Use Cases

Blue Button API data is valuable for any organization looking to innovate with claims data. The API supports many use cases for the over 70 million Medicare enrollees.

Examples of current use cases include:

Personal health data aggregators

Digital health applications use the Blue Button API to provide enrollees with a more comprehensive view of their health data. Research shows that 30% of Medicare enrollees have 2 or 3 chronic conditions. They also see 5 or more physicians each year.

Access to aggregated health data can

Increase Medicare enrollees’ awareness of their health conditions
Help them communicate more effectively with their providers
Facilitate care coordination across providers
Minimize redundant procedures.

Insurance plan finders

Insurance plan providers use the Blue Button API data. This helps them tailor plan options to each enrollee’s needs. Applications can reach users in two ways:

through Medicare enrollees or
Medicare brokers

Medicare enrollees can use insurance plan finder tools themselves to make informed decisions. Medicare brokers can also use these tools to help enrollees find the best plan options. They also minimize redundant procedures.

You can use Blue Button to:

Use claims and utilization data to make personalized recommendations for new plan options.
Estimate prescription costs to optimize Medicare plan guidance.
Check if a Medicare enrollee’s current providers are in-network for various plan options.

Record-sharing apps use the Blue Button API to help enrollees share their health data. Enrollees can choose to share with doctors, pharmacies, caregivers, and others.

You can use Blue Button to:

Integrate Blue Button data with Electronic Health Records (EHR) systems.
Allow patients to share health information with providers, caregivers, or others. This may include current medications.
Give caregivers an accurate picture of a Medicare enrollee’s health data. This can ease care coordination and communication with providers.

Clinical research studies

Organizations conducting healthcare research use the Blue Button API to streamline collecting data. Without the Blue Button API, enrollees complete long forms or submit data regularly throughout a study. With the Blue Button API, Medicare enrollees allow the organization to automatically pull their claims data. This reduces the need for repeated manual data entry.

Digital Insurance Card

Medicare enrollees often need to show their insurance card at a doctor’s office, pharmacy, or urgent care visit. But a lost or forgotten card can delay care and create unnecessary friction. The Blue Button API’s Digital Insurance Card (C4DIC) endpoint solves this by streamlining access to a Medicare enrollee’s coverage information. Coverage information includes essentials to render a digital Medicare card within your app:

Medicare Beneficiary Identifier (MBI)
Coverage type (Parts A, B, C, and D)
Coverage start dates
Plan details

Once an enrollee authorizes your app through Blue Button’s flow, you can display a digital card they can pull up from their phone at any time. This gives enrollees a convenient, always-available record of their Medicare coverage. This is especially valuable for applications that need to verify coverage at the point of care:

Health and wellness apps
Caregiver tools
Provider-facing

Data facilitators

Data facilitators use the Blue Button API. This lets other organizations access claims data. Data facilitators act as a middleman application. The Blue Button API team approves data facilitators. Then, the data facilitators provide the Blue Button API data as a service to other organizations. These organizations may lack the skills to build the infrastructure needed to support these requests.

Review other examples of how applications use the Blue Button API at the Blue Button app directory.