Remarks by Administrator Seema Verma at the SHIEC Annual Conference
(As prepared for delivery – August 19, 2019)
Thanks Dan for that kind introduction and to the SHIEC members, and to CRISP of Maryland and DC for hosting me today. All of your continued efforts help empower patients and doctors to access the data they need to make important and life-changing healthcare decisions.
On this day, 55 years ago the satellite Syncom 3 was launched into orbit. This satellite enabled Americans in the United States, for the very first time, to watch the 1964 Summer Olympics in Tokyo in the comfort of their own homes. Since then, information technology has had amazing advancements and we can now send information across the globe in less than a few seconds, except of course if that information is a patient’s healthcare record.
For that important, and at times lifesaving information, we still use antiquated fax machines.
But inefficiencies in health information sharing aren’t the only issues facing our healthcare system. The growth in healthcare costs continue to be an issue. The Medicare Trustees have warned that the Medicare trust fund will run out by 2026, threatening the program for current and future generations of seniors. And this problem isn’t limited to Medicare. Healthcare costs continue to spiral. By 2027, nearly one in every five dollars is projected to be spent on healthcare. That’s just seven years from today. It’s a looming cost crisis that will hurt our economy and reduce access to affordable high quality healthcare.
Medicare for All and similar proposals don’t solve these problems. They just upend the American healthcare system, while not doing anything to address the underlying costs of care. These proposals will just have the government pay for everything with a $32 trillion price tag, increasing taxes for all Americans, while stripping private health insurance from 180 million people, taking away choices and forcing people into a one-size fits-all government program. Other countries that have done this, have experienced rationing, which leads to longer wait times.
And we’ve already seen that big government solutions have not worked. In two reports published by CMS last week, we saw that, in terms of the individual market, even though premiums have decreased in the past year they are still too high for the individuals who are not subsidized. These individuals continue to leave the individual market in droves—2.5 million, a 40% drop from 2016 to 2018. The Affordable Care Act was supposed to make healthcare insurance more affordable but for millions of Americans that is just not the case.
That being said, while I do not support the transition to a full government takeover that does not mean I support the status quo. That’s why the Trump Administration is so focused on addressing the drivers of healthcare costs in our nation—drug pricing, price and quality transparency, ending surprise billing, cutting regulations, promoting competition, and addressing inefficiency in our healthcare system.
A great example of government healthcare interventions that have created chaos is the spending of more than $36 billion on electronic health records. But then not ensuring that the systems could actually talk to each other. Imagine if the government paid for everyone to have a cell phone but you could only call people who had the same carrier. It would be a communication disaster.
That is what we have today in our healthcare system, a communication disaster. Data is trapped in digital siloes, and we are not able to fully leverage our $36B investment and the full potential of EHRs to transform the United States healthcare system.
So, this Administration is doing everything we can to unravel government regulations that are impeding progress and accelerate the transformation to a value-based healthcare system, one that pays for outcomes rather than the amount of services delivered. One of our key initiatives is innovative payment models that align financial incentives for providers to deliver efficient, high quality care.
When providers have a responsibility for managing care and, their reimbursement is tied to results instead of volume of services, they will find innovative ways to keep people healthy, prevent disease, lower costs, and improve health outcomes.
The sharing of data and having interoperability between health systems underpin this entire move to value in healthcare and innovation and to me it’s one of the most significant actions the agency is taking. It impacts every patient and every provider and ultimately every interaction people have with the healthcare system on all levels.
Without access to their own health records, patients lack key insights—and therefore the power and ability—to take control of their health to shop for healthcare providers on the basis of cost and quality and then have the freedom to take their health record to these new providers. And without effective, open data sharing, providers cannot efficiently coordinate care, and without data to track patient’s progress through their healthcare journey, insurance companies cannot tie payments to outcomes.
I applaud the work that SHIEC and many of you in the audience today are doing to address these challenges by creating a network of health information exchanges that spans the entire country. You are on the frontlines dealing with these issues every day, and I know this is no simple task. Exchanging health data from place to place is something that is personally important to me. I work in DC, live in Indiana, and travel across the country so I receive healthcare in a variety of places. And when I’m traveling from one place to another I can’t carry around paper records of every single encounter with the healthcare system. It comforts me to know that there are dedicated individuals working to make sure that no matter where I go, my health information will follow me and that the same is true for millions of patients across the nation.
Like you, this Administration has been working since day one to unleash the power of data, and to give patients control of their health information. And all of our efforts have been in support of one goal: to put patients first.
Every patient deserves to be treated as a whole person, with consideration of their complete medical history.
We’re committed to putting health data firmly where it belongs, in the hands of patients and the providers who treat them. Just last year, we announced the MyHealthEData initiative to help achieve this goal and I’m proud to say we have already accomplished a great deal.
We made Medicare Advantage encounter data available to researchers for the very first time, and we announced we’ll be doing the same for Medicaid later this year.
