Growing the Qualified Entities Program to Support Informed Decision-making by Consumers and Providers

December 16

By Niall Brennan, CMS Chief Data Officer and the Director of the Office of Enterprise Data and Analytics (OEDA)

At CMS, we are committed to providing our stakeholders with information needed to support informed decision-making as they navigate the health care system. As such, we have been a government leader in promoting increased data transparency. For example, we have released data on geographic variation in Medicare utilization and quality, as well as data on provider level utilization, including prescribing patterns. A commitment to making such resources available puts engaged and empowered individuals at the center of their care, which is essential to transforming our system to one that delivers better care, smarter spending, and healthier people.

Today, I want to share some exciting developments related to the Qualified Entity (QE) program, which was established under the Affordable Care Act. The QE program facilitates the creation of publicly available performance reports and data that can be used to help improve provider quality, increase transparency in health care performance, and provide information for employers, consumer groups, patients, and caregivers to assist them in making more informed health care decisions.

There are currently 12 certified QEs – 11 QEs that will be reporting regionally and one QE that will be reporting nationwide. Since the launch of the program, two QEs have already released public performance reports. Today, I’m excited to announce further growth in the QE program with the approval of a second nationwide QE, Amino. With the addition of Medicare data, Amino will enhance its free service to help Americans make care decisions, including, for example, determining the providers from whom they choose to receive services.

Prior to the Affordable Care Act, provider reporting was fragmented, making it difficult for providers and consumers to access a comprehensive picture of provider performance on quality and cost. The QE program enables qualified entities to create a more complete picture of provider quality and cost of care by combing Medicare data with data from multiple health plans.

As we continue our effort to make actionable information available to consumers and providers alike, we are looking forward to the future release of a Notice of Proposed Rulemaking (NPRM) that will implement changes to the QE program enacted by Congress under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This legislation expands permissible uses and disclosures under the QE program. We look forward to receiving comments from interested stakeholders when the NPRM is released.