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CMS passes rules allowing claims data to be sold

por Lauren Dubinsky, Senior Reporter | July 08, 2016
Population Health
Hoping to add valuable transparency
to the care continuum
CMS passed new rules last week allowing qualified organizations to share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups that can then use that information to improve care.

This initiative is part of the Obama Administration's efforts to leverage data to create a health care system that achieves the triple aim.

The rules enhance the Qualified Entity Program, which enables organizations that meet specific qualifications to access patient-protected Medicare data to generate public reports. The organizations have to combine Medicare data with other claims data to create reports that depict how providers and suppliers perform across different payors.

To date, 15 organizations have received approval to be a qualified entity. Out of these, two have completed public reporting and 13 are preparing for it.

The new rules allow the organizations to confidentially share or sell the analyses of Medicare and private sector claims data to providers, employers and other groups, as well as physicians, nurses and skilled nurse facilities.

For example, the organizations can conduct analyses on chronically ill or other resource-intensive populations to better the quality of care and cut costs in the health care system.

The rule has stringent privacy and security requirements for all organizations that receive the data as well as expanded annual reporting requirements. They are required to use protections that are at least as rigorous as the requirements for protected health information under the HIPAA Privacy and Security Rules.

Ultimately, the new rules are intended to promote innovative ways to use Medicare data for non-public quality improvement and care delivery.

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