Case Study

In order to ensure that Medicare beneficiaries receive high quality care, the Centers for Medicare & Medicaid Services (CMS) has been leading efforts to give beneficiaries and their providers secure access to healthcare data. This empowers beneficiaries and public health stakeholders, like healthcare providers and Accountable Care Organizations (ACOs), with data to make informed decisions, such as which medication or treatment to try. Filling in the gaps with data can help improve the health of Medicare’s 65 million beneficiaries.

Application programming interfaces (APIs) are tools that help technology systems communicate. With the goal of meeting Medicare beneficiaries’ and providers’ unique needs, Nava is supporting the design, development, and operation of three of these APIs. Since they launched, the APIs we helped build have served claims data for over 28.7 million beneficiaries.

The first API — Claims Data to Part D Sponsors API (AB2D) — outlines how to share claims data for prescription drug plans (PDPs). This enables PDPs to improve care coordination and medication use, identify and monitor how effective treatments are, and aggregate beneficiary information in one place. PDPs can also use claims data to detect fraud and abuse, which can inform future policies and procedures.

The Beneficiary Claims Data API (BCDA) services ACOs, or groups of healthcare providers who voluntarily work together to give Medicare beneficiaries quality care. BCDA helps reduce repeat diagnostic tests and treatment by giving ACOs a holistic picture of beneficiaries’ medical history under certain conditions. By filling in the gaps for ACOs, BCDA helps improve patient outcomes while reducing cost of care. Similarly, the Data at the Point of Care API (DPC) shares Medicare fee-for-service claims data with providers, helping them to improve quality of care while reducing the need for burdensome paperwork.