Originally Aired - Wednesday, March 13 • 2:30 PM - 3:30 PM Eastern Time (US & Canada)
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Location: W230A
Type: General Education
Session ID: 151
Title: Using DaVinci Implementation Guides for an End-to-End Prior Authorization Collaboration
Description: Prior authorizations are a critical utilization management tool to ensure high quality and cost-effective care delivery. Unfortunately, many providers and health plans consider the prior authorization process—which relies heavily on manual interventions, analog technologies and inconsistent standardization—burdensome and a potential impediment to timely patient care. To address these pain points, a national health plan, EHR vendor, and real-time health information network embarked on a collaborative initiative to develop an end-to-end prior authorization process leveraging the Da Vinci Burden Reduction implementation guides. The goals of this collaboration were to improve transparency into the prior authorization process, reduce the administrative burdens for both the health plan and its provider network, leverage available clinical content, and accelerate the process through automation. This presentation, presented in a case study format, will describe in detail the goals of the collaboration; the specifics regarding implementation; how the organizations approached technical, data- and standards-based challenges; review critical lessons learned from the initiative; and provide key benchmarks and metrics of post-go-live success. (Note to Reviewers: The end-to-end authorizations initiative became generally available to providers in July 2023. The speakers expect initial measurable results in fall 2023 and will append those results to this proposal.)
Level: Intermediate
Format: 60-Minute Lecture
Learning Objective #1: Recognize areas for automation and real-time information exchange in an end-to-end prior authorization process within the provider’s existing workflow
Learning Objective #2: Demonstrate how the collaborators used the Da Vinci Burden Reduction implementation guides to trigger, facilitate, and bundle transactions related to end-to-end prior authorizations across all stakeholders
Learning Objective #3: Identify key data considerations required for transparent and traceable transactions between health plans and providers
