CMS
Administrator Seema Verma discusses the intersection between artificial
intelligence, price transparency, and patient empowerment.
April 10, 2019 - Artificial
intelligence will play a key role in fostering patient empowerment, improving
consumer decision-making, and ultimately reducing healthcare spending, says CMS
Administrator Seema Verma.
As CMS works to arm
patients with the data they need to make cost-effective decisions about
services and spending, artificial
intelligence will become increasingly important for
identifying opportunities for improvement and supporting meaningful decisions
at – or before – the point of care.
“We are at a turning
point in terms of how we can use data to support improvements to the healthcare
system,” Verma said to HealthITAnalytics.com in an exclusive
interview at the 2019 World Medical Innovation Forum. “The timing is
right for true digital transformation.”
“Artificial
intelligence is maturing. Data interoperability is starting to improve.
The drivers of consumer-focused healthcare are getting stronger,” she said. “We
need to use this new set of tools and motivations to equip patients and their
providers with the information they need to make good decisions.”
USING
REGULATION TO DRIVE INNOVATION
CMS is laser-focused
on increasing data interoperability between providers as well as making
personal health records much more portable for patients.
Using “every lever” at
its disposal, the regulatory agency has released a rapid-fire
series of proposed rules and finalized programs aimed at pushing the industry
toward becoming a much more open data-driven ecosystem.
In addition to the
recent overhaul of
meaningful use, now known as the Promoting Interoperability programs, CMS
started requiring
hospitals to publicize their chargemaster pricing data
starting January 1.
Its latest proposal
around information blocking has caused a bit of
a stir among health systems and EHR vendors wary of the
potential impacts of the sweeping rule, but Verma believes CMS has the
responsibility to keep driving providers forward.
“Data transparency
and pricing transparency are essential for achieving the goals we have as a
health system,” stated Verma. “We have one of the best healthcare systems
in the world, but we pay a lot, and our outcomes aren’t are not always the
best.”
“If we look at how we
can bend that cost curve and improve on quality, patients have to be at the
center of everything. In order to keep patients at the center of care,
they have to have access to their own data.”
Giving patients
access to their personal information can have immediate and impactful results,
Verma asserted.
“Earlier today I met
with OpenNotes,
and they were talking about some of the work they’re doing around medication
adherence,” she said. “They could show that when people had access to
their records, costs were lower and adherence rates were higher. We want
to expand on that by making data much more available than it is right
now.”
“If we match access
to the personal health record with access to cost and quality data, we have a
real opportunity to improve consumer decision-making and make a significant
contribution to costs and outcomes.”
LEVERAGING
ARTIFICIAL
INTELLIGENCE TO MAKE SENSE OF THE DATA DELUGE
All of that data
flooding across the care continuum will need to be filtered through
applications that offer simple, clear, and actionable interpretations of
pricing, quality, and outcomes information for both patients and policymakers.
That is where
artificial intelligence comes in.
CMS recently announced the launch of the
Artificial Intelligence Health Outcomes Challenge, an industry competition with
a $1 million top prize for the application that can best predict unplanned
hospitalizations and skilled nursing facility admissions.
“Our moves around
interoperability have made it clear that patients need access to their data,
but we want researchers to have appropriate access, as well,” said Verma.
“CMS has released a lot of data around Medicare Advantage, which hasn’t been
done before. This year, we are hoping to release Medicaid data,
too.”
“We’re doing this in
order to push the idea that this data should be productive for providers, and
the AI Health Outcomes Challenge is part of that.”
Preventable hospital
admissions and skilled nursing utilization are two extremely high-costareas of care, Verma
added.
“We want these AI
innovators to take all of this data and analyze it to pinpoint and predict
which patients have a high likelihood of an inpatient admission or a nursing
home admission – and then give providers the ability to take action to prevent
that.”
“This is just the
beginning of how we envision AI impacting the healthcare industry. There are so
many ideas about lowering costs and improving health outcomes, so it’s a very
exciting time for digital innovation.”
REEVALUATING
PRIVACY AND SECURITY IN THE BIG DATA ERA
Privacy and security are always top
of mind for CMS, but securing sensitive information will become an even
bigger challenge as data begins to move more freely between disparate systems,
Verma stressed.
“Privacy and security
are the most important thing to think about,” she said simply. “Patients
need to have a really good understanding of where their data is going and how
it’s being used, and they need to be in control of all of it.”
“When I think about
creating policy, I’m thinking about how I would feel about who might have my
data and what they’re doing with it. We’re all patients at the end of the
day, so our motto of putting patients first is also personal.”
CMS recognizes that
crafting a new data-driven ecosystem may require a reexamination of older data
protection protocols.
“For a lot of people,
healthcare data is much more sensitive than their consumer data, and it must be
protected much more heavily. We’re going to need to work on our HIPAA
privacy protections and how those are applied in an increasingly interoperable
environment,” said Verma.
“If data is being
generated by or moving to entities that are not necessarily covered by HIPAA,
we need to think about that, too. We’ve started to have conversations
with legislators about those issues, and it’s something with definitely need to
look at.”
CHARTING A
COURSE FOR AI-DRIVEN PATIENT EMPOWERMENT
Data liquidity,
artificial intelligence, and empowered patients will combine to produce a health system can that
offer better outcomes at a lower cost, Verma believes.
“Price transparency
is important, but so is making that data actionable and meaningful for patients
through applications that present the information in an understandable way,”
she said. “Artificial intelligence is likely to be a huge part of that.”
“Ideally, I’d like
patients to be able to pick up their phone and say, ‘I need this type of hip
surgery, and this is where I live,’ and instantly get access to the places nearby
that offer the surgery, the price it will cost, and the quality associated with
each provider.”
“I want it to be as
simple as picking up a device and opening an app, then going to that provider
and bringing all your health information with you.”
That level of
simplicity and accessibility will also bring benefits to providers, she continued,
especially as more and more organizations embrace value-based care.
“If a provider could
easily refer a patient to the lowest-cost place to get a routine x-ray, that
will do a lot to start cutting costs,” she explained.
“For more complex
care, we want providers and patients to be able to make the decision that yes,
this other place might be more expensive, but the quality of the outcomes is
higher, so maybe it’s worth the extra cost. Those informed decisions are
the key to starting to reduce low-value spending.”
The healthcare
industry has a lot of work to do before it becomes a turn-key consumer
experience, the Administrator acknowledged. But providers, regulators,
and developers are making good progress towards eliminating some of the most
challenging pain points affecting patients, and the best is yet to come, Verma
said.
“We need to start
having these conversations, and we will need to keep having them for some
time,” she said. “I think we’ve all, unfortunately, had the experience of
just being told what to do. We’ve probably all been in healthcare
situations where we feel like we don’t have all the information we need.”
“But if we can
empower patients with information, they can do more about making the decisions
that are best for them, and we can move towards the ideal state for the
industry very quickly.”
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