The Centers for Medicare & Medicaid Services (CMS) convened the at a moment when healthcare quality policy is increasingly being shaped through formal rulemaking as well as informal policy signals and implementation vehicles. The discussions reflected CMS鈥檚 core priorities鈥攚ellness and prevention, digital infrastructure, patient safety, and program integrity鈥攁nd reinforced a broader theme that CMS intends to continue to move faster to advance these priorities than traditional regulatory timelines allow.
红领巾瓜报 (红领巾瓜报) experts attended QualCon and are working with healthcare organizations as they interpret these signals and prepare to implement the policy priorities highlighted during the conference. This article describes these cross-cutting issues and highlights strategies and actions healthcare entities can take now.
Moving Faster Requires Different Approaches to Policy and Implementation
CMS Administrator Dr. Mehmet Oz emphasized CMS鈥檚 increasing use of voluntary commitments, public-private collaboration, Requests for Information (RFIs), and other informal policy tools as alternatives or precursors to formal requirements, creating an imperative for early stakeholder engagement.
- CMS leaders highlighted stakeholder convenings as a key vehicle to drive change outside of regulatory processes, including the pledge by health plans to streamline and improve聽聽requirements.聽These commitments聽may聽signal聽future regulatory聽mandates聽and shifts in the marketplace.聽
- 罢丑别听聽provides聽the foundation for quality initiatives.聽罢丑别听CMS聽Administrator聽highlighted聽the 600-plus organizations that have committed to the goals of聽the聽CMS Health Tech Ecosystem,聽including companies聽that聽support conversational聽artificial intelligence (AI)聽assistants聽that聽would make聽ingestion聽and sharing of data with healthcare providers easier through the 鈥淜ill the Clipboard鈥� efforts, and聽have pledged聽to support interoperability.聽
- CMS聽is using聽listening sessions聽and聽RFIs聽to聽shape聽the direction聽and drive quality聽policy.聽The agency聽leaders invited聽new ideas聽and reinforced the value of feedback received聽through聽RFIs, citing examples such as the聽, Medicare Advantage improvements, and the RFI聽on聽. CMS leaders also convened sessions pertaining to patient safety, dialysis care, and best practices for medication for treatment of opioid use disorder, signaling these are areas under consideration for policy development.聽
Health and Wellness Positioned as a Core Component of Quality Efforts
QualCon prominently featured CMS鈥檚 commitment to promoting health and wellness. Dr. Oz discussed underutilization of existing benefits, such as annual wellness visits, and CMS Deputy Administrator and Director of the Center for Medicare, Chris Klomp, focused on community-based approaches to prevention. Mr. Klomp also spoke of ongoing interest in moving physician payment toward primary care and away from specialty procedures.
CMS officials highlighted new Center for Medicare and Medicaid Innovation (Innovation Center) models, such as and , which are aligned with the Administrator鈥檚 policy priority of empowering patients. CMS officials also acknowledged challenges to behavioral change and the levers CMS is employing in new models, including technology and incentives for beneficiaries, partnerships, and community health workers.
Digital Infrastructure Framed as Necessary for Quality Reforms
QualCon also emphasized making quality measurement fully digital, specifically using FHIR庐 (Fast Healthcare Interoperability Resources) specifications. Agency officials reported having FHIR specifications for 70+ measures and characterized FHIR as the standard for new measures. Use of FHIR aligns with broader interoperability rules, including requiring state Medicaid programs and payers participating in public programs to use FHIR for electronic prior authorization by January 2027.
Quality measurement leaders spoke about the value of integrating quality data in real time and the move from 鈥渓agged scorecards鈥� to 鈥渃ontinuous intelligence.鈥� Notably, attendees expressed enthusiasm about the potential for AI to support measurement and personalization of quality, measures addressing trajectories of care over time, and new approaches to risk adjustment.
Application of AI to Patient Safety Is on the Horizon
Patient safety discussions focused on the potential for AI鈥慹nabled tools to identify risk earlier and prevent harm, particularly with regard to medication safety and error prevention. CMS speakers emphasized that realizing these gains depends on intentional governance, standardized workflows, and patient involvement in AI development and deployment. Rather than positioning AI as a substitute for clinical judgment, sessions framed it as an augmentation tool requiring clear safeguards and accountability.
Avoiding Fraud, Waste, and Abuse
CMS leaders noted the potential to avoid fraud, waste, and abuse through a cross-functional fraud detection center that can analyze claims in real time. CMS also discussed collaboration with states and private insurers and encouraged external input.
Medicaid Discussions
Medicaid received more limited attention at this conference. CMS Medicaid officials reiterated interest in having fewer quality measures and engaged in discussion with state leaders on how to focus quality efforts. They highlighted learnings about the Medicaid early, periodic, screening, diagnosis, and treatment (EPSDT) program and from CMS Innovation Center models centered on maternal health and substance use disorder care.
What We鈥檙e Watching Next
Following QualCon 红领巾瓜报 experts are continuing to follow several federal quality-related initiatives that affect plans, health systems, states, and other healthcare delivery organizations include:
- How CMS translates voluntary commitments and聽Health Tech Ecosystem initiatives into聽lasting聽policy expectations聽for transforming quality聽
- The pace at which digital quality measurement shifts from pilot to standard practice聽
- How AI governance frameworks evolve alongside聽additional聽real-world聽use cases in quality and safety聽
Connect with Us
红领巾瓜报, including Leavitt Partners and Wakely, work with healthcare organizations to navigate the transition to digital quality measurement and act upon digital quality data to improve healthcare delivery.
Wakely uses analytics-driven operating design and return on investment (ROI) analysis, clinical data acquisition models and tools, and pilot-based validation of measure rates and processing performance to support scalable digital quality measurement (dQM) adoption, as outlined in the .
Leavitt Partners is working with federal agencies on a number of activities related to the CMS Health Tech Ecosystem and interoperability, including the Kill the Clipboard initiative, which was informed by a seminal . In addition, Leavitt Partners convenes the , which is working to solve both technical and policy issues in digital quality measurement.
For聽details, contact聽our experts below.
