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Data are essential to the Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation’s (CMS Innovation Center’s) mission to develop and test innovative health care payment and service delivery models. Accurate and comprehensive data can support model operations, including payment, enable the evaluation of model performance, and can be an important resource for model participants trying to transform care delivery. Additionally, one of the CMS Innovation Center’s goals is to test ways to better share data, with the aim of incorporating these lessons into other CMS programs, thereby improving the infrastructure of value-based programs.
The CMS Innovation Center leverages and shares data in several ways. We collect data from model participants, including clinical and quality data; we generate data during model operations, such as attribution lists or benchmarking files; we use CMS-wide data, such as Medicare claims data, and we share certain data with participants through claims files, analytics, regional aggregators, and accountable care organizations (ACOs) to drive better coordination with and management of specialty services, in accordance with the law and CMS policies. Sharing data with participants is particularly critical given the opportunity to enable the success of model participants in reducing expenditures and enhancing quality.
The CMS Innovation Center has already taken significant steps to improve how we share data. For example, we continue to release CMS Innovation Center model data through the CMS Virtual Research Data Center—to date, more than 20 models have released data through this mechanism. Additionally, the CMS Innovation Center recently made bundled-payment data available to ACOs as part of our specialty strategy. These data, which includes claims data for services, supplies, and their associated payments grouped into episodes of care, provide ACOs with insights into care patterns and support ACOs looking to develop their own payment initiatives. Another example is our work sharing claims data with regional data aggregation entities in support of our Primary Care First (PCF) model to facilitate event-alerting notifications (such as admission, discharge, or transfer messages) to PCF practices for PCF-aligned beneficiaries.
Given the role and importance of data to the work we do and to our model participants, we are advancing our data-sharing strategy with a primary goal of identifying additional data-sharing needs across CMS Innovation Center models that ensures proper security, risk management, and privacy obligations are employed in tandem with sharing goals. The data-sharing strategy can also provide a framework that may be useful for other payers, reducing the burden of participating in value-based care overall by facilitating multipayer alignment.