Creator: Patrick Connole
CMS: Health Outcomes Will Now Measure Medicaid Quality
CMS said it is measuring quality in a new way with the launch of a program with the states to put health outcomes above all else for Medicaid and CHIP recipients.
The Centers for Medicare and Medicaid Services (CMS) is launching an initiative with a founding group of 37 states to focus on how quality is measured in Medicaid and the Children’s Health Insurance Program (CHIP).
The effort will put health outcomes — not processes and paperwork — at the center of how success is defined. CMS and its partners will prioritize measures that demonstrate meaningful improvements in prevention, chronic disease management, and behavioral health, the agency said.
“For too long, Medicaid has measured whether boxes are checked instead of whether patients are getting healthier — that must change,” said CMS Administrator Mehmet Oz. “We should judge success by what matters — preventing disease, managing chronic conditions, and improving patients’ health.”
Trimming Paperwork
A May 2026 CMS analysis of Medicaid managed care programs across 42 states found approximately 450 reporting requirements corresponding to roughly 260 unique quality measures for federal and state-specific quality reporting programs, largely with a focus on processes and utilization.
In addition, variations in state requirements can add to the reporting burden, especially for measures assessing similar topics, CMS said.
“For example, measures of diabetes control may be captured using different blood sugar levels [e.g., three different types of A1c cutoffs], making it difficult to compare performance across states,” it added.
CMS said its new effort, Investing in Health Outcomes, allows states to commit to a voluntary Medicaid Quality Pledge built around four principles:
• Prioritize health outcomes over process, with a focus on prevention, chronic disease management, and behavioral health.
• Streamline quality measure inventories to reduce burden without sacrificing accountability.
• Advance digital quality measurement, using near-real-time data instead of claims and chart abstraction where feasible.
• Align financial accountability with outcomes-oriented measures.
States Are Buying In
Participating states are committing to use these principles to develop targets for health outcomes and identify opportunities to incorporate outcomes-oriented measures into state quality strategies and upcoming procurements.
CMS said the Medicaid Quality Pledge and additional information around the Investing in Health Outcomes effort are available online. CMS will also hold workshops later this year focused on measure prioritization and value-based arrangements, reduced reporting burden, and digital quality measurement
For more information and to participate in the Medicaid Quality Pledge, visit: www.medicaid.gov/medicaid/quality-of-care/investing-health-outcomes.
Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.
