The December 23 report, Modernizing CMS Computer and Data Systems to Support Improvements in Care Delivery, provides a detailed plan for updating CMS computer and data systems that support approximately 100 million beneficiaries and pay benefits totaling approximately $800 billion a year.
Mandated by the Patient Protection and Affordable Care Act, CMS said its IT modernization program will allow it to establish capabilities to achieve the following goals:
Improved Business Operations: CMS must transition to flexible payment methods that integrate administrative claim, encounter, clinical, payment, and outcome data while maintaining its fee for service (FFS) and Medicare Advantage and prescription drug (MAPD) operations.
Effective Performance Measurement and Oversight: CMS oversees a wide range of quality management activities and payment systems for Medicaid, Medicare, and the Children's Health Insurance Program (CHIP). Improved data will facilitate a more robust performance management program and enhanced oversight.
Enhanced Public Accountability: CMS must streamline its program, billing, and eligibility information to make these systems and processes as informative as possible while reducing burdensome procedures, such as enrollment and claim processing, for providers. In addition, improving health outcomes involves promoting a patient-centered focus on prevention and wellness, chronic care management, and individual health responsibility. All three depend on the beneficiary's and provider's timely access to critical information about coverage, eligibility, and quality of care.
Innovation: To accomplish the goals of the Patient Protection and Affordable Care Act and modernize its computer and data systems, CMS must offer modern, analytical IT capabilities for cost and quality, supported by reliable storage systems and fully integrated enterprise-level databases.