The Centers for Medicare & Medicaid Services is launching an initiative with 37 state partners to refocus how Medicaid and the Children's Health Insurance Program measure success—shifting from tracking paperwork and processes to measuring actual health outcomes.
The effort, called Investing in Health Outcomes, asks participating states to adopt four principles: prioritizing health outcomes over process, with focus on prevention, chronic disease management, and behavioral health; streamlining quality measures to reduce reporting burden; advancing digital measurement using near-real-time data; and aligning financial accountability with outcomes-oriented measures.
"For too long, Medicaid has measured whether boxes are checked instead of whether patients are getting healthier — that must change," said CMS Administrator Dr. Mehmet Oz.
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. Variations in state requirements add to the burden, with some states using different metrics to measure the same outcomes. For example, diabetes control is measured using different blood sugar level cutoffs across states, making it difficult to compare performance.
Participating states are committing to use the new principles to develop targets for health outcomes and identify opportunities to incorporate outcomes-oriented measures into state quality strategies. CMS will hold workshops later this year on measure prioritization, reducing reporting burden, and digital quality measurement.