Verma: Move to value-based care slowed by lack of access to data

By | April 26, 2019

The value-based transformation in healthcare is not moving quickly enough, and a major reason for the industry’s slow adoption is the difficulty in obtaining health data.

That’s the contention of Seema Verma, administrator of the Centers for Medicare and Medicaid Services, who lamented the country’s lack of progress in transitioning away from fee-for-service.

“Value-based care means upending the current paradigm, and in my view, it’s not happening fast enough,” Verma said in a keynote on Thursday before the National Association of Accountable Care Organizations.

The CMS chief pointed out that just 10 percent of clinicians are participating in Advanced Alternative Payment Models (Advanced APMs) and taking on significant levels of risk.

“No wonder frustration continues,” Verma told the NAACOS conference. “Providers in value-based models need to know in real time how their patients are doing and where they should be targeting their efforts, but unless they can quickly obtain data on claims and quality from CMS and other payers and providers, they will not know how to succeed in a value-based paradigm.”

In addition, she commented that “providers also need data on the front end to help them understand how they’re doing before committing to a model.”

Seema Verma

Seema Verma

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“Technology, and the sharing of data, underpins the entire move to innovative payment mechanisms,” Verma observed. “Without effective, open data sharing, providers cannot keep patients healthy. Without data to track patient progress or understand quality, payers cannot tie payment to outcomes.”

To help drive the adoption of alternative payment models, Verma said CMS is modernizing its processes for data sharing.

“To reduce reporting burden for clinicians, we are encouraging the transmission of data via APIs wherever possible, while ensuring the privacy and security of patient data,” she noted. “For ACOs specifically, we have developed an API that allows providers to send data directly from their EHR system to CMS’s web interface. I am pleased to say that there were 104 ACOs, or about 16 percent of all ACOs in Medicare, using the API to submit quality reporting data for 2018.”

Further, Verma announced that this summer, CMS will be testing and rolling out a new monthly claims line API to enable ACOs to more easily receive monthly Part A, Part B and Part D claims data.

“That way, providers can track their beneficiaries’ healthcare utilization and spending at a granular level, and then modify a patient’s care plan in response,” she added.


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