limited in terms of the population studied, are expensive, and can incorporate biases.1
Another health care trend that has implications for CMS’s data-related efforts is the ongoing shift of individual practitioners from solo and/or small group practices into care systems and networks. This realignment of providers and institutions could result in far more payments for bundled services intended to achieve defined outcomes. The efficiency and effectiveness of such an approach will depend on the collection and transfer of a great deal of data.
CMS is in the process of transforming itself to enable a focus on information collection and data management while still fulfilling its traditional mandates, including retrospective payment for health services for segments of the population. Several trends in health care illustrate the broad need for a more data-centric approach, including the diffusion of electronic health records (EHRs), practitioner positioning into care networks, and increased consumer access to and demand for health and medical information.
In aggregate, these trends in health care regarding data will interact in ways to produce both additional work and new requirements for CMS. Although the ultimate result is currently unknowable, the drive to achieve great value for health care for both individuals and populations is not likely to abate anytime soon, especially in light of the demographic pressures and the size of the financial investment the nation is making in health care services.
Data are essential to and underpin nearly all of the efforts CMS is undertaking—and data are an essential driver for the strategic technology plan advocated in Chapter 2, motivate the meta-methodology outlined in Chapter 3, and are a key impetus for the organizational changes discussed in Chapter 4. Gathering these data and sorting out how to make data available and to whom cannot be envisaged adequately until all stakeholders have been engaged and are contributing to an ongoing discussion. Doing that incremental engagement is part of the committee’s recommended approach and is essential to the development of mechanisms for future data management as an aspect of CMS’s new and changing relationship to data and information. In addition, CMS has to grapple with ensuring that only authorized users have access to data such as personal health information or other individual-level information.2
1 Sharon Begley, 2011, “The Best Medicine: A Quiet Revolution in Comparative Effectiveness Research Just Might Save Us from Soaring Medical Costs,” Scientific American 305(July):50-55.
2 While posing technical challenges, the question of who is authorized to access what sorts of data is a policy matter distinct from the technical challenges.