 to January 2017, and Seema Verma had more similarities than differences.
In recognition of current failures in the health care market, growing gaps in health equity, and unprecedented threats to the solvency of Medicare and Medicaid, I believe that the vision for CMS should be a version of the Quadruple Aim:
- Equitably improve population health
- Flatten the total-cost-of-care growth curve
- Improve the health care experience for beneficiaries
- Improve the well-being of care teams
Even if a Republican-controlled Senate does not confirm the CMS administrator that Biden appoints through another Berwickian block, senior career staff are sufficiently familiar with the Quadruple Aim to steer CMS back…