Regence and MultiCare Connected Care are making the pre-authorization process faster, more secure, more convenient and efficient by embedding it in the clinical workflow.
Together, Regence and MultiCare are launching the nation’s first implementation of the HL7® FHIR® (Fast Healthcare Interoperability Resources) Prior Authorization Support Standard. Developed by the HL7 Da Vinci Project, this application programming interface (API) provides an interoperable method for providers to submit pre-authorization requests directly from electronic health records (EHR) at the point of care. This will enable faster determinations, reduce administrative burden and costs, and support better outcomes for patients.
“Pre-authorization helps ensure our members are receiving the most effective and appropriate treatments, while managing the costs of care,” said Kirk Anderson, Regence’s chief technology officer. “Regence and MultiCare share a vision of applying technology and data to transform the health care experience. Bringing pre-authorization to the point of care reduces the burden on health systems managing patient data and promotes timely, evidence-based care and a more seamless experience for our members.”
Historically, the process of requesting and receiving pre-authorizations has been slow and labor-intensive. Pre-authorization requests are often submitted by fax or through health plan-specific portals where re-keying clinical information is necessary and can result in data entry errors and delays in treatment. FHIR is widely supported by most electronic health records and will enable providers to submit authorization requests, including all necessary clinical information, and receive near real-time determinations within their existing workflow.
“Embedding pre-authorization in our native EHR system is a gamechanger,” said Anna Taylor, MultiCare Connected Care’s associate vice president of Population Health and Value Based Care. “Not only will we ease the administrative complexity of health care, but the ability to receive transparent and actionable data at the point of service accelerates care delivery and increases adherence. When providers can spend more time collaborating with their patients on treatment plans, they have a better chance of improving outcomes.”
With members from health plans, health systems and health IT companies, HL7 Da Vinci Project is a national, private sector initiative to accelerate the use of HL7 FHIR to enable value-based care through interoperable data. With support from the Centers for Medicare & Medicaid Services, Da Vinci Project was granted a HIPAA exception to test an end-to-end FHIR solution.
“Da Vinci Project fosters cross-sector collaboration to solve for common data sharing challenges that hinder care delivery and innovation,” said Jocelyn Keegan, Da Vinci Project’s program manager. “Regence and MultiCare are spearheading health care interoperability with this first-in-the-nation implementation of FHIR driven pre-authorization. This pilot will transform the member and provider experience and create the foundation for greater data sharing applications across the industry.”
Regence serves more than 3.4 million people through its Regence health plans in Idaho, Oregon, Utah and Washington. Each Regence health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com.
About MultiCare Connected Care
MultiCare Connected Care (MCC) is an independent Accountable Care Organization (ACO) established in 2014 as a wholly owned subsidiary of MultiCare Health System and operates as an independent entity. MCC has established a comprehensive Clinically Integrated Network (CIN) comprised of doctors and other health care providers, as well as hospitals, clinics and other health care services, such as imaging, labs and pharmacies. The CIN includes independent health care professionals in the community, as well as MultiCare employed providers totaling over 3,900 clinicians providing services across the continuum of care.
MCC is a physician-led organization with its own governing board and offers a commercial health benefit plan focus plus Medicare Shared Savings Program (MSSP) and is fast becoming the population health engine representing MultiCare Health System and its independent partners, in transforming health care in our region with 16 Value Based Contracts and serving over 120,000 lives. multicareconnectedcare.com
About the HL7 Da Vinci Project
As an HL7 FHIR Accelerator, the Da Vinci Project is a private sector initiative comprised of industry leaders and health information technology technical experts who are working together to accelerate the adoption of HL7® FHIR® as the standard to support and integrate value-based care (VBC) data exchange across communities. The Da Vinci Project focuses on minimizing the development and deployment of one-off solutions between partners with a goal to help all clinicians and health plans to better deliver clinical quality, value and care management outcomes. The core focus of phase one of the project is to deliver implementation guides and reference software implementations to the public for data exchange and workflows necessary to support providers and payers entering and managing VBC contracts and relationships. To learn more about the Da Vinci Project, visit https://confluence.hl7.org/display/DVP/Da+Vinci+Welcome.