Andrea Fletcher 

It’s a distressing and all-too-common occurrence within the U.S. health care system: Patients go to the doctor and get a bill they don’t understand, or one that is higher than expected, leading to medical debt or, worse, medical bankruptcy. 

Today, a rising leader in government is tackling this problem head-on. Andrea Fletcher, a 35-year-old public servant who joined the government just three years ago, now is the Centers for Medicare and Medicaid Services’ inaugural chief digital strategy officer. In this role, she leads teams that design, develop and roll out cutting-edge tools that empower patients to dispute unexpected medical charges, help hospitals make their prices more transparent, and enable CMS and other federal agencies to swiftly and seamlessly upgrade important digital services. 

“Andrea Fletcher has spearheaded initiatives to address the opaque and burdensome nature of health care costs in America,” said Leah Siskind, product delivery manager for digital services at CMS. “The lack of transparency, predictability and consistency in health care expenses is a pervasive issue in the country. Andrea has dedicated her career to unraveling this complex web of challenges.”  

Following the peak of the COVID-19 pandemic, Fletcher led CMS’ implementation of the No Surprises Act, a bill designed to limit out-of-pocket medical expenses, especially those for uninsured patients whose bills were much higher than those for people with insurance coverage. 

Informing patients of their rights 

Fletcher directed her team to build online and telephone support to inform patients of their rights, research solutions or submit complaints. The Medical Bill Rights site now receives about 45,000 visits per month, overwhelmingly by consumers facing billing complications, and includes claim forms that Fletcher and her team insisted be written in plain language and provide options for Spanish speakers. 

Under her direction, CMS also launched a free, downloadable hospital price validator tool, mandated by the Health Care PRICE Transparency Act of 2021, to help hospitals and insurers publish and verify the accuracy of standard charges and discounts. The format not only helps patients know their financial rights; it also helps hospitals with compliance. 

Under Fletcher, CMS also developed the first open-source data program in the federal government, offering freely licensed software that other users can copy, study and change. This helps hospitals, insurers, drug companies and others use a common ecosystem and avoid costs.  

Instead of taking three years to build new software from scratch, CMS used open-source data to create a new dental claim form, for example. The agency also made public the code it uses to create its annual Medicare beneficiary survey, enabling researchers and health care companies to perform similar analyses.  

“Her ability to help us understand technology and the opportunities to do things more efficiently is really her superpower,” said Jonathan Blum, the principal deputy administrator of CMS. 

Understanding how the system works 

Nick Sinai, a senior fellow at Harvard University’s Kennedy School where Fletcher works with students, said Fletcher is skilled in “bureaucracy hacking.” 

“She pairs her love and appreciation for the mission at CMS with an understanding of the rules and processes for moving that mission forward,” he said. “If you do not have those authentic relationships with human beings, which she does, you are not going to be successful at being able to effect change.” 

It helps, said Blum, that Fletcher is “one of the most curious people that I’ve ever come across.”  

“Because of her experience living in rural areas and abroad on global health initiatives, she understands health care challenges in a way that people in Washington often are completely unaware of,” Siskind said. 

John Czajkowski, CMS deputy chief operating officer, said Fletcher “doesn’t drag people toward these solutions. She gets them to walk if not run there on their own.” 

“It’s all about using the government to help people,” said Fletcher, who began working on global health issues while completing a master’s degree in public health at Emory University. 

“My role is to be a change agent at a huge organization,” Fletcher said. “I’m most proud of the fact that we’ve built out a team like this at a place like CMS and that we’re inspiring the next generation of technologists to come in and work on the health care system.”