CMS Builds on Success of Medicare Blue Button 2.0, Pilots Program to Give Clinicians Claims Data > Hospital Association of Pennsylvania

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CMS Builds on Success of Medicare Blue Button 2.0, Pilots Program to Give Clinicians Claims Data

August 01, 2019

A new federal pilot program will give clinicians direct access to claims data, a critical step to improving patient care.

The Centers for Medicare & Medicaid Services (CMS) unveiled “Data at the Point of Care” (DPC), which leverages Medicare’s Blue Button 2.0 data. Blue Button allowed Medicare patients to securely connect to a full picture of their care. Medicare Blue Button 2.0 lets patients connect their Medicare health information to other services, such as apps to keep track of regular tests and services or to track overall health. 

DPC will now give clinicians access to important claims data that provide a more complete patient history, with information like previous diagnoses, past procedures, and medication lists.

Clinicians will be able to access the DPC pilot data directly within their workflow. They will not have to log into another application. This streamlined approach reduces the burden in the exam room and gives clinicians more time to focus directly on patient care. 

CMS Administrator Seema Verma explained that “patient information often becomes trapped within health system silos, preventing patients from accessing their complete health information aggregated into one usable health record.” Doctors are sometimes left providing treatment solutions with incomplete patient histories. This gap can create care problems, duplicative tests, and unnecessary or costly treatments.

Clinicians participating in the DPC pilot program will be allowed to request a Medicare beneficiary’s claims data from CMS to get a full snapshot of their care including from other health care providers the beneficiary has seen.

CMS recently issued the Interoperability and Patient Access Proposed Rule. This proposed rule would require all health plans regulated by the rule to follow CMS’ lead with Blue Button 2.0 by making patient data available through an application program interface. This will make it easier to access, use, and share claims data for 85 million patients including those covered by Medicare Advantage, Medicaid, CHIP and health plans sold on the federal exchanges.

Clinicians who are interested in participating in the DPC pilot program can sign up through the CMS website. Blue Button information also is available through CMS.

If you have questions, please contact Kate Slatt, HAP’s senior director, innovative payment and care delivery.

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