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Artificial Intelligence at CMS

At CMS, Artificial Intelligence (AI) has the power to reshape the way we use data to make decisions. In fact, because CMS is such a data-rich agency, there is no better place to implement AI technology. To do so responsibly, we must educate our workforce, share knowledge with our partners, follow ethical standards, and experiment with new methodologies.

That is why we have created this website. It offers a starting point for stakeholders interested in any aspect of AI at CMS.

Leveraging the power of AI to serve America's healthcare needs

With nearly 150 million Americans enrolled in Medicare, Medicaid, and the Child Health Insurance Program, CMS possessesone of the most robust data portfolios in the federal government. We house patient and provider claims, beneficiary enrollments, and medical records, along with internal data such as budget documents and contract records.

Artificial Intelligence (AI) will play a key role in leveraging all of this data to fulfill its mission of advancinghealth equity, expanding coverage, and improving health outcomes for the American public. As defined by the Department of Health and Human Services, “AI enables computer systems to perform tasks normally requiring human intelligence.”

AI can analyze data, automate labor-intensive processes, find operational efficiencies, provide business insights, interact with customers, make predictions, identify disparities, and reveal new ways of solving problems. In short, AI is an emerging technology that will positively impact both CMS and the public we serve. The impacts include cost savings and better health outcomes.

CMS AI Resources

Those who wish to engage in AI-related activities, as either a CMS employee, partner, or vendor, should be aware of federal policies regarding the application of AI. Following are links to foundational governance documents on AI and other related resources:

  • Executive Order 13859: Maintaining American Leadership in Artificial Intelligence

    This 2019 Executive Order sets forth a federal strategy for promoting advancements in AI technology and innovation while protecting American technology, economic and national security, civil liberties, privacy, and American values and enhancing international and industry collaboration with foreign partners and allies.

  • National Artificial Intelligence Act of 2020

    The National AI Initiative Act of 2020 (DIVISION E, SEC. 5001) became law on January 1, 2021, providing for a coordinated program across the entire Federal government to accelerate AI research and application for the Nation’s economic prosperity and national security. The mission of the National AI Initiative is to ensure continued U.S.leadership in AI research and development, lead the world in the development and use of trustworthy AI in the public and private sectors, and prepare the present and future U.S. workforce for the integration of AI systems across all sectors of the economy and society.

  • The National Artificial Intelligence Initiative

    This website contains news and information about the five pillars of the national AI strategy as outlined in the National AI Initiative Act of 2020. Those pillars are: innovation, advancing trustworthy AI, education and training, infrastructure, applications, and international cooperation.

  • CMS AI Playbook

    Does leveraging AI seem as overwhelming as it does promising? Don’t worry. The AI Playbook is your how-to manual with detailed guidance on key design principles, best practices, and step-by-step instructions for building mission-critical, trustworthy AI solutions. It is designed to be readable even for those unfamiliar with the more technical concepts of AI. While leadership and managers alike can learn from the high-level principles in the playbook and apply them to their technology strategy, the Playbook’s full explanation of enterprise-level AI at CMS is especially useful for those with technical talent looking to get in on the ground floor.

    The Playbook also covers Responsible AI, a governance framework that defines the principles and practices an organization follows to address the societal, ethical, and legal impacts of AI. As AI processes mature and are deployed at greater scale, it will also be necessary to regularly measure the integrity of those processes via automation, sometimes called Machine Learning Operations (MLOps), also addressed in the Playbook.

  • HHS Trustworthy AI Playbook

    The goal of Trustworthy AI is to maximize the benefits while minimizing the risks of novel AI-enabled technologies. The Playbook covers six overarching principles of Responsible AI, based on Executive Order 13960, “Promoting the Use of Trustworthy Artificial Intelligence in the Federal Government," and OMB Memorandum M-21-06,“Guidance for Regulation of Artificial Intelligence Applications.” According to the Playbook, AI should be:

    • fair and impartial
    • transparent and explainable
    • responsible and accountable
    • robust and reliable
    • private
    • safe and secure

    Additionally, the Playbook lists concrete steps we can take to encode these principles while designing AI solutions.

