Medicaid Blue Button API Use Cases

This post is simply a list of use cases that helps all of us understand why the Medicaid Blue Button API is super important to Medicaid members.

Btw – here is the list of apps that are built using the CMS Medicare Blue Button API and another list of apps that have agreed to the CARIN code of conduct.

Providers

Claims data is one component of a patient’s complete, longitudinal digital health record adding cost, coverage and adherence.

These are ways in which Medicaid members having access to their claims information or sharing this data with their Provider can have an impact.

  • Providers can share data with each other given a patients consent
  • Patients can download their claims data into a personal health record like Apple Health and show information to their provider during the visit
  • Patients receive Infrequent procedure reminders (ex: annual exam, colonoscopy every 5 years, etc)
  • Easy way for family member/caregiver to access medical information in emergency (important for authorization access not to time out too quickly). Apple is also working on this (emerging).
  • Improving care coordination by sharing information with all members of a Medicaid member’s care team
  • Decreases printing of records a provider needs to do
  • An at-risk provider having difficulty accessing a patient’s longitudinal claims record (like we heard re: the Oncology Care Model – which shares such data up to six months after the initial trigger event) could gain more timely access to this data via Medicaid member granting permission.
  • Comparing & reconciling patient-level payor EOBs vs provider bills
  • Automatic pre-population of initial visit forms (save time, increase accuracy)

Example: Did Jane have a Cervical Cancer screening at her last OB/GYN visit?

  • Jane, a 55 yr old female Medicaid member visits her PCP. She is handed an iPad to checkin and sees “Login to your Medicaid account to share data with Dr. Smith.”
  • She logs with her Medicaid username and password
  • She sees a spinning wheel and reads “Your Medicaid claims data has been downloaded and is up-to-date!”
  • Her claims data from Medicaid is synced to Dr. Smith’s EMR
  • Dr. Smith pulls up her chart during the visit and sees that she’s had the recommended Cervical Cancer screening
  • The Provider is complying with this screening CMS quality measure

Research

From Apple’s Research Kit to Verily’s Project Baseline, making it easy for a patient to contribute health data to a clinical trial or research study is powerful.

  • A Contract Research Organization (CRO) can incorporate Medicaid claims data to improve the accuracy of monitoring during a Clinical Trial.
  • Apps like Verily’s Project Baseline enable participants to connect a variety of personal health data sources to better inform the researchers.
  • Clinical Trial enrollment – A research organization can pre-populate a medication list for a patient during clinical trial enrollment.
  • Donate data to research (ex: precision medicine, “All of Us” research cohort/Sync for Science, Health eHeart Study (UCSF)

Prescriptions

  • Medication adherence
  • Navigating affordable care options (eg brand vs generic medication)

Example: Signup for home delivery of medication 

XYZ Pharma is a full-service pharmacy that sorts your medication by the dose and delivers it to your door.  They would use Medicaid claims history to reduce the Patient’s burden during the signup process, to better understand their prior billing cadence and to build a better profile of their medication history.

Health and Fitness

Example: Personal Health Record

A 59 year old woman from Cleveland, OH named Bettie has an iPhone 8 and a Fitbit her son bought her for Christmas.  Her friend told her about an iPhone app that lets her see all of her medical records on her phone called “MedView”.  She searches for it in the app store and downloads it.  Her favorite apps on the iPhone are Weather.com and Facebook.  She opens the app and it asks her to login with her Medicaid account.  She enters her username and password and sees a “welcome message” display on the app.  Success!  The app shows her some personally identifiable information and tells her it’s downloading her entire record from Medicaid.  She sees a status bar going to 100%.  A few seconds later she sees a timeline view of her information.

Financial

  • Forecasting & planning a personal health care budget (based on previous year information)
  • Connect your Medicaid data to health insurance shopping app or an accounting app like Quicken for tax deductions.

Brainstorming list

Below is a list of terms and concepts to trigger more ideas about how patient access to claims data can help make an impact on people’s lives and health.

  • Folks moving from Medicaid to Medicare or from private health insurance on to Medicaid or vice-versa 
  • eLTSS examples
  • Home Health Care
  • Assisted Living
  • Primary Care
  • Senior Social Networks
  • Wearables
  • Transportation
  • Patient Portals
  • Chronic Disease Management
  • Social Isolation
  • Preventative Care
  • Medication Adherence
  • Digital Therapeutics 
  • EHR interoperability
  • Longitudinal Patient record
  • Patient education
  • Preference-sensitive care
  • Medication reconciliation & adherence tools
  • Care team indexing & name/ID sharing with other providers
  • Evidence-based clinical decision support
  • Quality-related application & services for Accountable Care Organizations (ACOs)
  • Chronic disease management (including personal health tracking – eg for patients with diabetes)

Good Articles

Use of the Blue Button Online Tool for Sharing Health Information: Qualitative Interviews With Patients and Providers (PubMed 2015)

New iPhone Health app feature gives doctors easier access to data (The Verge, June 2021)

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