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June 18, 2026
Quarterly Opinion
Pauline J. Lapin
Laurie McWright
Apr 10, 2026
Apr 7, 2026
Feb 27, 2026
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Federal, state, and local governments have increasingly focused on innovation, hiring Chief Innovation or Technology Officers to find solutions to improve the delivery of benefits and services and to address unresolved health care issues.
At the Federal level, Congress established the Center for Medicare and Medicaid Innovation (the Innovation Center) within the Centers for Medicare & Medicaid Services (CMS) under the Affordable Care Act to test innovative payment and service delivery models to reduce expenditures while improving or maintaining health care quality for people covered by Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Congress also gave the Secretary of Health and Human Services the authority to scale successful models through rulemaking.
Drawing on our combined 50+ years of experience at CMS and its Innovation Center, we offer insights on how to effectively create and sustain a culture for innovative public policy research and develop the next cadre of leaders. While our experience is in the public sector, these guiding principles may also be helpful to private sector leaders.
The Innovation Center and its broad authority are a useful avenue for addressing the nation’s health policy dilemmas, resulting in ambitious agendas independent of the political administration in power. For example, the Innovation Center continues to test Accountable Care Organization (ACO), drug, and specialty models, while also rolling out new models focused on prevention and technology. Public policy research and innovation require changes to the status quo, which carry risks and uncertainties, even when intended to serve the greater good. As policy agendas shift in government, as technology advances, and as our work evolves, it is essential to create a sustainable culture of innovation that is responsive to changing priorities and feedback.
We developed the following five principles to guide leaders charged with creating innovative public policy solutions.
1. Hire strategically and give employees space to create
Developing and testing innovative policies is not for everyone. Assembling a team that includes individuals with wide-ranging knowledge and experience is necessary, but not sufficient. Personality traits such as curiosity, creativity, objectivity, and the ability to tolerate ambiguity are equally important given the unpredictable nature of innovation. Public policy research is subject to changing policy priorities and new laws. Medicare program rules change every year, which can impact the innovative policies that the Innovation Center is testing. For example, the introduction of a new methodology for adjusting payments to Medicare Advantage plans based on enrollees’ risk scores required the Innovation Center to consider updating payment methodologies used in its ACO models. Design changes and policy tweaks mid-test can be frustrating, but hiring individuals who exhibit flexibility and a tolerance for change is imperative for creating and sustaining nimble innovative policy research.
Individuals well-suited for innovation-related policy research tend to be open-minded, value data, and embrace teamwork. Open and robust discussions, including with external experts, allow a variety of opinions to surface and be debated and are more likely to produce well-engineered policies that stand up to scrutiny. Successful hires do not allow conclusions to be skewed by preconceived notions. We have seen how the “the love the one you’re with” problem can lead to models continuing even when data indicate they should be modified or terminated. Achieving a delicate balance is critical, weighing the deep commitment required for model development and maintenance against the continued intellectual discipline needed to ensure the model’s integrity and impact.
Innovation flourishes when leaders assemble teams with diverse skills, characteristics, and academic backgrounds, and give them the freedom to create. A team-based approach is essential as it enables leaders to leverage and optimize diverse skill sets to produce results. Too much responsibility in too few hands risks implementation crises, such as the loss of a single burned-out staff member or bottlenecks that impede critical decision-making. Research shows that employees value autonomy and ownership of their work. Leaders who empower and support their employees through change are rewarded with thriving organizations.
2. Use data and feedback to define problems and identify innovative solutions
Problem definition is critical to developing innovative public policy solutions. Poorly defined problems can lead to ineffective solutions, wasted resources, and low morale when interventions fail to achieve aspirational results. Organizations should foster a culture of problem-solving and critical thinking that values data and hypothesis-driven approaches informed by diverse perspectives. Both quantitative and qualitative data create a robust picture of policy failures. In addition, mapping the impact of an existing policy and its shortcomings against the desired outcomes can identify inefficiencies ripe for innovation and inform the development of an improved program.
Gathering information from a variety of perspectives and data sources can shed light on a problem’s root causes and sow the seeds of creative, sustainable solutions not built in a silo. In designing the Cell and Gene Therapy Access Model, Innovation Center staff met regularly with states, beneficiary advocates, drug manufacturers, and clinical experts to gather input, which provided invaluable insights into challenges and opportunities and validated the need for the model. For example, states shared challenges they faced in providing Medicaid enrollees with access to expensive cell and gene therapies with limited evidence of long-term efficacy. Discussions with drug manufacturers helped assess their willingness to participate in the model. Further, clinicians shared their lessons learned from treatment and were instrumental in developing model outcome parameters.
A hypothesis-driven approach to identifying the root cause of a problem or designing a policy solution to test is more credible. It facilitates the development of a more focused research design that can be updated based on data collection and analysis. While artificial intelligence is a powerful tool for gathering and analyzing data, it should not replace critical thinking. There is no substitute for leaders who bring together talented minds for collaborative brainstorming.
3. Sync policy development with operations planning
Policy design and operations planning should travel on parallel paths in the same direction. We learned the value of syncing policy and operations planning during testing of primary care and ACO models that provided care management payments to support team-based care. We had to initiate development of a non-claims-based payment system concurrently with designing these models, because the claims-based infrastructure of Traditional Medicare payment operations could not support them.
