HCA News- Jared Kaltwasser -MAY 18, 2018

CMS plans to begin releasing Medicare Advantage (MA) data to health researchers, in a move that could substantially improve the quality and robustness of public health analysis.

“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,” CMS Administrator Seema Verma, MPH, said during last month’s announcement. “And although this is our first release, going forward, we plan to make this data available annually.”

Gerard Anderson, PhD, a professor at the Bloomberg School of Public Health at Johns Hopkins University, said the data will be an important piece of the puzzle as researchers track health usage, spending, and outcomes.

“Many us have been using Medicare fee-for service-data for 30-plus years,” he told Healthcare Analytics News™. “We did not have access to the same data on MA plans, and this made it difficult to determine if the care was better in MA plans than it was in fee for service. It also allows us to compare the mix of services that each program receives.”

CMS makes privacy-protected claims data available to researchers through its Virtual Research Data Center (VRDC), which Verma said has information on CMS’ 130 million current enrollees, as well as data from patients who previously were covered by CMS programs.

“If you’ve seen a study that references Medicare data, it probably came from an analysis of data in the VRDC,” Verma said.

The Medicare Advantage release wasn’t Verma’s only announcement. She said CMS will make additional databases available in the coming years.

“Next year, we expect to make Medicaid and Children’s Health Insurance Program data available,” she said. “This means researchers will have access to data on another 70 million patients, which represent a different population with different needs than Medicare beneficiaries.”

Currently, Anderson said, CHIP and Medicaid data are available in some states, but it must be accessed on a state-by-state basis, making it difficult to draw national conclusions.

“To get data on all 50 states will be a huge benefit to researchers, since we can look across states to see if the differences in benefits and eligibility can influence outcomes,” he said.

Verma said she expects that releasing this data will lead to advances in care for the low-income population served by Medicaid.

“Data has the potential to help produce better, more targeted treatments for these patients, improving their quality of life while at the same time reducing costs,” she said. “Our hope is that this data will be used for critical research on this vulnerable population.”

Even as she announced plans to make data more widely available to researchers, Verma said Americans are increasingly demanding better privacy protections for their data. She said engineers at CMS are working to strengthen controls around data access. But she also said her long-term vision includes finding a way for patients to access their own data.

“We’re working to ensure that our quality and cost data is available in a timely—and secure—fashion, and, eventually, if a patient wants the information, they’ll have it at their fingertips,” she said.

Questions about ACA, private Medical Insurance and health insurance reimbursement? Physician Credentialing and Revalidation ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844