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Medicare Claims Data APIs from the Centers for Medicare & Medicaid Services (CMS)Allison Oelschlaeger, CMS Chief Data Officer
MyHealthEData
The MyHealthEData initiative aims to unleash data to give patients control of their healthcare information and allow that information to follow them through their healthcare journey Government-wide initiative led by the White
House Office of American Innovation HHS and CMS are key partners in this initiative
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A Brief History of Blue Button
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2010
2018
May 2010: CMS & VA hold innovation event to increase consumer access to data through PHRs
Aug 2010: VA releases Blue Button download
Sept 2010:CMS releases Blue Button download
March 2018:CMS launches Blue Button 2.0 to add developer-friendly, standards-based API to the existing text and PDF downloads
February 2019:CMS releases Interoperability and Patient Access Proposed Rule
2019
Comparison of CMS APIs
Blue Button
Beneficiary Claims Data
• For Medicare beneficiaries
• Single data call
• bluebutton.cms.gov
• For Accountable Care Organizations (ACO)
• Bulk data calls
• bcda.cms.gov
• For Providers
• Bulk data calls
• dpc.cms.gov
Data at the Point of Care
CMS Claims API Projects
BFD
CMS Claims Data
Primary Care Doctor Specialists Care Manager
Patient
ACOs:Beneficiary Claims Data API
Patient- Blue ButtonCaregiver
FFS Providers:Data at the Point of Care
ACO Organization
Supporting Technologies
HL7 Da Vinci Project
Jocelyn KeeganProgram Manager, Da Vinci Project
Senior Consultant, Point-of-Care Partners
Provider, payer, vendor collaboration defining specific implementation guides to support value-based care Supported by over 45 organizations; fund SMEs, provide in kind
staff/resources and commit to implement in production Leverages HL7 FHIR across 14+ use cases; current progress
ranges from proposed (2) to draft standards (12) Use cases span:
Quality Measures Data Exchange Streamlining Prior Authorization Clinical Data Exchange between Providers and Payer Standards to Identify Shared Patients between Partners
2020 Focus - Mature Existing Guides, Artifacts, and Support Implementations
HL7 Da Vinci Project
Project ChallengeTo ensure the success of the industry’s shift to Value Based Care
Pre-Collaboration / Controlled Chaos:
Develop rapid multi-stakeholder process to identify, exercise and
implement initial use cases.
Collaboration:Minimize the development and
deployment of unique solutions. Promote industry wide standards
and adoption.
Success Measures:Use of FHIR®, implementation guides
and pilot projects.
Membership by Primary Industry Role
Vendors
Providers
Partners
For current membership: http://www.hl7.org/about/davinci/members.cfm
Payers
Use Case Focus Areas
Gaps in Care & Information
Coverage Requirements Discovery
Performing Laboratory Reporting
Data Exchange for Quality Measures
Prior-Authorization Support
Risk Based Contract Member Identification
Alerts / NotificationsPatient Cost Transparency
Chronic Illness Documentation for
Risk Adjustment
Patient Data Exchange
Clinical Data Exchange
Payer Data Exchange: Formulary
Quality Improvem
ent
Clinical Data Exchange
Coverage / Burden Reduction
Process Improvement
Member Access
Clinical Data Exchange
In Ballot Reconciliation
Use Case Status
Documentation Templates and Rules
Early February or February 2020 Ballot
In Build
In Discovery
Payer Data Exchange
Payer Data Exchange
Payer Data Exchange: Directory
Payer Coverage Decision Exchange
Join https://confluence.hl7.org/display/DVP/Da+Vinciand sign up for the HL7 Da Vinci Project listserv
Da Vinci Program Manager:Jocelyn Keegan, Point of Care Partners
Da Vinci Technical Lead:Dr. Viet Nguyen, Stratametrics [email protected]
Get Involved!
Alexandra MuggeDeputy Chief Health Informatics Officer
Centers for Medicare & Medicaid Services
Vision: A Connected, Interoperable Healthcare System
CMS Interoperability and Patient Access Proposed Rule
Ongoing Efforts
• Blue Button 2.0 API• Data at the Point of Care (DPC) API• Prior Authorization
• Documentation Requirement Lookup Service (DRLS) via FHIR-based API• e-Prior Authorization via FHIR-based API
• Quality Data Submission via FHIR-based API• Provider Directory Update
