Remarks by Administrator Seema Verma at the Blue Button Developer Conference
(As prepared for delivery – July 30, 2019)
Thanks Chris for that kind introduction, and to President Trump and the White House for hosting us today. I’m excited to welcome all of you to our second annual Blue Button 2.0 Developer Conference. The progress we’ve made is remarkable and we wanted to bring everyone together to celebrate our progress, and to discuss the path forward.
Again, I want to thank President Trump for his leadership and his unwavering commitment to protecting and strengthening the Medicare program. Under his leadership premiums have gone down, and we’ve increased benefits in Part D and Medicare Advantage. We’re also putting the needs of patients first and empowering them with the data they need to make decisions about their healthcare.
I also appreciate that we have Medicare beneficiaries joining us today: Larry McFall, Joan Hyatt, and Judy Biggs. Thank you so much for coming.
Last year, we promised to take action to give patients more control of their healthcare data, and we’ve delivered.
Today, we’re also celebrating Medicare’s 54th Birthday, which reminds me of when my kids were little. Their grandparents would come over to celebrate their latest milestone—give them a big hug—and say “my how you’ve grown!” So, happy birthday to you Medicare, and my, how you’ve grown!
When Medicare was signed into law 54 years ago today, there were only 19 million beneficiaries. Today, that number has tripled to almost 61 million and we are adding 10,000 people every day – my Medicare how you’ve grown! When they first started, Medicare and Medicaid accounted for only 2.3% of federal spending. These gov’t programs now account for 23.5% of federal spending. And unfortunately, 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.
This problem isn’t limited to Medicare. Healthcare costs have continued to spiral out of control. 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 destroy our economy, and so far government solutions haven’t been able to solve this problem. Now is the time to worry for our parents and eventually ourselves.
Doubling down on big government solutions is not the answer and will not address the drivers of healthcare costs. Some are calling for Medicare for All, but this proposal would strip 180 million people of their insurance coverage and cost $32 trillion.
The Trump Administration has a different vision to address the rise in healthcare costs—one that puts patients first and back in control of their healthcare. By unleashing the power of the American consumer, market forces—the same forces that deliver better cars, better phones, and better restaurants year after year—will address the underlying cost drivers in our healthcare system. Simply having the government pay for everything won’t do that. In the long run, it will lead to a painful choice between higher taxes and rationing of healthcare services, which is what we see in other countries that have embraced these ideas.
Instead, the Trump Administration is doing everything we can to accelerate the transformation to a value-based system. One of our key focuses is on innovative payments 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. Changing the way we pay providers will also allow patients to seek high value care.
The sharing of data and interoperability underpin this entire move to value in healthcare and innovation. Without access to their own data, patients lack the information—and therefore the power and ability—to shop around for services.
Our Administration is taking bold action on these challenges. Just last month, President Trump signed a historic Executive Order on “Improving Price and Quality Transparency in American Healthcare to Put Patients First” - to help ensure that patients have the necessary information on price and quality when making decisions. And just yesterday we announced an initiative that would require hospitals to post all of their negotiated rates by third party payers, which will give patients more useful pricing information when comparing procedures across hospitals.
Currently, the lack of patient access to price and quality information — and their electronic health record data—is a lost opportunity to keep our nation healthier and to drive down costs. The government spent more than $36 billion to encourage the adoption of electronic health records, but failed to make sure that the systems could actually talk to each other. We’re now left with a healthcare industry that still uses fax machines.
The Trump administration has been working since day one to unleash the power of data, and to give patients control of their health information. It’s why we announced the MyHealthEData initiative last year, and I’m proud to say we already have tangible results.
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.
We mandated clinicians and hospitals to use EHRs that make APIs accessible to patients, giving them access to their data and ability to use the tools they want. This was our first step in freeing up data from EHRs.
We’re also actively participating in the standards development process, to create a common language to exchange data.
And, of course, we launched Blue Button 2.0, the first ever FHIR based claims API for Medicare beneficiaries—and the reason we’re all here today.
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. You’ve been amazing partners in helping us empower patients with their data. 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 apps in production. These apps give patients ways to manage and improve their health, and later today you’ll hear from these app developers directly.
We all agree that the possibilities for Blue Button are exciting, and share the goal that one day beneficiaries should be able to view all of their health information, whether claims data, medical records, or wearables, in a single place.
But we’re not stopping there. We’re building on our Blue Button 2.0 work with our Interoperability and Patient Access Proposed Rule. This proposal will require all health plans regulated by the federal government to create their own version of Blue Button 2.0. This will make claims data easier to access and use for the 85 million patients across Medicare Advantage, Medicaid, and health plans sold on the federal exchanges.
Of course, this means that efforts by developers to get data in the hands of patients are even more critical. We look forward to issuing a final rule very soon.
