CMS Grants Full Access To Medicare Claims Data
By Christine Kern, contributing writer
The Health Care Cost Institute becomes the first ‘Qualified Entity’ and can now track and report on Medicare provider care costs and quality in all 50 states.
The Health Care Cost Institute (HCCI) has announced the Centers for Medicare & Medicaid Services (CMS) has certified HCCI as the first national “Qualified Entity” (QE). This makes HCCI first organization to have full access to national Medicare claims data for reporting on the costs and quality of healthcare services, allowing it to expand its health plan data set and offer the most comprehensive information available about the price and quality of healthcare services.
Created as part of the Affordable Care Act, the Qualified Entity Program permits select organizations to combine Medicare Parts A, B, and D claims data from CMS with other payer data to evaluate the performance of providers, services, and suppliers in the healthcare sector, among other things. As a Qualified Entity, HCCI will have access to 100 percent of the nation’s traditional Medicare claims data and about 40 percent of Medicare Part D prescription drug claims data. HCCI also currently holds data on roughly 40 percent of the Medicare Part C (managed care) population.
The HCCI was established in 2011 as a non-profit, independent, non-partisan research institute with support from Aetna, Humana, Kaiser Permanente, and UnitedHealthcare. Its mission is to promote independent, nonpartisan research and analysis on the causes of the rise in health spending.
Presently, HCCI has complied one of the largest private health insurance claims databases available for public reporting and academic research purposes. HCCI intends to convert its access to the Medicare data to a research license to pursue a broad research agenda using the combined dataset containing information on more than 100 million individuals.
“The addition of comprehensive Medicare claims data will now afford HCCI a unique and unprecedented opportunity to track and publicly report on healthcare trends using both public and commercial data,” said the institute according to HealthData Management. “Moreover, HCCI intends to convert its access to the Medicare data to a research license to pursue a broad research agenda using the combined dataset containing information on more than 100 million individuals.”
“The national Medicare cost data set will be a powerful addition to the HCCI transparency initiative, providing essential information to help us better understand what is needed to improve the quality and performance of the U.S. health system,” according to David Newman, executive director of HCCI. “Public reporting, as permitted with these data, when combined with cost and quality data from commercial health plans and state Medicaid data will represent the most credible information source for consumers, regulators and employers on healthcare cost and quality variation.”
Healthcare costs have been rising more than three times as fast as wages. Official estimates project that U.S. health spending will reach $4.7 trillion by the end of the decade – an 80 percent increase from $2.6 trillion in 2010 – underlining the need to better understand the prices of healthcare services to help make decisions and choices about purchasing care.
Other major commercial carriers have expressed interest and HCCI expects additional carriers to participate in the near future and be part of the initial release in early 2015. The cost data will be supplemented with quality and other information to provide consumers a transparent and comprehensive destination to make more informed decisions about healthcare.
In May, HCCI announced that it will create and administer an information portal that will provide consumers, employers and regulators free access to consistent, comprehensive information about the price and quality of healthcare. Aetna, Humana, and UnitedHealthcare have agreed to provide information on healthcare costs to HCCI. Other participating commercial insurers will be announced soon. The new online tool is expected to be available in early 2015.