MCG interoperability experts will join their counterparts from MultiCare Connected Care and Regence to present the first, scalable prior authorization automation technology.
“By improving transparency of clinical requirements and automating several steps in the workflow, we can repurpose labor to higher-value activities for both health plans and providers, and help drive down costs across the health care system.” – Heidi Kriz, Director of Medical Policy at Regence
SEATTLE, Wash. (PRWEB)
April 11, 2023
MCG Health, part of the Hearst Health network and an industry leader in evidence-based guidance and technology, announces its senior interoperability experts will join their counterparts from Regence and MultiCare Connected Care to present at the HIMSS Global Health Conference & Exhibition. The health IT innovators will discuss their recent success with automating prior authorization processes through newly developed technology and standards. The 2023 HIMSS event, happening April 17-22 in Chicago, Illinois, unites exceptional thought leaders in health information and technology to inspire education, innovation, and cross-industry collaboration.
MCG Associate Vice President of Technology and Interoperability, Rajesh Godavarthi, will co-present the first interoperability session with Regence’s Heidi Kriz, MPH, RD, Director of Medical Policy and Medical Management, PA Transformation Lead, and Anna Taylor, MS, CIPCT, the Associate Vice President of Population Health and Value-Based Care for MultiCare Connected Care. Their presentation, “Achieving the 1st Prior Auth Automation via HL7® FHIR: Parts 1 and 2”,” takes place on Tuesday, April 18, 2023, from 1:15-2:05 PM CT, and will evaluate prior authorization process improvements using the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard with the HL7 Da Vinci Project implementation guides. Regence, MultiCare, and MCG implemented these standards in 2022 to inform clinical decision-making with scientific evidence, reduce provider/payer administrative burden, and improve patient/member treatment timelines. This session will also cover the real-world lessons learned as they jointly launched the first scalable, prior authorization automation technology in the U.S.
Brandy O’Diam, MCG Associate Director of Product Management, and Danny Cawood, MCG Product Manager of Interoperability Solutions, will present the second interoperability showcase, “Automating Authorization: Impacts of Different Authorization Types,” on Wednesday, April 19, 2023, from 2:45-3:05 PM CT. This session focuses on successful implementations of prior authorization in different clinical use cases (inpatient vs. prior authorization) and how the automation impacted business, operations, and technology outcomes.
“Pre-authorization is a significant administrative burden for providers and health plans alike,” said Heidi Kriz, Director of Medical Policy at Regence. “By improving transparency of clinical requirements and automating several steps in the workflow, we can repurpose labor to higher-value activities for both health plans and providers, and help drive down costs across the health care system.”
When asked about speaking at the upcoming HIMSS 2023 event, Mr. Godavarthi said, “Due to recent CMS activity around prior authorization and interoperability, automation is a critical area of focus in healthcare. Our team is excited to share payer and provider experiences of successful implementation that is leading to better patient care.”
Regence, MultiCare Connected Care, and MCG Health are all members of the HL7 Da Vinci Project, a multi-stakeholder collaborative program engaging providers, payers and partners with the goal of accelerating the adoption of HL7 FHIR as the standard to support and integrate value-based care data exchange across communities in real time. Kriz, Taylor, and Godavarthi have been previously recognized as HL7 Da Vinci Project Community Champions within the accelerator program. For those interested in learning more about the HIMSS 2023 conference, please visit: https://www.himss.org/global-conference.
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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.
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.