CMS pulls back Medicare data curtain for innovators, entrepreneurs

CMS announced a new policy that will permit innovators and entrepreneurs to access CMS data, such as Medicare claims, as part of the Obama Administration’s initiatives to use data and information to drive transformation of the health care delivery system. According to CMS, the data access will allow innovators and entrepreneurs to conduct approved research that will focus on improving care, as well as providing better tools that should benefit health care consumers through a greater understanding of how best to employ results in health care. CMS noted that the data will not allow the patient’s identity to be determined, but will provide the identity of the providers of care.


Innovators and entrepreneurs will access data through the CMS Virtual Research Data Center (VRDC), which provides access to specific CMS program data, including Medicare fee-for-service claims data. Researchers working in the CMS VRDC will also have direct access to approved privacy-protected data files and will be able to conduct their analysis within a secure CMS environment. As such, researchers will not be allowed to remove patient-level data from the VRDC. Researchers will only be able to download aggregated, privacy-protected reports and results to personal workstations.

CMS also noted that all researchers will be allowed to request data on a quarterly basis, rather than relying on the annual updates that were available in the past. Technological advancements, such as the VRDC, have aided in access to more current data without higher data costs. The change in data access will allow researchers to conduct more rapid analysis of the delivery system.

Tool development

CMS stated that some tools or products innovators and entrepreneurs might develop under the new data access policy could include care management or predictive modeling tools, which could greatly benefit the health care system. CMS will begin accepting innovator research requests in September 2015.