How CMS plans to 're-examine' its relationship with insurers to drive patient-centric data sharing

Humana building
Humana was one of two insurers that came out in favor of CMS initiatives to put claims data in the hands of patients. (Humana)

LAS VEGAS—After announcing new federal initiatives aimed at putting claims data in the hands of patients, the head of the Centers for Medicare and Medicaid Services (CMS) made a specific plea to insurers to follow the government’s lead.

“I call on all insurers to do as we have done today and give patients their claims data electronically,” CMS Administrator Seema Verma told HIMSS18 attendees.

To facilitate that shift, CMS plans to leverage its existing relationships with private insurers to make sure that same level of data sharing is happening across the industry, Verma told reporters after the announcement. She said the agency would be “evaluating every single relationship” with insurers by making changes the Medicare Advantage star-rating program to emphasize patient access to data while reviewing its contractual relationships insurers that provide Medicaid managed care and exchange plans.

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“You’ll see over the course of the year how we’re going to be re-examining those relationships and making it clear we expect insurers to get their information to their clients,” she said.

According to Verma, that approach is supported by insurance executives that actually asked for additional pressure from the agency.  

“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.”

Two insurers—Humana and Blue Shield of California—were quick to applaud the new initiative. Blue Shield of California announced that it would begin requiring providers participating in its Accountable Care Organizations to also participate in Manifest MedEx, California’s health information exchange. Blue Shield CEO Paul Markovich told reporters the only way CMS’ vision would work is if “we all commit to bringing healthcare into the digital age.”

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Meanwhile, Humana CEO Bruce Broussard said prior efforts to share claims data have been “hampered” by inefficient data sharing and a lack of standards, but the insurer has begun providing claims data through a digital platform. He added that the new CMS initiatives would be key to value-based payment models.

“Connected and integrated health IT is the future of care,” Broussard said in a press call. “We’re very excited about how this will transform healthcare to be much more consumer-based.”