As purchaser, CMS seeks more data, higher value return

The Centers for Medicare & Medicaid Services (CMS) want value out of what they are purchasing, and thus increasingly will expect states to share more data on the care delivery of the 65 million Medicaid beneficiaries nationwide, said Jessica Kahn, MPH, director of the Division of State Systems at CMS at the State Healthcare IT Connect Summit on April 1.  

The agency wants to know who is enrolled, care utilization patterns, who the Medicaid providers are and overall care delivery patterns. These metrics can offer details on 30-day hospital readmission rates, medication adherence and health outcomes. “The idea is to really start to look at states for the value of what we are purchasing.”

Also, on a macro level, the agency is looking to understand enrollment patterns and service delivery patterns sliced by state delivery model.

Kahn said other data desired include information on waiver authority and state plans, Transformed Medicaid Statistical Information System (T-MSIS) data and performance measures, and Medicaid Budget and Expenditure System reported savings and expenditures. “I want to know what the average Medicaid IT and system design costs are,” she said.

“The idea is having a better way of accomplishing what we want to do, and knowing the benefits to CMS, the state and the consumer. We are at the point when negotiating with a state that we are able to look at a number like $750 million for systems that underpin an enterprise, and we want to talk about what we want to get out of that,” she said.

Challenges do exist, including lack of timeliness with encounter and claims data and differing datasets between states. But Kahn said states will increasingly be held accountable. “A little foreshadowing is that we won’t pay you to operate systems if you can’t give us data on what you’re doing. That’s good news for vendors, who can come up with dreams on how to make it happen for states.”

Kahn said that CMS does not want to hoard data, but share it with other states for benchmarking. Also, the agency intends to offer more guidance, technical assistance and more support for open source.

“This whole thing about ACA is that it’s not just about getting people covered. It’s about getting people covered so we can see what we can do about costs. Membership doesn’t mean anything if we have no idea if people are getting healthier,” she said.

Kahn encouraged connections between HITECH and the marketplaces “to enable data to move in the way you want it to move” and connections between marketplaces and Medicaid managed care and connections between Medicaid IT enterprise with health and human services and health information exchange.

“Don’t let these be separate silos,” she said.