AMGA supports CMS’ claims data pilot program, asks that it be expanded

The American Medical Group Association is expressing support for the Centers for Medicare and Medicaid Services’ Data at the Point of Care pilot program.

The initiative to give physicians access to Medicare beneficiary claims data directly within existing workflows using application program interfaces, or APIs.

“We believe that the supporting MyHealthEData Initiative will serve as a powerful tool to help accelerate the transformation to a value-based system and will empower providers and integrated systems of care to continue to find innovative ways to improve health outcomes,” said Jerry Penso, MD, president and chief executive officer at AMGA in a letter to CMS Administrator Seema Verma.


“We believe the creation of the DPC pilot is a critical step in ensuring that providers and systems of care deliver the next level of high-performance Health,” Penso added in the letter from AMGA, which represents 450 multispecialty medical groups with 177,000 physicians.

The rationale of the DPC pilot is that providers can’t easily access patients’ full health records, and Penso notes that successfully managing a patient population requires having access to claims data to determine the appropriate course of action to improve outcomes.

“Without this data, it is challenging to manage the cost and quality of care to a patient population, which is a goal of value-based care,” Penso tells Verma. CMS, Penso says, understands clinicians need access to Medicare beneficiary claims data to reduce physician burden in the exam room and permit more time for physicians to be providing care.

Now, however, also is the time to give to providers claims data from all health insurers, Penso contends. In surveys, his members express concern with the lack of timely access to Medicare and commercial payer administrative claims, which Penso on behalf of AMGA, cites as the most significant barrier to assuming risk and transitioning to value-based care.

“While AMGA understands that the DPC pilot allows providers to access only Medicare beneficiary claims data, our members also require access to data for patients who are commercially insured, which is out of CMS’ purview, Penso tells Verma. We anticipate that if this DPC pilot is successful, other insurers will follow your example and further move our healthcare system to one based on value.”

CMS further should consider working with providers in the pilot to study the challenges of using claims data in coordinating care across the fee-for-service Medicare program, Penso advised.