Kimberly Brandt, Chief Operating Officer and Deputy Administrator at the Centers for Medicare & Medicaid Services (CMS), joins host Jay Anders, MD, Chief Medical Officer of Medicomp Systems, on this episode of Tell Me Where IT Hurts from the Healthcare NOW Radio Podcast Network.
A longtime health policy and fraud-and-abuse expert, Brandt previously served as Principal Deputy Administrator for Operations and Policy at CMS, where she oversaw the agency’s $1.4 trillion budget and led the development of the first CMS interoperability rule. She has also held senior roles at the U.S. Senate Finance Committee, the HHS Office of the Inspector General, and the Medicare Program Integrity Group.
The conversation opens on CMS’s effort to better align quality and value across its payment systems. So far, progress has been slow. Only about 14% of Medicare beneficiaries are currently in value-based arrangements, and providers continue to raise three concerns about existing models: financial risk, administrative burden, and limited specialty integration. On the CMS side, the track record is similar. The Center for Medicare and Medicaid Innovation (CMMI), also known as the CMS Innovation Center, has proposed nearly 60 alternative payment models over the years, yet fewer than five have been made permanent in Medicare.
Brandt also examines how data quality and interoperability shape the CMS reform agenda. With one recent assessment finding a CMS provider directory just 6% accurate, the agency is mandating HL7 FHIR-based APIs, requiring adoption of the United States Core Data for Interoperability (USCDI) standard, and building a centralized national provider directory. She places current data quality at a C-plus to B-minus and is targeting a B-plus within the next year.
“We’re seven years out from the Medicare Part A trust fund being depleted. If we can extend that, thanks to some of these efforts, particularly on the fraud and waste and abuse side, then to me, AI is doing its job.”
Kimberly Brandt, COO and Deputy Administrator
CMS
On AI, Brandt is direct: CMS processes 4.5 to 5 million Medicare claims a day, and human reviewers can examine less than 1%. AI is helping push that figure closer to 10% in real time, a meaningful gain against an estimated $100 billion in annual fraud, waste, and abuse across Medicare, Medicaid, and the exchanges. Her guiding philosophy is “trust but verify,” with clinicians validating AI findings, particularly since two of three Medicare beneficiaries say they do not trust AI.
Brandt closes by previewing a voluntary CMS app suite that will help beneficiaries manage their health, review billing, and report suspected fraud, repositioning CMS from a payer of care to a partner in care.
Show Notes
Among the topics covered:
- The shift to value-based care in Medicare
- CMS Innovation Center alternative payment models
- Provider concerns: financial risk, administrative burden, specialty integration
- Interoperability and HL7 FHIR-based APIs
- USCDI (U.S. Core Data for Interoperability) requirements
- Building a national provider directory as a centralized source of truth
- Electronic prior authorization mandates
- AI for fraud, waste, and abuse detection
- Trust but verify as a guiding AI principle
- Beneficiary distrust of AI
- A voluntary CMS patient app for care management and fraud reporting
- The Medicare Part A trust fund and the case for fraud reduction
- And more…
Show Links
- Kim Brandt on LinkedIn
- Centers for Medicare & Medicaid Services
- CMS Initiatives Crushing Fraud, Waste, and Abuse
- CMS Innovation Center (CMMI)
- Dr. Jay Anders on LinkedIn
- Medicomp Systems on LinkedIn
- Tell Me Where IT Hurts on Healthcare NOW Radio