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Delivering Value, Quality, and Improved Outcomes in CMS Programs

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CMS is tasked with administering the two largest Federal health care programs, Medicare and Medicaid, as well as CHIP and the Health Insurance Marketplaces. More than 147 million people (43 percent of Americans) rely on Medicare and Medicaid for their health insurance including senior citizens, individuals with disabilities, low-income families and individuals, and individuals with end-stage renal disease.

Effectively and efficiently managing this complex suite of programs is a top HHS challenge. These programs use multiple delivery models (including FFS, managed care, and value-based care); cover a broad array of health conditions, providers, services, settings, and insurance plans; and operate pursuant to intricate statutory directives and regulatory schemes. Spending on these programs is massive, totaling $1.3 trillion in FY 2021.

Continue reading TMC 3