CMS Brings Integrated, Multi-Payer Claims Data Access to CPC+

January 13, 2017 - In an official blog post, CMS recently touted its success with improving primary care provider productivity by giving practices in the Comprehensive Primary Care (CPC) program more multi-payer claims data access.

The Medicare primary care program ended in 2016 after a four-year stint, but the federal agency plans to bring over and improve aggregated data reports under the Comprehensive Primary Care Plus model (CPC+), which launched this year.

“Aggregated data allows clinicians to get an overall snapshot of their patient population to identify care gaps and target areas for population health improvement,” wrote Patrick Conway, MD, CMS Acting Principal Deputy Administrator and Deputy Administrator for Innovation and Quality, and Pauline Lapin, MHS, CMS Innovation Center’s Seamless Care Models Group Director.

“It also reduces burden and saves staff time, which helps primary care clinicians focus on what they were trained to do: deliver high-quality patient care,” they added.

Through the CPC program, CMS partnered with commercial and state payers in seven regions to explore if multi-payer healthcare payment reform coupled with more claims data access and meaningful use of health IT would improve primary care and reduce healthcare costs.

The four-year initiative did reduce Medicare spending by approximately $57.7 million in 2015, according to CMS data from October 2016. But the program’s savings barely covered the $58 million in care management fees paid to participating practices that year.

The federal agency, however, designed the program’s claims data component in response to provider challenges with accessing claims data from multiple payers in a meaningful and less burdensome manner. Providers frequently reported limited data transparency because “clinicians often spend time sifting through multiple reports from different insurers, each with its own set of measures, and format, and much of the data is only applicable to a portion of the clinicians’ patients.”

A recent Health Financial Management Association (HFMA) report also shed light on the importance of integrated claims data access. HFMA stated that providers need access to raw claims feeds and aggregated management reports to identify unnecessary utilization trends and quality improvement opportunities.

However, the report noted that a lack of health IT standards and other healthcare interoperability challenges have prevented appropriate claims data access. Through the multi-payer CPC program, though, CMS partnered with other payers to establish data standards for integrated claims data reports.

In three of the regions, the federal agency and participating payers developed reports that integrated patient data from multiple payers into one report for primary care practices in the region. Data aggregation specialists also worked with payers to blend information from different sources and streamline data delivery.

Conway and Lapin noted that the reports also used patient privacy protections to ensure the “highest level of security of the health information.”

In the blog post, a CPC participant Austin Bailey, MD, Medical Director of University of Colorado Health, stated that the aggregated claims data reports were a “much anticipated solution to the complexities posed by not having access to consistent claims data, and a continuous desire to improve our approach to meeting CPC Milestones [program requirements].”

Bailey added:

“Our practices will continue to leverage the use of aggregated claims data using Stratus [the tool for practices in Colorado] to identify the cost patterns of high risk patients — for example, among our patients with diabetes, is the greatest cost associated with specialists, emergency department utilization, or medications? Having this information across multiple payers makes it more relevant and helps to build our confidence in selecting the appropriate interventions, identifying trends, and effectively assigning care management resources.”

While the CPC program may have ended, CMS intends to improve aggregated claims data reports in the program’s new phase, the CPC+ model. The next phase of the model expanded to 14 regions and includes over 50 commercial payers and state Medicaid agencies.

“We expect that aggregated data reports will be a top priority for CPC+ practices and partner payers and we look forward to the opportunity to build on the tremendous success we’ve had with data aggregation in CPC,” concluded Conway and Lapin. “Public and private payers working in partnership with primary care clinicians, engaging patients, and delivering the right data and information is essential to improving our health system and the care delivered to patients.”