Anthem, Humana along with Apple and Google testing API for patient access to claims data

Anthem headquarters
Major payers and big tech companies have agreed to perform real-world testing of an API to facilitate patient access to claims data. (Anthem)

While announcements from the Centers for Medicare & Medicaid Services and major tech giants took center stage at the Blue Button Developers Conference on Tuesday, another initiative was announced that could potentially have huge implications for patients getting easier access to their claims data.

The Carin Alliance, a private sector collaboration made up of major health insurers, providers, health IT companies and tech giants, announced at the conference that it has developed a data model and draft implementation guide to standardize claims data sharing with the aim of making medical claims data easier to access for patients.

The CARIN Blue Button data model and draft implementation guide, developed by a working group within the organization, includes more than 240 claim data elements that have been agreed on by multiple regional and national health plans, the organization said.

Whitepaper

Elevate Health Plan Member Engagement Through Call Center Transformation

Learn how health plans can rapidly transform their call center operations and provide high-touch, concierge service to health plan members.

These data elements are included in a common payer consumer data set. The Carin Alliance said it has taken these data elements and mapped them to HL7 Fast Healthcare Interoperability Resources to better assist health plans to implement the CMS interoperability and patient access proposed rule.

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

It builds on CMS' Blue Button 2.0 launched last year. CMS says the program gives 44 million Medicare fee-for-service beneficiaries digital access to their historical claims information through an app of their choice. 

Twenty organizations—including Apple, Anthem, Blue Cross Blue Shield, Cambia Health Solutions, Google and Humana—have agreed to perform “real-world testing” of the API to prepare for a broad product launch of the data standard in 2020.

"In 2020, our vision is to enable consumers to access, aggregate and manage their data freely, in a timely and secured fashion," Cambia Health Solutions CIO Laurent Rotival told FierceHealthcare. "Standardized data sharing will empower individuals to access their data in a secured and trusted way, anytime, anywhere and in a universal machine-readable format. Individuals will be able to authorize third-parties to access their data on their behalf."

Other organizations involved include California health information exchange Manifest MedEx, Microsoft, Pittsburgh-based UPMC Health Plan, Marshfield Clinic Health System-Security Health Plan, Prominence Health Plan and the states of North Carolina and Washington.

The data model and guide would set standards for sharing claims data with third-party developers to ease health data exchange, the Carin Alliance said in a press release. 

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

When consumers have access to all their health data, they are in a better position to make better decisions about care and treatment, Rotival said: "Open data sharing across the industry will ultimately help consumers achieve better health outcomes and reduce costs."

Patients and caregivers bear the burden of information silos in healthcare, Manifest MedEx CEO Claudia Williams told FierceHealthcare. The organizations involved in testing the API are committing to making it easier for patients to access their own digital health records, she said.

She also noted that tech giants Amazon, Microsoft, Apple and Google are building tools and infrastructure using open standards and often open source technology. "They recognize that inertia is the common challenge in health," she said. "We will overcome it by working together to create a new innovation ecosystem."

The Carin Alliance also plans to work with standards development organizations, health plans, state Medicaid agencies and third-party applications to continue to refine the data mapping, define the specific value sets, and develop a reference implementation to enable real-world testing later this year.

Suggested Articles

Nearly 10,000 patients involved in research studies were impacted by a third-party privacy breach that may have exposed their medical diagnoses, test results…

Employers looking to continue investing in their wellness programs are eyeing services targeting mental health and women’s health, a new survey shows.

Payers have made strides digitizing and automating many core processes, yet prior authorization remains a largely manual, cumbersome process.