In a letter sent to the chairman and the ranking member of the U.S. Senate Committee on Health, Education, Labor, and Pensions (Senate HELP Committee) on Wednesday, June 5, the Alexandria, Va.-based American Medical Group Association (AMGA), endorsed a proposal to incorporate into evolving legislation requirements for health plans to share data with providers and patients.
The letter, signed by AMGA president and CEO Jerry Penso, M.D., was addressed to Senators Lamar Alexander (R-Tennessee) and Patty Murray (D.-Washington), the chairman and the ranking member of the HELP Committee, respectively.
A press release published on Wednesday noted that “AMGA today provided the Senate Health, Labor, Education & Pensions (HELP) Committee with recommendations to address rising healthcare costs by continuing to move providers and delivery systems toward value-based care. In comments on the committee’s Lowering Health Care Costs discussion draft, AMGA offered detailed insights and comments on how the draft legislation can ensure providers have the tools they need to care for their patients. Specifically, AMGA strongly endorsed the HELP Committee’s commitment to ensuring both providers and patients have access to claims data. Access to claims data from all payers has been a longstanding priority for AMGA and its members.”
The press release quoted Dr. Penso as stating that “Claims data is essential for population health efforts, as well as for providing a level of accountability and transparency in the healthcare system. This data,” Dr. Penso added in his statement, “helps our providers deliver the best possible care and also will empower patients, who want to be an equal partner in how care decisions are made.”
The press release stated that “Requiring that providers have access to data in a standardized format also will reduce unnecessary costs and expenses. Our members report they frequently spend an inordinate amount of time and resources translating data sets from various providers. AMGA is pleased the discussion draft includes a requirement that payers must share data in a single, longitudinal format that spans, when applicable, the previous five years of enrollment in a plan. This data helps providers see how a patient’s condition has progressed and access to it is a key aspect of any population health effort.”
Speaking of the legislation being considered in the Senate HELP Committee, Dr. Penso’s letter stated that “We are encouraged by the committee’s inclusion of Section 2715B within the discussion draft, which requires a group health plan or health insurance issuer offering group or individual health insurance coverage to make commercial claims data available for both patients and providers through application programming interfaces (APIs). Access to claims data from all payers has been a longstanding priority for AMGA and its members. For the past four years, AMGA has conducted annual risk-readiness surveys of our membership to obtain a snapshot of the progress and challenges providers face during the value-based transformation of the U.S. healthcare system. In the surveys, AMGA members expressed concern with the lack of access to timely commercial payer administrative claims data as the most significant barrier to assuming risk and transitioning to value-based care. Members report that while some payers share this data with providers, the majority do not. Successfully managing a patient population requires that providers have access to data to ensure the most effective course of action in improving health outcomes. Without this data, it is challenging to manage the cost and quality of a population of patients, which is a goal of moving to value-based care.”
As noted on its website and in the letter to the Senate leaders, “Founded in 1950, AMGA represents almost 450 multispecialty medical groups and integrated delivery systems, representing approximately 177,000 physicians who care for one in three Americans. Our member medical groups work diligently to provide innovative, high-quality, affordable, patient-centered medical care, and they remain a resource to identify the best ways to solve the problem of rising healthcare costs.”