We significantly overhauled the Meaningful Use program—and now call it Promoting Interoperability—by rewarding doctors and penalizing hospitals to encourage patient access to their health data. And last week, I heard about a new website that even ranks hospitals and health systems on their compliance with a patients’ right to access their health information. This level of transparency is a powerful tool for patients and will hopefully spur competition amongst providers to make patient data more readily accessible.
We mandated clinicians and hospitals to use EHRs that make APIs accessible to patients, giving them access to their data and the ability to use the tools they want to manage their care. This was our first step in freeing up data from EHRs, and there is more to come.
We’re actively participating in the standards development process, to create a common language to exchange data.
And just last month we celebrated the second year of Blue Button 2.0, the first ever FHIR based claims API for Medicare beneficiaries, at the Blue Button Developers Conference.
As part of MyHealthEData, Blue Button 2.0 is already giving our beneficiaries the ability to securely connect their claims data to apps and other tools developed by innovators. We’ve seen over 2,000 developers—from over 1,100 organizations—using synthetic data in the Blue Button sandbox. And we currently have 28 organizations with live apps in production—apps that give patients ways to manage and understand their health data, and donate it to science.
At the same time, we also announced our Data at the Point of Care pilot program. Data at the Point of Care leverages the FHIR Bulk spec to provide Medicare claims data directly to providers to promote better patient care. This data provides valuable information on patients’ medical history, such as medications, tests, and previous doctors’ visits.
This effort is critical to providers participating in value based models, and giving them with important information about their patients. With Data at the Point of Care API there is no logging into another application or portal required; data is accessed right from providers’ existing workflow. This data will fill in information gaps, giving providers a more structured and complete patient history so they have all the information they need to make the best decisions about their care.
But we’re not stopping there. We’re building on our Blue Button 2.0 work with our Interoperability and Patient Access Proposed Rule. The policies in our rule would require all health plans doing business in Medicare, Medicaid, and through the federal exchanges to share health claims data and other important information electronically with their patients.
With all of those plans on board, by 2020, 85 million more patients will have access to their healthcare claims information, in addition to the 40 million who already have access through Blue Button 2.0. We look forward to issuing a final rule very soon.
But we all know that with better access to data, threats to security and privacy become more of a pressing concern. We’re always looking at new ways to ensure we are protecting patient information. My team can tell you that not a meeting goes by where I don’t bring up this issue.
With Blue Button 2.0, CMS focuses its privacy and security standards on ensuring that beneficiaries understand exactly what an app will be using their data for. From plain language in terms and conditions to ensuring that an application is transparent about ways a beneficiary’s data is being used.
Patients must have the peace of mind that their information is safe and secure.
The work of protecting privacy and security will never be done. We must be constantly vigilant, and ensure that our strategies evolve to keep up with emerging threats.
I call upon you to join us in making this a priority, ensuring that privacy and security is “top of mind” whenever you make important decisions for your businesses.
On our journey to a healthcare system that is improved by data exchange and access to information, there is much work still to be done and CMS cannot do it alone. Health Information Exchanges have an important role to play in a more connected, secure healthcare system that prioritizes the needs of patients. There are many opportunities for HIEs to work with providers and technology vendors to be part of the solution and to align your business models with a changing future ─ one that allows for innovation and access to data.
We envision a future where HIEs can evolve to keep pace with advancements in the healthcare industry, to create models that put patients front and center and in control of their healthcare. APIs will soon be a reality for every health system. And I encourage all of you to begin modernizing your infrastructure and utilizing APIs like the ones being developed by companies working with CMS, to ensure seamless and continuous data exchange.
I believe there are also opportunities to create tools specifically for patients to help them understand and use their data.
The data housed in HIEs also present a unique opportunity to drive innovation, and to develop better treatments for individuals and populations. I hope to see more HIEs that link social determinants of health to patient records in order to give doctors a more holistic understanding of their patients’ health. Connecting data between community services providers that deal with issues like food insecurity and homelessness can help us better deliver care, and address the social determinants of health that we know are critical to improving outcomes.
I hope to see more opportunities for patients to consent to give researchers access to data housed in HIEs so health information from a diverse set of people can be used to develop innovative personalized treatments. And I hope to see all of the HIEs that are doing this innovative work united by universal standards so that we can continue to share information and build off of each other’s efforts to create a better healthcare system for every American.
We all need to work together to make sure information flows across the healthcare system without anything blocking its path.
Imagine a world where our health records are created at the time of our mother’s pregnancy and accumulate information about our every interaction with the healthcare system…every test, every procedure, every medication…was readily available to every patient and their doctor. Imagine if that data weren’t just used by doctors in diagnosing and treating us, but if hospitals and providers allowed third-party applications to access and leverage that data in innovative ways for both the patient and the doctor to drive better health outcomes and prevent disease. Imagine if patients could authorize access to their record to researchers, who in an era of artificial intelligence, could analyze this data to develop personalized evidence-based treatments for their needs, and develop cures that could save millions of lives.
My challenge to you today is to be a part of making this vision a reality. We must all adapt in order to adjust for the rapid advances in technology that are happening every day.
Again thank you for having me here today and I look forward to seeing the progress that all of you make in the future.