Pacific Northwest insurer Regence is teaming with MultiCare Connected care to roll out a new tool that aims to ease the administrative burden of prior authorization.
Regence and MultiCare, an accountable care organization, will be the first in the nation to roll out new prior authorization standards backed by HL7's Fast Healthcare Interoperability Resources, or FHIR. As FHIR is supported by most electronic health records, the tool can be embedded directly in physicians' workflows and enables them to receive near real-time determinations.
Prior authorization has historically been a labor-intensive experience, as they're often submitted via fax or in insurer-specific portals that require data reentry. This can lead to data errors as well as delays for the patient.
“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, in the release. “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," Anderson added.
The standards were developed by the HL7 DaVinci Project, a private sector effort to accelerate the use of FHIR to enhance value-based care. The project has backing from the Centers for Medicare & Medicaid Services and was granted an exemption from the Health Insurance Portability and Accountability Act to test end-to-end FHIR tools.
The DaVinci Project includes representatives from health plans, health systems and health IT companies.
“Da Vinci Project fosters cross-sector collaboration to solve for common data sharing challenges that hinder care delivery and innovation,” said Jocelyn Keegan, the 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.”