Client Story: Centers for Medicare & Medicaid

Centers for Medicare and Medicaid (CMS) Profile:

The Centers for Medicare and Medicaid Services (CMS), part of the Federal Department of Health and Human Services, provides health coverage for more than 92 million customers through Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP). It is the nation’s largest health care purchaser.  In addition to CMS’s role of paying providers and healthcare institutions, it regulates all clinical laboratories and sets forth standards, rules and regulations. CMS also enforces federal safety and quality standards for hospitals, clinics and nursing homes; as well as enforcing health privacy standards and HIPAA.  The agency’s annual budget is approximately $850 billion.


With passage of the Affordable Care Act and continued escalation of costs and challenges in delivering high quality health care, CMS’s role as a driver of innovation and improvement in care across the US is taking on a new level of significance. Recognizing that CMS needs to be more proactive in supporting improvements in all areas of care—beyond just those services paid for through its programs—leaders of the organization launched an ambitious “Improvement Initiative” to achieve the vision expressed in the agency’s three-part Aim (see graphic).   CMS Pivotal Resources Consulting

Pivotal Resources Services and Solutions:

To support CMS’s efforts, Pivotal Resources was selected to provide:

  • A range of consulting, training and project coaching services to build internal improvement capability.
  • Deliver meaningful, customer- and patient- focused improvements across the full array of CMS services.


In a close partnership with CMS senior leaders and the Office of Operations Services, we have been able, in just over eight months, to:

  • Create a full, tailored 14-week blended curriculum, based on the IHI “Model for Improvement” featuring classroom, webinar and coaching services.
  • Train nearly 200 CMS managers from the Central Office and its 10 Regional Offices.
  • Support a board range of local and system-wide projects, ranging from selecting and administering innovations in health care to speeding hiring to reducing cycle time in adapting regulations to changing needs.
  • Developed a Sustainability Plan to ensure continued application of improvement effort, methods and mindset across CMS.

We are continuing to help CMS build on this foundation with additional training, leadership development, and project consulting.

Contact us for more information.