Remarks by Administrator Seema Verma at the 2019 HIMSS Conference
(As prepared for delivery – February 12, 2019)
Thank you Dana [Alexander] for that kind introduction. As always, it’s a pleasure to join you all at HIMSS.
First, I want to thank President Trump for his commitment to making healthcare more affordable to all Americans and Secretary Azar for all of his efforts to move us towards a value-based healthcare system. I applaud the Secretary’s message today that made clear we must work together to build an interoperable, patient-focused health IT system, and to ensure that patients are at the forefront.
Last year, I was with many of you in Las Vegas when I made a promise—not a gamble, not a bet—but a promise to put patients at the center of the healthcare delivery system and empower them with the data they need to make the best decisions for themselves and their families. That promise was based on our vision for a transparent healthcare system that serves every American by empowering patients, focusing on results, and unleashing innovation. The seamless flow of healthcare data is essential to this vision.
And that’s why we launched MyHealthEData, a government-wide initiative spearheaded by the White House Office of American Innovation, under the outstanding leadership of Jared Kushner and Chris Liddell. MyHealthEData is about empowering patients by giving them control of their healthcare data and allowing it to follow them through their healthcare journey.
Before I provide you with more details about these exciting new efforts, let’s go back to why taking action wasn’t and isn’t a choice, but a necessity.
Our actuaries predict that if nothing is done to better control healthcare costs, by 2026 we’ll be spending one in every five dollars on healthcare. For millions of families and businesses this is a huge problem. It is an even bigger one for the federal government. It amounts to a cost crisis that will destroy our economy.
No wonder we hear that more Americans than ever are deeply concerned about healthcare. While we have one of the best healthcare systems in the world, we pay more for that care than any other country.
We don’t even get the best bang for our buck. Despite ever-increasing spending, we have a greater number of avoidable hospital admissions than any other developed country. We’re also seeing a growing prevalence of chronic diseases like diabetes, resulting in an expanding epidemic of poor health across our country. Seventeen percent of Medicare beneficiaries have six or more chronic conditions, and spending on that group alone is more than half of all fee-for-service Medicare spending. This is certainly not a prescription for good health—either for the people of this country, or for our economy.
We know that the current state of healthcare is partially due to underlying flaws in reimbursement—paying for episodes of sickness rather than promoting a lifetime of health. Some of it is due to the costs of regulation and administration.
For CMS, the solution starts with payment innovation, to better align financial incentives for providers to deliver efficient high quality care to get the results we desire. When providers have responsibility for managing a budget and their reimbursement is tied to the results they produce, they will find innovative ways to keep people healthy and lower costs.
Technology, and the sharing of data, underpin the entire move to innovative payment mechanisms in healthcare. Without effective, open data sharing, providers cannot keep patients healthy. Without data to track patient progress or understand quality, insurance companies cannot tie payment to outcomes.
The current healthcare system is complex, opaque, and difficult to navigate for patients. Whether it’s tracking down records…or just determining the cost of a procedure…the system is not patient-centered. Patients lack information—and therefore power and the ability—to make the best decisions about their healthcare. A lack of access to quality, price and medical record data at the critical time when patients need to make decisions about their care is a lost opportunity to keep our nation healthier and drive down costs.
And, we still have physicians faxing information to patients or other providers. Yes, you heard it right – faxing. Not any kind of instant electronic interface, but old school, dial up faxing.
An employee of mine tried to get his electronic health records from his provider. They seemed confused. When he asked if they could simply e-mail them to him, he was told that, “We don’t do that around here.” Instead, they offered to fax it to him….but he’s so young he didn’t know where to find a fax machine, much less how to use one.
And you know that this isn’t just one experience. This kind of thing happens to patients every day, all over the country. And this is what we, as patients, have become accustomed to from our healthcare providers.
We can sequence the entire human genome, but we still can’t get much more than a print-out, fax or CD-ROM when we leave the doctor’s office.
