Monetized Data: Medicare's Lifeline?

“The numbers just don’t add up. The angles are too high on Medicare costs.”

Fred Trotter thinks one of the only ways that Medicare will survive is by leveraging its treasure trove of claims data.

“The numbers just don’t add up. The angles are too high on Medicare costs,” he told Healthcare Analytics News at a meeting in Philadelphia. “You have to do something to deal with it…The monetization of the data itself creates a competitive function that you really need to have.”

It isn’t a surprise that Trotter believes this. He’s founder and CEO of DocGraph and CTO of its sister company, CareSet, which is a Medicare data vendor. More specifically, CareSet is the only Medicare data vendor that can release data sets.

Under the Obama administration, CMS became more transparent, granting a select few companies the ability to access its valuable claims data. Trotter called the move “revolutionary.” His companies are now authorized to remotely connect to CMS’s data and assemble cohorts. CareSet, the commercial outlet of the pair, can sell access to that aggregated information to those who may be able to use it. The company’s customers are primarily in pharma, but Trotter said they do business with a few accountable care organizations as well.

He was sure to illustrate just how meaningful the information can be, describing the information as a detailed view of the American healthcare system at a structural level. CMS has millions of claims data that have previously gone unused, often because the agency lacked the time and resources to process all of it.

“What has happened in the past is that the administration of Medicare has generated a massively valuable data set that Medicare beneficiaries themselves don’t get the benefit of,” Trotter said.

“When you have a business that’s trying to create a healthcare efficiency, and it knows how to deploy it correctly because of Medicare data, that drives down the long-term ballooning costs,” he explained. “You want to create an efficiency.”

He pointed to a company his team assisted. That organization was trying to sell cardiovascular procedures. With the wide expanse of data CareSet can access, the client can pinpoint precisely where those procedures may do the most good. Although healthcare costs can go up in the short term from the deployment of those services, their preventative benefit provides a net savings.

CareSet is careful not to do business with entities looking to do the opposite and exploit existing inefficiencies for financial gain. “We would never work with a client that’s actually doing something that is fundamentally bad for Medicare,” Trotter said.

He considers the work as a service as much as a business. Joe Biden’s Cancer Moonshot program endorsed the philosophy, entrusting DocGraph with the release of an open cancer data set featuring millions of claims events.

The necessity lies in “slicing layers off the beast that is the cost of Medicare,” as Trotter put it. In order to do that work, however, the company needs to maintain a good relationship with a transparent CMS. Although he admitted to being critical of the agency under Obama, he expressed worry that it may become less transparent under the Trump administration.

“I hope the Trump administration can look at this and see the case that I am making, which is that data transparency is good for new business initiatives, and therefore new business initiatives are going to be part of the cure. That’s actually a very conservative value,” he said, noting that the Obama administration was emphasizing the exact same transparency from a perspective of public good. “The patients have a right to know. It’s one of the few areas of consensus in these divisive politics.”