Humana and more than 20 other health-related organizations are cooperating to improve data-sharing systems in ways that will lead to better care and lower costs.
The companies have formed the Da Vinci Project, a private-sector initiative that is leveraging HL7 Fast Healthcare Interoperability Resources (FHIR®) to better share information in value-based care (VBC) arrangements.
Such improved interoperability and standardization will allow payers and providers to create efficient care-delivery solutions and effective care-management models.
“Humana has a vested interest in making the experiences of members and partner physicians the best they can be,” said Patrick Murta, Principal Solution Architect, Business Technology Leadership, at Humana. “As an industry, we don’t have a great model for the sharing of clinical data between doctors and payers. But new technologies like FHIR can allow us to integrate in new ways.”
Da Vinci stakeholders are industry leaders and health IT experts working together to accelerate the adoption of HL7® FHIR® as the standard to support and integrate value-based care data exchanges.
The project has identified two initial use cases:
• 30-Day Medication Reconciliation Medication reconciliation programs can reduce the incidence of adverse drug events after discharge. The objective is to create a simple workflow that enables care providers to indicate a 30-Day Medication Reconciliation was done for a specific patient on a specific date.
• Coverage Requirements Discovery Coverage discovery enables care providers to request and receive information on health plan coverage requirements at the point of service.
The objective is to minimize the use of multiple unique data solutions and to guide the development and deployment of interoperable solutions on a national scale.
“Some of these problems have existed for a long time — prior authorization, medication reconciliation,” Murta said. “And the technology was not well-suited for solving those problems. But by using new approaches and modern integration technologies, we are able to integrate workflows and share actionable information in ways not previously possible. So our ability to either send information to the providers, when and where they need it, or get info from providers, when and where we need it, is a win-win for providers and members.
“Let’s say you go to the family doctor for an injury. You have to figure out if Humana has to approve a referral to a specialist, whether that’s covered, etc. It may not be easy to figure out; you have to make some phone calls. Or if you’re discharged from a hospital, and your doctor doesn’t know what medications you were discharged with or if you are seeing specialists for follow-up.
“In the new world, that info will show up as part of the normal workflow between payers and clinicians,” he said.
“Partnering with others in the industry provides standardization, which results in better care, and also lowers cost,” Murta said. “If we all follow the standards, it’s simply an implementation, not a customization.”
Read more about the project in this press release.