How Provider-Payer Collaboration Maximizes Value Based Performance Reporting (ID #810)

 The HL7® Da Vinci Project is a multi-stakeholder collaborative effort engaging providers, payers and partners with the goal of accelerating the adoption of HL7 FHIR® (Fast Healthcare Interoperability Resources) as the standard to support and integrate value-based care (VBC) data exchange in real time. As fee for service shifts to value-based care, value-based contracts have emerged as a mechanism that providers and
payers may use to better align their contracting structures with broader changes in the healthcare system.

This session provides you with front-row access to HL7 Da Vinci Project’s newest use case that aims to develop an HL7 FHIR Implementation Guide to support value-based performance reporting for quality and risk contracts. Proposed by a provider, this use case seeks to solve challenges around the lack of reporting format standardizations, the resource-intensive process, lack of scalability and the complexities of data
reconciliation.

After a brief high-level perspective regarding the value-based performance reporting component, presenters will highlight the genesis, development, project scope and progress of the use case. The opportunities to tackle the challenges of gathering performance data will be a focus as well as how you can leverage the HL7 Da Vinci project Implementation Guides to improve your reporting.

Semira Singh, Director, Population Health Informatics, Providence 

Teresa Younkin, Project Co-Lead, HL7 Da Vinci Project PMO and Senior Consultant, Point-of-Care Partners

Comply with the Proposed CMS Payer to Payer & Provider Access API with Member Consent & FHIR®

Description: Discover how a holistic approach to an interoperable member consent solution can help payers meet upcoming mandates and solve business problems that nobody is talking about.

Speakers: Kevin Day, Principal Business Advisor, Edifecs & Sergiu Rata AVP Product Management, Edifecs

Da Vinci Kiosk

Interoperability Showcase North Building | Hall B | Booth 7946-28 

Da Vinci Demos: Price Cost Transparency

Join us to see how implementers use our Implentation Guides and take the opportunity to ask questions!

Kevin Day, Edifecs 

Alice O'Carroll, FloridaBlue 

CONFIRMED 

 Micro

FHIR Implementations 

A Da Vinci use case is one of three implementations to be showcased in the hour.

(1:15pm - 1:35pm)

COMBINED SESSION

1:15 - 2:05 p.m. 

Achieving the 1st Prior Auth Automation via HL7® FHIR: Pt. 1

• Evaluate the prior authorization process improvements and interoperability standards (HL7® Da Vinci FHIR®) used to automate and inform clinical decision-making, reduce provider burden, and improve patient outcomes. Attendees will learn about (1) best practices for implementation, (2) payer and provider perspectives on the transformation, and (3) the project’s success metrics.

Raj Godavarthi

AVP, Technology & Interoperability | HITAC Member, MCG Health

Heidi Kriz

Director of Medical Policy and Medical Management; PA Transformation Lead, Regence

Anna Taylor

MS CIPCT | AVP – Population Health & Value Based Care 

MultiCare Connected Care

(1:45 p.m. – 2:05 p.m.)

COMBINED SESSION 

1:15 - 2:05 p.m. 

• Evaluate the prior authorization process improvements and interoperability standards (HL7® Da Vinci FHIR®) used to automate and inform clinical decision-making, reduce provider burden, and improve patient outcomes. Attendees will learn about (1) best practices for implementation, (2) payer and provider perspectives on the transformation, and (3) the project’s success metrics.

Da Vinci Kiosk

Interoperability Showcase North Building | Hall B | Booth 7946-28 

Da Vinci Demos: Prior Authorization and Attribution 

Join us to see how implementers use our Implentation Guides and take the opportunity to ask questions!

MCG, Regence, Multicare

INVITED

HL7 Da Vinci Project: FHIR solutions of Interoperability needs (Prior Auth, Attachments, etc.) named in proposed Federal Regulations (NPRM)

Susan Belille

Availity

Matt Schuller

BCBSA

 Micro

Kirk Anderson

CTO

Cambia Health

 Micro

CDex with GuideWell

PDex with Humana and GuideWell

Da Vinci Kiosk

Interoperability Showcase North Building | Hall B | Booth 7946-28 

Da Vinci Demos: Payer Data Exchange 

Join us to see how implementers use our Implentation Guides and take the opportunity to ask questions!

