Fact sheet

Data Driven Patient Care Strategy

Data Driven Patient Care Strategy

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, outlined a new Data Driven Patient Care Strategy as part of the MyHealthEData initiative. This strategy strives to make CMS 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 cost.

There are three cornerstones to the strategy – 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.

Putting Patients First

CMS is committed to putting patients at the center of the healthcare system by empowering them with the data they need as consumers of healthcare to make informed decisions. In March, the Administrator announced the launch of Blue Button 2.0 to allow Medicare beneficiaries to take charge of their own data by providing them access to and the ability to share their claims data in a universal and secure digital format. Blue Button 2.0 is a developer-friendly, standards-based API that enables Medicare beneficiaries to connect their claims data to the applications, services and research programs they choose.

Empowering Medicare fee-for-service consumers with their data is not the only step CMS is taking. We are also encouraging Medicare Advantage plans to adopt data release platforms for their enrollees that meet or exceed the capabilities of CMS’ Blue Button 2.0. In addition, for the 70 million people on Medicaid, CMS has started working with states to make enrollees’ claims data available to them.

CMS is also putting patients first by ensuring that across all our 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. We recognize 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 we make 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. Our hope is this data will be used to conduct research that helps drive innovation and competition in the healthcare system and, ultimately, helps doctors and patients make the best choices about care 

CMS is announcing 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. Medicare encounter records contain a similar level of information as a fee-for-service claims data including provider identifiers, dates of service, type of service and diagnosis codes. Files covering all six settings (inpatient, skilled nursing facility, home health, outpatient, carrier/provider and durable medical equipment) will be available. For more information or to request encounter data visit the CMS Research Data Assistance Center website at: www.resdac.org.

API Approach for Exchanging Data

CMS is taking an API approach to modernize how we exchange data with our partners. We’re working to ensure our data is available in a timely, secure and private fashion. APIs are the primary medium for information sharing and for transactions in modern technology systems—including CMS’ Quality Payment Program (QPP) and the Office of the National Coordinator’s (ONC) health IT certification criteria (2015 Edition).

Last July, CMS launched the QPP Submissions API, which is designed with continuous feedback from the health IT industry. This API increases the speed of submitting Medicare quality measures, and reduces reporting burden. The industry response has been extremely positive, with over 250 organizations to-date (registries, qualified clinical data registries (QCDRs) and EHRs) requesting access to QPP’s "developer preview" pre-release test environment. Some of these organizations have used the API to enable end-to-end submission, a transaction where the clinician does not have to leave their core applications, and where they receive useful feedback in those same applications. CMS continues to gather feedback from industry in order to iterate on and improve the QPP Submissions API.

CMS also encourages its partners to take an API approach as well. ONC’s 2015 Edition includes several new API-based certification criteria, which will help clinicians access and exchange health information and patient data in EHRs more easily.

The API approach allows CMS to focus on putting patients first and increasing the amount of data available — while empowering the market to surface that data in new, interesting and meaningful ways to clinicians and patients alike.  

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