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Prior Authorization – A Burning Problem in Need of a Solution

[fa icon="calendar'] Apr 20, 2021 12:52:49 PM / by Lynda Rowe posted in FHIR, HL7 community, interoperability, Da Vinci, value based care, prior authorization, FHIR Accelerator, FHIR Implementation Guides

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Those of us who have been in healthcare a long time know that prior authorization can been a challenge for both payers, providers, and patients. One might think it’s time to remove prior authorization altogether, but until we have consistent clinical practice across the entire US healthcare system, it’s very hard to justify.

The current processes create a huge burden for providers and payers, and cause delays sometimes critical in patient care.

Why is prior authorization such a thorny problem[i]?

  • Prior authorization issues contribute to 92% of care delays
  • Nearly all of provider care delays are associated with inefficiencies and administrative issues with current prior authorization
  • Providers take 6 hours on average to complete these requests, which is the equivalent of two business days. Thirty-four percent of providers have staff dedicated exclusively to completing prior authorizations.
  • The prior authorization process costs $23 to $31 billion per year in the US, according to a 2009 study published in Health Affairs.
  • The health plan cost per manual prior authorization is $3.68, compared to $0.04 per electronic prior authorization, according to a 2017 Chilmark Research report.
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Upcoming Da Vinci & HL7 FHIR Event Provides Keys to Payer-Provider Data Exchange Business Transformation

[fa icon="calendar'] Apr 13, 2021 12:36:03 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Da Vinci, FHIR Accelerator, FHIR Implementation Guides

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Whether Attendees are Novices or Experts on Implementation Guides, Education Will Increase Knowledge and Build Community

Communicating the value of HL7’s Fast Healthcare Interoperability Resource (FHIR®) in healthcare isn’t always easy. Do you tell the story in purely technical terms? Describe the problems it’s intended to solve? Or offer examples of where it’s providing benefits?

The upcoming Da Vinci Education & HL7 FHIR Implementation Event addresses all of those questions for a variety of audiences.

The presenters at the virtual event, scheduled for the week of April 26 to 30, will explain the sense of urgency that underscores the need to accelerate adoption of FHIR-based use cases. They will also provide real-world context to show that these use cases are not just a theoretical construct, but are providing immediate benefits to those organizations that are using it to power the shift to value-based care.

The adoption of FHIR is picking up speed because of this growing recognition of its benefits in reducing clinician burden, improving the exchange of quality measure data and enabling real-time access to data by patients, providers and payers. The adoption of FHIR-based use cases also provides a way for organizations to meet federal rules governing interoperability and patient access to their medical information.

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HL7 Da Vinci Project Recognizes Six Champions Who Highlight FHIR’s Potential

[fa icon="calendar'] Mar 29, 2021 11:00:00 AM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Da Vinci, FHIR Accelerator, Da Vinci Champions

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Program Showcases Individuals Making Significant Contributions to Advancing Implementation Guide Use

Initiatives such as the Da Vinci Project make strides toward interoperability as organizations adopt the vision and push it forward to reality

To achieve the progress the HL7 Da Vinci Project has made to date, it relies on the extraordinary efforts of individuals who consistently work to advance the organization’s goals. This might entail stepping forward to lead a work group of peers, spending extra hours editing and reviewing work in progress workflows, recruiting business partners to test early versions as early adopters, or scouring their organization to find the right subject matter expert for a particular business challenge or question, all to ensure that early HL7 Fast Healthcare Interoperability Resources (FHIR®) implementation guides work.

These team members exemplify the spirit and intent of our collaborative industry-first Da Vinci efforts, said Jocelyn Keegan, program manager for the Da Vinci Project. “The work of Da Vinci is, at its core, a human powered effort,” she noted. “It is imperative that we publicly acknowledge the contributions of the smart, dedicated thought leaders who are redefining how payers and providers collaborate.”

To recognize individuals who are taking a lead role in working to make the outputs of Da Vinci real, the project has named six leaders as the initial class of the Da Vinci Community Champion program for their contributions in 2020.

With the ascent of value-based care, interoperability is expected to evolve at an even faster pace to meet the business demands that new reimbursement incentives are producing.

