CMS Data and ACOs – Analytics Driving Innovation for Value Based Care
Niall Brennan, acting director, office of enterprise management, US Centers for Medicare and Medicaid Services presented a keynote session ‘Using CMS data for healthcare change’ at Healthcare IT Connect’s Accountable Care and Healthcare IT Strategies Summit in Chicago.
Healthcare’s future is more dependent on data than science fiction, and the US Centers for Medicare and Medicaid Services can help with the data, says Niall Brennan, acting director of CMS’ office of enterprise management during his keynote address.
“I run the mysteriously named office of enterprise management, but it has nothing to do with Star Trek, and everything to do with data analytics and stewardship of meaningful use,” Brennan joked.
As the nation’s largest single payer for healthcare in the US, CMS generates data on billions of claims and non-claim points. The agency is transitioning from a passive payer of claims to active purchaser, and it wants to drive innovation. Therefore, the agency is employing analytics for advanced information projects, and responding to exponentially increasing demands for data from providers, payors and other healthcare stakeholders making the switch to value-based care.
The CMS data site, https://dnav.cms.gov, the agency’s data navigator, consists of dashboards and data that are aggregated by state, hospital region and county levels, as well as by chronic conditions and facility usage:
• ACOs—CMS sends monthly claims feeds to ACOs. For the first time in a fee for service system, providers can see a whole patient, bringing the system one step closer to patient centered care. Successful ACOs will integrate this data and bring it into point of care.
• Quality entry program—part of ACA that deals with private/public reporting. Previously, physicians would get report from private insurers, but nothing from Medicare. With QEP, third party entities can receive Medicare data, as long as they can combine them with data from other payors. The QEP can also create comprehensive reports on a provider’s practice.
• Research dissemination—The Chronic Condition Warehouse stores “tons of Medicare data, linked across setting, across time, across payors,” said Brennan. Researchers access encrypted data remotely and securely. This is safer for patients, and cheaper for researchers.
• Blue Button—The VA, DOD and CMS adopted this online tool for patients to access their own data. In a beta program so far, Blue Button beneficiaries can download 3 years of their hospital, provider and treatment data. 300,000 people have used it so far. The aim is to avoid duplication of care, and coordinate with providers.
CMS’ own analytics has been newsworthy:
CMS data released in April found very high variation within very small geographic areas. Variations for circulatory disorder DRGs in Manhattan, for example, are “spectacular.”