Clinicians Access To Patients’ To Claims Data From Medicare

Clinicians Access To Patients’ To Claims Data From Medicare
Health & Hospital Administration

The CMS on Tuesday rolled out a new pilot program to give clinicians access to claims data for their Medicare patients. Agency leadership announced the “Data at the Point of Care” pilot at the White House’s Blue Button 2.0 Developer Conference in Washington, D.C. The CMS launched Blue Button 2.0 last year to allow Medicare beneficiaries to connect their Medicare health information to third-party apps and computer programs via an application programming interface.

Medicare claims data

Blue Button 2.0 and the Data at the Point of Care pilot are part of the agency’s My Health EData initiative; hence an interoperability effort that aims to give patients more control over their health data. To date, more than 2,000 developers are using the Blue Button 2.0 API to build applications; also 28 organizations have launch programs; so that are available for beneficiaries to download; such as apps to help organize medication lists.

The new pilot, which also leverages APIs, “is really about providers,” CMS Administrator Seema Verma said on a call with reporters. “Whereas Blue Button 2.0 focus on putting data in the hands of patients; so this is about getting their doctors their medical information.” Fee-for-service providers who sign up for the voluntary pilot; this will be able to request Medicare claims data from the CMS for their patients.

The goal is to overcome silos in the healthcare system; so that clinicians can view a more complete medical history for patients before making decisions about their care. Providers who have access to a patient’s previous diagnoses; so past procedures and medication lists may be less likely to duplicate costly tests or treatments, according to the CMS. Verma said she thinks providers; so that are participating in value-based models, or considering value base models; which will be particularly interested in the pilot.

Clinicians won’t access patient’s

She added that although clinicians won’t have access to a patient’s complete medical record from other providers; so access to claims data will give them a “more robust” picture of the patient’s previous care. “This data gives them more information about their patients; so they are better able to impact their care, and it allows them to do the analysis about their patient population,” she said.

To participate in the pilot program, providers must establish a way to access the Medicare claims; so data from within clinician workflows, without logging into a separate application. That will require working with vendors of electronic health record systems and other tools used at the point of care to connect the appropriate system to the Data at the Point of Care API.

The CMS plans to begin the pilot with its first few providers in fall 2019; so with plans to slowly roll out access to additional participants over time. Ultimately, it may make the API available to all fee-for-service providers. The pilot in many ways echoes themes include in the propose interoperability rule the CMS released earlier this year. The rule outlines how regulators will require insurers to share medical data; hence with patients, including through the use of APIs that connect beneficiary data to third-party apps; so similar to the Blue Button 2.0 API and the Data at the Point of Care API.