Big Barriers to Big Data Analytics in Medicare

Eugene Roberts

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Essay from the year 2017 in the subject Sociology - Medical Care, , language: English, abstract: The Center for Medicare and Medi...

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Essay from the year 2017 in the subject Sociology - Medical Care, , language: English, abstract: The Center for Medicare and Medicaid Services (CMS) manages health care for over one hundred million patients. A large majority of these are Medicare members, for which the CMS is responsible for administering health care benefits through medical claims data. For this population, comfortability with their health care physician, quality of life, cost, and longevity are all of concern. Indeed, Medicare members' financial and health concerns burden not only the members themselves, but families and taxpayers as well. The recent emergence of big data analytics (BDA) has provided solutions to issues like these in many other patient populations. The CMS has recently conducted some internal BDA and has shown efficacy in fighting fraud and lowering hospital readmissions. However, the agency cannot possibly conduct research to addresses all Medicare members' needs in such an encapsulated manner. Other government agencies that house similar data provide easy access, and even some analytical discovery tools, to outside researchers in varying settings. The CMS has partners to help manage data and its availability to researchers, however, large barriers to BDA in Medicare still exist. In addition to conventional challenges with big data characteristics, the CMS faces regulatory and legal hurdles in health care policy and data privacy. Additionally, extremely rigorous application processes and prohibitively high costs limit researchers' access to Medicare data for discovery and early-stage research purposes. These barriers need to be overcome to expand the CMS's success in other areas to addressing all the health needs of Medicare members.