On March 6, 2018 at the Healthcare Information and Management Systems Society (HIMSS) 2018 conference, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced a new initiative furthering the current Administration’s focus on value-based care and increasing patient access to healthcare data. The initiative — called MyHealthEData — will be led by the White House Office of American Innovation, in collaboration with the Department of Health and Human Services (HHS), CMS, the Office of the National Coordinator for Health Information Technology (ONC), the National Institutes of Health (NIH), and the Department of Veterans Affairs (VA). (CMS press release here.)
The MyHealthEData Initiative
Verma unveiled the key elements of the MyHealthEData initiative, which seek to provide patients with greater control of their health data and to empower them to make more informed decisions about their care:
- Patient Access and Data Control. The MyHealthEData initiative promotes patient-centric, value-based care by reducing barriers to electronic access and control of a patient’s own medical records. By allowing patients secure access to their data, patients will be in a better position to choose providers who meet their needs, and subsequently share their health data with that provider.
- Prohibition on Information Blocking. Verma reaffirmed the Administration’s continued laser focus on information blocking — a practice that Verma stated “traps patients” in healthcare systems by limiting the interoperability of patient records and preventing access by outside systems. Verma expressed complete intolerance of this practice as incompatible with the MyHealthEData initiative.
- Interoperability and Data Portability. CMS will require providers to update systems to ensure data sharing abilities, such that patients’ data can follow them wherever they go. The initiative aims to increase interoperability — not only by overhauling CMS’s Electronic Health Records (EHR) Incentive Programs, but also by exploring innovation with new measures that will impact providers, payers, and patients.
- Reducing Provider Burden. CMS intends to streamline documentation and billing requirements (particularly by overhauling the documentation requirements of Evaluation and Management codes used to bill Medicare for patient visits) so that physicians can spend more time with their patients.
- Blue Button 2.0. Verma announced the second iteration of the Medicare Blue Button — a mechanism that originally allowed Medicare beneficiaries to download their Medicare claims data. The new iteration, called Blue Button 2.0, will involve a “developer-friendly, standards-based API that [will] enable Medicare beneficiaries to connect their claims data to secure applications, services, and research programs they trust.” It will include four years of claims data, prescriptions, and primary care treatments, and will be provided in a universal and secure digital format. Verma encouraged private plans to follow CMS’s lead and give patients their claims data electronically.
The Administration’s Renewed Priorities
Following closely on the heels of Verma’s HIMSS18 speech, HHS Secretary Alex Azar spoke to America’s Health Insurance Plans (AHIP) on March 8, 2018, and outlined the roll-out of new initiatives to further the Administration’s commitment to “the value-based transformation of [the] entire healthcare system.” Azar outlined four areas of emphasis that would be “vital to laying down the new rules of the road, accelerating value-based transformation, and creating a true market for healthcare”:
- Giving Consumers Greater Control Over Health Information Through Interoperable and Accessible Health Information. In addition to citing both the MyHealthEData initiative and Blue Button 2.0, Azar echoed Verma’s sentiments regarding the need for increased interoperability and patient data control and access, as well as a zero-tolerance policy on information blocking.
- Encouraging Transparency from Payers and Providers. Azar emphasized another key element of the MyHealthEData initiative: price transparency. Healthcare consumers will be unable to make informed decisions unless payers and providers become more transparent about the costs and quality of healthcare services. As such, payers should allow patient access to information about pricing (list price vs. actual price), as well as the outcomes of services and products.
- Using Experimental Models in Medicare and Medicaid to Drive Value and Quality Throughout the Entire System. In light of Medicare and Medicaid’s market concertation and heft, Azar discussed the unique role of the federal government in driving value-based change. Azar spoke specifically about the government’s ability to experiment with new payment models to catalyze innovation.
- Removing Government Burdens That Impede Transformation. Recognizing the potential for increased costs, market consolidation, and administrative barriers as an outgrowth of added regulation, Azar reaffirmed the Administration’s commitment to removing regulatory burdens as a tool in advancing value-based care. Focus areas include revamping price reporting rules, lifting certain restrictions on communications with consumers, and reviewing current interpretations of various anti-fraud protections.
The Rub: Takeaways for Payers and Providers
Both Verma and Azar presented MyHealthEData as a continuation of the Administration’s efforts to increase competition in healthcare markets and to empower patients to be active healthcare consumers and decision-makers. There is a focus on transparency and data liberation.
Where there is a carrot, however, there must also be a stick. Both Verma and Azar strongly implied that failure to comply with the new initiative would result in serious consequences. Verma, for her part, stated that CMS would be “reexamining all of our partnerships with health insurers” and “reviewing our quality measures across our Stars programs” in light of the MyHealthEData initiative. Secretary Azar likewise made clear that HHS has “plenty of levers to push [price transparency] along.”
As a result, the initiative puts pressure on providers to employ portable electronic health records systems that make it easier for patients to access and share their health information, and on payers to increase transparency about pricing and quality. Physicians may see a decrease in time spent on administrative duties as CMS works to streamline documentation and billing requirements – yet they will likely be required to update their records systems to ensure interoperability and security of health records. Likewise, while Blue Button 2.0 presents opportunities for developers, it also increases competition in the marketplace and creates a breeding ground for “disruptive innovation.”