- CMS Administrator Seema Verma announced a new Data Driven Patient Care Strategy, an initiative that strives to make CMS data more accessible and usable, including Medicare Advantage encounter data.
- The agency is starting by releasing a preliminary version of the 2015 MA encounter data, with a final version of that data planned for release later this year. Encounter records for subsequent years will be released on an annual basis.
- Verma, speaking at the industry conference Health Datapalooza, also laid out plans to make Medicaid and Children’s Health Insurance Program data available next year.
CMS had planned on unveiling MA encounter data last year, but halted the release citing questions about the data’s accuracy and its readiness to support research use.
A recent JAMA Viewpoint urged CMS to release MA claims data. While the data would shed light on how providers interact with Medicare, the authors primarily argued that the matter is one of transparency and that taxpayers should have a deeper understanding of how their money is being spent.
That government spending on the program has been steadily increasing over the past 15 years. According to the paper, government payments to MA plans have increased from $77 billion in 2004 to more than $200 billion 2017.
The announced annual release of MA encounter data is a good start toward more transparency, as encounter records contain a similar level of information as fee-for-service claims data. It's worth noting that this data is not available to enrollees. Rather, researchers will have access to "approved, privacy-protected data files" within a "CMS environment that is safe and secure."
According to CMS, files covering inpatient, skilled nursing facility, home health, outpatient, carrier/provider and durable medical equipment will be available.
"We recognize that the MA data is not perfect, but we have determined that the quality of the available MA data is adequate enough to support research," Verma said.
CMS has a large amount of data on its 130 million beneficiaries and previous enrollees, she said, but data "doesn’t mean anything unless it’s accessible and usable." The new strategy hopes to make CMS data easier for researchers and technologists to use.
When Verma spoke at HIMSS18 last month, she called on private insurers to give patients full access to their medical records. She repeated that directive at Datapalooza, adding that CMS has started working with states to make claims data available to the 70 million Medicaid enrollees.
"Who knows what knowledge, what treatments and cures, are hidden in the reams of CMS data," Verma said. "Help us use it securely."