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

Seema Verma
Data portability has gradually emerged as one of Seema Verma's top three priorities. (Evan Sweeney/FierceHealthcare)

The Centers for Medicare & Medicaid Services (CMS) is considering a mandate for Medicare Advantage plan sponsors to adopt data-sharing platforms that can interact with Blue Button 2.0 beginning in 2020.

For now, the agency “encourages” health insurers to use data release platforms for members that “meet or exceed the capabilities of CMS’s Blue Button 2.0,” according to an announcement (PDF) this week that raised MA payment rates 3.4% in for fiscal year 2019.

Unveiled at the HIMSS18 annual conference last month, Blue Button 2.0 uses Fast Healthcare Interoperability Resources (FHIR) standards to allow app developers to deliver Medicare claims to beneficiaries. Following a speech in which she called on insurers to “give patients their claims data electronically,” CMS Administrator Seema Verma told a group of reporters that the agency would be “evaluating every single relationship” with insurers, including changes to the Medicare Advantage star-rating program.

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But it appears the agency is at least exploring a more rigorous approach that would require insurers to adopt platforms compatible with Blue Button 2.0. Verma has previously said insurers wanted that level of top-down pressure from regulators to share claims data with beneficiaries.

“I will tell you that when we’ve had conversations with insurance executives they’ve said, ‘You need to force us to do this,’” she says. “They’ve said that explicitly.”

Health data portability has gradually moved up Verma’s list of agency priorities over the last five months, according to an HHS official who wasn’t authorized to talk on the record.

RELATED: White House interoperability meeting focuses on regulatory relief, barriers to data sharing

That emphasis has been bolstered by physician complaints about EHR usability, along with a handful of meetings hosted by the White House Office of American Innovation focusing specifically on solving interoperability issues across the healthcare continuum. During the first meeting, officials discussed enhancements to the original Obama-era Blue Button initiative.

At the same time, Apple is making a strong push to get medical records in front of patients through its Health Records app, which also uses FHIR specifications to pull patient data from nearly 40 participating hospitals. Although it's still unclear whether Apple will add claims data to that functionality, doing so could prompt more providers to make their EHR data available to patients.