In this Hot Take, Brian Murphy discusses the recent Patient Access API requirement from the Centers for Medicare and Medicaid Services (CMS).

This requirement is being implemented as part of The Interoperability and Patient Access final rule in the 21st Century Cures Act. The Patient Access API is being implemented to provide patients with easier access, through a third party of their choosing, to their claims and clinical data from any CMS-regulated payer (specifically Medicare Advantage (MA), Medicaid, CHIP, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs)).

On paper, the idea that any consumer anywhere can get access to their clinical data or their claims data…Arguing against that is like arguing against the entire idea of kittens. However the reality of engaging patients is a lot more difficult than simply making data available.

While well-intentioned, the regulation misses the mark without there being greater incentive for patients to care and buy into the utility of this type of service. As we saw with Google Health and Microsoft HealthVault, the American healthcare consumer has yet to take an interest in mass adoption of this type of service to better manage their own care.

Brian’s latest research is focused on the market for Integration Infrastructure solutions. To receive updates on that research, please complete the form on the report interest page.

Transcript (mostly generated by AI – please excuse typos):

[00:00:00] Welcome back to our channel. I’m Brian Murphy. I’m an analyst here at Chilmark Research, and I wanted to spend a minute or two talking about patient access APIs.

[00:00:15] So I’m being told that you should like, subscribe and click the notification below just so you won’t miss anything from us in the future.

[00:00:24] So it will come as no surprise to many people who might be watching this video that there was a certain level of skepticism about potential uses of patient access APIs. And I guess I’m in the school that says this idea probably is a dud, the patient access APIs, I think, the primary value is to get people thinking about APIs.

[00:00:47] Patient access is an extremely difficult problem. The difficulties of getting patients engaged are well known, well documented, and APIs in and of themselves aren’t going to solve them in twenty twenty one.

[00:01:00] So the patient access APIs were a tremendous idea. On paper, the idea that any consumer anywhere can get access to their clinical data or their claims data…Arguing against that is like arguing against the entire idea of kittens. The reality of engaging patients is a lot more difficult than simply making data available. CMS has offered a fee-for-service beneficiaries access to their claims data, through the Blue Button program for a number of years. Most of the applications that have been dealt there are really about one Medicare Advantage plan using that data to displace another Medicare Advantage plan.

[00:01:41] While that’s a valuable service, it’s unclear it really advances the entire idea of patient engagement. So the patient access APIs, while a guide for now at least, offer the promise for developers to really begin to develop more innovative applications.

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