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CMS: Payers Must Make Claims Data Available to Beneficiaries

At HIMSS18, CMS urged payers to share claims data with beneficiaries and announced agency initiatives to make claims data more transparent.

CMS urges payers to share claims data with beneficaries

Source: Thinkstock

By Thomas Beaton

- CMS Administrator Seema Verma recently called on healthcare payers to make claims data available to their beneficiaries. The agency also announced a new initiative called MyHealthEData to give patients control of their healthcare data.

Verma made a public announcement at HIMSS18, detailing MyHealthEData as a partnership between CMS, ONC, VA, and NIH to help public payer beneficiaries access their healthcare data, share that data with professionals, and ultimately understand the best possible healthcare options.

Verma also discussed another CMS update called the Blue Button 2.0 initiative, which allows Medicare beneficiaries to share their healthcare information, previous prescriptions, treatments, and procedures with a new doctor. The intent of Blue Button 2.0 is to drive lower rates of duplicative testing and improve continuity of care.

Blue Button 2.0 allows beneficiaries to share their healthcare information within preferred, secure applications. There are already 100 organizations that have partnered with Blue Button 2.0 in a developer preview program. The initiative contains four years of claims data for 53 million Medicare Part A, D, and D beneficiaries.

Verma explained that CMS can lead healthcare payers in a direction that maximizes the use of digital claims data sharing to improve beneficiary healthcare experiences.

“CMS serves more than 130 million beneficiaries through our programs, which means we are uniquely positioned to transform how important healthcare data is shared between patients and their doctors,” Verma said.

“Today, we are calling on private health plans to join us in sharing their data with patients because enabling patients to control their Medicare data so that they can quickly obtain and share it is critical to creating more patient empowerment.”

CMS plans to re-examine expectations for Medicare Advantage (MA) plans and qualified health plans (QHPs) offered through the federally facilitated exchanges and urged payers to release their data.

The agency believes private plans that contract through MA and federal exchanges need to provide the same benefit that is being provided through Medicare’s Blue Button 2.0.

CMS provided an additional fact sheet that calls for providers and health systems to support healthcare data sharing initiatives and prepare for value-based care.

In the fact sheet, CMS asked providers to help by streamlining billing procedures, updating information systems to encourage data sharing, and ensuring patients receive healthcare data upon discharge from a care facility.

Verma concluded by calling upon the healthcare industry as a whole to use these data sharing programs as opportunities to advance patient data capabilities.

“Today I challenge the entire healthcare industry to join us in achieving the goals of the MyHealthEData initiative. Let’s empower patients to access to their records, so that they may seek treatment whenever and wherever they choose,” Verma said.

“We cannot do this alone, but together we can accomplish wonderful things,” she continued. “Ten years from now let’s look back on this conference and the launch of MyHealthEData as the beginning of a new era in patient care and empowerment and celebrate the advances that we can’t even imagine today. And for all patients, let's not let what's been achieved this week in Vegas, stay in Vegas!”


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