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Of the 65 million beneficiaries covered by Medicare programs, stand-alone Prescription Drug Plan (PDP) sponsors cover more than 22 million people. AB2D provides Medicare Parts A and B claims data to fill gaps in patients' health information for a holistic view that supports better care.
The Centers for Medicare & Medicaid Services (CMS) developed AB2D to implement Section 50354 the Bipartisan Budget Act of 2018 (BBA). Regulations at 42 CFR § 423.153(g) describe the manner in which CMS will implement this section of the law.
AB2D provides PDPs with Medicare Parts A and B claims data. This data helps PDPs promote the best use of medications to improve health outcomes. AB2D utilizes the Bulk Fast Healthcare Interoperability Resources (FHIR) standard for exchanging healthcare information electronically in order to make data sharing efficient and secure.
Identify Medication Therapy Management enrollees by using data for a more thorough search capability.
AB2D data can help you identify beneficiaries who may be eligible for your Part D Medication Therapy Management (MTM) programs. You can use AB2D data to help identify enrollees who meet the MTM targeting criteria, like those with certain chronic diseases or diagnoses.
Part D Star Ratings evaluate the quality of services received by beneficiaries in your plan. CMS offers incentives to Prescription Drug Plan (PDP) sponsors with high Star Ratings:
- CMS highlights contracts with an overall rating of 5 stars.
- Beneficiaries may enroll in a 5-Star PDP, MA-PD, or MA-only plan through a Special Election Period.
- PDPs with 5-star plans may market year-round.
Medication adherence is one of the quality measures used to rate PDPs. AB2D data can address medication adherence, as well as statin use in persons with diabetes or other medication therapy problems, by proactively identifying MTM enrollees who may benefit from targeted intervention. As a result, this may help improve their health, the effectiveness of your programs, and your Star Ratings.
Find suspicious patterns from providers or suppliers to reduce fraud and financial losses. By adding AB2D’s Bulk FHIR data to your existing data streams, you can conduct trend analysis and search mass enrollee data to quickly identify:
- duplicate billing
- services misaligned with enrollee histories
- opioid overutilization
- outliers in cost or service frequency
Due to final rule regulations, AB2D data can be used to detect fraud, waste, and abuse from providers and suppliers only. This can’t be used to influence coverage determination for enrollees.
Plan sponsors can use AB2D data to get a holistic overview of enrollees' health histories. This allows for more informed discussions between the MTM provider and enrollee during comprehensive or targeted medication reviews:
- Promote safe and effective medication use.
- Prevent potential gaps in medication therapies.
- Identify appropriate medication alternatives.
- Reduce adverse drug events or interactions.
- Enhance coordination of care across providers and pharmacists.
- Allocate resources efficiently to save on costs.
AB2D is one of several CMS APIs that offer Medicare claims data sharing in FHIR format:
- The Beneficiary Claims Data API (BCDA) helps Alternative Payment Model participants who provide high quality, coordinated care by simplifying their access to bulk Medicare Part A, B, and D claims.
- The Blue Button 2.0 (BB 2.0) API enables beneficiaries to connect their Medicare claims data to the applications, services, and research programs they trust.
- The Data at the Point of Care (DPC) API enables healthcare providers with claims data to fill-in gaps in patient history at the point of care and deliver high quality care to Medicare beneficiaries.
