The 2023 KLAS Points of the Light report highlights successful collaborations between payers, healthcare organizations, and health IT vendors that have improved interoperability, reduced costs, and improved patient experiences. For their accomplishments in areas like interoperability, prior authorization, and value-based care, the report honours 25 partnerships. Building partnerships based on trust and collaboration, deploying proactive health IT partners, developing governance frameworks, and utilizing data to drive better results are some of the key lessons gained.
Interoperability in healthcare refers to the ability of various health IT systems and applications to exchange and utilize data seamlessly. Achieving interoperability has been a challenge in the healthcare industry, as disparate systems and data silos make it difficult to obtain a comprehensive view of patient data. However, collaborations between payers, healthcare organizations, and health IT vendors can help drive interoperability and lead to improved care outcomes. The 2023 KLAS Points of Light report celebrates successful partnerships that have reduced costs and improved the patient experience, highlighting 25 collaborations for a 2023 Points of Light award.
Interoperability between Payer and Provider Organizations:
Transparent data sharing between payer and provider organizations is critical to the success of value-based care initiatives. The collaborations focused on interoperability were able to give both parties access to a more comprehensive view of patients’ health for care coordination. These partnerships also improved the accuracy of quality measure submissions, contributing to lower costs and higher reimbursements.
Prior Authorization:
Partnerships that automated prior authorization processes helped drive efficiency by eliminating administrative burdens. These collaborations leveraged strategies like artificial intelligence and clinical decision support to standardize the submission process, reduce manual workflows, and improve data exchange. The initiatives also helped increase the visibility of patient coverage and improve the speed of treatment for patients.
Value-Based Care:
Initiatives focused specifically on value-based care required technological investment. “The partnerships that focused on this area upgraded their technology stacks to include care coordination systems and data analytics tools, improving access to real-time data on outcomes and utilization patterns to allow them to accurately assess patient risk, reduce costs of care, and inform HEDIS quality measures and star ratings,” the KLAS authors wrote. They noted that in these collaborations, stakeholders had to be willing to learn new workflows and technologies to support and sustain bundled-payment programs.
Lessons Learned:
The report outlined four key lessons learned from the 25 case studies.
- Build Partnerships of Trust and Collaboration:
Focus on common ground and have a collaborative mindset. Foster open communication throughout all phases of the initiative.
2. Choose Proactive Health IT Partners That Offer Robust Technology:
Vendors must develop technology that integrates with SMART on FHIR, CDS Hooks, and non-FHIR APIs and leverage scalable and sustainable technology, according to the report’s authors.
3. Create the Groups and Governance Structures Necessary for Success:
Establish governance groups comprised of representatives from all relevant stakeholders.
4. Utilize Data to Drive Improved Outcomes:
Understand the data needed to meet CMS requirements and HEDIS quality measures in value-based care contracts. Benchmark your performance against other healthcare organizations in closing quality care gaps.
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