On July 30, CMS Administrator Seema Verma spoke at the Blue Button Developer Conference at the White House and announced a number of policy developments to highlight and celebrate the 54th birthday of the Medicare program. We focused on the following statement:

To make it easier for providers to participate in risk-based contracts, and to ensure that they can effectively manage spending, providers need to have data on all their patients to understand how they are moving through the healthcare system and using services.” S. Verma

We agree!  And, in fact, we believe that providers participating in risk-based contracts should demand to have data on the cost and clinical specifics of all the elements of the care that’s been provided to patients for which they are financially responsible.

Administrator Verma went on to recount recent developments that allow CMS to share claims data with ACOs through its Beneficiary Claims Data API (BCDA) which will eventually supplant the Claim and Claim Line Feed (CCLF) currently provided to ACOs participating in the Shared Savings program.

“Earlier this year at HIMSS we announced the Beneficiary Claims Data API. This API is an improved way for CMS to share claims data with ACOs. It’s a key first step in enhancing data sharing to drive value-based care and increase participation in new payment models.”

These developments excite us.  As the Next Generation ACO model, now in its fourth year with the third year of performance history expected by month end, continues, information sources that can be integrated into the point of care are vital.  While FRG has developed significant expertise in the processing and analysis of attribution, claims accumulation and network performance of the CCLF data set, the sharing of information outside of the clinical workflow limits effectiveness and can, unfortunately create conflict between finance managers and clinicians when risk is not perfectly aligned.  Or, worse, it’s just ignored.

“Today’s announcement is a critical step in our efforts to change provider reimbursement and move towards value. Providers often struggle to have a complete picture of a patient’s medical history, including procedures, medications, and preventive services. And patients carry the burden of remembering their health information at each and every encounter. “

FRG has experience working with clinicians who are financially accountable for the total cost of care and are able to review total cost of care analysis in the context of diagnostic history data.  Better, of course is to have a workspace that brings these two disparate data sets together and, because provider compensation is linked to watching both sides of the equation, making care decisions with the patient and a complete picture of value of each choice.

The gap for a long time has been the standards in technology, and the perfusion of working ones into the marketplace, to make this possible.  Administrator Verma’s emphasis on the HL7 FHIR standard suggests that change is coming.

“By leveraging the FHIR Bulk spec, Data at the Point of Care ensures that providers can access crucial data and insights on their patients. We did it for ACOs, and now we’re doing it for all doctors.”

FRG is excited to welcome more providers into the value-based and risk-based care marketplace and agrees that this sort of action is important, the true course, and urgent for our nation’s financial strength.

For the complete remarks by Administrator Seema Verma at the Blue Button Developer Conference, follow this link: