CMS To Run Pilot Giving Providers Access To Medicare Claims Data

In another step in fleshing out its interoperability efforts, CMS has announced plans to launch a pilot program giving clinicians access to claims data.

During the pilot, which is called “Data at the Point of Care” or DPC, clinicians will be able to access the claims data from CMS’s Blue Button 2.0 functionality. The idea behind this effort is that the claims data will provide clinicians with a more complete patient history, providing information such as previous diagnoses, medication lists and past procedures.

Clinicians participating in this initiative will be able to access the DPC pilot data directly from within their workflow rather than having to log into another application. As one might expect, CMS will pull in the Medicare claims data available using an API based on HL7 FHIR. That’s how Blue Button 2.0 works.

In its announcement, CMS noted that it had already made Medicare claims data available to the beneficiaries themselves using Blue Button 2.0. Meanwhile, CMS says, it has been working with more than 2,000 developers from over 1,100 organizations who are using synthetic data in the Blue Button 2.0 sandbox. At the time of the late-July announcement, 28 of these organizations had applications in production.

This seems like a worthwhile use of Blue Button capabilities, which to date have gotten very tepid support from EHR vendors over time. (For example, I note that Cerner announced plans to participate in a Blue Button 2.0 predecessor initiative, Blue Button +, though even that minor news dates back to 2013.)

Still, over time compromises like the Blue Button have done little to address the bigger interoperability problems the healthcare industry faces, for a variety of reasons that we’ve covered at length on this site. It’s hard to tell if adding claims data to the mix will make as much of an impact on clinicians as CMS hopes.

As a side note, consumers haven’t shown wild enthusiasm for the Blue Button approach. CMS has gamely continued to get consumers engaged with their own medical information, particularly under the umbrella of its MyHealthEData initiative launched in May 2018, but if these efforts are having much of an impact, I haven’t heard anything about it.

All told, for me this latest news raises more questions than answers. In particular, I’m wondering how CMS plans to measure whether clinicians are benefitting from claims data access. As we all know, more data isn’t necessarily good in and of itself, and what’s more, may not be easy to work with on the fly even if integrated into clinical workflows.

Don’t misunderstand me, I’m always happy to see CMS pushing interoperability and health data access forward, and sharing claims data may indeed make sense. I just keep waiting, almost certainly in vain, for CMS to test out some bigger, bolder approaches.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.