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CMS proposes sharing claims data with providers, employers to improve care

New rules are anticipated to allow organizations -- those approved as qualified entities -- to confidentially share or sell analyses of the data.

Jeff Lagasse, Associate Editor

The Centers for Medicare and Medicaid Services has proposed new rules it expects will expand access to analysis and data that helps employers and providers make more informed decisions about care delivery.

As required by the Medicare Access and CHIP Reauthorization Act, the new rules are anticipated to allow organizations -- those approved as qualified entities -- to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and anyone else who can use that data to improve care. Those qualified organizations will also be allowed to provide or sell claims data to providers.

The rule also outlines strict privacy and security requirements for any entity receiving Medicare analysis or data. Additionally, there will be new annual reporting requirements.

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"Increasing access to analyses and data that include Medicare data will make it easier for stakeholders throughout the healthcare system to make smarter and more informed healthcare decisions," said CMS Acting Administrator Andy Slavitt.

The qualified entity program, authorized by the Affordable Care Act, allows qualified organizations access to patient-protected Medicare data to produce public reports. Such entities must combine the Medicare data with other claims data, such as private payer data; this enables them to produce quality reports representative of how providers and suppliers are performing across multiple payers (Medicare or Medicaid, for example, or various commercial payers).

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To date, 13 organizations have applied for, and received, approval to be a qualified entity. Of these, two have completed public reporting. The other 11 are preparing for that.

The new rules, said CMS, aim to bolster the current qualified entity program, allowing for more innovating uses of Medicare data for non-public uses, while at the same time ensuring the privacy and security of beneficiary information.

Twitter: @JELagasse