Earlier this year, Andy Slavitt was named Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). As Acting Administrator, Andy oversees programs that provide access to health care for 140 million Americans, including Medicaid, Medicare, the Children’s Health Insurance Program, and the Health Insurance Marketplace.
1. You’ve been at CMS 100 days. Tell us about how you’ve spent your time.
The best way to learn anything is to ask a lot of questions. Over the last 100 days, I’ve met with over 300 CMS employees in Washington, Baltimore, and at regional offices and I’ve talked with many more staff at all our employee meetings. I’ve also conducted well over 100 external constituent meetings. When I meet with people I like to ask: How does CMS need to improve? How does your work contribute to CMS’s mission? What do you want CMS to be known for? As I ask questions, I share a little of my personal philosophy on leading, thoughts about our priorities, and how we should get our work done. I talk about the power of an execution mindset; the importance of keeping the people we serve at the center of our work; the need for us to be good partners, which means being clear, consistent, urgent and foster simplification; and to not just drive change, but support it. Over the last couple of months, I’ve really enjoyed the opportunity to learn more about the Agency. I’ve been close to Medicare and Medicaid my entire career, but there’s nothing like learning from the people who are most invested in the success of these programs.
2. What do you see as the biggest priorities for the agency?
Our priority is simple – continue to improve our health care system by providing better care, with a smarter payment system that keeps people healthier. The progress that has been made as we stand here at the 50th Anniversary of Medicare and Medicaid and at the 5th anniversary of the passage of the Affordable Care Act is encouraging, but it’s only a start. The opportunities before us are exciting. We are at the center of change—with the opportunity to expand the impact we have as we cover more people in new programs and purchase care differently to reward physicians and hospitals who deliver high-quality care. At CMS, we need to focus on the changing needs of our consumers, on providing access to high quality care, and to delivering on our commitment to do everything we do transparently, with urgency and with accountability.
3. What are your formative career and health care experiences? How have they prepared you for this job?
Like many people who work in health care, a personal experience was a big shaper of my career. I lost one of my closest friends at a young age and helped his wife deal with the threat of personal bankruptcy in the wake of his death because of the medical expenses he incurred. I learned it was far from uncommon for a young mother with two babies to start her life over in bankruptcy for no other reason than her husband’s illness and that situations like hers happened to countless people every year. I left my job to create a company, HealthAllies, with the goal of helping solve this problem through a consumer web-based service that contracted nationwide for affordable care for the underinsured like my friend’s family. I will never forget the feeling of vulnerability that’s at the center of all of our experiences with the health care system.
In many ways, everything I experienced in the private sector was preparatory work for my work here at CMS. I’ve been involved in Medicare, Medicaid, Children’s Health Insurance Programs, and the private sector delivery of health care – and the transformation of it – for nearly my entire career. From building primary care practices to developing the largest data and analytics tools and measures to driving innovation by using health care technology and population health. During these years, I learned that so much of what the federal government does impacts what happens on the ground – to consumers and to physicians. If there’s one thing local communities want from us it’s to simplify things to allow care givers to spend more productive time with patients, keeping them well and keeping them at home. Leading CMS is an enormous privilege and I am committed to what drove me into health care – to remembering that health care is local and it’s personal. My job and every other CMS employee’s job is to help make the health care system stronger through listening to the needs of consumers and being good supportive partners with the delivery systems, states and other stakeholders.
4. What grounds you in this job?
Today CMS serves 140 million beneficiaries and consumers. I wake-up every day thinking about them. How many are in a hospital, aching to go home? How many are struggling to find good care for an asthmatic child? How many are between jobs and looking for coverage and hoping for something affordable? The fact is: serving close to half the people in the country means the daily needs and circumstances are diverse and profound. That’s why whenever I travel, I visit nursing homes, health centers, and ERs. I ask about the discharge planning. I ask what can be done to simplify their relationship with us. The first thing I do every morning is to read and personally answer emails from beneficiaries and make sure their situations are being followed up on. It’s the single action I can take that lets people know what I think is important.
The other people that ground my thinking are taxpayers. There’s no doubt I bring a business performance perspective to the job. If beneficiaries are our customers, then in a private sector analogy, taxpayers are our shareholders. American families invest their tax dollars every year to support the Medicare and Medicaid programs; they expect these programs to not only perform well today but to be available for them when and if they need them in the future.
On any given day, you’re not going to make everyone happy in a job like this. I just need to go to sleep every night feeling like we’ve done the best job possible for the people who count on us the most and will count on us in the future.
5. What motivated you to join the team at CMS?
I have been working in health care my entire career. As a country, we are transitioning from a time when the action was all about debating policy to a time when the focus needs to be on getting it done and making it work. I believe in the adage that success is 90% about implementation. From overseeing the health insurance exchanges to implementing Accountable Care Organizations and making improvements to the long term health of Medicare, Medicaid or CHIP, I have this vision of CMS as an arm of government that is all about providing access to quality health care to millions of Americans but also getting the job done right. We have a lot of important things to accomplish. If we can bring the speed, the focus, the accountability and the transparency that exists in the best of organizations to the job we’re doing every day at CMS, millions of people benefit. Before I took this job, I don’t think I realized how many good things could get done every day. It’s one reason why I love this job.
6. Finally, how about something personal. How does your family feel about your taking this new role?
I’m not going to pretend that being away from my wife and my two teenage sons is easy. I fly home to Minnesota every weekend. We’re quite aware that the kids’ time at home is limited and precious. The four of us are extremely close and spend a lot of time laughing together, having serious conversations about the world, and finding ways to support one another. My wife knows what it’s like for people who struggle economically and health wise and she’s one of the smartest and most capable people most people know. Doing public service is something of great importance to both my wife and me and she does everything in her power to make sure I can focus on the important opportunity I have to do the job in front of me.