This is a major barrier in our efforts to transform our payment systems to hold clinicians accountable for providing high quality, coordinated, and efficient care. The healthcare system needs greater technical efficiency so we don’t repeat expensive tests, run the risk of adverse drug interactions, and compromise patient safety – all things that drive up healthcare costs.
As we unpack the issues related to sharing health data, we realize that each participating party blames someone else. The game of pointing fingers and feigning innocence has to end. We are all part of what makes the healthcare system work, and similarly we all are… insurers, providers and the government…culpable for the lack of data sharing.
Insurers hold rich data on patients. Just by looking at their claims history, you can see the rapid decline of someone’s health and you can even predict future healthcare events. A patient who moves from one primary care visit in three years, to a hospitalization from congestive heart failure, should have had an earlier intervention. Liberating claims data for providers, patients, and innovators, can help us understand what tests have been provided and where…it can identify which medications a patient is taking…and provide other data that is useful to understanding a patient’s health.
Claims data from insurers is just the beginning. Hospitals have invested billions of dollars into electronic health records and systems that don’t meet their clinicians’ needs let alone the needs of their patients. On top of that, some hospitals even have to ask permission from EHR vendors to use their own data. Yes, you heard me right – hospitals have to ask the vendors they pay for permission for the right to actually use the data.
Let me be clear…the idea that patient data belongs to providers or vendors, is an epic misunderstanding. Patient data belongs to patients, period!
Yesterday in the 21st Century Cures Rule, the Office of the National Coordinator, under the leadership of Dr. Rucker, provided us all with additional clarity around what information blocking is and what is not. So there is no more room for excuses.
We won’t tolerate it anymore, and those of you that continue down this road will see less opportunities to engage in this practice in the future. Information blocking is a thing of the past.
Monolithic, legacy technology is also thwarting our transition to a healthcare system that pays for the results we desire. In the past, as new technologies have entered the market, they were quickly shut down by the complexities around government policy, single technology systems that do it all, and the proprietary data models underlying the whole system.
In the future, these opportunities must be allowed in, and nurtured. Our closed, complex system must be opened and simplified to allow the next life-changing, life-saving technologies an opportunity to grow, making our system more effective and efficient to drive down costs and deliver better results.
In the rest of our daily lives, technology now moves to meet us, as users, where we are. Looking for your lab results should be as easy as typing a few words into a search box and pressing go. Instead, we have to look through multiple patient portals, remember complex logins and hope that our information was entered correctly. Data from disparate systems is not consolidated into a single record because of fears around allowing other systems to write data into EHRs. Some of these fears are valid, but they can be addressed.
The days where data is trapped in unusable silos are numbered. Disruptive technology has already quietly entered healthcare, finding opportunities to transform not just the records systems, but the way we interact with and drive our own healthcare. New companies are taking once trapped data and making it available for patients and innovators alike. So, we can either stand in their way, or open the gates.
CMS is opening the gates. Government also plays a role in seamless data exchange and so this Administration is creating policies that drive to a system where doctors and their patients are incentivized to make sound decisions based on ALL of a patient’s information—their health data, and, yes, their payment information—in a safe and secure environment.
Our agenda is to create a future where the underlying databases that power our health system are connected using APIs and other modern technologies to not just share data, but incorporate it into a single record. And in the future, hopefully the very near future, the data available won’t be limited to a predefined set of parameters. But will include the entire HIPAA designated record set.
With all of this data available, physicians and health systems will use tools like Artificial Intelligence and Machine Learning to help interpret the information to provide high quality, evidence-based, cost-effective care. And the tools that are used at the point of care will be user-friendly for clinicians. No extra effort or millions of clicks, meaning access to the right data, for the right person, when they need it.
The American healthcare system will be…and must be…powered by technology, not burdened by it.
