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Where Do We Begin? Hear First-Hand Accounts of Payer-to-Payer Data Exchange and End-to-End Prior Authorization Implementations at Upcoming Community Roundtable

[fa icon="calendar'] May 20, 2024 2:09:35 PM / by Leslie Amorós posted in FHIR, Payers, Da Vinci, prior authorization, FHIR Accelerator, PDex, FHIR Implementation Guides, burden reduction

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May 29 Sessionfeatures athenahealth, Availity and Humana and honors HL7 Da Vinci Project Community Champions from 4:00 - 5:30 pm ET

Join us this month to hear real-world HL7 FHIR and Da Vinci implementation stories that will provide you with inspiration and insight into how you can apply the learnings of athenahealth, Availity and Humana to your organization’s efforts to reduce friction, increase efficiency and meet the federal interoperability rules. 

After recognizing the 2023 HL7 Da Vinci Project Community Champions, representatives of Availity and Humana will provide a current snapshot of Da Vinci’s effort to create a nationwide interoperable approach among payers using the Payer Data Exchange (PDex) Implementation Guide, which enables payers to create a member’s health history using clinical resources which can be understood by providers and electronic medical records (EMR) systems. This discussion provides an opportunity to better understand dynamics you’ll encounter in achieving payer-to-payer exchange compliance such as consent and endpoint discovery.  Attendees will gain a foundational understanding of the new regulatory requirements, learn about technical and business challenges and benefits from real-world implementers and gain insight into how industry is working together. 

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CMS Final Rule Overview Added to Next Week’s HL7 Da Vinci Project Community Roundtable

[fa icon="calendar'] Jan 19, 2024 12:15:02 PM / by Leslie Amorós posted in FHIR, health IT policy, CMS, Da Vinci, prior authorization, FHIR Accelerator, FHIR Implementation Guides, CDex, policy

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January Roundtable also features Providence’s Clinical Data Exchange Implementation Journey

Are you interested in hearing federal officials provide an overview of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057)?

If so, register now for next week’s HL7 Da Vinci Project Community Roundtable, “CMS Interoperability Final Rule Overview and a Clinical Data Exchange Success Story: How Standardization Improves Value Based Care Performance,” scheduled for Jan. 24 from 4 – 5:30 p.m. ET.

The HL7 Da Vinci Project is thrilled to have CMS join next Wednesday’s Community Roundtable to offer highlights of the final rule in addition to the scheduled program showcasing Providence’s Da Vinci Clinical Data Exchange (CDex) Implementation Guide implementation journey.

Providence became the first major health system to implement CDex standards, and their journey included piloting with Premera Blue Cross and the vetting and approval by internal quality teams and external Healthcare Effectiveness Data and Information Set (HEDIS) auditors. The session concludes with a discussion of benefits experienced using CDex, including improved decision making, reduced burden, improved patient outcomes and enhanced quality of care to patients.

The Da Vinci Project is a private-sector initiative that accelerates the adoption of HL7 FHIR as the standard to support and integrate value-based care (VBC) data exchange across communities. The goal of the project is to help payers and providers positively impact clinical, quality, cost and care management outcomes, enabling providers to see the right data at the right time for patient-centered care.

The presenters will include:

  • Lorraine Doo, Senior Policy Advisory,Centers for Medicare & Medicaid Service
  • Alex Mugge, Deputy Chief Health Informatics Officer, Centers for Medicare & Medicaid Service
  • Semira Singh, Director, Population Health Informatics, Providence  
  • Michael Westover, Vice President, Population Health, Providence 

The session will be  moderated by Alix Goss, HL7 Da Vinci Project PMO, and Senior Consultant, Point-of-Care Partners.

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HL7 Da Vinci Project Use Case Progress Aids Market Readiness

[fa icon="calendar'] Dec 20, 2023 9:31:58 AM / by Howard Anderson posted in FHIR, Da Vinci, value based care, DEQM, prior authorization, alerts/notifications, notifications, coverage requirements discovery, documentation templates and payer rules, FHIR Accelerator, FHIR Connectathon, patient cost transparency, PDex, FHIR Implementation Guides, burden reduction, CDex, member attribution, VBPR, Value-Based Performance Reporting, CRD, PCT, HRex, prior authorization support

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2023 Accomplishments Position Industry for Year Ahead

Substantial progress has been made this year on HL7 Da Vinci Project Implementation Guides (IGs), which describe how to use HL7’s Fast Healthcare Interoperability Resources (HL7 FHIR®) standard for exchanging data to support value-based healthcare and implementations of the guides.

Sizing Up Accomplishments

At the December Da Vinci Community Roundtable, Hans Buitendijk, Da Vinci Project Steering Committee Vice Chair, reviewed progress this year and offered an outlook for 2024.

We have a number of organizations across the spectrum that have adopted one or more of our [FHIR implementation] capabilities. … That's fantastic in the short number of years that this initiative started to look at what is necessary to make it happen,” Buitendijk said.

