Leaders in prior auth automation recognized for their innovative work in the HL7 ® Da Vinci Project
SEATTLE, Wash., June 27, 2023 /PRNewswire-PRWeb/ -- MCG Health, part of the Hearst Health network and an industry leader in technology-enabled, evidence-based guidance, along with Regence Health Plans and MultiCare Connected Care, were recognized by KLAS with the 2023 Points of Light award. This was the first collaboration between a payer, provider, and clinical decision support vendor to produce a scalable and automated prior authorization (PA) workflow based on the HL7 Da Vinci Project's implementation guides (IGs). The three organizations were presented with the KLAS Points of Light award during the annual KLAS K2 Summit on May 10, 2023, in Salt Lake City.
KLAS recognized MCG, Regence, and MultiCare Connected Care for utilizing interoperability standards from the HL7 Da Vinci Project to create an end-to-end HL7 FHIR® (Fast Healthcare Interoperability Resources) workflow for prior authorizations. This technology automated the submission of prior authorization requests from the provider's electronic health record (EHR) to the payer's medical management system and was able to return an authorization determination in real-time back to the provider's EHR. MCG's rules engine was integrated into the process to ensure care decisions were support by vetted, scientific evidence.
The results recognized as part of the award include:
- 60% of auth requests were able to be completed immediately as "no auth required" and communicated to the provider via their EHR
- 41% of requests requiring prior auth (from an initial data sample) were auto approved which meant no human review was required
- The provider achieved 140% to 230% increase in PA productivity
- Improved workflows for the payer and provider, leading to faster authorization decisions; Many determinations were returned in seconds, compared to a previous turnaround time of three-to-five days
- Reduced administrative burden for stakeholders, and faster access to care for patients
MCG President and CEO, Jon Shreve, said of the recognition, "MCG is humbled to stand with Regence and MultiCare Connected Care as recipients of the 2023 KLAS Points of Light award. This collaboration sets the stage for a new era in patient-centered care with evidence-based clinical decisions and timelier treatment."
KLAS' annual Points of Light awards celebrate success stories—or "points of light"—achieved by payers, healthcare organizations, and vendors who have partnered to reduce costs and inefficiencies and improve the patient experience. In total, 25 collaborations were awarded a 2023 Points of Light award. The report is available to KLAS members here: https://klasresearch.com/report/points-of-light-2023-case-study-14-leveraging-hl7-fhir-interoperability-standards-to-automate-prior-authorizations/3183
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About Regence
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. It is transforming healthcare as a population health engine that represents a Clinically Integrated network (CIN) of independent & MultiCare Health System clinicians' services across the entire social medical model of care. Under this entity, 350,000 lives are served within 30 value-based contracts.
Unlike the traditional "fee for service" health care model – where each visit, service, test, and procedure has a separate cost – MCC's foundation is built first and foremost on providing patient-centered, quality care at an appropriate cost. Specific measures are used to determine how well doctors, hospitals, and other providers are keeping healthy people healthy, effectively treating illnesses, and helping people better manage their chronic conditions. In this way, all the participating providers share the responsibility of providing patient-centered, high quality, efficient, cost-effective care.
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 5,100 clinicians providing services across the continuum of care. multicareconnectedcare.com
About MCG Health
MCG, part of the Hearst Health network, provides unbiased clinical guidance that gives healthcare organizations confidence in delivering patient-centered care. MCG's artificial intelligence and technology, infused with clinical expertise, enable its clients to prioritize and simplify their work. MCG's world-class customer service ensures that clients maximize the benefits of licensing MCG solutions – demonstrating improved clinical and financial outcomes.
For more information visit http://www.mcg.com or follow our Twitter handle at @MCG_Health.
About Hearst Health
The mission of Hearst Health is to help guide the most important care moments by delivering vital information into the hands of everyone who touches a person's health journey. Care guidance from Hearst Health reaches the majority of people in the U.S. The Hearst Health network includes FDB (First Databank), Zynx Health, MCG, Homecare Homebase, and MHK (formerly MedHOK). Hearst also holds a minority interest in the precision medicine and oncology analytics company M2Gen. Follow Hearst Health on Twitter @HearstHealth and LinkedIn @Hearst-Health.
Media Contact
Arri Burgess, MCG Health, (206) 389-5405, arri.burgess@mcg.com
SOURCE MCG Health
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