Building on the MyHealthEData initiative unveiled at HIMSS and a revamp of the Meaningful Use program, Seema Verma, the head of the Centers for Medicare and Medicaid Services, said the agency is making Medicare Advantage encounter data available to researchers. Further, it plans to release much sought after Medicaid and Children’s Health Insurance Program data (CHIP), data next year.
Encounter data includes data generated by healthcare providers,
that documents not only the clinical conditions they diagnose but also services and items delivered to beneficiaries to treat these conditions, according to America’s Health Insurance Plans, or AHIP.
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Previously, only Medicare claims data for the fee-for-service program was available. CMS has collected data from private insurers that provide Medicare Advantage plans since 2012 and has used it since 2016 to help calculate risk-adjustment payments but has not made the data public, according to Fierce Healthcare.
Speaking at the Health Datapalooza conference this week, Verma said that the shift to value based care can’t happen until patients are at the center of the healthcare system and making this data available will help towards that goal.
“We know there are some problems with the CMS data,” said Verma.
“It’s not widely used, not widely accessible and it is not fulfilling its potential to fuel innovation — other than that it’s great!”
Despite that, Verma noted that the agency had determined that the quality of the Medicare Advantage data is good enough to support research. It plans to make that data available annually.
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At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
The move by CMS is part of a broader plan to improve transparency and access to data. As part of the MyHealthEData initiative, the CMS Blue Button 2.0 API is designed to help an estimated 53 million Medicare members share four years worth of their claims information with providers, clinical researchers, and digital health services. That data includes drug prescriptions, primary care treatment, and cost, plus Medicare coverage.
Big data is a critical resource for companies developing and refining machine learning algorithms for healthcare from identifying biomarkers associated with serious medical programs to supporting drug development. Although the new streams of data becoming available will be welcomed by healthcare researchers, they represent a portion of a wider range of healthcare data.
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