CMS Administrator Implores Private Sector to “Follow Our Lead” on Making Data Accessible

Feb. 13, 2019
In a passionate speech to health IT executives at HIMSS19, CMS Administrator Seema Verma underscored her determination to compel the industry forward into a new era of data sharing and interoperability

At the HIMSS19 conference in Orlando this week, CMS (the Centers for Medicare & Medicaid Services) Administrator Seema Verma was not shy in her assertion that the government has done its part in opening up health data silos; now it’s up to the private sector to follow suit.

Verma, while speaking in a closing session on Tuesday, Feb. 12, the first official day of the conference, told attendees that in the past 18 months, the goal of federal health officials has been crystal clear: empowering patients with their health data. And, she said, her agency, the nation’s largest health insurer, has backed up the talk through a variety of initiatives and regulations, starting with the “MyHealthEData” campaign launched last year at HIMSS18, aimed at revolutionizing the relationship of U.S. healthcare consumers to their patient data.

Since then, Verma noted, the agency has put out final rules for hospitals and clinicians that essentially mandate providers share data with their patients, and if they don’t, they will see hits to their Medicare reimbursements. She also pointed out Medicare’s Blue Button 2.0 initiative, which allows Medicare beneficiaries to access and share their personal health data in a universal digital format. “We led the market with Blue Button 2.0 and with that we unleased all our claims data for Medicare patients,” Verma said. “There are now over 1,500 developers with a Blue Button Sandbox Account. We have 18 Blue Button apps that are using our API [application programming interface] in production.  For the first time, patients have the ability to donate their data to researchers,” she noted, adding that Blue Button 2.0 has provided access to claims data for nearly 40 million Medicare beneficiaries.

Now, through the lever of two incredibly significant proposed rules released this week—one from CMS and one from ONC (the Office of the National Coordinator for Health IT)—Verma said, “We are requiring that other insurers follow our lead.” The CMS Administrator asserted, “For the first time, we are proposing that all health plans doing business in Medicare, Medicaid, and through the federal exchanges share health claims data and other important information electronically with their patients.”

With all those plans on board, by 2020, 85 million patients who are in commercial health plans will have access to their claims information, in addition to the 40 million beneficiaries in traditional Medicare who already do, Verma stated. “Beneficiaries will now have access to electronic claims data, including pricing

Why the Free-Market Administration Had to Step In—This Time

What’s especially noteworthy is that Verma—who admits she is “deregulatory by nature,” noting that CMS doesn’t want to “micromanage the process, which is what [the agency] has [previously] done”— contended that these proposed rules are necessary in this particular instance.

Responding to a question from Healthcare Innovation in a small press briefing yesterday on how the administration’s free-market philosophy conflicted with this rulemaking, Verma said, “The federal government has invested $36 billion and look where we are. Patients don’t have access to their medical records. There is a time for us to focus on deregulation, but in this particular case, the industry hasn’t done the right thing. People are entitled to have their health information and their records, and because that didn’t happen, it’s requiring the government to step in. “

Verma believes that despite the requirements, which will put unparalleled degrees of accountability on stakeholders, the rules will be generally supported by the industry. “We have talked to variety of stakeholders—from CEOs of insurers and health systems—and everyone knows this is the right thing to do. [They said], ‘We need the government to force us to tell us to do this.’ And if it was being done [already], we wouldn’t have to do what we are doing [now].”

In a brief video statement that preceded Verma’s speech, HHS (Department of Health & Human Services) Secretary Alex Azar agreed with the CMS chief, remarking, “Our approach to health IT is defined by a rejection to micromanage and the encouragement of entrepreneurship. We will develop rules of the road and then you [the private sector] take it from there.”

Similarly, in the conference’s opening keynote panel discussion, Aneesh Chopra, who served as White House CTO under the Obama administration, noted that the government set the floor in the early stages of the meaningful use program by requiring that clinicians must provide electronic summaries of patient records. The assumption was that with this bar being set, the private sector would do the rest. But that hasn’t happened, and that’s what led to these new proposed rules, Chopra said.

Verma also feels that by identifying the FHIR standard to implement these policies, as outlined in the CMS proposed rule, “we are promoting scalable data sharing, not just an individual patient record from hospital to hospital but a model that supports the flow of information across the entire healthcare system. We encourage industry to align in this direction, because it is coming. Locking information into proprietary data models will soon be a thing of the past,” she said.

Information Blocking a Persistent Theme

In her speech Tuesday afternoon, Administrator Verma returned to a theme that she has consistently pursued in her public speeches, comments and press briefings over the past year-plus—that of information blocking and the idea that data needs to be liberated from confinement on the part of some health insurers, providers, and vendors.

“As we unpack the issues related to sharing health data, we realize that each participating party blames someone else,” she said. “The game of pointing fingers and feigning innocence has to end. We are all part of what makes the healthcare system work, and similarly we all are… insurers, providers and the government…culpable for the lack of data sharing.”

That’s where this week’s rulemaking on the part of CMS and ONC is connected to the various stakeholder groups in healthcare, including health plans. “Insurers hold rich data on patients,” she underscored. “Just by looking at their claims history, you can see the rapid decline of someone’s health and you can even predict future healthcare events. A patient who moves from one primary care visit in three years, to a hospitalization from congestive heart failure, should have had an earlier intervention. Liberating claims data for providers, patients, and innovators, can help us understand what tests have been provided and where…it can identify which medications a patient is taking…and provide other data that is useful to understanding a patient’s health.”

Further, she noted, “Claims data from insurers is just the beginning. Hospitals have invested billions of dollars into electronic health records and systems that don’t meet their clinicians’ needs let alone the needs of their patients. On top of that, some hospitals even have to ask permission from EHR vendors to use their own data. Yes, you heard me right—hospitals have to ask the vendors they pay for permission for the right to actually use the data. Let me be clear,” she said forcefully, “the idea that patient data belongs to providers or vendors, is an epic misunderstanding. Patient data belongs to patients, period!” Her verbal emphasis on the word “epic” caused a ripple of murmurs in the audience, many of whose members caught the allusion.

And, Verma continued, “Yesterday in the 21st Century Cures Rule, the Office of the National Coordinator, under the leadership of Dr. [Donald] Rucker, provided us all with additional clarity around what information blocking is and what is not.  So there is no more room for excuses. We won’t tolerate it anymore, and those of you that continue down this road will see less opportunities to engage in this practice in the future. Information blocking is a thing of the past.”

She continued, “Monolithic, legacy technology is also thwarting our transition to a healthcare system that pays for the results we desire. In the past, as new technologies have entered the market, they were quickly shut down by the complexities around government policy, single technology systems that do it all, and the proprietary data models underlying the whole system. In the future, these opportunities must be allowed in, and nurtured. Our closed, complex system must be opened and simplified to allow the next life-changing, life-saving technologies an opportunity to grow, making our system more effective and efficient to drive down costs and deliver better results.”

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