Effective preauthorization enables health plans to ensure evidence-based care for members, reduce administrative burden and manage costs of unnecessary or inappropriate services. But the preauthorization process is labor intensive, may increase treatment wait times and creates administrative burden. Operational efficiency is a win-win-win for payers, providers and members alike.
In October 2022, Regence and MultiCare Connected Care partnered on the nation’s first implementation of the HL7 FHIR Prior Authorization Support Standard. This application programming interface allowed Regence to create a workflow that embeds the preauthorization process in MultiCare’s EHR and integrates vendor MCG’s app for surfacing the clinical criteria.
This successful collaboration will open the door for further innovation. Once data interoperability is achieved, the possibilities are endless for containing costs and improving outcomes. In the future, health plans can surface when preventive screenings have not been completed for members and alert a provider in real time in their workflow at the point of care. This can improve the member’s clinical outcome and reduce potential costs of additional care.