Scope of the Position:
The Administrator of the Centers for Medicare and Medicaid Services (CMS) is responsible for the oversight of all of the programs Americans use as part of the Medicaid and Medicare entitlement programs. With a budget exceeding $970 billion, CMS handles the largest portion of the federal government's spending every year. While promoting efforts to improve the quality of healthcare, the Administrator should seek to transform and modernize the U.S. healthcare system to allow doctors and patients to make informed decisions about the most effective medical care available.
The Administrator must be committed to strengthening and modernizing the nation's healthcare system and must try to provide access to high quality care at the lowest cost possible. Under this umbrella of responsibilities falls the implementation and management of the Affordable Care Act, which requires oversight of consumer protections and private health insurance market regulations.
Illustrative Management Challenges:
In January 2011, CMS became responsible for the implementation of the Affordable Care Act's consumer protections and private health insurance market regulations. These provisions include: new coverage options for previously uninsured Americans with preexisting conditions; reimbursement for employers to help pay part of the costs of providing health benefits for early retirees, their spouses, and dependents; new requirements regarding the market conduct of private healthcare insurers; and new consumer outreach and education efforts to help consumers assess their options and determine their eligibility for public health programs.1 In addressing many concerns about managing fraud, waste, and abuse, GAO has designated CMS as a high-risk program. Medicare has been designated as a high-risk program because its complexity and susceptibility to improper payments, in addition to its size, have led to serious management challenges. Addressing these challenges requires improvements to payment methods, program management, and program safeguards.2 With the increasing needs for affordable healthcare, CMS has had to rapidly expand its ability to administer necessary grants, contracts, and financial and administrative management systems. In 2014, Medicare covered approximately 54 million people at an estimated cost of about $600 billion. CMS faces many challenges related to implementing payment methods that encourage efficient service delivery, including implementing changes to payment models outlined in the Medicare Access and CHIP Reauthorization Act, managing the program to serve beneficiaries well, and safeguarding the program from loss due to fraud, waste, and abuse.
In providing prescription drug coverage for 41 million Medicare Part D and 71 million Medicaid beneficiaries, CMS must ensure the proper use of a rapidly expanding budget. Since its inception in 2006, spending for Part D has more than doubled to $121 billion in 2014. In expanding access to healthcare, CMS must manage the growing epidemic of prescription drug abuse. As of May 2015, the IG had 540 pending complaints and cases involving Medicare and Medicaid prescription drug fraud, representing a 134 percent increase in the last five years. Pharmaceutical manufacturers and pharmacies accounted for more than 60 percent of the Medicaid Fraud Control Unit's cases that resulted in civil settlements and judgments in 2014.3
1FY 2017 Budget Justification
22015 GAO High Risk List; gao.gov; February 2015.
3OIG's FY 2015 Top Management and Performance Challenges Facing the Department of Health and Human Services; oig.hhs.gov; 2015.
Similar to the HHS Deputy Secretaries, almost every CMS Administrator held extensive experience in the healthcare industry prior to their appointment. Experiences include CEOs of healthcare-related trade associations, hospital CEOs, academia, and health-related legal practices. The level of expertise required for success in this position narrows the pool of potential candidates to those with highly specialized experience in the medical field.
Andy Slavitt (Acting) (2014-present): Prior to serving as Acting Administrator, Slavitt joined CMS as the Principal Deputy Administrator. Before working with CMS, Slavitt was founder and CEO of HealthAllies, a consumer healthcare service company focused on serving people who are uninsured or underinsured by contracting affordable care on their behalf. Before founding HealthAllies, Slavitt was a strategy consultant with McKinsey & Company and an investment banker with Goldman Sachs. Slavitt graduated from the Wharton School and the College of Arts & Sciences at the University of Pennsylvania, and he received his MBA from the Harvard Business School.
Marilyn B. Tavenner (20112015): Prior to being confirmed by the Senate as CMS Administrator, Tavenner spent roughly two years as the Acting CMS Administrator. Immediately preceding her time at CMS, Tavenner served as Secretary of Health and Human Resources of Virginia under Governor Tim Kaine. Tavenner became President of HCA's Central Atlantic Division in 2001. She previously served as CEO of Johnston-Willis hospital in Virginia. She holds a BS in nursing and an MHA from Virginia Commonwealth University.
Donald Berwick (2010-2011): Berwick is currently a Clinical Professor of Pediatrics and Healthcare Policy at Harvard Medical School and a Professor of Health Policy and Management at the Harvard School of Public Health. Prior to his time as CMS Administrator, Berwick was President and CEO of the Institute for Healthcare Improvement. He began his career as a pediatrician at Harvard Community Health Plan and became its first Vice President of Quality-of-Care Measurement in 1983. Berwick holds an MD from Harvard Medical School and a master's in public policy from Harvard's Kennedy School of Government.
Charlene Frizzera (2009-2010): Charlene Frizzera currently serves as a Senior Advisor at Leavitt Partners. Prior to her appointment as CMS Administrator, Frizzera held several positions at CMS, including Chief Operating Officer, Deputy Chief Operating Officer, and Deputy Director for the Center of Medicaid and State Operations.
Mark B. McClellan (2004-2006): McClellan currently serves as the Director of the Robert J. Margolis, MD, Center for Health Policy at Duke University. Prior to his appointment with CMS, McClellan held numerous positions with Stanford University, including Associate Professor of Economics, Associate Professor of Medicine, practicing internist, and Director on Health Outcomes Research. He previously served as Deputy Assistant Secretary of the Treasury for Economic Policy and was a member of the President's Council of Economic Advisors. McClellan worked as a White House Senior Policy Director for healthcare and related economic issues during the George W. Bush Administration. He received his MD and holds a PhD in Economics.
Thomas A. Scully (2001-2003): Scully currently works as a General Partner at Welsh, Carson, Anderson & Stowe. Prior to serving as Administrator of CMS, Scully was President and CEO of the Federation of American Hospitals, a partner at Patton Boggs, and Deputy Assistant to the President for Domestic Policy and Associate Director of OMB. After leaving CMS, Scully worked as Senior Counsel at Alston Bird. Scully received a JD from Catholic University and a BA from the University of Virginia.
Nancy-Ann Min Deparle (1997-2000): Deparle currently serves as the Director of CVS Health. Since her time with CMS, Deparle has held positions such as Director of Accredo Health, Trustee on the Robert Wood Johnson Foundation, Director of Medco Health, and Deputy Chief of Staff for Policy at the White House. Prior to her time as the Administrator of CMS, Deparle served as the Commissioner of the Tennessee Department of Human Services. Deparle received her law degree from Harvard Law School.
Bruce C. Vladeck (1993-1997): After his time at HCFA, Vladek became a senior adviser to Nexera and was appointed by President Clinton to the National Bipartisan Commission on the Future of Medicine. Before joining the federal government, Vladek served a 10-year term as President of the United Hospital Fund of New York. He also held positions on the faculty of Columbia University, the Robert Wood Johnson Foundation, and served as Assistant Commissioner of the New Jersey State Department of Health.