AMGA urges Congress to give providers access to claims data

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The American Medical Group Association wants to see legislative reforms to ensure providers have access to administrative claims data to realize the promise of value-based care.

“Access to claims data not only helps providers deliver better care, but it additionally empowers the patient,” wrote Jerry Penso, MD, AMGA’s president and CEO, in a letter to House Speaker Nancy Pelosi. “Patient access to claims data will lead to better conversations with their providers and subsequently lead to better health outcomes. Access to data also ensures more accountability between the provider and the payer regarding a patient’s care.”

AMGA, which represents more than 450 multispecialty medical groups and integrated delivery systems, contends that now is the time to give providers access to claims data as the healthcare industry shifts from fee-for-service to value-based care.

In particular, Penso notes in his letter to Pelosi that AMGA has worked with the Senate Health, Education, Labor and Pensions (HELP) Committee to include a commercial claims data-sharing provision within its Lower Health Care Costs Act. Specifically, the legislation would require a group health plan or health insurance issuer offering group or individual health insurance coverage to make commercial claims data available to both patients and providers via application programming interfaces.

“The broader bill passed out of the HELP committee and now awaits further consideration in Congress,” states Penso’s letter. “Congress should ensure that this provision is included in an upcoming healthcare legislative package.”

According to Penso, AMGA’s members—which include 175,000 physicians—have repeatedly expressed in surveys their concern with the lack of access to administrative claims data, which they say is the most significant impediment to assuming risk for their patient populations and transitioning to value-based care.

In addition to ensuring access to claims data, Penso makes the case for data standardization.

“Providers with access to data still face challenges, as they must spend excessive amounts of time and resources translating data sets from different types of payers,” states the letter. “Currently, medical groups are required to submit data to different insurance companies in different formats, creating a massive administrative burden and resulting in a diversion of resources from providing care to reporting data.”

To remedy the problem, Penso contends that Congress should require federal and commercial payers and providers to standardize data submission and reporting processes.

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