The Administrator for the Facilities for Medicare & Medicaid Providers (CMS), Dr. Mehmet Oz, spoke to non-profit well being system executives, buyers, and business observers this week on the 25th Annual Not-for-Revenue Healthcare Buyers Convention sponsored by Barclays, HFMA and the American Hospital Affiliation. Dr. Oz outlined his imaginative and prescient for CMS – after joking that the distinction between a “imaginative and prescient” and a “hallucination” is whether or not an individual can deliver others together with them – and addressed among the important coverage points associated to Medicaid at present below debate in america Congress.
Dr. Oz centered on two precedence areas for CMS: (1) the digital transformation of well being care, together with the request for data (RFI) that CMS revealed on Might 16, 2025; and (2) eliminating “fraud, waste, abuse,” citing examples of hospice suppliers and DME suppliers submitting fraudulent claims to Medicare for objects and companies not truly wanted or disbursed and people enrolled in Medicaid or sponsored plans supplied by means of medical insurance Exchanges that they have been unaware of attributable to abusive practices by enrollment brokers.
Dr. Oz defined the targets of the RFI are to extend entry to healthcare data for each sufferers and docs. The target is to empower particular person sufferers to raised perceive their well being and make knowledgeable selections about their care, whereas additionally eliminating paperwork and different administrative burdens for docs, permitting them to focus extra of their time and a spotlight on affected person care. He needs to scale back bureaucratic processes and ease administrative burdens, together with bettering the prior authorization course of. He additionally inspired the viewers to examine a future the place Medicare beneficiaries obtain messages on their telephones to handle primary well being points or have interaction in each day train, and the place they’ll work together with an AI-enabled doctor avatar to debate their situation or perceive what to anticipate from an upcoming process earlier than arriving at their appointment.
Dr. Oz additionally described CMS’s deal with the “core” populations supposed to be lined by the Medicaid and Medicare applications as youngsters and getting old adults, respectively, and expressed his assist for requiring adults to hunt employment, volunteer, pursue schooling or to handle another person with a purpose to be eligible for Medicaid advantages, a difficulty at present being debated in Congress.
Dr. Oz applauded Medicare PACE applications and advantages that assist Medicare beneficiaries keep wholesome and energetic as they age. He additionally welcomed “insurgents” within the well being care market, noting that private-equity assist for newcomers to healthcare is a method to assist new gamers with actually good concepts to compete towards the established market gamers.