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March Community Roundtable Celebrates Da Vinci Community Champions and Showcases MiHIN's Payer-Provider Directories' FHIR Deployment

[fa icon="calendar'] Mar 18, 2021 4:44:44 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, Da Vinci, value based care, FHIR Accelerator, Da Vinci Champions, PDex

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Monthly Event is Scheduled for 4:00 to 5:30 p.m. ET on Wednesday, March 24, 2021

Advancing the use of HL7’s Fast Healthcare Interoperability Resources (FHIR®) takes both strong proponents advocating for the cause and pioneering organizations that lead the industry by putting concepts into practice.

Both aspects important to FHIR adoption will be on display at the March Community Roundtable of the Da Vinci Project, scheduled for Wednesday, March 24, from 4 to 5:30 p.m. ET. The roundtable has become a staple of the Da Vinci Project’s efforts to highlight successful deployments of its implementation guides, intended to help healthcare organizations manage value-based care initiatives.

MiHIN Shares Lessons Learned with Plan-Net

An example of a real-world implementation will be provided by the Michigan Health Information Network (MiHIN). A team from the organization will share lessons learned from its deployment of Plan-Net, the Payer Data Exchange (PDex)-Plan Network Directory Implementation Guide that focuses on Payer-Provider Directories. FHIR offers the potential to automate this typically manually intensive process for all parties, and MiHIN will describe its journey to putting the implementation guide into place to achieve this.

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HL7 Da Vinci Project Recaps Standards Progress, Looks to Document Value of Implementation Guides

[fa icon="calendar'] Mar 10, 2021 9:14:05 AM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, Da Vinci, value based care, prior authorization, Gaps in Care, FHIR Accelerator, patient cost transparency, risk-based coding

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Project Achieves a Tipping Point as Adoption Begins in Earnest to Meet Upcoming and Proposed Federal Regulation and Solve Interoperability Challenges

The Da Vinci Project made significant progress in 2020 in advancing the maturity of implementation guides, and now looks to increasingly demonstrate the value of its implementation guides (IGs) across production implementations this year.

Members of the HL7 FHIR® Accelerator group helped push forward work on several implementation guides that were published in 2020, but further refinement lies ahead, said project managers who presented a progress report on the Da Vinci Project at its January Community Roundtable.

In addition to the update on progress with publishing new standards, the presentation offered members a tour of the Da Vinci Project’s enhanced Confluence website, as well as an invitation for more organizations to consider membership to help ensure implementation guides meet the needs of the entire healthcare community.

This year, there will be a growing need to use the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard, as application programming interfaces (APIs) emerge to meet federal information exchange requirements and business needs of value-based care.

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Reducing Industry Burden Focus of February’s HL7 Da Vinci Project Community Roundtable

[fa icon="calendar'] Feb 15, 2021 4:37:09 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Payers, implementation, Da Vinci, value based care, implementation guide, prior authorization, FHIR Accelerator

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Join the Webinar Highlighting MCG Health’s Prior Authorization Journey and Da Vinci’s Two New Use Cases for 2021 on Wednesday, February 24 from 4:00 - 5:30 pm ET.

Healthcare organizations increasing their exposure to value-based care find many tasks complicating the transition, and reducing the burden of those changes is key to thriving under new reimbursement schemes.

New payment approaches incentivize both payers and providers to become more efficient, and that means reducing the number of manual interventions in exchanging data. In addition, value-based care is uncovering new reasons to make information more easily available, to bring new efficiencies to the system.

Examples of these capabilities will be featured in the HL7 Da Vinci Project’s Community Roundtable on February 24. The title for the event is "What it Takes: Learn about MCG Health’s Journey to Help Reduce Prior Auth Burdens and Discover New Da Vinci Use Cases."

The upcoming roundtable will offer an inside understanding of the 18-month effort at MCG Health to advance the use of the HL7 Fast Healthcare Interoperability Resource (FHIR®) standard in solutions that support burden reduction in facilitating the prior authorization process.

