Vizient receives CMS certification as Qualified Entity for access to Medicare claims data

Aug. 24, 2021

Vizient, Inc. announced it has received certification as a Qualified Entity from the Centers for Medicaid & Medicare Services (CMS). The CMS Qualified Entity (QE) Program (also known as the Medicare Data Sharing for Performance Measurement Program), enables certified organizations to receive Medicare claims data under Parts A, B, and D for use in evaluating provider performance. Only 33 organizations are QEs and of those, only 17, including Vizient, have access to nationwide data.

Vizient members increasingly are adopting alternative pay models and value-based care payment methods, requiring data and analytic insights that span the care continuum. Access to the nationwide Medicare claims brings Vizient one step closer to having the most comprehensive pool of patient, encounter, supply chain, and claims data in the US and expands Vizient’s capabilities in helping its members measure quality outcomes.

The QE certification gives Vizient access to claims data for 38 million unique annual Medicare fee-for-service covered lives comprising claims data in these areas: inpatient, skilled nursing facility and home health agency care (Part A); durable medical equipment, outpatient and carrier (Part B); and prescription drug (Part D). In all, the data represents more than 6 billion claims at $1.62 trillion. When paired with Vizient data, it will offer insights on care and outcomes for more than 70% of the U.S. population.

QEs are required annually to use Medicare claims data to generate public performance reports for providers and suppliers on measures of quality, efficiency, effectiveness and resource use. QEs may also use the Medicare data to provide or sell non-public reports to authorized users.

Vizient expects to begin receiving CMS data in mid 2022 and begin publishing reports related to provider performance in 2023.

Vizient release