An area worth exploring is how to ensure policy and operations remain in sync across different functional areas of an organization to anticipate potential program integrity concerns. For example, egregious billing by suspect providers for catheters and skin substitutes affected ACOs and prompted CMS to quickly develop new policies to minimize their impact on shared savings calculations and future benchmarks. Novel operations are still needed to support real-time monitoring of utilization and billing, not only to safeguard Medicare trust funds, but also to enhance trust in CMS as a partner.
4. Be transparent and acknowledge constraints to build trust
Creating and sustaining a culture of transparency starts with leadership—at all levels—embracing and fostering openness and proactive communication. Transparency is key to building strong relationships and trust both internally and externally, and enables communication to flow freely, allowing staff to receive valuable input that includes policy and operational concerns. Specifically, information and feedback from private entities or state governments enable public policy leaders to leverage a broader pool of experience and knowledge, avoiding inefficiencies such as going to market with an unwanted product or an ineffective policy, and minimizing the potential need for rework, which compromises budgets, timelines, and resource use.
Leaders should create an environment in which feedback with openness and curiosity is the norm. Although iteration is critical, leaders must be willing to set boundaries on model changes for several reasons. Feedback may conflict with design objectives or be self-serving to the organization recommending changes at the expense of others participating in the model. Any legal, operational, and budgetary constraints that all parties involved in a model might face should be considered when making changes. For example, the ACO REACH and Kidney Care Choices models were modified based on data, participant feedback, and Administration priorities, while preserving the models’ original intent.
Limitations to full transparency exist. Early on, leaders must distinguish and share with stakeholders instances when complete transparency may not be possible, for example, to ensure compliance with any proprietary or federal rules. Acknowledging these limitations up front can set expectations and reduce the potential for misunderstandings and damaged partnerships. Transparency is hardest when a study is not producing desirable results, but the willingness to acknowledge challenges, complexity, and constraints is even more important for maintaining trust.
5. Align priorities with the organization’s vision and resources
In government organizations with multiple programmatic responsibilities, it is incumbent upon program component leaders to align under a shared vision and present clear, balanced recommendations that help agency heads set budgetary priorities that minimize risk while allowing for experimentation. Leaders need to set nuanced priorities that balance supporting existing programs with allowing some “innovative program disruption.” For example, the Administration’s interest in reducing Medicare beneficiary costs for insulin led to the Medicare Part D Senior Savings Model, which required support from the CMS component that operates Medicare’s Part D prescription drug program to synchronize policy and operations, avoiding program and model design conflicts and confusion for Part D sponsors.
Leaders must foster an environment in which blue-sky thinking is encouraged given how critical creativity is to innovation. Creating a culture that supports generating multiple creative ideas, followed by a disciplined, transparent process to evaluate each concept, is crucial to determining which concepts to launch.
While “moonshots” are possible, government leaders have a responsibility to ground their teams in operational realities, resources, timeframes, and their sphere of impact. Creating and sustaining a culture in which leaders are expected to set priorities and routinely assess progress and alignment with the organization’s overall vision helps teams maintain focus and connection to those priorities while minimizing confusion. This can be challenging in government organizations where turnover among senior leadership is expected or frequent, as priorities can shift. To ensure the best outcomes for innovative cultures, leaders should encourage their teams to communicate effectively and collaborate across functions so that resources are used efficiently and silos are minimized.
After reflecting on our experience at CMS and the Innovation Center, we are eagerly watching the Center continue to carry out the bold mandate set forth by Congress and believe that keeping these principles in mind will help it advance its ambitious agenda to improve health outcomes and access to high-quality, affordable care.
Pauline Lapin, MHS, is the former director of the Seamless Care Models Group within the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). In this capacity, she provided executive leadership for the design, implementation, and oversight of complex, nationwide payment and delivery system reforms. Her portfolio included innovative payment and delivery models focused on primary care, accountable care organizations, kidney disease, Medicare Advantage, and prescription drugs — advancing CMS’s shift toward value-based, patient-centered care. Pauline retired from federal service in April 2025 after more than 32 years of distinguished public service. Her work contributed not only to the expansion of value-based care but also to shaping policies to increase the use of preventive services among Medicare beneficiaries. Pauline holds a Master of Health Science degree from the Johns Hopkins Bloomberg School of Public Health.
Laurie McWright is the former deputy director of the Seamless Care Models Group within the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Laurie oversaw the development of drug pricing model concepts for Medicare Parts B and D as well as for states. In her role, she led successful negotiations with pharmaceutical manufacturers for the Center’s novel Cell and Gene Therapy Access Model, which is designed to test federal-private partnerships. Laurie’s work also included the Innovation Center’s research and models on Medicare Advantage. Laurie served in other leadership roles at CMS, including at the Office of Legislation and the Center for Consumer Information and Insurance Oversight. Laurie retired from federal service in April 2025 and has launched LTM Coaching and Consulting, LLC, where she draws on over two decades of federal leadership experience managing people, navigating complex change, and driving mission-driven work to assist leaders in meeting their strategic goals and organizations in delivering on their high-impact initiatives.
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