Humana and GuideWell

West Building | Level 1 | Jackson Park A

HL7 Da Vinci 101

Join us and learn the basics of the HL7 Da Vinci Project, a private sector initiative comprised of more than 50 industry-leading providers, payers and technology vendors who are working together to accelerate the adoption of HL7 Fast Healthcare Interoperability Resources (HL7® FHIR®) as the standard to support and integrate value-based care (VBC) data exchange across communities.  Learn about Da Vinci, its use cases and implementation guides as well as how you can access the free resources and join the community. 

West Building | Level 1 | Jackson Park A

Overview of Quality on FHIR

Discover the whole ecosystem of quality improvement via FHIR, where you can collect data as it occurs in real-time. Learn the latest regarding how HL7 FHIR standards and the work of the HL7 Da Vinci Project, a collaborative effort of payers, providers and partners, are transforming quality measurement and identification of gaps in care. An overview of the resources available, as well as the challenges and opportunities of digital quality measurement, will be discussed, highlighting how FHIR is improving data exchange and compliance as well as reducing manual work.

Linda Michaelsen, Da Vinci lead, Optum, and Anna Taylor, MultiCare 

 Micro

Prior Authorization

A 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.

Susan Bellile
Principal, Clinical Solutions
Availity

Amy Mattingly
Director, UM Interoperability Product Management
Humana

Michael Palantoni 
Vice President Platform and Data Services
athenahealth

 Micro

Comply with the Proposed CMS Payer to Payer & Provider Access API with Member Consent & FHIR®

Description: Discover how a holistic approach to an interoperable member consent solution can help payers meet upcoming mandates and solve business problems that nobody is talking about.

Speakers: Kevin Day, Principal Business Advisor, Edifecs & Sergiu Rata AVP Product Management, Edifecs

"Gift of Time" - Hooks Approach to Leveraging Da Vinci IG Standards 

We envision a healthcare system that’s liberated from waste, where access to data and a collaborative approach between payers and providers leads to high-quality care at the point of care.

Lorenzo Granato CEO, Founder

Kevin Carroll, Chief Growth Officer

Hook MD

Da Vinci Kiosk

Interoperability Showcase North Building | Hall B | Booth 7946-28 

Da Vinci Demos:  Payer Data Exchange

Join us to see how implementers use our Implentation Guides and take the opportunity to ask questions!

Kevin Day

Edifecs

Sergiu Rata

HCSC

Da Vinci Kiosk

Interoperability Showcase North Building | Hall B | Booth 7946-28 

Da Vinci Demos: Prior Authorization 

Join us to see how implementers use our Implementation Guides and take the opportunity to ask questions!

Lorenzo Granato CEO, Kevin Carroll CGO

Hook MD

Simplifying Prior Authorization Workflows at the Point of Care

Discussion will cover how the DaVinci CRD implementation guide supports can support accelerated prior authorization workflows requiring only provider, member, and procedure details to support determinations. Gold carding further simplifies processes by removing need to submit a prior authorization for providers with a successful track record of prior authorizations submissions.

Joshua Lamb 

Architect, Optum

Jay Sandhaus, CTO, Rhyme

HL7 FHIR Accelerator Panel (Featuring Da Vinci, CARIN, Argonaut, and CodeX)

Automating Authorization: Impacts of Different Authorization Types

• With recent CMS activity around prior authorizations and interoperability, the nuances of automation are a critical focus. Attendees will learn from experts who implemented two types of clinical use cases (elective surgeries and emergent inpatient admissions) and hear how divergent clinical use cases impact business, operations, and technology outcomes.

Brandy O'Diam

Associate Director, Product Management

Danny Cawood

Product Manager

Da Vinci Kiosk

Interoperability Showcase North Building | Hall B | Booth 7946-28 

Da Vinci Demos: Prior Authorization with Home Health Care

Join us to see how implementers use our Implentation Guides and take the opportunity to ask questions!

MCG and Palmetto

INVITED

An Introduction to the Value-Based Performance Reporting HL7® FHIR® Implementation Guide

The HL7® Da Vinci Project has initiated a new HL7 FHIR® use case to support and integrate value-based care data exchange in real time.  This session outlines what problem the use case is solving and how the Implementation Guide will support standard value-based performance reporting for quality and risk contracts.