But we know that with access to data comes threats to security and privacy, and we’re looking at ways to enhance Blue Button 2.0 to ensure patient confidentiality. My team can tell you that not a meeting goes by where I don’t bring up this issue. Patients must have the peace of mind that their information is safe, secure, and only shared when they’ve given their consent.
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. That’s why we will be rolling out some changes to our Terms of Service with app developers and making improvements to the Blue Button API over the next six months.
Unfortunately, as all of you know, current health privacy regulations don’t extend to most apps. I’ve had conversations with Congress about how important this issue is, and I’ve made it clear that action is needed. We all need to make sure that privacy and security is “top of mind” when building apps and services that help patients manage their healthcare. We must think of it as an obstacle to confront, not an insurmountable barrier that would force us to retreat. I call upon you to join us in making this a priority and to voluntarily use CMS’s privacy requirements—or I ask the industry themselves to come up with standards, so we can ensure patients’ trust.
And earning patients’ trust extends beyond just privacy. It’s also about ensuring that patients are receiving the highest quality care for the lowest cost and moving towards a system that pays for value. And from providers to ACOs—and in every aspect of our healthcare system—our move to value requires access to the data that helps better deliver patient care.
For our ACOs, our partnership has always included access to claims data. This data has helped ACOs to make operational decisions, to offer support and tools for providers, and to ensure that patients under their care stay healthy.
To make it easier for providers to participate in risk based contracts, and to ensure that they can effectively manage spending, providers need to have data on all their patients to understand how they are moving through the healthcare system and using services.
That’s why earlier this year at HIMSS we announced the Beneficiary Claims Data API. This API is an improved way for CMS to share claims data with ACOs. It’s a key first step in enhancing data sharing to drive value-based care and increase participation in new payment models.
This API was the first implementation of the FHIR Bulk Spec to share Medicare claims data. As you all know, bulk is one of the most important keys to interoperability, allowing us to share data on groups of patients instead of just individuals.
But now I’m getting to the really good part. Building on all our work with Blue Button and ACOs, I’m extremely pleased to announce this afternoon our new Data at the Point of Care pilot.
Today’s announcement is a critical step in our efforts to change provider reimbursement and move towards value. Providers often struggle to have a complete picture of a patient’s medical history, including procedures, medications, and preventive services. And patients carry the burden of remembering their health information at each and every encounter.
Personally, I can barely remember what I had for breakfast, let alone the date of my last tetanus shot. For me, I live in Indiana, but work in D.C. And when I need to see doctors in both places, I don’t want to have to travel with folders of paper records. Claims data can fill in these information gaps.
The Data at the Point of Care pilot provides Medicare claims data directly to providers to promote better patient care. Accessed right in a providers existing workflow, there is no logging into another application or portal required.
By leveraging the FHIR Bulk spec, Data at the Point of Care ensures that providers can access crucial data and insights on their patients. We did it for ACOs, and now we’re doing it for all doctors.
Everything this Administration is doing has one goal: to put patients first. That’s why we’re putting health data firmly where it belongs, in the hands of patients and the providers who treat them.
We’re witnessing the beginning of what I’ve called the digital data revolution. We have all this data that moved from paper to digital, but it’s largely still stuck within the doctor’s office or health plans. Fortunately, our Administration is bringing the capabilities to unleash innovation.
Our work won’t end here. The government spent $36 billion on EHRs, but they haven’t delivered and clinicians are beyond frustrated. The reality is that we need EHRs to work better for our providers and for clinician workflow – not billing systems. The ONC’s 21st Century Cures Regulation has already laid the tracks for a better future for EHRs, but it’s now up to us to build the trains. EHRs either need to work for providers and patients, or open their systems to allow for integration. In an era of rising healthcare costs we need technological innovation to help us create a more efficient system. And if EHR developers cannot keep pace with the rest of the healthcare system, they are holding us back from the next generation of innovation and they must create open systems that allow others to innovate.
I believe a future where we leverage new technology while respecting EHR proprietary issues is possible. It’s a journey we’re on together. This administration is always listening, and we’re here to remove the roadblocks that are standing in your way of driving innovation.
My challenge to you today is to figure how to take full advantage of the data we are unleashing to lower costs, improve quality, and support a more sustainable healthcare system.
Ultimately, our work together could change the lives of millions of Americans and the trajectory of our nation’s healthcare spending. I can think of no better way to honor the Medicare program today, on its 54th anniversary.
It’s been a pleasure to open today’s conference, and I’m really excited about our agenda which includes some exciting new announcements from our private sector and government partners. It also features some great panel discussions this afternoon. They include one with Medicare beneficiaries discussing how they’re making use of the new technologies, as well as updates on the latest work being done on the Blue Button and Bulk FIHR APIs.
Again, thank you all for coming, and I wish you a successful—and innovative—meeting. Thank you.
Press Release available here: https://www.cms.gov/newsroom/press-releases/cms-advances-myhealthedata-new-pilot-support-clinicians