CMS administrator Verma calls on insurers, providers to give patients their data

For the millions covered by Medicare, accessing their healthcare data ought to be simple – after all, the data belongs to them, according to Centers for Medicare & Medicaid Services administrator Seema Verma.

Earlier this year, CMS launched the latest version of the Blue Button initiative, a program designed to allow Medicare beneficiaries to collect their claims data and transfer it to secure applications, providers, services and researchers.

Verma called on private insurers to give the same opportunity to their patients, saying that the agency is going to reexamine their relationships with private payers.

She also floated another idea: should providers participating in the Medicare program be required to give patients their data?

“We’re doing it. We’re giving our patients our data. The expectation will be that other people are giving the data,” Verma told MassDevice.com recently at the World Medical Innovation Forum conference in Boston. “So we’re making it very clear to the industry that if you’re going to be in the Medicare program, these are the requirements. The patients’ needs are the most important.”

In recent weeks, the agency has signaled an interest in tackling drug prices and helping ensure that patients can access their own data – issues that are top-of-mind for Verma. But the problem that keeps her awake at night? How much money the U.S. spends on healthcare.

“We’re still on target to spend 1 in 5 dollars on our healthcare services,” she said at the forum last month.

In an attempt to cut costs across the industry and boost outcomes for patients, Verma and CMS – like many private insurers – are looking towards the promise of value-based payment models. She wants CMS to “move away from a system that’s pay for volume and towards one that’s paying for value,” she explained.

Verma said she wants to modernize CMS programs and reevaluate the way that the agency thinks about value, starting with giving patients more information when they interact with healthcare systems.

“Over the past years, we haven’t been able to bend the cost curve and I always think, ‘Where’s the patient in this discussion?’ We’ve all had the experience of going to a provider and not having information in terms of cost and quality,” she said.

Hospitals are already required under CMS guidelines to make a list available, upon request, of their standard charges. But in late April, CMS updated those rules, requiring hospitals to post that information. The agency also requested comment from stakeholders to identify ways that hospitals can create interfaces for consumers to compare providers.

Millions of people are covered by CMS – the agency is the single largest payer of healthcare in the United States. And the woman in charge of it knows that her decisions can move the needle on a number of trending topics in healthcare.

“If it’s not happening at CMS and it’s not happening through Medicaid and Medicare, it’s probably not going to happen nationwide,” Verma said.

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