Michael Patwell, Principal Business Advisor, Edifecs

David DeGandi, Sr. Interoperability Strategist, Cambia Health

Semira Singh, Director of Population Health Informatics, Providence

Da Vinci Kiosk

Interoperability Showcase North Building | Hall B | Booth 7946-28 

Da Vinci Demos:  Prior Authorization

Join us to see how implementers use our Implementation Guides and take the opportunity to ask questions!

Maxim Abramsky, AVP Product Management Prior Authorization, Edifecs

CONFIRMED

How HL7 Da Vinci Project enables “True Auth” - A Complete Prior Authorization Solution

With the release of the CMS Proposed Rule it is clear a Da Vinci-enabled authorization solution is the path forward. Join us to explore how the industry will get to an automated solution connecting payers and providers using the Da Vinci IG’s and what a “True Auth” solution would look like.

Andrew Johnson

VP Growth and Innovation

Optum Insight

Nick Radov

Distinguished Engineer

Optum Tech

Risk Adjustment Reporting at the Point of Care​

Learn how the Da Vinci Risk Adjustment Implementation Guide supports exchange of risk adjustment gap reports at the point of care and how standard protocols which are payer agnostic enable communication of chronic conditions and simplified workflows. Providers gain ability to share real-time feedback and clinical evidence to address gaps.  

Josh Lamb (Optum)

Linda Michaelsen (Optum)

Michael Palantoni (Athena Healthcare)

Why Should You Move to APIs and Structured Data?

Clearly understand why the industry is at an inflection point from many different shifts underway: technology advancement, policy and market dynamics. The rising availability of data via APIs, payment transformation to Value Based Care, and increasingly larger populations covered by government programs will fundamentally change how providers and payers engage with patients. Learn about the emerging capabilities enabled by the rise in use of HL7 FHIR, and the patterns and tools from HL7 Da Vinci that can help organizations and their partners fuel their move to real time exchange of data across critical business areas to manage quality, risk, care coordination and prior authorization.

Hot Coals – Expanding your FHIR Footprint

This session will discuss how UCDavis Health supports API Connectivity with outside entities and how adding partners like Zeomega is made easier by leveraging industry stands like Da Vinci/FHIR APIs, allowing both organizations to expand our world of API connections – and how quickly it enables connecting to new partners and supports a variety of use cases.

ZeOmega Mike Gould, 

Michael Marchant  
Director, Interoperability

UC Davis Health

Advancing Da Vinci Use Cases and Implementation Guides within the BCBS System

The BCBS System has made significant investments in the adoption of health IT standards as provider utilization of EHRs has increased, health IT standards have matured, and federal requirements have created urgency.  Learn how the system is implementing Da Vinci best practices in its current and future interoperability strategies.

Panelists:

Satish Padiyar, Div. VP, Platforms & Governance, HCSC

Matt Schuller, Director HIT, BCBSA

Moderator: Karuna Relwani, Business Interoperability Lead, BCBSA 

FHIR Implementation Progress Leveraging the HL7 Da Vinci Project

Learn about the real-world story of MultiCare Connected Care, an HL7 Da Vinci Project member, and learn how MultiCare is using FHIR and the Implementation Guides to solve problems, streamline workflow and improve data exchange.  For example, MultiCare implemented Da Vinci’s member attribution use case, which resulted in a 10% improvement in patient matching.  This benefit helped MultiCare further improve patient safety by ensuring clinicians have the full picture about their patients in real time.

Business Value Beyond Compliance: Prior Authorization, AI, and FHIR®

Government mandates can feel like a box to check with little reward. What if you could gain business value by leveraging requirements for strategic business objectives? Leverage AI and FHIR to standardize and automate prior authorization to streamline a shared workflow and improve collaboration, patient outcomes, and member experience.

Maxim Abramsky, 
AVP of Product Management, Prior Authorization, Edifecs

Vaishali Dubey, Sr Manager Guidewell Provider Interoperability, Florida Blue

Building a FHIR Platform to Support Da Vinci Use Cases
Da Vinci Use Cases leverage the power of FHIR. How do healthcare organizations acquire, manage, compute on, and exchange data using FHIR APIs? We discuss how a number of health insurers have built a holistic FHIR interoperability platform to support healthcare data transactions and the use cases they enable.

Pamela Nasr

Senior Product Manager

1upHealth