CMS Opens Big Medicare Data

July 13, 2016

Categories: Thought Leadership


Big data has long been hailed for its enormous potential to change the way we deliver health care. Think about it: just about everyone uses health care and in doing so, generates huge caches of data.

The Centers for Medicare & Medicaid Services (CMS) is taking an unprecedented step to improve healthcare claims processing, announcing it has established a new rule that “allows approved organizations to confidentially share or sell analysis of Medicare and private sector claims data to providers, employers, and other groups that can use the data to support improved care.”

Here’s an example of how this will work. Let’s say you have symptoms that lead you to believe you have the flu. So you head to your doctor and he confirms that yes, you have the flu and can expect to spend the next week on the couch recovering. He or she will write you a prescription for some medicine, which you will head to the pharmacy to fill.

That might seem excruciatingly normal, but in even the most average health care interaction there is a litany of data. For starters, there is your personal information (age, gender, height, etc.). Then there is the diagnosis (flu, this time), the treatment type (maybe Zanamivir), and the cost and payment method (private insurance, Medicare or Medicaid, etc.). And that’s just one example out of millions.

If you could combine all of that data you would have a powerful database to analyze. Data scientists relish these data treasure troves, and patients should too. It’s overwhelmingly likely that weaknesses in the system – as millions of similar interactions are analyzed – would be spotted so insurers, care providers and lawmakers (if necessary) could increase efficiency to deliver better care at less cost.

The problem, as we’ve discussed many times before on this blog, is sharing protected health care data is not as easy as it sounds. There aren’t many incentives for the disparate entities that house the data to work together. There are also serious concerns about the security of personal data.

The government can’t force private entities to share data, but this step clears the path for cooperation (in part by allowing information to be sold, which provides increased incentive). It’s just the latest in CMS’ effort to more seamlessly integrate the delivery of care.

We’re excited to see how quickly the industry reacts to CMS’ new rule. We’ll be following closely. In the meantime, tweet us your thoughts by finding us on Twitter @CNSIcorp.