Two Data Fixes to Improve America’s Health Care System

Recently, Centers for Medicare and Medicaid Services Administrator Seema Verma publicly laid out an emphatic demand: The health care industry needs to use the increasing amount of health data available to improve outcomes and reduce costs.

Verma urged health insurers to follow the agency’s lead on making individual health data accessible to their own members. The administrator is absolutely correct.

America spends twice as much on health care administrative costs than any other country. The lack of easily accessible health data means doctors have trouble assessing a patient’s full health history; insurers can’t give accurate advice on claims management, and patients end up confused and upset. Worse, patients might not get the care they need. If health care providers, systems and insurers work together to ease patient data access, America’s health care system could get the modernization it desperately needs.

Today, patient health data is stored in numerous electronic health record and payment systems that rarely communicate with each other at the level of detail necessary to provide a comprehensive view of a patient’s medical history. Privacy consent documents are governed by a multitude of complex laws and rules, including CMS regulations, the Health Insurance Portability and Accountability Act, the Federal Trade Commission Act, and state privacy laws. With such a complicated infrastructure, it’s no wonder that a recent ScalaMed survey found that nearly 63 percent of Americans don’t know where their medical data is stored or who has access to it.

Health care should be easier, and there are two simple ways Congress and regulators can help make this happen.

First, we need a clear process for Americans to access and share their health data in a secure, transparent way. According to a Deloitte survey, 79 percent of Americans want to share their data when there is an obvious benefit to them, such as improving health outcomes. Applying a streamlined global consent system and compliance structure instead of having patients agree to each system would allow Americans to securely share their information.

This simplified system would also provide clinicians, providers and health plans the data necessary to improve quality and develop personalized interventions. This would not only simplify the process and eliminate confusion for a patient, it would also significantly speed up access to patient data.

Second, it should be easier for patients to control their personal health information. CMS should require entities that serve Medicare, Medicaid and other federal program beneficiaries to use trusted applications that allow their patients to share their data with providers, insurers and family members. In the technology space, we call such a tool an “application programming interface.” An API, much like a bank teller, can process your request and return valuable information in a timely, secure and standard way, without sacrificing the privacy of the owner of those assets.

In health care, electronic health records leveraging open APIs improve the ability for patients to access their own data in an effort to fill in potential gaps in treatment history and have insights about their personal health to make informed decisions, all while preserving patient privacy. For example, an individual can download his or her own data from the provider’s electronic medical record or the health insurer and allow a trusted partner to access that data. The partner can then recommend interventions leading to better health outcomes and decreased costs. A secure interface can facilitate large volumes of personal data — prescription data, electronic health records, laboratory tests and wearable device data — to be meaningfully organized and interpreted by trusted health care partners for the patient.

In making it easier to understand consent documents and requiring entities to use open interfaces that allow for the secure transport of data, regulators can make our complicated system much easier. That’s why we at Clover Health, a Medicare Advantage insurer, fully support Verma’s call to expand access to personal health data while ensuring it remains protected and private.

Fortunately, CMS made progress in creating a system that allows for secure data sharing by unveiling Blue Button 2.0, an interface that enables Medicare beneficiaries to connect their claims data to the applications, services and research programs they choose. The result is a platform that contains four years of Medicare Part A, B and D data that can be used by providers and beneficiaries themselves to improve health and reduce costs. Streamlining the way patient consent is given to initiatives like Blue Button 2.0 will enable all federal entities to more efficiently leverage this valuable information.

Under Verma’s leadership, CMS is stepping up to the plate to improve interoperability between health providers and payers and empower Medicare beneficiaries with access to their own information. Clover Health looks forward to sharing how our data analytics is improving health outcomes for our members. Together, we can scale these benefits across the entire health system.


Dr. Sophia Chang, a physician, is the chief clinical informatics officer for Clover Health and holds a master’s degree in public health. Calvin Chock is the chief product officer for Clover Health.

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