Bennet Urges More Access to Medicare Data to Help Reduce Costs, Offer Better Care

Colorado U.S. Senator Michael Bennet today urged the Senate Finance Committee to explore options to expand access to Medicare claims level data to help evaluate doctor and hospital performance and find innovative, more effective, and less expensive ways to offer health care to patients.

The Affordable Care Act already permits certain “qualified entities” access to this data to evaluate and report on the performance of health care providers, however only nine organizations across the United States, including one in Colorado, are currently qualified entities and are extremely limited in their use of Medicare data. Expanding access to the data and the allowable uses will help get a bigger picture of how providers stack up against each other in terms of cost, quality of care, and other factors.

“Accessing and evaluating health care data is one of the major ways to lower health care costs,” Bennet said. “Doctors and hospitals can greatly benefit by learning where to make performance improvements, which can only benefit Coloradans. If the Medicare program spends time collecting data, we should ensure that this translates into a meaningful way to benefit patients and providers, and ultimately lower health care costs while improving quality.”

Full text of the Letter:

December 3, 2013

Dear Chairman Baucus and Ranking Member Hatch,

I would like to thank you for your work on the discussion draft of the SGR repeal, especially the section expanding the use of Medicare claims level data (“data”) under the “Qualified Entity” program.  Although the current proposal is a step in the right direction, I believe that we can expand the use of data further in a secure and transparent manner. It is my hope that we can work together to find a way to expand both the number of qualified entities as well as the allowable uses of data.

The Finance Committee should explore options that will increase the number of qualified entities.  Currently, this number is inadequate to generate the intended public benefit of the statute.  Because “qualified entities” generally cover a limited region, the low enrollment must be improved in order to generate a nationwide benefit.  The “Qualified Entity” program should create avenues for sustainable business models, enabling entrepreneurs, consumer organizations, and businesses to use this data to drive down health care costs.  By increasing the number of qualified entities, we can increase transparency and quality.

The Finance Committee should also explore options to expand the allowable uses or users for the data beyond reports on provider and supplier performance.  These expanded uses should be limited to providers and organizations that agree to use the data to improve the quality of care and are in compliance with all statutory and industry privacy standards.

There are several significant benefits to this structure.  First, comprehensive claims level data will be available to smaller and regional entities, including providers and hospitals.  As a result, the analysis generated will be more reliable.  The revenue generated from subscriptions could also encourage entrepreneurs and emerging companies to become qualified entities.  This would have the effect of increasing enrollment into the program in the short and long term.  Finally, because “cleaning up” raw claims data would take significant time and be resource intensive, this will increase the quality of data available for analysis.  The revenue generated will help keep the “qualified entities” model sustainable, ensuring that the intended public benefits will also continue.

The previous law regarding Qualified Entities sought to ensure that downstream businesses and insurers could have enough data points to develop accurate profiles of providers. For example, in one system, one provider may be viewed as low quality and high cost, while in another the same provider may be viewed as efficient and higher quality. With thoughtful modifications to the current program, I believe we could see this shared intent become reality.

Thank you again for your commitment and work on this issue.  I look forward to working with you to find a solution.