And through the MyHealthEData initiative – Patients are entitled to access their data, and empowered to be in control of and engaged in their health. This transparency will reduce costs and improve quality by ensuring that the information necessary for healthcare delivery or payment is readily available in a usable format, for anyone entitled to it. And finally, freeing data from locked silos will spur innovation at a pace we have never seen before, supporting future advancements in healthcare through new medications, devices and more personalized treatments.
Over the past year, we’ve delivered on this promise and let me take some time to remind you what we’ve done. When your team has worked hard all year, you get to come back and brag about it…..So that’s what I’m going to do.
Last year at HIMSS we launched Blue Button 2.0—our first developer friendly open API for Medicare beneficiaries. Blue Button 2.0 allows Medicare beneficiaries to share their claims data, with applications and services that help them manage and engage in their health, as well as share that information with their doctors and caregivers. With the highest standards of privacy and security, it’s allowing beneficiaries to not only connect their data to apps…but to enjoy the level of transparency and access that Americans expect, in almost every other area of their lives.
There are now over 1,500 developers with a Blue Button Sandbox Account—and many of you are here today. We have 18 Blue Button apps that are using our API in production. Congratulations to all of the Blue Button developers. A list of these apps are now posted on Medicare.gov.
Thousands of Medicare beneficiaries are already using Blue Button 2.0, with the response being overwhelmingly enthusiastic. For example, one person wrote us and said, “I’ve used it to connect my claims data to an app that provides me with a health risk score. The score was average, and of course I wanted excellent. This prompted me to meet with my doctor about how to better manage my conditions.”
Because of impact like this, CMS is working on new ways to update our nearly 40 million Medicare beneficiaries on the availability of Blue Button 2.0 applications. While some of them still love their paper Medicare handbook, we know that more and more of our beneficiaries are enjoying technology and we want YOU to help us build applications that will help them understand and engage in improving their health.
Blue Button was just our first step in unleashing CMS data for use in applications. And, we also can’t forget about how data can spur innovative research. Last year we also made Medicare Advantage encounter data available to researchers for the first time ever and we announced that we would be making Medicaid data available later this year. Just imagine how this data, covering 130 million lives, could be used by researchers and others to open new windows on prevention, new doors to treatments, or even increase the efficiency of treatments, saving millions of lives.
Claims data represents just one piece of the future of seamless information exchange in support of better care. CMS is drawing clinical data out of electronic silos and making it available to patients. Last year, we finalized a significant overhaul of the Meaningful Use programs.
In fact, the changes were so significant it warranted a name change. In our new Promoting Interoperability Programs, clinicians and hospitals are no longer incentivized or penalized based on just using an EHR. We eliminated thresholds and removed check-the-box measures in favor of scoring based on performance and results around interoperability and giving patients their data. We meant what we said about putting patients at the center of the system; nearly half of a hospital or clinician’s score in these programs is now based solely on sharing data with patients.
Last year, we took great steps to deliver on our promise—but they were just the beginning. I am extremely proud to announce that yesterday, CMS furthered our efforts to empower patients through the Interoperability and Patient Access proposed rule. This rule has policies that touch on just about every entity CMS regulates. From health plans to hospitals and clinicians to post-acute care providers, we want every stakeholder focused on the need for seamless data sharing.
Last year, with Blue Button 2.0, we provided access to claims data for nearly 40 million Medicare beneficiaries. Now, we are requiring that other insurers follow our lead.
For the first time, we are proposing that all health plans doing business in Medicare, Medicaid, and through the federal exchanges share health claims data and other important information electronically with their patients.
With all of those plans on board, by 2020, 85 million patients will have access to their health claims information, in addition to the nearly 40 million beneficiaries in traditional Medicare who already have access to their information through our Blue Button 2.0 API. Beneficiaries will now have access to electronic claims data, including pricing information that can be aggregated in one place.
Patients should be able to take their data, as they move throughout the healthcare system—from doctor to doctor and plan to plan. Just because a patient changes plans, that shouldn’t mean that they lose access to their health history. In an age when information is just a click away, patients must have easy access to their own cumulative personal health information. Applications that support this are already here, thanks in part to our Blue Button 2.0 app developers and having access to newly available claims data that will fuel adoption and drive the sharing of data.
