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CMS Financial Alignment Initiative

A black senior woman with cancer is at a medical consultation. She is wearing a scarf on her head to hide her hair loss. The doctor is a black man. The patient and doctor are sitting next to each other on an examination table in a medical clinic. The doctor is asking the patient questions and taking notes on a clipboard.
Monitoring programs to control costs and align care for dually eligible individuals
  • Client
    Centers for Medicare & Medicaid Services
  • Dates
    2012 - Present


There was inefficient coordination of care for people enrolled in both Medicare and Medicaid.

Individuals who are dually eligible for Medicare and Medicaid are among the nation’s most vulnerable populations. They also account for a disproportionate share of the nation’s health care spending. Without coordination between the two systems, inefficiencies and cost duplication abound. To explore options for improving clinical care while reducing costs, the Centers for Medicare & Medicaid Services (CMS) created the Financial Alignment Initiative (FAI) to test different approaches to coordinating care and financing across Medicare and Medicaid.


NORC supported CMS’s new Financial Alignment Initiative.

CMS contracted NORC to serve as FAI’s Operation Support Contractor. Initially, this involved conducting readiness reviews to ensure that health plans and states could implement the program’s requirements. As the program became operational, we developed monitoring measures and performance metrics that each state and health plan would be required to report. Our current focus is ensuring that health plans and states submit performance measure information at required intervals, collecting and analyzing this information, and providing monthly, quarterly, and annual reports to CMS. Additionally, we conduct source code validation of selected measures, and work with CMS to develop a public use file that contains information on how each health plan has scored on a variety of measures. We also run help desks for each participating state that provide technical assistance on measures and reporting, and we offer webinars and FAQ documents that clarify requirements for each measure. Finally, we conduct Consumer Assessment of Healthcare Providers and Systems surveys for the managed-fee-for-service model to assess beneficiary satisfaction with the program.


NORC provided support and monitoring to 69 health plans across ten states.

After a successful initial five-year contract, CMS awarded NORC a second one and now a third. This ongoing collaboration with CMS is a testament to our ability to manage complex and evolving operations, anticipate requirements, develop procedures and performance metrics, and provide operational support that has allowed CMS to collect the data required to evaluate different models and ultimately improve lives.

Project Leads

“We have been instrumental in keeping these programs going, and demonstrations rolling, allowing CMS and the states to monitor what’s going on through the duration.” 

Principal Research Director

“We have been instrumental in keeping these programs going, and demonstrations rolling, allowing CMS and the states to monitor what’s going on through the duration.” 

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