CMS Announces Data RFI Around Data-Sharing, Targeting Medicare Advantage Plans

On Jan. 25, the Biden-Harris Administration launched a new effort to increase transparency around Medicare Advantage health plan service, announcing a data RFI—request for information—aimed at health plans participating in the Medicare Advantage program.

A press release posted to the website of the Department of Health and Human Services (HHS) began thus: “On December 7, the Biden-Harris Administration announced new actions to promote competition in health care, including increasing transparency in the Medicare Advantage (MA) insurance market and strengthening MA programmatic data. Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is continuing momentum in this area by releasing a Request for Information (RFI) to solicit feedback from the public on how best to enhance MA data capabilities and increase public transparency. Transparency is especially important now that MA has grown to over 50% of Medicare enrollment, and the government is expected to pay MA health insurance companies over $7 trillion over the next decade. The information solicited by this RFI will support efforts for MA plans to best meet the needs of people with Medicare, for people with Medicare to have timely access to care, to ensure that MA plans appropriately use taxpayer funds, and for the market to have healthy competition.

“Americans with Medicare who have managed care plans called Medicare Advantage should not feel like their health care is a black box,” said HHS Secretary Xavier Becerra, in a statement contained in the press release. “The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions. It deprives researchers and doctors of critical data to evaluate problems and trends in patient care. Transparency is key to the Biden-Harris Administration’s effort to increase competitiveness and ensure that Medicare dollars are spent on first-rate health care.”

And CMS Administrator Chiquita Brooks-LaSure said in a companion statement that “The Biden-Harris Administration is committed to improving the Medicare Advantage program. This Request for Information builds on our existing Medicare Advantage data transparency efforts to further align with Traditional Medicare and provide the data we need to ensure the growing Medicare Advantage program best meets the needs of enrollees.”

The press release went on to note that “CMS has already taken several steps to improve transparency in this market, outlined below, and the MA data RFI is the next step in these efforts. CMS is seeking data-related input from the public related to all aspects of the MA program, including access to care, prior authorization, provider directories, and networks; supplemental benefits; marketing; care quality and outcomes; value-based care arrangements and equity; and healthy competition in the market, including the effects of vertical integration and how that affects payment. We are also seeking comments on improving MA data collection and release methods. The RFI has an extended comment period of 120 days to encourage feedback from a wider array of stakeholders and to allow time for convenings and other efforts to synthesize detailed feedback to CMS.”

“In health care, you can’t improve what you don't know, and the way to know is with data. We need to have transparent Medicare Advantage data to see what’s working and what’s not working to inform our efforts to protect enrollees and drive high-quality care and competition,” said Meena Seshamani, M.D., Ph.D., CMS Deputy Administrator and Director of the Center for Medicare. “Through this RFI, we look forward to engaging all parties interested in the Medicare Advantage program.”

Among other elements CMS officials are working to collect more comprehensive payment data related to Medical Loss Ratios (MLRs), new data streams for supplemental benefits costs and utilization, new data collection and public posting requirements related to prior authorization, and new collection of race and ethnicity data. CMS has also increased requirements for the completeness of encounter data. CMS officials also want to obtain more complete and accurate reporting of encounter data by MA organizations.

The full text of the press release can be found here. And the RFI can be accessed here.