CMS’s Medicaid Quality Pledge Is Redefining How Health Outcomes Will Be Measured

October 14, 2026

What states, health plans, providers, and Medicaid partners need to know about the shift toward outcome-focused quality measurement.

CMS’s Investing in Health Outcomes initiative signals a significant change in the future of Medicaid and CHIP quality measurement.

The voluntary Medicaid Quality Pledge encourages participating states to move beyond extensive process and utilization reporting and focus more directly on whether Medicaid programs are helping people become healthier.

That means prioritizing meaningful outcomes, rationalizing quality-measure inventories, expanding digital quality measurement, and aligning financial accountability with demonstrated improvement.

Download the report to understand what this shift means—and how your organization can prepare.

Why this matters now

Medicaid agencies, managed care organizations, providers, vendors, and associations are being asked to improve outcomes while managing complex and often duplicative reporting requirements.

CMS’s review of managed care programs in 42 states identified approximately 450 reporting requirements corresponding to roughly 260 unique quality measures. The pledge creates an opportunity to replace fragmented measurement with a more focused and actionable system—but only if measures are meaningful, data are trusted, and accountability is aligned with the realities of care delivery.

The report examines the four principles shaping this transition and the implications for organizations across the Medicaid ecosystem.

What the report examines

1. Prioritizing outcomes over process

The future of Medicaid quality measurement will require greater emphasis on measurable changes in health—not simply whether a healthcare activity occurred.

That shift raises important questions about attribution, risk adjustment, benchmarks, social needs, and shared accountability across providers, plans, community organizations, and other partners.

2. Rationalizing quality-measure inventories

Fewer measures will not automatically mean less work. A smaller portfolio will be expected to do more: support improvement, enable accountability, work across diverse populations, and increasingly inform payment.

States will need to match each measure to its intended use, whether learning, public reporting, contractual accountability, or payment.

3. Using digital quality measurement as an enabler

Digital quality measures, FHIR APIs, interoperability, and near-real-time data can improve timeliness and help organizations identify gaps earlier.

Technology alone, however, will not produce trusted results. Successful digital measurement will also require common specifications, data-quality governance, validation, documentation, and practical feedback loops.

4. Aligning financial accountability with outcomes

As states and plans connect payment more directly to outcomes, methodological rigor and data trust will become increasingly important.

Organizations will need to address questions such as:

• Who should receive credit for an outcome?
• How should performance be assessed when members receive care across multiple organizations?
• How can accountability promote improvement without penalizing organizations serving populations with greater needs?
• How should contracts and incentives reflect measure maturity, time horizons, and stakeholder control?

What this means for Medicaid stakeholders

The pledge will affect organizations differently, but all stakeholders will need to translate broad principles into practical decisions about policy, contracts, operations, data, and accountability.

For states

States will need to align quality strategies, managed care procurements, contracts, external quality review, value-based payment, data investments, and oversight around a prioritized set of outcomes.

Key areas of preparation include:

• Defining priority outcomes
• Assessing stakeholder readiness
• Establishing governance
• Addressing attribution and risk adjustment
• Setting credible benchmarks
• Creating phased implementation roadmaps

For health plans

Health plans will experience the pledge through new contract terms, reporting specifications, performance targets, and procurement expectations.

Plans should evaluate their readiness across:

• Data infrastructure
• Quality measurement capabilities
• Care management
• Provider partnerships
• Value-based payment arrangements
• Data-sharing and interoperability
• Performance improvement operations

For providers

Providers will be central to translating outcome priorities into clinical practice and measurable improvement.

They will need clear expectations, aligned measures, practical workflow support, and data capabilities that enable care coordination and performance management.

For associations

Health plan and provider associations can help shape implementation by developing shared positions on measure selection, attribution, risk adjustment, phased timelines, and realistic data expectations.

This collective perspective will be particularly important for local and safety-net providers serving members with complex medical and social needs.

Key takeaway

The Medicaid Quality Pledge is not simply a reporting-modernization effort.

It represents a broader opportunity to create a more focused, trustworthy, and actionable quality-measurement ecosystem—one that connects policy, measurement science, technology, governance, operations, and quality improvement.

The defining question is simple:

Are Medicaid programs helping people become healthier?

This report explains what it will take to answer that question with confidence.

Download