Beginning next year, Medicare claims data will be available to community stakeholders for the purpose of transparency and quality improvement, thanks to a health care data reporting provision in recently-passed legislation. MN Community Measurement is one of only a handful of organizations that are approved to share and compare that data.
Additionally, the legislation lays the groundwork for several exciting new opportunities for regional data collaborative organizations, such as MNCM, as Medicare moves further into value-based payment models.
MNCM is one of 12 “Qualified Entities” (QE) around the country. QEs have been certified by the Centers for Medicare and Medicaid Services (CMS) to receive standardized extracts of Medicare claims data and combine it with claims data from other payers to evaluate the performance of providers. To be certified, QEs mjust demonstrate their ability to protect the privacy and security of the claims data.
“Comparing data from Medicare to commercial and Medicaid payers provides a more holistic view of cost and quality in the health care system,” explained Jim Chase, President of MNCM. “We need that comprehensive view to make the systematic changes in health care delivery and payment models that we know are critical to reducing health care cost in Minnesota and our country.”
The QE program is an important first step in expanding use of Medicare data to drive improvement and value in the health care system; however, until recently, significant restrictions prevented QEs from using this data meaningfully. Last year, MNCM joined with several other QEs to recommend federal legislation to improve our ability to use Medicare data to benefit our communities. The language received bi-partisan support and was ultimately included in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), also known as the Sustainable Growth Act (SGR) fix, that was passed by Congress in mid April and signed into law shortly thereafter.
“This will allow us to realize the potential of quality reporting and demonstrate how having the right data can and will result in transformational change at the practice level,” explained Elizabeth Mitchell, President and CEO of the Network for Regional Healthcare Improvement (NRHI). Eleven of the 13 QEs, including MNCM, are members of NRHI.
The new legislation also places regional health improvement collaboratives, including MNCM, at the center of Medicare’s shift to value-based payment models by creating a role for “regional data intermediaries,” which would provide technical assistance to providers as they transition to alternative payment models. It specifically calls out regional health improvement collaboratives as one of a few appropriate entities to play this role. We will be discussing the implications of this new role with CMS over the coming months.
The changes to the QE program become effective on July 1, 2016.