Megan Worstell is CMS' CFO and director of the office of financial management and has worked for the agency for more than 22 years.
As CFO, Ms. Worstell oversees all financial management functions for the agency, including the release of CMS' annual financial report and its budget to congress. She also acts as liaison to HHS, the assistant secretary for financial resources, the office of management and budget, and the Congressional appropriations committees for all matters relating to CMS' operating budget.
Ms. Worstell sat down with Becker's to discuss CMS' "true north star," value-based care goals, advancing health equity and biggest cost-saving opportunities for the future.
Question: What financial performance metrics does CMS prioritize, and how do these metrics align with the agency's broader mission of providing comprehensive healthcare coverage?
Megan Worstell: Our true "north star" will always be the one-in-three Americans who benefit from our programs. CMS serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage and improving health outcomes. Our strategic plan not only makes that mission concrete but also operationalizes how we evaluate our work, promote innovation and improve connections to coverage across Medicare, Medicaid and the health insurance marketplaces.
To cite just one example: In 2022, CMS released frameworks to focus agency efforts to operationalize health equity across CMS programs and policies for the next 10 years. The CMS Framework for Health Equity identifies five priority areas to reduce health disparities:
1. Health equity data
2. Causes of disparities
3. Workforce capacity
4. Language access
5. Accessibility
The Path Forward: Improving Data to Advance Health Equity Solutions details steps taken and next steps to improve health equity data collection, analysis, stratification and reporting. In addition, the CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities builds on the larger framework to identify six priorities specific to rural communities, Tribal nations, territories and those in geographically isolated areas. Together, these documents provide an integrated approach to build health equity into existing and new efforts by CMS and our stakeholders.
Q: Where does CMS see the biggest opportunity for cost savings over the next two to three years?
MW: Under the Biden-Harris Administration, more people than ever before have healthcare coverage. In August 2022, President Biden signed the Inflation Reduction Act into law. The law expands Medicare benefits, lowers drug costs and improves the sustainability of the program for generations to come. For the first time in history, Medicare will be able to negotiate directly with drug companies for the price of certain high expenditure drugs covered under Medicare Part D and eventually, Part B, that do not have generic or biosimilar competition.
The agency's new ability to negotiate prices for covered drugs will improve drug affordability for people with Medicare and lower costs for the program, improving access to innovative, life-saving treatments for people that need them. And through the work of our Center for Consumer Insurance Information & Oversight (which also operates the health insurance marketplaces), implementing landmark legislation like the No Surprises Act is helping curb surprise billing for millions of Americans with job-based and individual health plans who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
We also value and prioritize innovation, which is why the CMS Innovation Center has a growing portfolio testing various payment and service delivery models that aim to achieve better care for patients, smarter spending and healthier communities.
Q: With an ever-growing population relying on Medicare and Medicaid, how is CMS ensuring financial efficiency and sustainability for these programs in the long run?
MW: When CMS is a good fiscal steward, we aren't just protecting the solvency of our program for years to come but also ensuring Americans have access to high-quality, affordable health insurance. That's why landmark legislation like the Inflation Reduction Act is so important to our present and future. The law provides meaningful financial relief for millions of Medicare beneficiaries by improving access to affordable treatments and strengthening the program both now and in the long run. It also makes improvements to Medicare that will expand benefits, lower drug costs, keep prescription drug premiums stable and improve the strength of the program. For the first time ever, Medicare will be able to negotiate directly with drug manufacturers to lower the price of some of the costliest single-source brand-name Medicare Part B and Part D drugs. This means that people with Medicare will have increased access to innovative, life-saving treatments, and the costs will be lower for both them and Medicare.
Q: How can CMS, providers and payers collaborate more effectively to accelerate the shift to value-based care?
MW: This is a great reason to watch the work of the CMS Innovation Center, which develops new payment and service delivery models. Additionally, Congress has defined — both through the Affordable Care Act and previous legislation — several specific demonstrations to be conducted by CMS. The Innovation Center also plays a critical role in implementing the Quality Payment Program, which Congress created as part of the Medicare Access and CHIP Reauthorization Act of 2015. In fall 2021, the CMS Innovation Center set a strategic goal for its next 10 years: to transform the health system into one that achieves equitable outcomes through high quality, affordable, person-centered care. As part of this, the center is committed to designing models that are inclusive of a variety of providers who care for underserved populations, ultimately increasing beneficiaries' access to high-quality care.
Accountable care organizations are a critical component of the value-based care goals, in particular. ACOs bring together groups of physicians, hospitals and other providers to deliver coordinated care to beneficiaries. They are also essential to achieving CMS' goal of having all beneficiaries in the traditional Medicare program cared for by providers who are accountable for costs and quality of care by 2030. CMS is aligning its ACO initiatives and policies, creating pathways for payers and providers to advance accountable care in Medicare. This approach will help us to bring improved quality and patient experience — as well as the ability to be part of a care relationship that meets medical and social needs — to more beneficiaries. For providers, alignment of initiatives and policies is designed to increase participation rates and accelerate care transformation. We aim to send clear and consistent signals that the opportunities provided by the Medicare Shared Savings Program, the agency's permanent flagship accountable care program, and Innovation Center models represent a coordinated pathway for supporting participation in value-based care arrangements.
Q: Given the evolving nature of the healthcare landscape, where do you see CMS's financial challenges and opportunities in the next decade, and how are you preparing for these shifts?
MW: As Administrator Chiquita Brooks-LaSure made clear, looking at fiscal solvency for our programs is something we do regularly. We're very excited about enhancements like the drug price negotiation program, which will make Medicare more affordable, both for the people who use the program and for taxpayers. Ultimately, across all our programs, we're committed to expanding connections to coverage to support access to high-quality, affordable healthcare coverage. That not only can reduce costs but ultimately build healthier communities for generations to come.