Medicare claims data are collected and assembled by the Centers for Medicare & Medicaid Services (CMS) as a byproduct of Medicare program administration. These data provide an unparalleled source of information on the costs and quality of health care in the United States. Each year hundreds of researchers, providers, and contractors request and receive sensitive Medicare data as part of their research studies and health care operations activities. However, regulations and policies have limited access to identifiable data (data that connects to the beneficiary’s identity) to protect beneficiary privacy. Data releases for program evaluations, demonstrations, and research projects have been supported, whereas releases for analytic and public reporting purposes have been more limited and use for commercial purposes has been prohibited.
To support the use of Medicare claims data by a variety of users in a manner that protect beneficiary privacy, CMS is interested in adding statistically de-identified Medicare claims data to its product portfolio. Statistically de-identified data would include actual beneficiaries with their associated diagnoses, treatments, outcomes, and costs. This beneficiary experience represents the real world of health care in the Medicare program and although the removal of identifiers and geography may limit some research objectives, de-identified data can still provide a rich resource to support a wide range of desirable health care system analytics. For example, these data could provide information for commercial and nonprofit companies for the evaluation of treatments and drugs, examination of trends in health care cost and service utilization, and development of new analytic methods and tools.
HHS Entrepreneurs is one of our in-residence pathways that is bringing new talent into government. HHS Entrepreneurs pairs HHS employees with external expertise to work on an identified problem for a 12 month period. This project is one of six projects from the third cohort of HHS Entrepreneurs. Learn more about HHS Entrepreneurs.