On Thursday, April 26, 2018, Centers for Medicare and Medicaid Services Administrator Seema Verma announced the Agency’s new Data Driven Patient Care Strategy, as part of the MyHealthEData initiative. CMS is hoping to make its data more accessible and usable in a secure manner that honors the privacy of patients and ensures that CMS will support industry innovation in unleashing the power of data to drive system transformation – enhancing efficiency, improving quality, and reducing costs.
Included in this new Strategy are three pillars: putting patients first, increasing the amount of available data, and taking an application programming interface (API) approach to exchanging data in a secure and digital manner.
Essentially these changes will allow CMS to demonstrate whether providing patients and researchers with claims and encounter data will enhance efficiency, improve quality, and reduce costs across healthcare systems.
Putting Patients First
Verma noted that CMS is committed to putting the patients at the center of the healthcare system and plans to do so by “empowering them with the data they need as consumers of healthcare to make informed decisions.”
CMS is also putting patients first by ensuring that across all its efforts, strict privacy and security requirements to protect patient data are put in place from the beginning and play a prominent role in all decisions. CMS already has strong controls in place to protect the privacy and security of all data the agency collects and recognizes that this issue is a critical part of unlocking the power of data and will be continuing efforts to protect patient data across all our programs.
Increasing the Amount of Data Available
CMS is expanding the data made available to researchers starting with the 2015 Medicare Advantage Encounter Data. This data provides detailed information about services provided to beneficiaries enrolled in a managed care plan under the Medicare Advantage program in calendar year 2015. Roughly one-third of Medicare beneficiaries (19 million) are enrolled in these privately managed care plans, but to date none of their utilization or diagnosis information has been widely available for research. Since researchers already have access to detailed data for beneficiaries enrolled in the fee-for-service program, this release will provide researchers with data to understand a fuller picture of care provided to Medicare beneficiaries. CMS hopes that this information will be used to conduct research that helps to drive innovation and competition throughout the healthcare system.
CMS also announced the availability of a preliminary version of the 2015 Medicare Advantage (MA) encounter data. A final version of that 2015 data will be released later this year. CMS plans to release encounter records for subsequent service years on an annual basis.
API Approach for Exchanging Data
CMS is taking an API approach to modernize how the Administration exchanges data with its partners and ensuring the data is available in a timely, secure, and private fashion. According to CMS, the API approach allows CMS to focus on putting patients first and increasing the amount of data available while at the same time allowing the market to surface that data in new ways to clinicians and patients.
During her remarks on the subject, Administrator Verma tried to differentiate this new path in relation to previous efforts CMS has taken to move towards a value-based system. She noted, “…what is different now is that we know we can’t achieve value-based care until we put the patient at the center of our healthcare system. And that requires that we empower patients with the data they need to become a consumer of healthcare and make informed decisions. Ultimately, the cornerstone of a patient centered system is data, quality data, cost data, a patient’s own data.”