Regence and MultiCare launch FHIR-based approach to pre-authorization

This first national initiative will facilitate the exchange of information directly from the CCO’s electronic health record system.

An FHIR-based approach should expedite treatment pre-authorization for patients through the use of an FHIR-based API.

An initiative using a standardized method developed by the Da Vinci Project aims to facilitate the prior authorization process to obtain medical care approval for patients.

The effort involves Regence, a parent company of health plans in four northwestern states, and MultiCare Connected Care, an independent accountable care organization that is a subsidiary of MultiCare Health System. The organizations say this is the first attempt in the country to use FHIR-based pre-clearance.

Anna Taylor, Associate Vice President of Population Health and Value-Based Care, MultiCare

“When providers can spend more time collaborating with their patients on treatment plans, they have a better chance of improving outcomes.”

The intention is to use the Fast Healthcare Interoperability Resource (FHIR) standard to enable faster turnaround times for pre-authorization decisions. The process of obtaining payer approval for clinical interventions has remained a challenge for the healthcare industry, with growing concerns that the traditionally manual process is an administrative burden, delaying clinical workflow and lead to interruptions in care, which could have an impact on patient safety.

Developed by the HL7 Da Vinci Project, the Application Programming Interface (API) provides an interoperable method for providers to submit pre-authorization requests directly from electronic health records (EHRs) at the point of care. Organizations believe this will enable faster determinations, reduce administrative burden and costs, and promote better patient outcomes.

Looking for more efficiency

The process of applying for and receiving prior authorizations has always been slow and cumbersome. Prior authorization requests are often submitted by fax or through health plan-specific portals where re-entry of clinical information is required and can lead to data entry errors and processing delays.

FHIR offers a way to speed up the process. It is widely supported by most electronic health records and will allow providers to submit authorization requests, including all necessary clinical information, and receive near real-time determinations within their existing workflow.

Prior authorization is both a means of ensuring that patients receive effective and proven care, while ensuring that the cost of care is controlled.

“Prior authorization helps ensure that our members receive the most effective and appropriate treatments, while managing the costs of care,” said Kirk Anderson, Chief Technology Officer at Regence.

Efficiency will be improved by allowing FHIR to access information with MultiCare’s EHR, making it part of the clinical information system’s capabilities, the organizations say.

“Integrating pre-authorization into our native EHR system is a game-changer,” said Anna Taylor, associate vice president of population health and value-based care at MultiCare Connected Care. “Not only will we ease the administrative complexity of healthcare, but the ability to receive transparent and actionable data at the point of care will accelerate care delivery and increase compliance. »

Benefits for patient care

“Regency and MultiCare share a vision of applying technology and data to transform the healthcare experience,” Anderson said. “Bringing pre-authorization to the point of care reduces the burden on healthcare systems managing patient data and promotes timely, evidence-based care and a more seamless experience for our members.

The effort should also pay off in terms of improving the quality of care and outcomes, Taylor adds. “When providers can spend more time collaborating with their patients on treatment plans, they have a better chance of improving outcomes.”

“The Da Vinci Project encourages cross-sectoral collaboration to address common data sharing issues that impede care delivery and innovation,” said Jocelyn Keegan, program manager for The Da Vinci Project. “Regency and MultiCare are spearheading healthcare interoperability with this first nationwide implementation of FHIR-led pre-authorization. This pilot project will transform the member and provider experience and create the foundation for broader data sharing applications across the industry. »

With members from health plans, health systems and health informatics companies, The Da Vinci HL7 Project is a national private sector initiative to accelerate the use of HL7 FHIR to enable patient-based care. value through interoperable data. With support from the Centers for Medicare & Medicaid Services, The Da Vinci Project was granted a HIPAA exception to test an end-to-end FHIR solution.

To learn more about the Da Vinci Project, visit this website.

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