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CMS will Make Medicare Advantage Data Available to Researchers

April 27, 2018
by Rajiv Leventhal
| Reprints

Furthering its goal to unleash the power of patient data, the Centers for Medicare & Medicaid Services (CMS) has announced its intention to make 2015 Medicare Advantage (MA) encounter data available to researchers.

This data provides detailed information about services to beneficiaries enrolled in a Medicare Advantage managed care plan in calendar year 2015, according to CMS. Researchers already have access to Medicare claims data for the fee-for-service program, and this release of MA data will provide a fuller picture of care provided to Medicare beneficiaries.

The announcement was made by CMS Administrator Seema Verma this week at the ninth annual Health Datapalooza conference in Washington, D.C., and is part of the agency’s new Data Driven Patient Care Strategy, within CMS’ MyHealthEData initiative that was originally announced at HIMSS18 in February.

CMS said in a fact sheet that 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. CMS is announcing the availability of a preliminary version of the 2015 MA encounter data, with a final version of that 2015 data to be released later this year.

The MyHealthEData campaign, inclusive of Blue Button 2.0 and CMS’ recent proposed hospital payment rule that could overhaul the meaningful use program, is designed to help patients access and share their medical data throughout their healthcare journey while ensuring they are empowered to make decisions about when to share it, keeping their information secure and private, as stated by CMS officials.

The federal agency said it is 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.

As the latest effort under MyHealthEData, the Data Driven Patient Care Strategy is based on three key cornerstones, as outlined by Verma: putting patients first, making more data available and taking an “application programming interface (API)-approach” to exchanging data in a secure and private manner with CMS partners in the spirit of improving healthcare for all beneficiaries.

CMS also plans to release data from Medicaid and the Children’s Health Insurance Program (CHIP) next year, realizing such data has the potential to facilitate research that will help drive innovation and competition in the healthcare system and, ultimately, help doctors and patients make the best decisions about care, the agency said.

“We know we can’t achieve value-based care until we put the patient at the center of our healthcare system,” Verma said. “The Data Driven Patient Care Strategy will empower patients with the information they need as consumers of healthcare to enable them to make informed decisions about the care they need. Ultimately, the cornerstone of a patient-centered system is data—quality data, cost data and a patient’s own data.”

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