On March 16–18, the Centers for Medicare and Medicaid Services (CMS) convened agency leaders, staff from CMS’s Center for Clinical Standards and Quality, health system experts, federal contractors, state representatives, life sciences organizations, and clinical professional societies for the 2026 CMS Quality Conference. The conference focused on the future of healthcare quality measurement, payment innovation, and implications for patient access.

The conference theme of “MAHA: Innovating Together for Better Health” highlighted a decisive shift toward prevention-focused, digitally-enabled care models, alongside growing expectations for effective use of artificial intelligence, a push for better and more real-time evidence on the impact of improvement efforts, and goals of better alignment between payment incentives and clinical outcomes. These  priorities have significant implications for how the life sciences industry seeks coverage and how it demonstrates value to health systems accountable for quality to Medicare, Medicaid, and commercial payers.

Key Themes

The Avalere Health team joined plenary sessions and stakeholder discussions focused on evolving quality frameworks and policy priorities. Seven key themes emerged:

1. Prevention as a Cornerstone of Quality: CMS signaled that prevention, not just treatment, is now central to its quality strategy. Leaders emphasized incentivizing preventive services (e.g., annual wellness visits), integrating nutrition and lifestyle interventions into care models (including new uses for GLP-1s), and aligning payment and coverage to keep populations healthy upstream. Demonstrating how products contribute to prevention or reduce downstream utilization will be increasingly important. These messages were clear from the top down: CMS Administrator Dr. Mehmet Oz led both the opening and closing sessions of the conference, accompanied in the opening panel by Food and Drug Administrator (FDA) commissioner Dr. Marty Makary and National Institutes of Health (NIH) director Dr. Jay Bhattacharya, who offered an in-depth conversation about aligning around a “bench-to-bedside” vision. Dr. Bhattacharya outlined the importance of big innovation through research and evidence and how their institutions can all contribute towards optimizing prevention of disease. Drs. Makary and Oz discussed how life sciences companies would benefit from designing their evidence generation strategies to meet both FDA “safe and effective” requirements while also demonstrating they are “reasonable and necessary” for CMS coverage.

2. Whole-Person Care and Technology as Enabler: HHS leaders reported that root-cause solutions, including nutrition and behavioral interventions, are now being written into federal innovation model and quality program architecture. Technology is positioned not to replace but to strengthen connections between patients and care teams. Manufacturers should consider how their products fit into holistic models that emphasize proactive health management.

3. Digital Transformation and Real-Time Measurement: Conference speakers noted that quality measurement is rapidly shifting from retrospective reporting to real-time digital infrastructure powered by AI and interoperable data exchange (e.g.,Fast Healthcare Interoperability Resources). This enables continuous performance monitoring embedded directly into clinical workflows. Manufacturers will need robust digital evidence generation strategies, including real-world outcomes data, to support value demonstration.

4. Simplification and Alignment Across Value-Based Models: CMS acknowledged complexity across current value-based programs but committed to streamlining measures and aligning incentives across Medicare, Medicaid, and CMMI programs. Outcome-aligned payments are prioritized over process-heavy compliance requirements, raising the bar for therapies to demonstrate measurable impact on patient outcomes.

5. Speed to Innovation: CMS Innovation Center (CMMI) leadership, including chief medical officer Dr. Susannah Bernheim and CMMI director Abe Sutton, shared their vision for evidence-based prevention, patient empowerment, and increased choice and competition through innovation. They emphasized that quality underlies their entire strategy, but that the health sector needs to move faster to ensure that evidence is driving how care is delivered and reimbursed. They also envision CMMI models laying a foundation for “spillover” change in commercial and other payer markets.  The leaders talked about how their teams go down into the details of operational models to understand participant experience and use their learnings to rapidly innovate,  demonstrated by the fact that CMMI announced nine new alternative payment models in 2025.

6. Operational Innovation: Prior Authorization Reform and Fraud Prevention: Administrative burden remains a barrier to timely access; CMS is piloting “gold card” prior authorization models for high-performing providers while also leveraging technology for fraud detection (“CRUSH RFI”). Streamlined pathways may accelerate time-to-treatment but also heighten expectations around up-front safety/effectiveness data.

7. Limited Focus on Medicare Advantage (MA) and Part D Stars: Despite strong emphasis on unified approaches across Medicaid, CMMI demonstrations, and fee-for-service Medicare this year, substantive discussion around MA and Part D Stars quality issues was notably absent given that approximately half of Medicare beneficiaries are enrolled in MA plans. As a result, manufacturers with significant portfolios or planned launches in these channels received limited signals about upcoming changes to Star ratings methodology or related access levers.

Why This Matters

In considering their market access and policy strategies, manufacturers need to carefully consider how to align their evidence and messaging with CMS imperatives:

• Generating real-world evidence of preventive impact
• Enabling seamless integration with digital provider workflows
• Minimizing administrative barriers through operational innovation

At the same time, limited visibility into MA/Part D-specific priorities means life sciences organizations should monitor alternative channels for updates relevant to these lines of business and consider direct outreach where needed. Early engagement with CMMI pilots or regulatory comment periods can help shape policy direction. While this message was echoed by multiple leaders, CMMI leaders in particular asked for collaboration and input, challenging attendees to share actionable data on barriers or solutions that improve affordability and quality and how to drive rapidly scalable innovations.

How We Can Help

Avalere Health’s experts offer deep knowledge at the intersection of evidence generation, policy analysis, value demonstration, and market access strategy, helping clients navigate shifting CMS priorities under the new quality paradigm.

We work with life sciences organizations to set flexible HEOR strategies, generate compelling real-world evidence; partner with external KOLs, develop cost-effectiveness analyses, build digital integration roadmaps, and communicate product value within an increasingly outcomes-driven environment.

To learn how Avalere Health can help you prepare adaptive evidence generation, policy engagement, and market access strategies amid ongoing change at CMS and ensure your innovations reach patients who need them, connect with us today.