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HL7 FHIR Accelerator for Translational and Clinical Research; Vulcan Launches

[fa icon="calendar'] Jan 7, 2021 9:35:50 AM / by Amy Cramer, MMCi, RN, CPHQ posted in FHIR, interoperability, health IT, clinical research, FHIR Accelerator, Vulcan

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Clinical care data is a foundation for research. It is used to understand patient populations and as the core for clinical data capture. The introduction of HL7 Fast Healthcare Interoperability Resources (FHIR®) and its adoption rate creates a new opportunity to exchange data for clinical and translational research. Building off the work already accomplished to create interoperability standards for the exchange of healthcare data bridges clinical research into the greater healthcare ecosystem.

HL7 FHIR® accelerators have been a successful catalyst for standards development and adoption. Following the path of other accelerators, the research community collaborated to create Vulcan. In August 2020, Vulcan was launched by convening the following member organizations: TransCelerate Biopharma, Duke University, Johns Hopkins, Oregon Health and Sciences University, UT Health San Antonio, Society for Clinical Data Management, U.S. National Library of Medicine, National Center for Advancing Translational Sciences (NCATS), Danish Medicines Agency and U.S. Food and Drug Administration. Membership is rapidly growing with new organizations being onboarded each month.

Vulcan Use Cases

After consultation with the Steering and Operations Committee of Vulcan, project teams have been formed to move forward three use cases. These were selected from a larger effort to collect as many as eighteen uses cases which were prioritized based on impact and the ability to deliver to the community. The initial selected use cases include:

  • Real world data (including secondary use of electronic health record data)
  • Phenopackets
  • Schedule of activities
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Drinking from the FHIR Hose: A Newbie's Perspective on HL7 and the Da Vinci Project FHIR Accelerator

[fa icon="calendar'] Oct 9, 2020 3:09:44 PM / by Vanessa Candelora posted in FHIR, HL7 community, interoperability, Payers, CMS, Da Vinci, value based care, ONC, FHIR Accelerator, FHIR Connectathon

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Just over one month ago, I leaped into  HL7 FHIR through involvement of the Da Vinci Project. Having worked in the healthcare technology industry for more than 10 years aligned with implementers of payer-provider workflows, data reporting and analytics, it was compelling to see how the proverbial “sausage is made” in the standards world. I made my debut by attending the HL7 FHIR Patient Access API Implementation event in August and I have since attended the September HL7 Connectathon.

Here are three key takeaways from my first month in the FHIR community.

The Room Where it Happens: Developing a Standard Doesn’t Transpire Behind Closed Doors By the Elite.

As an implementer reading a standards’ implementation guide (IG), it’s inevitable to reach a point of confusion where you say to yourself, “Clearly the writer of this didn’t consider my business need.” HL7 has a robust process that prioritizes adoption and reaching consensus among the public community before stamping approval on a standard. The continuous improvement method includes one or more balloting cycles (where the public community essentially critiques the IG and provides detailed feedback) as well as multiple connectathons (at which IGs are tested against by the community), providing ample opportunity for feedback from the community to evolve the IG. The HL7 Da Vinci Project, as well as other FHIR accelerators, have reference implementation prototypes, documented examples, sample test scripts and weekly calls open to the public, encouraging participation throughout the development lifecycle.

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HL7 Launches Project Vulcan FHIR Accelerator Program

[fa icon="calendar'] Aug 17, 2020 12:10:29 PM / by Amy Cramer, MMCi, RN, CPHQ posted in FHIR, HL7 community, BioPharma, interoperability, clinical research, implementation guide, FHIR Accelerator

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Multi-stakeholder initiative aims to use widely accepted health care standard to enable data exchange to streamline translational and clinical research

HL7 recently announced the launch of its newest FHIR Accelerator, Project Vulcan, which seeks to use its widely recognized data exchange standards to help health care researchers more effectively acquire, exchange and use data in translational and clinical research.

The effort, called Vulcan, intends to use a model for collaboration among diverse stakeholders in the translational and clinical research community to define a common set of standards that can be implemented internationally, built on current agreements to use the HL7 Fast Healthcare Interoperability (FHIR®) standard to facilitate data exchange.

“Improving data sharing can bring significant benefits to medical research, which is often a time-intensive and costly process that unnecessarily delays progress in discovering treatments for medical conditions because researchers are unable to share critical information,” said HL7 International CEO Charles Jaffe, MD, PhD, “Project Vulcan aims to develop common solutions to help partners overcome these challenges.”

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