Using Medicare And Private Sector Claims Data for Patient care Quality

MACRA providing expanded opportunity to drive higher quality, lower cost care

Discovering that Medicare and private sector claims data have a great role in providing an improved care, the Centers for Medicare & Medicaid Services (CMS) proposed rules that aim to drive quality and patient care improvement. According to their new rules, the providers, employers, and others can have a greater access to analyses and data rules that will help make more informed decisions about care delivery. The Medicare Access and CHIP Re-authorization Act (MACRA) will allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data. In addition, qualified entities will be allowed to provide or sell claims data to providers. This also ensures to qualify strict privacy and security requirements for all entities receiving Medicare analyses or data, as well as new annual reporting requirements.

“Increasing access to analyses and data that include Medicare data will make it easier for stakeholders throughout the healthcare system to make smarter and more informed healthcare decisions,” said CMS Acting Administrator Andy Slavitt. The Obama administration considers this initiative a broader effort to create a health care system that delivers better care, spends dollars more wisely, and results in healthier people.

The program was authorized by Section 10332 of the Affordable Care Act, allowing organizations that meet certain qualifications to access patient-protected Medicare data to produce public reports. Qualified entities must combine the Medicare data with other claims data (e.g., private payer data) to produce quality reports that are representative of how providers and suppliers operate. Currently, 13 organizations have applied and received approval to be a qualified entity. Out of these, only 2 have completed public reporting while others are still preparing for public reporting.