CMS to release Medicare Advantage encounter data as part of new data-driven strategy

Seema Verma speaking at press conference
The Medicare agency is finally making good on its promise to release encounter data that it collects from Medicare Advantage. (whitehouse.gov)

The Centers for Medicare & Medicaid Services is planning to release encounter data from Medicare Advantage plans nearly a year after canceling a planned release that drew the ire of researchers. 

Seema Verma, administrator at the Centers for Medicare & Medicaid Services (CMS), announced that the agency is releasing the sought-after data during her keynote address at Health Datapalooza on Thursday. 

CMS has collected data from private insurers that administer Medicare Advantage plans since 2012 and began using it in 2016 to help calculate risk-adjustment payments but has not made the data public. The agency planned to release the first batch of 2015 data last June but canceled at the last minute, citing concerns about accuracy.

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That raised the ire of former federal officials and researchers, who have argued that if the data is reliable enough to use to calculate payments, then it's reliable enough for researchers to use to study the program's efficiency and the rapid growth of private plans. 

Medicare Advantage programs continue to grow and now encompass over one-third of Medicare beneficiaries. Private MA plans have also been pushed by the administration as a way to keep healthcare costs down.

RELATED: JAMA piece urges release of Medicare Advantage encounter data

Verma now says, 10 months later, that the 2015 data is ripe for release, even if it still has its flaws. 

"We recognize that the MA data is not perfect, but we have determined that the quality of the available MA data is adequate enough to support research," Verma told the audience. "Data has the potential to help produce better, more targeted treatments for these patients, improving their quality of life while at the same time reducing costs. Our hope is that this data will be used for critical research on this vulnerable population."

The CMS says it will release the MA data from subsequent years annually. Data from traditional Medicare is already available to researchers.

Additionally, the agency says it will release Medicaid and Children’s Health Insurance Program data in 2019. The CMS will also use data it collects from Medicaid for its first Medicaid Scorecard, planned for release later this year. 

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

The data dump is part of a newly announced "Data Driven Patient Care strategy" rolled out by CMS on Thursday. That approach relies on putting patients first, adopting an "API-first approach to data sharing" and increasing the amount of available data, Verma said. 

It adds to the agency's previous announcements regarding its MyHealthEData initiative and the rollout of Blue Button 2.0. Verma said Blue Button 2.0 is currently in production and more than 200 developers are experimenting with the API. 

"I have also called on all insurers to do what we’ve done and give patients their claims data electronically," she said. "And I urged everyone in the healthcare industry to dismiss the idea that they can deny patients’ access to their health records."

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