“We currently have about eight publishing updates that have been accomplished and quite a few ballot processes that are in flight and being planned for, and there is a good amount of commitment to making this happen. So, we really need to be proud of what we have achieved to date, and particularly in the last year.”

In the year ahead, alignment with emerging regulations, including the final CMS Interoperability Rule, will be a top priority, he pointed out.

Interoperability efforts must go beyond a general set of data to ensure adequate support for public health, research, quality measures and more, he added. “We are all going to impact the ability and the opportunity to share more data over time,” he said.

The key to advancing interoperability by leveraging FHIR, he stressed, is to involve many different parties and develop the same language where we have a minimum set of capabilities that everybody can support, and leaving room … to grow, to explore, to define new things.”

He also pointed out: “We must continuously raise the bar for what we can exchange and determine what is relevant across many different stakeholders that we should all do in the same way … because the data that we have covered so far is still only a part of the variety of data exchanges that are relevant and can benefit from improvements."

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HL7 Da Vinci Project and CodeX Discuss Prior Authorization Successes, Implementation Guides and their Application in Oncology at August Community Roundtable

[fa icon="calendar'] Aug 16, 2023 2:45:00 PM / by Leslie Amorós posted in FHIR, interoperability, Da Vinci, prior authorization, FHIR Accelerator, CodeX

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Explore the Cross Accelerator Collaboration During the Discussion Aug. 23, 4 :00 – 5:30 p.m. ET

Reducing Prior Authorization Burden and Improving Oncologic Care with HL7 FHIR,” August’s Community Roundtable, will highlight why and how Da Vinci is tackling prior authorization and hear how CodeX is leveraging the work of the Da Vinci Implementation Guides (IGs), which have been referenced in federal proposed interoperability rules, to tackle prior authorization challenges in oncology.

 Join the session and discover the endeavors of the CodeX Prior Authorization in Oncology Use Case team to improve the care journey for cancer patients by expediting prior authorization via automation. 

The discussion will share real-world success stories from Da Vinci and how these efforts can serve as building blocks for CodeX solutions, as well as reveal how you can become involved and the benefits of participation in this work.

Presenters for this session include:

  • Ellen Anderson, Enterprise Architect, Evernorth
  • Kirk Anderson, Vice President and Chief Technology Officer, Chair, Da Vinci Steering Committee, Cambia Health Solutions
  • Su Chen, MD, CodeX Program Manager, Clinical Science Principal, MITRE

Alix Goss, HL7 Da Vinci Project PMO, and Senior Consultant, Point-of-Care Partners, serves as the session moderator.

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CodeX Makes Strides in Prior Authorization in Oncology

[fa icon="calendar'] Jun 29, 2023 12:31:37 PM / by Leslie Amorós posted in FHIR, interoperability, prior authorization, FHIR Accelerator, CodeX, oncology

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Latest advances in the use case and the success of Mayo Clinic’s adoption of minimal Common Oncology Data Elements (mCODE) to improve routine oncology clinical care focus of June Community of Practice

Prior authorization continues to be a pain point across the health care spectrum, and this month’s CodeX Community of Practice meeting will be highlighting prior authorization and how a standards-based approach is improving care at the Mayo Clinic.

According to a 2022 American Medical Association survey, 94% of physicians reported care delays associated with prior authorization, and 80% said these requirements can at least sometimes lead to patients abandoning treatment.

When treating cancer, the delays could be deadly.

Within CodeX, the Prior Authorization in Oncologyuse case focused on prostate cancer treatment is making strides in its iteratively phased proof-of-concept (POC). A goal of the use case is to automate prior authorization for cancer treatment so that 80% of approvals do not require manual inspection, expediting care for patients and reducing physician burden. CodeX participants are proving the utility of the Implementation Guides Coverage Requirements Discovery (CRD), Documents Template Requirements (DTR) and Prior Authorization Support (PAS) as developed by the HL7 Da Vinci Project Burden Reduction use case as well as in the Centers for Medicare and Medicaid Services December 2022 proposed rule Advancing Interoperability and Improving Prior Authorization Processes.

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Da Vinci's April Community Roundtable to Feature Implementation of Burden Reduction IGs

[fa icon="calendar'] Apr 25, 2023 9:35:11 AM / by Leslie Amorós posted in FHIR, interoperability, Da Vinci, prior authorization, FHIR Accelerator, burden reduction

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The Da Vinci Project’s April Community Roundtable to be held April 26 from 4:00 – 5:30 pm ET

Join us for our April Community Roundtable this Wednesday, April 26, from 4 – 5:30 pm, to hear the latest from the HL7 Da Vinci Project and recent industry activity as well as our featured implementation story from athenahealth, Availity and Humana.

Straight from the Spotlight Theater at HIMSS23, this national payer, EHR vendor and health information network will share lessons learned from their collaborative development of an end-to-end prior authorization process leveraging the Da Vinci Burden Reduction Implementation Guides.

