The Administrator for the Centers for Medicare & Medicaid Services (CMS), Dr. Mehmet Oz, spoke to non-profit health system executives, investors, and industry observers this week at the 25th Annual Not-for-Profit Healthcare Investors Conference sponsored by Barclays, HFMA and the American Hospital Association. Dr. Oz outlined his vision for CMS – after joking that the difference between a "vision" and a "hallucination" is whether a person can bring others along with them – and addressed some of the critical policy issues related to Medicaid currently under debate in the United States Congress.
Dr. Oz focused on two priority areas for CMS: (1) the digital transformation of health care, including the request for information (RFI) that CMS published on May 16, 2025; and (2) eliminating "fraud, waste, abuse," citing examples of hospice providers and DME suppliers submitting fraudulent claims to Medicare for items and services not actually needed or dispensed and individuals enrolled in Medicaid or subsidized plans offered through health insurance Exchanges that they were unaware of due to abusive practices by enrollment brokers.
Dr. Oz explained the goals of the RFI are to increase access to healthcare information for both patients and doctors. The objective is to empower individual patients to better understand their health and make informed decisions about their care, while also eliminating paperwork and other administrative burdens for doctors, allowing them to focus more of their time and attention on patient care. He wants to reduce bureaucratic processes and ease administrative burdens, including improving the prior authorization process. He also encouraged the audience to envision a future where Medicare beneficiaries receive messages on their phones to address basic health issues or engage in daily exercise, and where they can interact with an AI-enabled physician avatar to discuss their condition or understand what to expect from an upcoming procedure before arriving at their appointment.
Dr. Oz also described CMS's focus on the "core" populations intended to be covered by the Medicaid and Medicare programs as children and aging adults, respectively, and expressed his support for requiring adults to seek employment, volunteer, pursue education or to take care of someone else in order to be eligible for Medicaid benefits, an issue currently being debated in Congress.
Dr. Oz applauded Medicare PACE programs and benefits that help Medicare beneficiaries stay healthy and active as they age. He also welcomed "insurgents" in the health care market, noting that private-equity support for newcomers to healthcare is one way to help new players with really good ideas to compete against the established market players.
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