CMS Names Niall Brennan First Chief Data Officer

The Centers for Medicare & Medicaid Services (CMS) today announced the formation of the Office of Enterprise Data and Analytics (OEDA) which will be led by Niall Brennan, the agency’s first Chief Data Officer (CDO), and tasked with overseeing improvements in data collection and dissemination as the agency strives to be more transparent. OEDA will help CMS better harness its vast data resources to guide decision-making and develop frameworks promoting appropriate external access to and use of data to drive higher quality, patient-centered care at a lower cost.

CMS collects a wealth of data that is critical to decision making for the agency and other stakeholders in the nation’s health care system. CMS generates data administering the Medicare, Medicaid and CHIP programs. In addition, new responsibilities, including stewardship of the EHR Incentive Programs, more expansive quality measurement programs, and the establishment of the Health Insurance Marketplaces, have expanded the scope of data that CMS collects. As CMS works to shift the focus from volume of services to better health outcomes for patients, coordinating care, and spending dollars more wisely, the need for CMS to analyze data across its multiple programs and provide greater access to this data, whether in granular or aggregate form, will only intensify.

“It’s clear how much data transparency will help the country improve outcomes, control costs and aid consumer decision making,” said CMS Principal Deputy Administrator Andy Slavitt. “This appointment signals to the industry that there is no turning back from the health care data agenda. Niall Brennan will help make sure CMS leads the way.”

The creation of this new post and the data and analytics office  builds on the steps CMS has taken in recent years to better harness its data resources both internally and externally. CMS is now routinely analyzing claims data in real time and applying predictive analytics to proactively identify fraud and abuse and track key metrics such as hospital readmissions. Accountable Care Organizations and State Medicaid agencies receive monthly near real-time feeds of Medicare data to support care coordination. CMS has launched the Virtual Research Data Center to facilitate lower cost access to CMS data for researchers and federal grantees. CMS has also released numerous public use datasets; the most notable releases to date include the release of data on hospital charges and physician utilization in 2013 and 2014.

“Our commitment to transparency is matched by our commitment to keeping personal information safeguarded. We can't expect to advance health outcomes unless we also ensure that our policies and practices around data privacy are leading the way,” said Slavitt. “We look forward to building on the success of recent releases, providing a clearer picture of the health care delivery system.”

Polls Show Number of Uninsured Adults Lowest Since Obama Took Office

The deadline to enroll on the new insurance exchanges is quickly approaching, with just three weeks remaining. The deadline seems to be spurring a dramatic up-tick in the number of adults enrolling in health insurance plans. Acording to the Gallup-Healthways Well-Being Index released Monday the number of Americans with no health insurance has dropped to the lowest levels since President Obama was sworn in. The index found that the percent of uninsured adults dropped from 17.1-percent in the last quarter of 2013 to 15.9-percent in 2014. Experts attribute the increasing number of insured adults to the insurance plans made available by the Affordable Care Act.

The increase in enrollment was found across all demographic groups examined by the index. Hoewver, enrollment throughout the Latino demographic lagged behind other demographic groups. This is notable because the Obama Administration is actively reaching out to the relatively young Hispanic community to encourage enrollment. 

A significant drop in the rate of uninsured adults occurred among African-Americans with a 2.6 percentage point decline. The rate declined 1percentage point among white adults, but only eight-tenths of a percentage point for Latinos. The largest drop in the uninsured rate was a 2.8 percentage point difference for households with an annual income of less than $36,000.

Healthcare Enrollment May Be Stifled By Federal Website Maintenance

Consumers attempting to complete health insurance applications through online healthcare exchanges before the February 15th deadline may be frustrated this weekend. February 15 is the deadline to apply for coverage that will begin on March 1. 

The Department of Health and Human Services (HHS) announced Monday that heavy maintenance to the Social Security Administration's website (SS) will result in the inability of HealthCare.gov to verify Social Security numbers and other personal details required for coverage under the Affordable Care Act. 

The maintenance is expected to begin Saturday, February 15 at 3p.m. and end Tuesday, February 18 at 5a.m. Those consumers that are affected by the website maintenance should phone the federal call center on Tuesday to arrange for coverage March 1. The number to the federal call center is 1-800-318-2596.

Obama Administration Announces Health Insurance Mandate Delay and Reduction of Percentage of Workers Covered Requirements

The Obama Administration announced changes in the implementation of the Affordable Care Act provisions related to the employer mandate for "medium-sized" businesses.  The provisions were originally drafted to go into effect this year. 

The changes in implementation deadlines do not affect most businesses. Companies with fewer than 50 workers remain exempt from the mandate. 

First, the deadline to meet the coverage requirements under the mandate for medium-sized businesses, companies that employ between 50 and 99 workers, has been delayed until January 1, 2016. The delay is conditional and requires companies to promise that the employer will neither cut an employees' hours nor let go of employees for the purpose of making their business qualify as a "medium-sized" business with 50-99 workers. Officials describe the verification process of this promise as "self-attestation" and the IRS has not provided information on how it will determine the companies' veracity. 

White House advisor Phil Schiliro explained the reasoning behind the change, "For the two-percent of American businesses that have between 50 and 99 employees, the Treasury Department concluded that a phase-in was the most common-sense way to implement the law." 

The employer provisions will go into effect for companies that do fall into categories covered by the employer mandate that do not have 50-99 workers. However, the requirement that the employers offer coverage to 95% of their full-time employees by January 1, 2015 has been reduced by 25%. The employers will now be required to offer coverage to 70% of their full-time employees by January 1, 2015. The Treasury Department's final rules state that the requirement for employers to offer coverage to 95% of their full-time employees has been delayed until 2016. 

Other changes affect seasonal workforces, adjunct faculty and volunteer firefighters and paramedics. Seasonal workers that work less than six months will not be considered full-time employees. The changes include a method for estimating the hours of adjunct faculty that accounts for hours spent working outside the classroom. The Administration's promise that volunteer firefighters and paramedics would not be considered full-time employees was formally implemented in the most recent changes. 

Many commentators are suggesting that the adjustments in implementation deadlines and requirements for businesses will increase pressure on the Obama Administration to extend deadlines for individuals so that they are not subject to the $95 or 1% of income fine for failing to purchase health insurance this year. Other experts counter that extending the deadline for individuals would result in fewer healthy individuals signing up now which could drastically shift the ratio of sick-to-healthy individuals enrolled. If too many individuals with significant health problems enroll without the balance of healthy individuals it could make the price of coverage more expensive. 

Enrolling for Coverage in Health Insurance Marketplaces: Tax Credits, Fraud, and the IRS

Many individuals will qualify for tax credits to purchase the required health insurance from the health insurance marketplace in 2014. The Internal Revenue Service is responsible for calculating the tax credits accurately. 

The IRS will use a software program to verify tax credit calculations and assess penalties prior to issuing them to health insurers. However, there is concern about fraud because the agency has not completed a fraud mitigation strategy to prevent people that underestimate their incomes from fraudulently collecting health subsidies. As currently established, the IRS would issue the tax credits prior to verifying income.


The IRS has outlined tax provisions related to the Affordable Care Act here.

The report from the Treasury Inspector General for Tax Administration is available here.