“If you’re focused on what’s wrong, you can always find it. Focus on what’s right,” Tony Robbins told an audience of CMS leaders and quality professionals at the 2026 CMS Quality Conference. The remark came during a fireside chat with CMS Administrator Mehmet Oz. Robbins’ appointment to the Department of Health and Human Services’ newly formed Healthcare Advisory Committee shortly after the conference suggest that the conversation was less a motivational interlude than a signal of the direction Oz is taking the agency.
That direction was consistent throughout the conference: away from reacting to problems after they occur and toward shaping how care is delivered, paid for, and evaluated before they do.
Administrator Oz described a shift in emphasis from treating illness to preventing it. That approach is reflected in efforts to increase use of Medicare annual wellness visits, currently utilized by fewer than half of eligible beneficiaries, and to strengthen early screening and intervention in Medicaid, particularly for children through the Early and Periodic Screening, Diagnosis, and Treatment program.
Readers of our coverage of the Better Medicare Alliance Executive Policy Summit, held just days earlier, will recognize the through-line. The themes CMS Deputy Administrator Chris Klomp and Chief Policy and Regulatory Officer John Brooks outlined there, including payment accuracy, competition on care delivery rather than coding, and long-term program sustainability, were present at QualCon26 as well, situated within a broader vision of what the agency is trying to build.
The policy changes underway in Medicare reflect a sustained focus on how payment is structured. CMS officials described continued movement away from traditional fee-for-service incentives and toward approaches that more directly link payment to value. That includes updates to the Physician Fee Schedule, efforts to reduce low-value care and address site neutrality, and continued expansion of accountable care organizations, with work underway to improve their technical foundation, grow savings, and streamline quality reporting.
CMS is also preparing to move away from the current Merit-based Incentive Payment System. Officials indicated that MIPS will give way to more targeted reporting through MIPS Value Pathways, a set of more focused reporting options designed to reduce burden while improving the relevance of quality measurement. Discussions are also underway about the potential role of mandatory reporting measures, a signal that CMS is willing to move beyond voluntary frameworks if necessary.
In Medicare Advantage, CMS is applying similar principles. Agency officials reiterated priorities around payment accuracy, competition, and beneficiary experience. Risk adjustment remains a central focus, with ongoing efforts to move competition away from coding practices and toward care delivery, a point Klomp made directly at the BMA Summit and that carried equal weight here. CMS also pointed to continued work to reduce administrative burden and improve access to care.
Medicaid policy is moving along a parallel track. Dan Brillman, Director of the Center for Medicaid and CHIP Services, outlined three priorities: aligning spending with value, improving outcomes for beneficiaries with chronic conditions and social needs, and supporting longer-term economic mobility. On that last point, officials identified work requirements and community engagement as significant levers, a notable signal about the direction of Medicaid policy under this administration. Officials also emphasized reducing the number of quality measures while improving their usefulness and called on the private sector to help identify what is worth measuring.
Technology is a consistent thread across all of these efforts. CMS pointed to several specific areas of focus: interoperability and clinical data exchange, a national provider directory, and the use of artificial intelligence in program administration and care delivery. Officials were candid that the existing regulatory framework was not designed with AI in mind, and that meaningful progress will require both updated infrastructure and updated rules. The message was that technology is not an add-on to CMS’s agenda; it underlies it.
Program integrity is another area where CMS is signaling a posture change. The agency described a deliberate shift away from the traditional pay-and-chase model, in which improper payments are identified and recovered after the fact, and toward real-time detection and prevention. That includes predictive analytics and AI-driven monitoring of incoming claims, expanded on-site compliance reviews in hospice and durable medical equipment, and a request for information under the agency’s CRUSH initiative aimed at generating collaborative solutions to fraud, waste, and abuse.
The CMS Innovation Center is also recalibrating. Leadership described a sharpened emphasis on prevention, integrated care models combining home-based and supportive services, and greater alignment across Medicare, Medicaid, Medicare Advantage, and commercial payers. Future models are expected to place greater weight on patient experience, public reporting of provider performance, and payment structures designed to reduce financial barriers to care.
Taken together, the Quality Conference reinforced what the BMA Summit suggested: CMS under Administrator Oz is not making incremental adjustments to existing frameworks. It is pursuing a more fundamental shift in how the program operates, from illness to prevention, from payment volume to payment value, and from reactive oversight to proactive integrity. How quickly that vision translates into durable policy will depend on the the paths CMS pursues for implementation, the pace of rulemaking, and the engagement of stakeholders.
