Blue Cross and Blue Shield insurer Regence has launched data-sharing initiatives with two Northwest-based healthcare providers, MultiCare and Oregon Health & Science University (OHSU), designed to improve interoperability.
These initiatives are part of the HL7 Da Vinci Project, a private sector initiative that aims to address the needs of the value-based care community by leveraging the HL7 FHIR (Fast Healthcare Interoperability Resources) platform. Collaborating with these health systems, Regence is shifting to a value-based care approach powered by interoperability, aiming for more coordinated care between members and their healthcare providers, officials attested in an announcement made last week.
Regence serves approximately 3.1 million members through Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (select counties in Washington). Each health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association.
During one initiative last year, Regence and MultiCare Connected Care—the accountable care organization (ACO) that is a wholly owned subsidiary of MultiCare Health System, based in Tacoma, Wash.—teamed up on a Da Vinci Project use case based on HL7 FHIR as the standard for value-based care data exchange.
This use case, centered around medication reconciliation—the process by which a patient’s medication history is verified to ensure there are no discrepancies when considering medication changes—enabled MultiCare to send proof that a patient’s medication history had been verified upon hospital discharge. This data is submitted daily and directly to Regence, with the goal of reducing administrative burden, costs and improving quality. This reconciliation is often conducted during transfers of care as an important value-based care quality and patient safety measure, officials pointed out.
“Our partnership with Regence has been instrumental to streamlining the clinical workflow and ensuring patient safety,” said Anna Taylor, director of operations, MultiCare Connected Care. “By working together, we were able to quickly reduce labor-intensive administrative work so that our providers can dedicate more time to caring for patients.”
Meanwhile, in a separate initiative, Regence is working with the Portland-based OHSU to expedite and simplify decisions on the most appropriate care for members. The current prior authorization process can be time-consuming for patients, providers and payers, and a costly administrative burden that potentially delays care. As such, providers need real-time access to health plan coverage requirements to efficiently deliver more informed and timely treatment decisions, officials contended To combat these challenges, collaborating with OHSU, Regence is integrating prior authorization tools directly in the electronic health record (EHR), including delivering automatic coverage decisions.
Pointing out that the healthcare industry currently lacks standards for sharing this data between payers and providers, Regence is working with MultiCare Connected Care to implement a FHIR-based approach to share key information needed for member attribution in value-based arrangements. As part of this work, Regence’s corporate parent is sponsoring and leading the development of one of the Da Vinci Project’s implementation guides, which will aim to provide a standard, consistent process for providers and payers to share key information needed for members in value-based arrangements.
The goal of all Da Vinci Project use cases is to expand their use to additional providers and payers, establishing new standards for improving data sharing across the industry.
“The more we are able to simplify provider workflows and lighten the administrative load, the more quickly we can accelerate successful value-based care programs for patients, providers and payers alike,” said Kristie Putnam, Regence’s vice president of provider partnership innovation. “These innovative partnerships are offering a more complete view of patient history, resulting in a better outcome and more affordable care for patients and increased efficiency overall.”
Jocelyn Keegan, program manager, Da Vinci Project, further noted that “Founding members of Da Vinci Project, Regence and its corporate parent provide deep thought leadership, a wealth of subject matter expertise and real-world implementation experience back to the emerging FHIR community across focus areas. Regence and its partners are demonstrating the power of standards and FHIR to reduce burden and improve outcomes for patients, providers and payers.”