CMS is launching a project to share Medicare claims data with accountable care organizations in bulk, Administrator Seema Verma announced Tuesday at HIMSS19 in Orlando, Florida.
The project, called the Beneficiary Claims Data API (BCDA), will allow ACOs participating in the Medicare Shared Savings Program to retrieve Part A, B and D claims data for their beneficiaries — including Medicare claims data from care received outside the ACO.
BCDA will provide this data to ACOs in a similar format to how CMS provides them with claims data, according to a website on the application programming interface.
A day after CMS and ONC released nearly 1,000 pages in proposed rules on interoperability, the announcement that CMS is troubleshooting a HL7 FHIR-compliant API hints that the agency is focused on next steps including standardization.
Under the ONC rule, the industry would accept FHIR, or Fast Healthcare Interoperability Resources, as the standard API format.
"We know right now the standards provide us with limited data," Verma said. "CMS is committed to not sitting on the sidelines, but instead taking an active role in maturing and building standards."
CMS' proposed rule, building off its Blue Button 2.0 initiative, would expand the Medicare fee-for-service API to Medicare Advantage plans, state Medicaid and Children's Health Insurance Program plans, CHIP managed care entities, Medicaid managed care plans and health plans in the federal Affordable Care Act exchanges.
But the BCDA isn't Blue Button, according to CMS. Blue Button's most recent iteration, Blue Button 2.0, provides FHIR-formatted data one Medicare FFS beneficiary at a time.
BCDA, by comparison, provides FHIR-formatted data in bulk files to an ACO for all MSSP-eligible beneficiaries.
"I am pretty sure we are one of the first to use this," Verma said.
The Google Group on BCDA includes developers, analysts and ACO administrators. The group is currently implementing clear user documentation, formatting data to FHIR specifications and automating processes to make human interventions as minimal as possible, according to CMS.