Even with empowered patients, we need the healthcare system to have data sharing and notification abilities in place. In our new proposed rule, we are improving the experience for patients and providers when transitioning between settings. As a condition of participation in Medicare, the strongest lever we have, we are proposing that hospitals must electronically notify providers in a patient’s care team whenever a patient is admitted, discharged, or transferred to another care setting. This is a small step in improving the discharge process for patients and their care teams, but it’s a significant first phase of the policies we are proposing.
Looking forward, we want to see a future where it’s more than notification at discharge, instead the entire record set will follow the patient.
The success of data sharing relies on our ability to standardize on structure and semantics, or common meaning of medical terms. And our rule took a strong step to make this a reality. By identifying the FHIR standard to implement our policies, we are promoting scalable data sharing, not just an individual patient record from hospital to hospital but a model that supports the flow of information across the entire healthcare system. We encourage industry to align in this direction, because it is coming. Locking information into proprietary data models will soon be a thing of the past.
We know that right now the standards provide us with limited data. And now, CMS is committed to not sitting on the sidelines, but instead taking an active role in maturing and building standards. In fact, today, we are launching a project that uses the FHIR Bulk Spec to share Medicare claims data with Accountable Care Organizations or ACOs. And for those of you non-techies, this means we are sharing claims data for ACO participants in a bulk format. And I am pretty sure we are one of the first to use this!
In putting out this proposed rule and investing in projects using FHIR standards, I’m doubling down on the need for additional standards, AND I am also putting out a call to action to all of you. We want the entire HIPAA designated record set made available electronically and fast. It is time to accelerate this process and give patients and providers ALL of the data that they need.
Now, if you haven’t done so in the last 36 hours, I urge all of you to read the over 250 page proposed rule, and provide us with comments. We do review every comment, and we take each of them into consideration, so if you want to be a part of the future of healthcare IT, we invite you to work alongside us!
The rules announced this week build on the MyHealthEData work from last year, and are the next step in CMS’ efforts around driving interoperability to move our healthcare system to improve patient access, seamless data exchange and enhanced care coordination.
CMS will also double down on our efforts to ensure that patient data is private, safe and secure. We must be consistently vigilant to protect our patients and their healthcare information.
We are not done. We look forward to continuing our initiative this year. In particular we will continue our review of the RFI comments we solicited last year around making the sharing of electronic health data with patients a requirement for providers that participate in the Medicare program.
I hope you’ll also comment on our new RFIs in the rule this year… because we need your input on our next steps. And I am confident you will have a lot to say. In particular, we want to know how we can put the weight of CMS behind patient identity and patient matching. This is a critical issue that has plagued data sharing efforts for years, and we need to find a solution. We are asking for comments on how CMS can ensure that post-acute care providers adopt health technology, allowing for a more seamless flow of data.
Our rules are a landmark step for patient data access and interoperability, but it is not a step to rest on. We will not stop until we ensure that patients will always be able to get their records, to utilize them, and to share them as they wish. Not only for patient empowerment, but because the future of our healthcare system depends on it—for data is the fuel of healthcare innovation.
Ultimately, we all need to work together to drive the seamless flow of information across the healthcare system. As I’ve said, that means a healthcare future where patients are able to obtain and share their health data, securely and privately, with just a few clicks. That’s a future that truly empowers patients, and is the beginning of the digital data revolution.
Imagine a world where our health records are created at the time of our birth and accumulate information about our every interaction with the healthcare system…every test, every procedure, every device…was readily available to every patient. 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 and prevent disease. Imagine if patients could authorize access to their records to researchers who could develop personalized evidence-based treatments for their needs—but who could also use that information to develop cures that could save millions of lives.
This is data and knowledge that could change the life of a patient—or the trajectory of an unsustainable healthcare system. That’s the promise that lies within our data.