Medicare Advantage Claims Data Unleashed

Researchers are being granted access to detailed claims data for the large and growing segment of the Medicare beneficiary population.

For the first time, the federal government is granting researchers access to Medicare Advantage claims data with the stated goal of driving innovation and competition.

Centers for Medicare & Medicaid Services Administrator Seema Verma announced the change Thursday during a speech at Health Datapalooza in Washington, D.C., touting the move as part of the agency's MyHealthEData initiative.

"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 in her prepared remarks. "And although this is our first release, going forward, we plan to make this data available annually. And we’re not stopping with MA data."

The agency expects to release data from Medicaid and the Children's Health Insurance Program (CHIP) next year as well, she said.

Researchers already have access to detailed data from the fee-for-service program, but they have pushed for the MA data as well because it represents a large and growing segment of the beneficiary population: about 19 million people, or one-third of all Medicare beneficiaries, last year.

In an opinion piece for the Journal of the American Medical Association, researchers Niall Brennan, MPP, of the Health Care Cost Institute; Charles Ornstein of ProPublica; and Austin B. Frakt, PhD, of the Department of Veterans Affairs and Boston University, wrote last month that MA plans have more flexibility than traditional Medicare, making them more popular.

"Despite the important and increasing role of Medicare Advantage plans, there is fairly little insight into the relative value Medicare Advantage provides to beneficiaries or the funder, the US taxpayer," they wrote.

With this newfound access to detailed MA data, the researchers may be able to better assess how well MA modifications are working.

In a written announcement, CMS said the agency will begin with a preliminary version of the 2015 Medicare Advantage Encounter Data, followed later this year by a final version.

Anyone seeking additional information or looking to request encounter data can do so online at the CMS Research Data Assistance website.

For more information or to request encounter data, please visit the CMS Research Data Assistance Center website.