Key Takeaways
- 37 states joined CMS's Investing in Health Outcomes initiative, a voluntary Medicaid quality initiative representing about 56 million beneficiaries and $700 billion in spending.
- The initiative aims to standardize state Medicaid quality measures after CMS found approximately 450 reporting requirements across managed care programs, corresponding to 258 unique quality metrics.
- States committed to an outcomes-oriented Medicaid pledge focused on behavioral health, chronic disease management, and prevention rather than process measures.
- The Medicaid CHIP quality metrics framework prioritizes near-real-time data over claims and chart abstraction, and aligns financial accountability with health outcomes.
- CMS will host workshops later this year to help states implement these principles in their quality strategies and upcoming procurements.
On September 25, the Centers for Medicare & Medicaid Services (CMS) launched the Investing in Health Outcomes (IHO) initiative, a voluntary pledge aiming to improve health outcomes by standardizing quality metrics for Medicaid and the Children's Health Insurance Program (CHIP). 37 states have signed the pledge, representing about 56 million Medicaid and CHIP beneficiaries and $700 billion in fiscal year 2024 Medicaid spending. This initiative follows a May 2026 CMS analysis of managed care programs, which found substantial state variance in reporting requirements. Specifically, CMS observed approximately 450 reporting requirements, corresponding to 258 unique quality measures that largely focused on processes and utilization. CMS remarked that this variance can increase reporting burdens and make it difficult to compare quality performance across states.
IHO invites health plans, states, and various stakeholders to commit to an outcomes-oriented Medicaid Quality Pledge focused on behavioral health, chronic disease management, and prevention. The pledge additionally commits to four principles:
- Prioritizing health outcomes over process;
- Streamlining quality measure inventories;
- Using near-real-time data for quality measurement over claims and chart abstraction; and
- Aligning financial accountability with outcomes-oriented measures.
CMS called these principles a "north star vision for Medicaid quality" that will provide a basis for implementing state Medicaid quality measures. Participating states also committed to using these principles to develop health outcome metrics and outcomes-oriented measures for state quality strategies and upcoming procurements. Lastly, CMS will host workshops later this year to discuss measure prioritization, value-based arrangements, reducing reporting burdens, and digital quality measurement.
Track Health Care Policy
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Investing in Health Outcomes (IHO) Initiative
The Investing in Health Outcomes initiative is a voluntary CMS program through which states, health plans, and other stakeholders pledge to improve Medicaid and CHIP quality by standardizing metrics and shifting focus from process measures to health outcomes. Participating states commit to principles such as using near-real-time data, streamlining reporting requirements, and aligning financial accountability with outcomes-oriented measures.
Medicaid Quality Measures
Medicaid quality measures are standardized tools used by states and the federal government to assess the performance of Medicaid managed care programs, including the quality and outcomes of care delivered to beneficiaries. Historically, these measures have varied widely across states, creating inconsistent reporting burdens and limiting the ability to compare performance nationally.
Frequently Asked Questions
What is the CMS Investing in Health Outcomes initiative and which states have joined?
The Investing in Health Outcomes (IHO) initiative is a voluntary pledge launched by CMS on September 25 to improve health outcomes by standardizing quality metrics for Medicaid and CHIP. 37 states have signed the pledge, representing approximately 56 million Medicaid and CHIP beneficiaries and $700 billion in fiscal year 2024 Medicaid spending.
What are the four principles of the Medicaid Quality Pledge under the IHO initiative?
The four principles are: prioritizing health outcomes over process, streamlining quality measure inventories, using near-real-time data for quality measurement over claims and chart abstraction, and aligning financial accountability with outcomes-oriented measures. CMS described these principles as a "north star vision for Medicaid quality" to provide a basis for implementing state Medicaid quality measures.
What problem did CMS identify with current state Medicaid quality reporting requirements?
A previous CMS analysis of managed care programs found approximately 450 reporting requirements corresponding to 258 unique quality measures, with substantial variance across states. CMS noted that this variance can increase reporting burdens and make it difficult to compare quality performance across states.
What are participating states committing to under the IHO Medicaid Quality Pledge?
Participating states committed to using the pledge's four principles to develop health outcome metrics and outcomes-oriented measures for state quality strategies and upcoming procurements. The pledge focuses on behavioral health, chronic disease management, and prevention.
What follow-up activities is CMS planning after the IHO initiative launch?
CMS will host workshops later in the year to discuss measure prioritization, value-based arrangements, reducing reporting burdens, and digital quality measurement. These workshops are part of the broader effort to implement the outcomes-oriented direction established by the IHO initiative.