The quarterly newsletter of the
CMS Office of Healthcare Experience and Interoperability
 Dear Colleagues and Partners,
We are thrilled to welcome you to the new year and express our gratitude for your continued engagement with our initiatives. Your partnership and collaboration is crucial, and we look forward to achieving even greater successes together in 2025.
We would also like to extend a special thank you to everyone who attended the 2024 CMS Conference on Optimizing Healthcare Delivery to Improve Patient Lives. This remarkable event gathered influential leaders from the healthcare community and federal government, including 32 amazing speakers and panelists, to exchange innovative ideas, valuable lessons learned, and best practices to enhance the healthcare experience and improve access to quality care. The energy and enthusiasm present at the conference were truly inspiring.
For those who couldn’t attend or want to revisit the sessions, we are pleased to announce that the recordings from the conference are now available! You can access that information on our website to catch up on all the valuable discussions and presentations.
In this newsletter, you will find other important updates and releases from our office, including comprehensive FAQs and a fact sheet on the CMS Qualified Health Plan (QHP) Directory Pilot, and information on our recently released Optimizing Care Delivery Framework.
Thank you for your support and partnership. Together, we can achieve great things in the coming year to improve the healthcare experience and achieve safe, high-quality care.
Wishing you all a happy and prosperous New Year!
Stella “Stace” Mandl
Director, Office of Healthcare Experience & Interoperability
Centers for Medicare & Medicaid Services
Optimizing Care Delivery: A Framework for Improving the Health Care Experience
Released on December 9, Optimizing Care Delivery: A Framework for Improving the Health Care Experience is CMS’ five-year strategy for improving health care delivery and the care experience by addressing administrative burdens and other frictions in the programs it oversees as well as the health system more broadly. It establishes a CMS-wide vision for reducing administrative burden and further moving towards a health care system that operates seamlessly and equitably to achieve health. With it, we aim to support the national conversation on opportunities for reducing administrative burden, as well as create new avenues for the voices of patients, caregivers, and health care workers to be centered in CMS policies, programs, and operations. Safely and effectively reducing administrative burden can return time to providers, time they can spend focusing on what truly matters, the health and well-being of the people who rely on them for care.
The Framework establishes a set of seven strategic priorities to guide CMS’ work to improve the care experience in health care over the next five years.
You can view the entire Framework, as well as let us know your thoughts and share your best practices for identifying and eliminating sources of administrative burden, here or by emailing us at cmsburdenreductionframework@cms.hhs.gov.
CMS Qualified Health Plan (QHP) Directory Pilot
As part of its ongoing work to improve access to care, reduce clinician burden, and support interoperability throughout the health sector, the Centers for Medicare & Medicaid Services (CMS) announced on September 17, 2024, a partnership with the state of Oklahoma on a first-of-its-kind directory pilot. One goal of this pilot is to develop an automated, single, statewide centralized directory for Qualified Health Plans (QHPs) and providers in Oklahoma to improve data accuracy, lessen burden on providers and payers, lower administrative costs, support interoperable data exchange, and ultimately improve patient and provider experiences. CMS believes that this pilot will serve as a proof-of-concept and help inform any future development of an National Directory of Healthcare (NDH) that can serve as a centralized database for provider information. For questions, please contact QHPDirectorypilot@cms.hhs.gov.
CMS has created additional resources for the pilot, including a Frequently Asked Questions and a Fact Sheet.
 Modifications to the National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards; and Modification of Medicaid Subrogation Standard Final Rule (CMS-0056-F)
On December 12, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a final rule that adopts updated versions of the National Council for Prescription Drug Programs (NCPDP) retail pharmacy standards for electronic retail pharmacy transactions. These updates are designed to significantly improve the efficiency and accuracy of electronic retail pharmacy transactions, which is vital for the entire health care industry — especially pharmacists and the people they serve. These standards are adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), legislation that governs the exchange of certain electronic health information. These updated standards modify the current standards for the following retail pharmacy transactions: health care claims or equivalent encounter information, eligibility for a health plan, referral certification and authorization, and coordination of benefits. These standards are informed by recommendations from the National Committee on Vital and Health Statistics (NCVHS). This final rule also modifies the standard for the Medicaid pharmacy subrogation transaction.
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