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By Desirea Votaw, Creator, Meraki Creators, LLC

I am going to introduce you to one of my favorite annual, almost 400-page documents, (yes, I have more than one #nerd), the Centers for Medicare and Medicaid Services (CMS) Justification of Estimates for Appropriations Committees, or as I affectionately refer to it (mostly in my head), JoE.

If you ever wonder where CMS is heading, or what their priorities are, follow the money. And the money must be justified and explained, which is where Joe comes in. I especially like to compare Joes across fiscal years (FYs) to try to discern where the priorities are shifting. What can be especially telling is the absence of previous years’ content, or the presence of new content.

FY18’s is especially interesting as it was the first one authored by the new CMS Administrator, Seema Verma. JoE begins with a Message from the Administrator. If you do not have the time (or desire) to read JoE, I encourage you to read this message. In Andy Slavitt’s introduction for FY17, he focused on continuing the work to implement the Patient Protection and Affordable Care Act (aka ACA or Obamacare). He wrote, “Building on our success in transforming America’s healthcare system and making quality, affordable health insurance available to millions of Americans continues to be our priority in FY 2017.”

In FY18’s JoE, Ms. Verma focuses on moving to a more patient-centered healthcare system, reducing provider burden, and giving states more flexibility. She wrote, “This performance budget will allow us to focus on improving the experience providers, patients, caregivers, and the states have with CMS in a way that we can anticipate their needs and better serve them.”

Another important section to understanding CMS’ priorities is the Key Initiatives. In the FY17 Joe, under the leadership of Andy Slavitt, the Key Initiatives were: Health Insurance Marketplace, CMS Workforce, and Improve CMS Systems and Infrastructure.

Unsurprisingly, the Key Initiatives identified by Ms. Verma in the FY18 JoE are completely different. They are: Reduce Costs through Contract Efficiencies, Prioritize Customer Service, Invest in Program Integrity, Stabilize and Streamline the Federal Exchange, and Strengthen the Federal Workforce.

I have had this idea floating around in my head about comparing how many times words or phrases appeared in the FY17 JoE versus the FY18 JoE to see if there were any differences between the two years to try to discern any high-level shifts in priorities.  Many words appeared an almost equal number of times in both JoEs: MACRA (Medicare Access and CHIP Reauthorization Act), HCFAC (Health Care Fraud and Abuse Control), innovation, waste, abuse, providers, and program integrity.

Some words appeared with more frequency in the FY2017 than in the FY2018:

Some words were much more prominent in the FY18 JoE than the FY17 JoE:

So now that you have been informed, and lectured (a little). What to do? It’s the first quarter of the FY, and this is the time for planning. While you are planning your pursuits for this year or the next, look through the JoE, and find your next opportunity to help CMS achieve its goals, and create more solutions. And remember: first, do no harm.I will leave this for you to interpret as you will. However, as this is an opinion piece, I will offer one opinion on the differences between the two JoEs. The word Obamacare appears eight times in the FY18 JoE. It is used in a pejorative fashion, which only adds drama to the current political landscape. I think we can all agree, no matter where in the political spectrum you may fall, more drama is unnecessary.

You can read JoE for FY17 here.

JoE for F18 is here.



  1. This is a thoughtful, useful analysis of a document more federal contractors should be familiar with. Congratulations Ms Votaw!

  2. Desirea is obviously a BD consulting talent, and I know there are many large and small firms that can benefit from her SME…


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