The Centers for Medicare & Medicaid Services has launched a new pilot program to give healthcare providers easier access to claims data, helping fill in gaps in information – previous diagnoses, past procedures, medication lists – and enabling a more complete patient history.

WHY IT MATTERS
Launched Tuesday at the White House Blue Button Developers Conference, the goal of the project – called Data at the Point of Care – is to "enable providers to have the information they need to deliver high quality care to Medicare beneficiaries," said CMS Administrator Seema Verma. "This new program will help fill in the areas of missing information that currently plague providers."

The DPC initiative uses the Blue Button 2.0 API, which Verma said by now has enabled "nearly 40 million Medicare beneficiaries to connect their claims data with applications that help them manage their health."

Joining Verma on the Monday press call was Jared Kushner, senior advisor to President Donald Trump, who has worked on healthcare interoperability initiatives on behalf of the administration.

Blue Button 2.0 has been "a very, very big success," he said. "It has a robust developer community around it. There's more than 2,000 organizations that are actively building applications using the API, which is even larger than we anticipated."

Right now there are 28 apps developed in Blue Button 2.0 sandbox available for download.

But whereas Blue Button 2.0 was first developed as a way to enable data sharing with patients, "this is about sharing patient data with providers," said Verma.

"Claims data can inform providers of previous diagnoses, past procedures and medications," she said. "And providers know where to look for more robust records when needed, and answer questions like, 'Has my patient had a flu shot?' By providing claims data directly to the providers at the point of care, we're enabling them to spend more time providing high quality care for their patients and less time chasing down information or working with an incomplete picture of the patient's medical history."

Clinicians participating in the DPC pilot program – they can sign up at dpc.cms.gov – will be able to access data within their workflows, without needing to log into another application.

The ability to request Medicare beneficiaries' claims data from CMS, enabled by Blue Button's FHIR API, will offer a more complete picture of care received from other healthcare providers.

"This program is launching first in a pilot phase where we will work with providers and healthcare systems to pilot the API, test features and improve our program to provide the highest impact for providers and our beneficiaries," said Verma.

"Starting tomorrow, providers can sign up to be a part of our initial pilot," she said. "And in three months CMS will be rolling out production data. Starting in January 2020, all Medicare providers will be able to receive claims data for the patients they are treating.

"Through this effort," she added, "American patients will have seamless transitions in care and our providers will have access to the most comprehensive longitudinal data currently available."

“If you think about all of that data that is in different silos with different providers that patient may see, we think the average is seven doctors per Medicare patient that they see on average. The doctor will be able to request any patient that is seen under expert treatment or that they have an upcoming appointment for,” explained Amy Gleason, digital service expert at the U.S. Digital Service (which helped develop the Blue Button API) in an interview today with MobihealthNews.

"They could ask for information on those patients using the bulk API, and then CMS will evaluate whether they have access to that information based on the treatment rules under HIPAA. Then they will get that information back by bulk response.”

THE LARGER TREND
"At the 2018 HIMSS conference, we announced the MyHealthEData Initiative, which is a whole-of-government approach to enabling citizens access to their health records and to support true interoperability, which was really the goal that we wanted to achieve," said Kushner. "This is a very exciting initiative that we've taken on, and it's one that everyone here in the White House and throughout the government is very, very passionate about."

"I call on all insurers to give patients their claims data electronically," said Verma at HIMSS18. “CMS believes the future of healthcare depends on the development of open APIs. We need more payment data."

ON THE RECORD
"The government has a ton of data," said Kushner on Monday. "The private market has a ton of data. And by making things interoperable we're trying to give more power to the patients, give them more control but also encourage a whole new wave of innovation so that we can take this data and turn it into applications that could make people healthier, give them more insight, more control over their healthcare, and really make a big difference.

"This is something we've had a lot of people in and out of the White House (to discuss) the last couple of years," he added. "We've had insight from people from the right, we've had insight from people from the left. But mostly these are people who just want to see America succeed. This is a massive industry, we spend a lot of money on this as a country and everyone would like to see us have better outcomes where people are healthier and it's done in a more efficient way."