Seema Verma Envisions a US Health System That Shares Data, Is Truly Value-Based

Creating a healthcare system that prioritizes a well-informed consumer and rewards improvements in quality requires overhauling the current system. Through a series of programs and initiatives, CMS, under Administrator Seema Verma’s leadership, is trying to fix some of the issues that plague the current US health system and make accessing care challenging for patients.

“Our current healthcare system is complex, opaque, and difficult to navigate for patients,” Verma told The American Journal of Managed Care^® in written responses. “Empowering patients starts with giving them better access to their own personal health data.”

Data sharing is one area where CMS is making strides. The US healthcare system has done a notoriously poor job of making data in electronic health records (EHRs) usable and easy to share.^1-4 Under Verma, CMS launched the Medicare Blue Button 2.0 program and overhauled the CMS EHR Incentive Programs. CMS also recently hired a chief healthcare informatics officer, who will help drive health information technology and data sharing, Verma wrote in a blog post when the role was first announced.

These changes are being implemented to create an easier system for patients to navigate, with data that flow seamlessly between patients and providers. In the past, Verma has recounted her own personal experience with the health system when her husband went into cardiac arrest during a layover at an airport. After going through numerous tests, getting a diagnosis, and receiving care, she and her husband had trouble getting the documentation so he could continue receiving care closer to home.

Verma noted that patients should be able to access their own health information as easily as they access financial information through mobile banking. Creating a system that allows for this sort of access and the ability to share data will mean not only that patients can be better engaged in their healthcare, but also that providers can deliver more coordinated care without ordering repeat tests, and researchers can access more robust data, which will lead to more personalized healthcare.

In addition to the programs and initiatives that have been implemented, CMS has unveiled the Interoperability and Patient Access proposed rule, which would require all Medicare, Medicaid, and federal exchange plans to share claims data and other important information electronically with patients.

“With all of those plans on board, by 2020, 85 million more patients will have access to their health claims information, in addition to the 40 million who already have access through Blue Button 2.0,” Verma said.

CMS is also looking to make regulatory changes to provide better care for patients by advancing value-based transformation. In order to have a value-based health system, providers need to be held accountable for cost and quality while having the flexibility they need without burdens caused by government regulations.

Verma identified the Stark law as an example of outdated regulations. When it was first enacted, the law “addressed real issues regarding the potential for financial incentives to inappropriately influence how physicians make decisions,” Verma said. Although it was important for providing safeguards in a fee-for-service system, it is hampering providers^5,6 when they have incentives to control volume and take accountability for costs.

“When payment is for outcomes, and not for services, providers need more flexibility to make referrals,” Verma said. “However, the safeguards put in place under the Stark Law limit providers’ ability to make referrals or coordinate care in innovative ways. Therefore, we are undergoing a top-to-bottom review of Stark Law regulations to ensure that they are encouraging, rather than hindering, the move to value.”

References

1. Oyeyemi AO, Scott P. Interoperability in health and social care: organizational issues are the biggest challenge. J Innov Health Inform. 2018;25(3):196-198. doi: 10.14236/jhi.v25i3.1024.

2. Thompson MP, Graetz I. Hospital adoption of interoperability functions [published online December 27, 2018]. Healthc (Amst). doi: 10.1016/j.hjdsi.2018.12.001.

3. Shah GH, Leider JP, Luo H, Kaur R. Interoperability of information systems managed and used by the local health departments. J Public Health Manag Pract. 2016;22(suppl 6):S34-S43.

4. Holmgren AJ, Patel V, Adler-Milstein J. Progress in interoperability: measuring US hospitals' engagement in sharing patient data. Health Aff (Millwood). 2017;36(10):1820-1827. doi: 10.1377/hlthaff.2017.0546.

5. Kanter GP, Pauly MV. Coordination of care or conflict of interest? Exempting ACOs from the Stark law. N Engl J Med. 2019;380(5):410-411. doi: 10.1056/NEJMp1811304.

6. Pollack R. Perspective: time to make Stark work for 21st century care. AHA Perspective. aha.org/news/perspective/2018-07-20-perspective-time-make-stark-work-21st-century-care. Published July 20, 2018. Accessed May 31, 2019.