Verma calls on insurers to use APIs. Some answer more enthusiastically than others

Seema Verma has called on insurers to release claims data via API. (YouTube)

At the Blue Button Developer Conference on Monday, Centers for Medicare & Medicaid Services Administrator Seema Verma called on insurers to follow the agency’s lead and jump on board the open standards train.

“We are leading by example and calling on all insurers to release data in an API format," Verma said. "You'll see through our regulatory process that we're very serious about that."

It’s the second time Verma has called on insurers to adopt an API format. In April, shortly after unveiling Blue Button 2.0, CMS said it is considering a mandate that would require payers to use data platforms that “meet or exceed the capabilities of CMS’s Blue Button 2.0.”

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Verma’s warning shot on Monday indicated those requirements may be on the way.

RELATED: CMS hints at Blue Button 2.0 mandates for Medicare Advantage plans in 2020

But gauging the industry's enthusiasm in moving toward the use of APIs depends on whom you ask. FierceHealthcare reached out to a dozen insurers to see if they are currently using APIs or when they plan to have the capability to release claims data in that format.

Some are ready now. Aetna, for example, says it already makes claims data available to members through managed APIs. Spokesperson T.J. Crawford said the insurer supports the administration’s efforts to make claims data more accessible.

Clover Health, a technology-based startup that sells Medicare Advantage plans in four states, was enthusiastic about the shift to APIs, indicating it will be “fully capable” of participating in Blue Button 2.0.

“We are actively working on testing our FHIR integration infrastructure to process these claims, to enhance and supplement our existing set of patient data, in the coming months,” Calvin Chock, Clover’s chief product officer, said in an email.

Chock added that “we firmly support using APIs as a standard for healthcare data access and interoperability; along with making it a requirement to participate as a Medicare Advantage Organization.”

A spokesperson for Bright Health said the company views open standards and APIs “as predisposed in that they yield efficiencies for the consumer which can help drive down costs and optimize health outcomes.”

And while other insurers are broadly supportive of efforts to improve interoperability in general, they were hesitant to offer specifics about whether they are currently using APIs or when they plan to have that capability. 

“We look forward to learning more about CMS’s specific proposal when it is available,” Molina Health spokesperson Laura Murray said in an email, noting the insurer is “supportive” of efforts to improve health data portability.

Justine Handelman, the senior vice president of the office of policy and representation at Blue Cross Blue Shield Association, said the insurer has “long championed the development of a system in which a patient’s health information can be easily shared.”

“We fully support an interoperable healthcare system and we will continue to work closely with public and private sector partners to support this effort,” she said in an emailed statement.

Humana, WellCare, Cigna, UnitedHealth and Centene did not respond to emailed questions. Anthem and Oscar declined to comment.

America’s Health Insurance Plans said insurers are working on “new innovative ways” to share information, citing web portals, digital apps, telehealth and secure messaging as examples.

“We will continue to work closely with Administrator Verma and CMS on these types of initiative and we look forward to receiving additional guidance on Blue Button 2.0/APIs to ensure implementation enhances care coordination and makes care more efficient while also protecting patient privacy,” spokesperson Cathryn Donaldson said.

Part of that hesitancy may stem from a wait-and-see approach around what CMS expects when it wants insurers to “meet or exceed” the capabilities of Blue Button 2.0. Ryan Howells, a principal at Leavitt Partners, noted that payers are “willing to engage in a dialogue” about APIs and are “definitely interested” in helping to define any potential CMS requirements.

Howells said the CARIN Alliance, where he sits on the management team, is focused on developing industry consensus and defining what data elements health plans need to share with members.

“It’s early. The [call letter] just came out, but we haven’t encountered any payers yet who are not willing to exchange portal data via an API with their members,” Howells said, referring to the April Medicare Advantage call letter. “Most payers realize the tremendous value of getting a consumer more involved in their health.”

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