Interoperability is crucial to improving health care and costs, but data flow between fee-for-service Medicare and Medicare Advantage has posed challenges for health plans, according to a recent Health Affairs opinion piece.
Medicare covers approximately 38 million Americans, making it the largest payer in the US.1,2 A greater number of those beneficiaries are choosing MA plans: 50% of enrollees could be in an MA plan as early as next year.3 “Traditional Medicare urgently needs to build a better way of exchanging data with MA plans,” the authors write.1
Medicare helped pioneer data exchange, and inroads to interoperability have been made through provisions in the 21st Century Cures Act, including the use of HL7 FHIR application programming interfaces to establish a base for exchanging information.1 The previous and current CMS administrators have both pledged to break down barriers to interoperability and ensure portability of patient health data. The authors concurred, arguing that policymakers “must embrace interoperability as a way to improve customers’ experience, not as another government mandate or ‘checking a box.’ ”1
A host of APIs developed in the past by the federal government have helped foster data exchange with the private sector, including Blue Button and MyHealtheData. The authors suggest that CMS use its authority to implement a new API that would share data from Medicare Parts A and B to Part C so MA plans can get a more complete picture of a potential enrollee’s claims history to ensure optimal care.1
CMS should leverage its knowledge and authority to launch a new “AB2C”API, which would signal its commitment to data exchange and interoperability, as well as help ensure continuity of care, the authors argue.1 “Releasing an AB2C API would not only give beneficiaries an easier way to share their Medicare fee-for-service history, it would also further accelerate the US toward the long-held dream of interoperable health data.”1
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References
- Anderson, Kirk; Dodge, David; and Kim, Oliver. To Share Data With Medicare Advantage, Medicare Must Go Further On Interoperability. Health Affairs. June 24, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20220622.471521
- Total Number of Medicare Beneficiaries by Type of Coverage. Kaiser Family Foundation. https://www.kff.org/medicare/state-indicator/total-medicare-beneficiaries/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
- The Medicare Advantage program: Status report and mandated report on dual-eligible special needs plans. Special Report to the Congress, Chapter 12. Medicare Payment Advisory Commission. March 2022. https://www.medpac.gov/wp-content/uploads/2022/03/Mar22_MedPAC_ReportToCongress_Ch12_SEC.pdf
