Electronic Health Reporter

AMGA has endorsed two new Centers for Medicare & Medicaid Services (CMS) initiatives that are designed to ensure providers have access to claims data. Expanding access to administrative claims data for providers and their patients has been a longstanding AMGA priority.

The initiatives include Data at the Point of Care (DPC) and MyHealthEData. DPC is a new pilot application programming interface (API) program that would make beneficiaries’ Medicare claims data available to the provider for treatment. MyHealthEData, relies on Medicare’s Blue Button 2.0 initiative to provide beneficiaries and their providers with claims data. AMGA appreciates CMS enabling providers to access Medicare beneficiary claims data directly within their existing workflows through APIs, and we share CMS’ belief that access to a patient’s complete health record is crucial to managing a patient population and improving health outcomes.

“Access to claims data from all payers has been a longstanding priority for AMGA and its members,” Jerry Penso, M.D., M.B.A., AMGA president and CEO, said. “CMS’ latest initiatives support AMGA’s work by allowing providers to access Medicare claims data, and in effect, ensuring the successful transition from volume to value. If successful, CMS’ initiatives should inspire commercial insurers to follow suit in data sharing, a crucial step in delivering the most effective care for patients and improving health outcomes.”

Over the past four years, AMGA members repeatedly have indicated that access to timely Medicare and commercial payer administrative claims data is the most significant barrier to assuming risk. The DPC pilot and the MyHealthEData initiative could benefit organizations transitioning to value-based care. A study in the Annals of Internal Medicine further found that access to this data could be very helpful in providing effective courses of treatment with patients; however, care coordination challenges were still present. AMGA looks forward to working with CMS to help ensure the success of these initiatives and demonstrate the need for data sharing in the commercial setting.

AMGA’s comments on the DPC pilot program and the MyHealthEData initiative are available here.