CMS Ramps up Data to Support Value-Based Payments

Over the next few years, the Centers for Medicare and Medicaid Services will adopt a value-based payment policy as part of an unprecedented attempt at industry-wide delivery system reform. Yet, according to CMS Acting Administrator Andy Slavitt, none of it matters unless healthcare data helps providers deliver better care to patients.

“Our priority is clear—to drive a delivery system that provides better care, with a smarter payment system that keeps people healthier,” said Slavitt on Tuesday at the 2015 CMS Quality Conference in Baltimore. “This means specifically that by 2018 we will reach a tipping point in our payments, with over 50 percent of Medicare fee-for-service payments rewarding for quality and value and aligning Medicare Advantage and Medicaid to do the same.”

However, Slavitt emphasized that payment policy is not CMS’s goal. We are not just a payer, we are an information partner,” he said, adding that the agency wants to turn healthcare into an “information industry” that supports patients and the caregivers that serve them.

Last week, CMS released its 2016 CMS Quality Strategy in support of Medicare’s shift from volume-based to value-based care, which the agency states will require “better organization and use of data and health information, including the use of electronic health records and other health IT resources” as well as paying providers to incentivize quality instead of quantity. According to Slavitt, smarter payments will help cut down on inefficiencies and the overuse of costly tests and other diagnostics.

“Change often boils down to practical decisions on where to invest and we aim to make the case that investment in a quality program and population health will carry a greater return than another expensive MRI machine or a 100 new beds in the hospital,” he told the audience. “And our commitment extends beyond how we pay to data, tools and sharing best practices as we commit to providing leadership in data transparency and in technical support.”

Also See: Are You Ready for Value-Based Payment?

To achieve those goals, CMS will measure and publicly report providers’ quality performance and cost of services provided.

“Delivering usable information must be part of our larger commitment to the healthcare system,” Slavitt argued. “CMS has begun this journey—beginning with how we release data and we are extending it further. We now release over 200 new and updated data files on everything from geographic variation in Medicare, to chronic disease patterns to utilization and prescribing patterns and quality data on hospitals, nursing homes, home health agencies, physicians, and dialysis facilities. And, we are making the creation of usable information part of doing business with the federal government.”

Nonetheless, Slavitt noted that some providers in alternative payment models tell him that some health plans don’t provide them access to their data, or if data is provided it is through individual reports or portals that don’t integrate with data on the rest of a provider’s practice. But, he made the case that payers need to support providers in improving the entirety of their practice or delivery system reform won’t succeed. 

Toward that end, Slavitt said that CMS is requiring commercial health plans that do business in the marketplace and in Medicare to make data that is valuable to providers or patients available in machine-readable form. “We have led the development of a federated data infrastructure on health plans,” he asserted. “We are building and investing in a Medicaid data infrastructure. We will use every opportunity to plant the seeds that permanently change data availability and create a usable information pipeline for researchers and software developers. And we now provide data to providers on their populations’ claims experience in near real time as we get the data from our claims system.”

However, he made the case that it is business practices, not technology, that is holding back the healthcare industry, particularly when it comes to health information blocking. “We continue to hear stories of those who intentionally block information from moving outside of their own systems,” Slavitt said. But, he offered that “very soon” all EHRs will be required to have open application programming interfaces enabling developers to build apps and safely and securely connect to the data.

“Information blocking is not acceptable to patients or to us. People don’t experience care in silos and their data can’t live in silos,” concluded Slavitt, who added that “if you experience any practice that blocks information from moving, send an email about it to” 

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