At HIMSS 2019, CMS Administrator Seema Verma reminded the throngs of health IT enthusiasts that patient data belongs to patients. We couldn’t agree more.
In a white paper published last year, we introduced the concept of the Smart Health Market and discuss the topics of interoperability, data access, and data ownership. This move by CMS kicks that conversation into high gear.
Verma said CMS is “opening the gates to unleash data” so it can be available to patients within tech-enabled solutions. And in a Smart Health Market, patients represent the most powerful force to drive quality and value.
When armed with data, consumers can actively engage in their health and make rational choices about where and when to seek services. Their power of choice will incentivize providers to compete for their business. Quality and value will mean everything.
For its part, CMS is doubling down on consumerism with its MyHealthEData initiative. The one-year-old program aims to create systems which entitle patients to access their data and empower them to be in control of all aspects of their health. One critical piece involves creating a consumer-facing digital record for each person. The record, created at birth, would travel seamlessly throughout every care encounter, aggregating data from every source.
Imagine a retired store clerk tapping on her smartphone to see the date of her last mammogram and the cost of her primary care office visit – within seconds. No phone calls. No annoying hold music. Just convenient data where and when she wants it.
But we aren’t there yet.
That’s why CMS recently proposed policy updates related to MyHealthEData that would advance electronic data exchange and pry open today’s information siloes. For example, Medicare fee-for-service beneficiaries soon will be able to access their claims information on their smartphones. Under the new rule, CMS would require Medicare Advantage, managed Medicaid, CHIP, marketplace plans and others to make that same technology available to their members.
The effort is made possible by an application programming interface developed for CMS known as Blue Button 2.0. The interface can access four years of claims data for 53 million beneficiaries in Medicare Parts A, B and D.
As it turns out, some private payers like Humana are already moving forward with Blue Button integration for their Medicare Advantage populations. That’s good news.
The new rules also would require the plans to support electronic exchange of data for transitions of care as patients move between the various plan types. That way, no one will get lost in the shuffle. Approximately 125 million people would be connected to their data if the proposal is finalized.
And there’s more. Regulators are looking to publicize a list of payers, providers, and vendors that engage in any type of “information blocking” that undermines interoperability. Leaders believe publicly outing the blockers will incentivize them to start cooperating.
In other words, proprietary systems are no longer an acceptable excuse to hold patient data hostage. We know who you are, and the jig is up.
Verma noted that CMS has led the effort to create worthwhile patient-facing data resources, and she’s challenging everyone else to catch up. It’s clearly a call to action for the private sector to move ahead in the emerging pro-consumer market.