CMS to Make Medicare Advantage Data Available

CMS to Make Medicare Advantage Data Available

Stratasan’s Physician Patterns to Offer Expanded Physician Referral Insights

By Dave Sellers and Jason Haley

As you may have heard, CMS Administrator Seema Verma announced that The Centers for Medicare and Medicaid Services is making Medicare Advantage encounter data, which covers provider identifiers, diagnoses and date and type of service, available for the first time to researchers.

This new effort is part of the CMS and White House patient data collaboration, known as MyHealtheData. CMS also plans to encourage Medicare Advantage programs to use release platforms that meet the capabilities of CMS' Blue Button 2.0 feature, which allows patients to access their own claims data. A patient-centered system requires focus on "data, quality data, cost data, a patient's own data," Vema shared.

How does this update affect Stratasan customers, and particularly, those in Medicare-only states: Alabama, Arkansas, South Dakota, Idaho, and Hawaii?

iStock-927809262

This data is being released through the VRDC, the same channel we use to provide Physician Referrals data. Meaning:

  • We’ll have access to additional volumes in our Physician Patterns product
  • We’ll be able to conduct more in-depth research of significant factors relating to physician referrals

We’ll have more insight as to how this will affect specific payors when the data comes out, but for Medicare-only states, this will notably increase coverage and insight of physician referrals. Medicare Advantage data will include commercial payers for the Medicare-eligible population (65+) allowing for increased opportunity to analyze the commercial payer mix of a market. Additionally, since Medicare Advantage is run by private companies, we expect that we’ll be able to better analyze the competitive landscape if the data lists out payer and plan names.

The release of Medicaid and CHIP (Children's Health Insurance) in 2019 will also expand data coverage for these populations by an additional 70 million individuals. Again, having particular benefit to states where the CMS data is the only statewide information available.

It’s important to note that we will not be able to generally interrogate this new information as fully as we can with state datasets. In the case of state datasets, the data has been purchased and can be used for whatever purposes desired, whereas our DUA authorizes for CMS data to only be used for the research purposes specified in the project application, in this case, as it relates to physician referrals.  

For more information about this new data release and how you can leverage it to improve your understanding of physician referrals in your market, contact your Customer Success Manager or reach out to support@stratasan.com. 

Leverage Data CTA

Blog post by Dave Sellers, Data Specialist and Jason Haley, Senior Manager, Customer Success for Stratasan

Connect with Stratasan on LinkedIn or follow Stratasan on Twitter and Facebook

physician referral data analysis data analytics healthcare data medicare healthcare market data healthcare data analytics physician patterns