The Down-Low on Data for Value-Based Enterprises and Their Participating Providers

Value-based enterprises depend on timely, accurate data, yet the rules that govern how that data moves between the Centers for Medicare & Medicaid Services (CMS), accountable care organizations, payors, and providers remain complex and often inconsistent. On this episode, Epstein Becker Green attorneys Kevin Malone and Karen Mandelbaum unpack the regulatory frameworks shaping data exchange in value-based care. They outline how federal privacy laws, CMS rules, the Health Insurance Portability and Accountability Act (HIPAA), and state requirements intersect; why CMS-sourced data operates under a different regime than Medicare Advantage; and where organizations face the biggest operational hurdles when using, sharing, and governing data across large networks. Key Takeaways: Distinct Legal Frameworks: CMS data is controlled by the Privacy Act, while Medicare Advantage data falls under HIPAA. Disclosure Tracking Requirements: CMS data use agreements demand strict tracking and downstream compliance. Operational Data Challenges: Silos and uneven data quality remain major barriers to effective value-based care. Tune in to learn how today's rules shape data access, data quality, and the real-world mechanics of value-based care. Visit our site for related resources and email contact information: https://www.ebglaw.com/dhc92 Subscribe for email notifications: https://www.ebglaw.com/subscribe. Visit: http://diagnosinghealthcare.com. - This podcast is presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.