Programs and Initatives

AI will play a major role in the future of CMS, but it is also already here. Below you can find details on AI programs and initatives that are revolutionizing CMS operations. Keep reading to learn more about how CMS is applying AI techniques to increase efficiency, improve health outcomes, and detect waste, abuse, and fraud.

  • CMS AI Explorers Program

    The AI Explorers Program is an exciting opportunity for CMS employees to prototype AI applications for testing and potential development. For two years, OIT accepted proposals for projects that applied AI and ML techniques related to CMS's mission and to the applicant's team functional area. From these submissions,OIT executive leadership supported 10 total projects. Support included funding and matching with pre-qualified vendors. Awardees tested their hypotheses over the course of three to six months.

    The goals of the pilot were to:

    • bootstrap both proofs of value and initial Minimum Viable Products
    • encourage applicants to get acquainted with AI/ML and grow their technological skill sets
    • test out hypotheses using Agile methodologies prior to a large-scale development effort
    • develop incremental expertise, and boost confidence in the AI domain
    • establish a baseline framework on how to bring an AI/ML project from ideation to production readiness within CMS

  • Workforce Resilience Program

    Workforce Resilience (WR) is a program designed for CMS employees who range from curious to passionate about emerging tools and technologies. Its goal is to help learners continually develop knowledge, skills, and practical experience to grow their careers and deliver greater value to the most vulnerable populations in the United States.

    WR includes an Artificial Intelligence and Machine Learning track as well as a closely-related Data Science track.Courses in these subject areas are tailored to employees with varying levels of knowledge, from beginner to expert. Specifically, WR works with program participants throughout three phases in the learning life cycle: awareness, competency, and engagement.

    • At the awareness level, participants build foundational knowledge and skills
    • At the competency level, they deepen understanding by partnering with instructors, subject matter experts, and mentors in thought-provoking discussions and hands-on learning projects
    • At the engagement level, they strengthen leadership skills by adding emerging concepts and tools to their daily practices and interact with other leaders to accelerate change across CMS
  • AI/ML Track

    The four primary subfields of AI – ML, robotics, computer vision, and Natural Language Processing (NLP) – are transforming the way business gets done. According to Fortune Business Insights, the AI market size in the U.S. will increase from $35.92 billion in 2021 to $360.36 billion by 2028. In healthcare alone, there are several applications: robotic surgeries, data management automation, call center chatbots, diagnostics, and virtual nursing, just to name a few.

    At the Awareness level, the AI/ML track introduces key concepts: AI, ML, models, algorithms, NLP, language models, and AI Ethics. At the higher levels, program participants learn how to operationalize AI methods by turning them into AI solutions, and eventually, exploring use cases at CMS.

    Email: ai-pilots@cms.hhs.gov

  • Data Science Track

    In the era of “Big Data”, it’s not hard to find information. Turning that information into knowledge, however, is another story. That’s what data science is all about. It’s an interdisciplinary field that uses scientific methods, processes, algorithms, and systems to extract insights from noisy structured and unstructured data, and to apply those insights across a broad range of applications.

    Data science is reshaping healthcare in multiple applications, for example by improving diagnostic accuracy and optimizing clinical performance. CMS oversees multiple federal healthcare programs and generates an extensive amount of data daily that, when understood, can further streamline effective healthcare delivery to the American public. In sum, data science practices can help us reduce work burdens, make better decisions, and optimize solutions for our stakeholders. The practice of data science entails gathering data, examining it, sorting it, modeling it, interpreting it, and visualizing it. The Data Science Track of WR is your first step to empowering yourself with knowledge of these techniques.

    Email: datascience@cms.hhs.gov

  • Pluralsight

    Pluralsight is an online educational platform that we use for our WR program. It allows us to combine pre-packaged educational materials with CMS-designed, CMS-specific content. Pluralsight is an important tool for creating a robust learning community at CMS where staff is empowered to acquire industry knowledge at the foundation of human-centered design, agile, and lean methodologies.