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Analysis

CMS Pilot Gives Clinicians Direct Access to Claims Data

By John Commins  
   July 30, 2019

Participanting clinicians can request a Medicare beneficiary's claims data from CMS to get a full history of care, including from other healthcare providers.

The Centers for Medicare & Medicaid Services on Tuesday unveiled a new pilot program that will give clinicians direct access to Medicare beneficiaries' claims data.

CMS Administrator Seema Verma says the "Data at the Point of Care" pilot is designed to improve care, sharpen diagnoses, and reduce redundant services by knocking down silos that prevent patients and their providers from accessing their complete health history in one record.

"Technology, coupled with open data sharing, is how we will improve value, control costs and keep patients our healthcare system into the 21st century," Verma said in prepared remarks.

Clinicians in the DPC pilot program can request a Medicare beneficiary's claims data from CMS to get a full history of care, including from other healthcare providers.

The pilot will rely on Health Level 7's Fast Healthcare Interoperability Resource standard, a widely used protocol that joins systems to promote interoperability and data sharing.

The DPC pilot is the latest attempt to improve access to healthcare data for clinicians and beneficiaries that the Trump administration has rolled out over the past two years under its MyHealthEData initiative.

CMS launched Blue Button 2.0, the first-ever FHIR-based claims application programming interface that allows Medicare beneficiaries to securely connect their data to apps and other tools.  

In February, CMS issued the Interoperability and Patient Access Proposed Rule, which would require all government and commercial health plans regulated by the rule to follow CMS's lead with Blue Button 2.0 by making data available on 85 million patients including those covered by Medicare Advantage, Medicaid, CHIP and health plans sold on the Federal exchanges.

(Clinicians who want to participate in the DPC pilot program can sign up by visiting: https://dpc.cms.gov.  Beneficiaries who wish to opt out of data sharing can do so by calling 1-800-Medicare.)

“Technology, coupled with open data sharing, is how we will improve value, control costs and keep patients our healthcare system into the 21st century.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

Clinicians in the DPC pilot program can request a Medicare beneficiary's claims data from CMS to get a full history of care, including from other healthcare providers.

The pilot will rely on Health Level 7's Fast Healthcare Interoperability Resource standard, a widely used protocol that joins systems to promote interoperability and data sharing.


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