Presenters for this session, “A Transformative Trifecta: An End-to-End Prior Authorization Journey,” include:

  • Susan Bellile, Principal, Clinical Solutions, Availity
  • Jocelyn Keegan, Program Manager, HL7 Da Vinci Project; Payer/Practice Lead, Point-of-Care Partners
  • Amy Mattingly, Director, UM Interoperability Product Management, Humana
  • Gillian McCabe, Director, Product Management, Authorization Management, athenahealth

The moderator for the Community Roundtable is Alix Goss, HL7 Da Vinci Project PMO, Vice President and Senior Consultant, Imprado.

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Are You Preparing for the Proposed Prior Authorization and Attachments Rules?

[fa icon="calendar'] Feb 16, 2023 5:11:35 PM / by Diana Manos posted in FHIR, health IT policy, interoperability, CMS, Da Vinci, prior authorization, FHIR Accelerator, attachments

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Learn about the rules, how innovators are reaping the benefits of HL7 FHIR APIs and the value of automation at this month’s  Da Vinci Project Community Roundtable

In this month’s Community Roundtable, the HL7 Da Vinci Project is exploring healthcare interoperability with a full line-up of speakers. The virtual roundtable, titled, “Advancing Interoperability via FHIR APIs: An Industry Discussion on Progress, Proposed Rules and the Value of Automation,will be held Wednesday, Feb. 22, from 4:00 - 5:30 PM EST.

The session will break down the latest federal proposed rules impacting interoperability, the Prior Authorization and Attachments Rules, published last December. Continuing where the January Roundtable left off, Da Vinci guest speakers will address the complex rules and explain their significance in moving forward with FHIR APIs to seamlessly exchange information between payers and providers. CMS is awaiting March comments on the rule, and this roundtable will be a good prep for those who are preparing to comment on this landmark regulation impacting interoperability and seeking to invest in FHIR.

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CMS Officials and Da Vinci Leaders Present a Community Roundtable on the Proposed Federal Rules and How Da Vinci Implementation Guides Meet Them

[fa icon="calendar'] Jan 20, 2023 1:45:01 PM / by Leslie Amorós posted in FHIR, health IT policy, interoperability, CMS, Da Vinci, prior authorization, FHIR Accelerator, attachments

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The Da Vinci Project’s January Community Roundtable to be held January 25 from 4:00 – 5:30 p.m. ET

With the issuance of the new federal prior authorization and attachments rule proposals last month, the innovative interoperability work advanced by the HL7 Da Vinci Project is once again being recognized as a path forward for game-changing industry transformation that will reduce burden, increase automation and improve care.

The Intersection of Federal Regulation and The HL7 Da Vinci Project, January’s Community Roundtable, features an overview and frequently asked questions about the rules and their accompanying RFIs from CMS officials. Da Vinci leaders then will share an overview of the implementation guides that are suggested in the proposed rules and how they meet the rules’ objectives.

At the January 25 session, which is scheduled from 4:00 – 5:30 p.m. ET, attendees will learn how to access the resources, participate in community feedback and start getting involved.

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HL7's FHIR Accelerator CodeX Launces Pilot to Simplify Prior Authorization in Oncology

[fa icon="calendar'] Sep 6, 2022 12:45:39 PM / by CodeX FHIR Accelerator posted in FHIR, HL7, health IT, prior authorization, FHIR Accelerator, FHIR Community, CodeX, oncology

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CodeX-logo-simple (003)                           Evernorth

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Learn How UC Davis Health, Centene and InterSystems Use HL7 Da Vinci Implementation Guides to Tackle Prior Authorization at the HL7 Da Vinci Community Roundtable

[fa icon="calendar'] Aug 16, 2022 10:20:39 AM / by Leslie Amorós posted in FHIR, interoperability, Da Vinci, prior authorization, FHIR Accelerator

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The HL7 Da Vinci Project’s August Community Roundtable to be held August 24  from 4:00 – 5:30 p.m. ET

Da Vinci’s Community Roundtable returns after a summer hiatus with a powerful program highlighting a real-world implementation of Da Vinci’s Prior Authorization Implementation Guides.

“Celebrating HL7 FHIR's Success: From Champions to Prior Authorization Implementers,” will begin with a program update and brief recognition of the 2021 HL7 Da Vinci Community Champions, showcasing individuals making significant contributions to advancing value-based care by leveraging HL7 Fast Healthcare Interoperability Resources (FHIR®) and making the outputs of Da Vinci real.

After the updates, representatives of the 646-bed health system UC Davis Health, the 25.4-million-member payer Centene, and technology solutions vendor InterSystems will discuss their Da Vinci prior authorization journey and the benefits achieved to date.

Presenters for next week’s session include:

  • Howard Cohen, Director, Advanced Technology Team, Centene
  • Michael B. Marchant, Director, Health Information Exchange, UC Davis Health
  • Lynda Rowe, Senior Advisor, Value-based Markets, InterSystems
  • Mahesh Siddanati, Vice President, Digital Solutions and Product (Regulatory and Quality), Centene

Attendees will hear first-hand accounts of the considerations, challenges and benefits of working together to establish infrastructure to streamline prior authorization workflows, remove latency and enable real-time data sharing.

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