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Three federal agencies recently released a model data-sharing agreement describing how far states can and can’t go in sharing Medicaid, public health, and other types of information. The move is part of the federal government’s push for state Medicaid programs to expand their role beyond claims payers to being data-driven, outcomes-oriented advocates for their beneficiaries.
To help the cause, the federal government is willing to free up existing categorical funding for health care programming. States that follow the government’s recommendations for "mission oriented" programs stand the best chance of seeing their grants funded.
The obstacles to combining Medicaid data with information from other health agencies are legion and long-standing. Government officials face regulatory hurdles, real and imagined, from laws and regulations that protect the confidentiality of patient-specific data. Linking databases is a technically complex task that depends upon the presence of a common field, usually a unique patient identifier. Turf battles over the use of data can sabotage even the best-crafted and worthwhile projects.
An initiative from the Health Care Financing Administration (HCFA), which administers the Medicaid program, and the Health Services Research Administration and the Centers for Disease Control and Prevention, which oversee many of the nation’s key public health initiatives, provides a map for state agencies on that rocky road to collaboration.
"Frankly, in HCFA, we have been urging the states to move into more of a public health mode in managing the Medicaid program," says Stanley Nachimson, a technical director in the data and systems group within HCFA’s Center for State and Medicaid Operations.
"It’s not just paying claims, enrolling beneficiaries, and enrolling providers. It’s making sure they’re getting quality health care and value for their dollars, especially in contracting with managed care plans."
The model agreement focuses on the statutory and administrative constraints involved in sharing Medicaid data. "Those were probably the strictest," says Mr. Nachimson.
Patient-level Medicaid data can be released outside a Medicaid agency only "for the direct benefit of Medicaid beneficiaries," explains Mr. Nachimson, but that restriction still allows matching of Medicaid data with information from other programs. State officials who want to link Medicaid information with other types of information can give the data to the Medicaid agency to complete the analysis.
"There’s some misunderstanding about what the barriers are. People will say, I’m just not permitted to share my data and that’s it.’ It isn’t quite that strict," Mr. Nachimson says.
Summary data describing Medicaid utilization always has been allowed to be shared with other agencies without fear of violating Medicaid confidentiality restrictions, Mr. Nachimson points out.
To encourage data-sharing projects, the federal government is freeing up existing categorical funding for that purpose. The goals of successful proposals will address "resource-oriented improvements," i.e., those that save time, money, or personnel resources. The guide to the grant proposals recommends that projects address "mission-oriented" areas such as the following:
• improvements in prevention effectiveness;
• improvements in public health practice;
• improved service to customers;
• timeliness of processes;
• quality of information;
• improvements in public health research;
• responsiveness to information needs.
The next task in the federal collaboration is to identify and analyze a small number of successful data-sharing programs to use as models throughout the country.
Contact Mr. Nachimson at (410) 786-6153.