CMS Releases New Medicare Advantage Data Resource

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma has announced the agency’s new Data Driven Patient Care Strategy as part of the MyHealthEData initiative at the ninth annual Health Datapalooza conference in Washington, D.C. The strategy positions CMS to further support industry innovation in unleashing the power of data to inform patients’ healthcare decisions and transform the healthcare system by enhancing security and privacy, improving quality, increasing efficiency, and reducing costs.

In March 2018, the Trump Administration announced MyHealthEData, a government-wide initiative spearheaded by the White House Office of American Innovation, designed to help patients access and share their medical data throughout their healthcare journey while ensuring they are empowered to make decisions about when to share it, keeping their information secure and private.

As the latest effort under MyHealthEData, the Data Driven Patient Care Strategy is based on three critical cornerstones: putting patients first, making more data available and taking an “application programming interface (API)-approach” to exchanging data in a secure and private manner with CMS partners in the spirit of improving healthcare for all beneficiaries. These cornerstone principles are reflected in the data initiatives CMS is announcing today and other federal efforts underway to improve the nation’s healthcare system through data innovation.

“We know we can’t achieve value-based care until we put the patient at the center of our healthcare system,” Administrator Verma said. “The Data Driven Patient Care Strategy will empower patients with the information they need as consumers of healthcare to enable them to make informed decisions about the care they need. Ultimately, the cornerstone of a patient-centered system is data—quality data, cost data and a patient’s own data.”

Additionally, as part of CMS’ commitment to data-driven innovation, Administrator Verma announced Medicare Advantage encounter data is now available to researchers for the first time, and annual updates are planned. Release of the Medicare Advantage encounter data will provide researchers insight into care delivered under Medicare Advantage and permit research that will improve the Medicare program.

Expanded Access to Encounter Data

CMS is expanding data available to researchers starting with 2015 Medicare Advantage (MA) encounter data, which provides detailed information about services to beneficiaries enrolled in a Medicare Advantage managed care plan in calendar year 2015. Researchers already have access to Medicare claims data for the fee-for-service program, and this release of MA data will provide a fuller picture of care provided to Medicare beneficiaries.

CMS also plans to release data from Medicaid and the Children’s Health Insurance Program (CHIP) next year, realizing such data has the potential to facilitate research that will help drive innovation and competition in the healthcare system and, ultimately, help doctors and patients make the best decisions about care.

“Data has the potential to help produce better, more targeted treatments for patients, improving their quality of life while at the same time reducing costs,” Administrator Verma said.

For more information or to request encounter data, please visit the CMS Research Data Assistance Center website at www.resdac.org.

More CMS Efforts to Unleash the Power of Data

Today’s data-related announcements follow and build on several ongoing initiatives the Trump Administration launched earlier this year to put patients’ health information into their own hands and make healthcare data more useful to consumers:

  • Blue Button 2.0: As part of MyHealthEData, CMS in March 2018 launched Blue Button 2.0, which allows Medicare beneficiaries to take charge of their own claims data by providing it to them in a universal, secure digital format. Blue Button 2.0 is a developer-friendly, standards-based API enabling beneficiaries to connect their claims data to the applications, services and research programs they choose.
  • Promoting Interoperability: CMS, in the proposed hospital payment rule issued this week, announced plans to overhaul the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, which are now known as the Promoting Interoperability programs. CMS has proposed to focus the program requirements on EHR interoperability and providing patients with electronic access to their health information, so data follows the patient and consumers can take ownership of and access their records in a useable format.

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