Big data tools help CMS transform healthcare

New developments in data architecture, storage and analysis are helping the Centers for Medicare & Medicaid Services make better use of data to transform the healthcare system, according to a new article outlining the agency's efforts published this month in Health Affairs. CMS is using technology to convert mountains of raw data into actionable information and share it securely.

In the past, it was difficult for CMS to manage the high volumes of data it collects since such data often is housed in incompatible systems, the authors--including CMS Administrator Marilyn Tavenner and Acting Director of CMS' Offices of Enterprise Management Niall Brennan--noted. Types of data contained include Medicare and Medicaid claims information, patient assessments and surveys along with data on quality, Medicare Advantage encounters and prescription drug events. Now, however, CMS can integrate its systems "to link billions of transactional data records from disparate sources at the desired unit of analysis (such as the beneficiary or the provider) and look across time and programs," the authors said. That, they added, yields a more holistic view of patients and providers in various care settings over time.

Moreover, CMS is using predictive modeling to fight fraud. Medicare's Fraud Prevention System stopped, prevented or exposed approximately $115 million in overpayments in its first year of use, according to the authors. An Office of Inspector General report published last month determined that the U.S. Department of Health and Human Services' use of the system led to $54.2 million in actual and projected savings for the Medicare fee-for-service program.

Real-time claims analyses are driving Medicare payment policy changes that lower spending without compromising patient care, the authors said.

The agency's prior efforts to release aggregated data through encrypted hard drives were slow and costly. But last fall, CMS launched the Virtual Research Data Center which allows researchers to access data from their own computers, the authors said.

Affordable Care Act requirements to combine Medicare data with information from other payers has made more robust quality of care reporting possible, they added. CMS now provides data feeds to accountable care organizations so they can see--for the first time--the entirety of a patient's care, regardless of who delivered it and where it happened.       

But besides its boons, the big data revolution brings challenges. CMS, the authors suggested, must protect the privacy and security of beneficiary information and work to cut the cost of data access, all while continuing to manage numerous data requests.

For more:
- here's the Health Affairs abstract

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