AMGA throws backing behind CMS pilot giving clinicians access to claims data

doctor using tablet
Access to timely Medicare and commercial payer administrative claims data is the most significant barrier to assuming risk and transitioning to value-based care, according to American Medical Group Association members. (Khunatorn/GettyImages)

While healthcare industry groups have pushed back against proposed interoperability rules from federal policymakers, the American Medical Group Association (AMGA) is voicing strong support for new Centers for Medicare & Medicaid Services (CMS) data sharing initiatives.

CMS' Data at the Point of Care (DPC) pilot, which was announced in July, would help expand access to administrative claims data for providers and their patients, AMGA President and CEO Jerry Penso, M.D., wrote in a letter (PDF) to CMS Administrator Seema Verma.

AMGA represents 450 multispecialty medical groups and integrated delivery systems comprising approximately 177,000 physicians.

The DPC pilot program will put claims data directly into the hands of healthcare providers and clinicians through application programming interfaces (APIs) via the Medicare Blue Button program, according to Verma, who announced the DPC pilot at the White House Blue Button 2.0 Developer Conference July 30.

RELATED: CMS launching pilot program to give providers direct access to claims data

The pilot program, which will start in September, builds on the agency's MyHealthEData initiative and Blue Button 2.0, two programs that CMS launched last year. MyHealthEData, led by the White House Office of American Innovation, focuses on giving patients more control over their health data. Blue Button 2.0 uses an Fast Healthcare Interoperability Resources-based API to give Medicare beneficiaries access to their claims data.

Through the DPC pilot, providers will have access to Medicare beneficiary claims data directly within their existing workflows through APIs. Access to a patient’s complete health record is crucial to managing a patient population and improving health outcomes, AMGA wrote.

"We believe that the MyHealthEData initiative will serve as powerful tool to help accelerate the transformation to a value-based system and will empower providers and integrated systems of care to continue to find innovative ways to improve health outcomes. The DPC pilot will provide an essential step toward to achieving these goals," Penso wrote.

Physicians have indicated that access to timely Medicare and commercial payer administrative claims data is the most significant barrier to assuming risk and transitioning to value-based care, according to AMGA surveys.

RELATED: CMS launches new initiatives to expand patient access to health data, plans ‘complete overhaul’ of Meaningful Use

A study published in the Annals of Internal Medicine found that while providers found access to claims data to be helpful in providing effective courses of treatment with patients, there were still challenges with care coordination.

The DPC pilot allows providers to access only Medicare beneficiary claims data. Physicians also need access to data for patients who are commercially insured, Penso said. If CMS' DPC pilot is successful, other insurers may follow suit, Penso wrote.

“Access to claims data from all payers has been a longstanding priority for AMGA and its members,” Penso wrote. “CMS’ latest initiatives support AMGA’s work by allowing providers to access Medicare claims data, and in effect, ensuring the successful transition from volume to value. If successful, CMS’ initiatives should inspire commercial insurers to follow suit in data sharing, a crucial step in delivering the most effective care for patients and improving health outcomes.”