API Pilot Deployment Based on HL7® FHIR® Standards Yields Double-Digit Improvements by Providing Complete Patient Information in Realtime
SEATTLE, Nov. 10, 2022 /PRNewswire/ -- Opala, a healthcare data exchange solutions provider, today announced commercial availability of its Attribution API, which streamlines delivery of value-based care to patients in a way that yields significant administrative efficiency and improves reimbursement for providers. In tandem, the company announced the first deployment of this solution at MultiCare Connected Care.
Designed in partnership with MultiCare in Washington State and a multi-state health insurance provider in Washington State and Alaska, the API leverages the Health Level Seven® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) standard to identify which patients are part of value-based care contracts and ensure that providers and payers have complete information about patients in real time.
Historically, comparing lists of patients on value-based contracts with those in providers' records has been a time-consuming, error-prone manual process, overly reliant on Word documents or Excel spreadsheets to share information. Without clear visibility into a patient's coverage, providers often are unsure of which patients qualify for comprehensive and preventative care.
"Provider and payer organizations have spent the last 25 years trying to figure out how to unlock the promise of value-based contracting. Today, Opala accomplished this goal," said Opala CEO Ken Chandler. "Our Attribution API uses FHIR standards to automate information sharing between payers and providers, delivering member data that is accurate and available in real-time, in a scalable format so it can easily be implemented to any provider or payer organization."
Pilot Demonstrates Promise of Value-Based Care
Opala piloted the Attribution API with a multi-state health insurance provider in Washington State and Alaska, and MultiCare Connected Care. The API automates patient matching processes by taking member data – coverage and attribution to a primary care provider based on their past care history – from the insurance provider, then converting it into FHIR-based attribution (ATR) lists that can be ingested directly into MultiCare's software systems.
"Multi-payer data exchange solutions, like Opala's, are key to delivering high-value care," said Anna Taylor, associate vice president of Population Health and Value-based Care at MultiCare. "Since implementing Opala, patient matching has improved and we are able to see patient benefits in real-time, which allows us to earn higher reimbursement for value-based care."
MultiCare providers use the information from the Attribution API to identify patients they are accountable for under value-based contracts with the insurance provider while the patient is in the office. The Opala solution improved patient matching, correctly identifying that the patient in their office is the same as the person on the insurance provider's value-based contract roster. Using this new automated process, the pilot showed a 10% improvement in patient matching between the insurance provider's rosters and patients in MultiCare's EHR.
Building on HL7 Standards to Conquer Real-World Challenges
For payers and providers, patient matching can hit their bottom line. Problems with patient matching cost an average of $1,950 per patient per inpatient stay. And 33% of denied claims resulted from inaccurate patient identification or incorrect patient information, costing the average hospital $1.5 million and the U.S. healthcare system $6 billion annually.
Opala joined the HL7 Da Vinci Project, an accelerator developing the HL7 FHIR standard to address interoperability issues hampering delivery of value-based care. One focus of the group has been member attribution lists used by payers and providers for implementing risk-based contracts, value-based contracts, care gap closures and quality reporting.
"The addition of the Opala team to Da Vinci membership and their testing and production use of ATR is invaluable to the community. Our ability to enable providers to reuse standards-based APIs is foundational to ensure scaling and accuracy required for value-based contracts. It is critical that partners have accurate matching to increase transparency to real-time information about their patients to improve outreach, interventions, and time to service," said Jocelyn Keegan, HL7 Da Vinci Project program manager.
Opala's Attribution API provides providers with coverage and payer information, all integrated into the provider's existing EHR system, to ensure a seamless process for transferring information. The new solution has played a key role in building on the HL7 FHIR standard to ensure that providers know which patients are part of a value-based care contract and have complete information about patients in real-time.
Founded in 2020, Opala's mission is to vastly improve healthcare information flow in real time. With solutions directly connecting information across the healthcare system, Opala provides a complete longitudinal clinical view, enabling every patient's experience to be optimized through seamless collaboration between payers and providers. In 2021, Opala launched the Opala Data Hub and CMS Interoperability Compliance products – Patient Access API, Provider Directory API, Payer to Payer Exchange - with a multi-state health insurance provider in Washington State and Alaska. Opala's newest solutions – Attribution API and Clinical Data Exchange – automate and standardize payer and provider data exchange and support Accountable Care Organizations (ACOs), value-based contract performance, and quality of care. Opala is headquartered in Seattle, Wash. For more information, visit www.opala.com.
MultiCare Connected Care (MCC) is an independent Accountable Care Organization (ACO) established in 2014 as a wholly owned subsidiary of MultiCare Health System and operates as an independent entity. It is transforming healthcare as a population health engine that represents a Clinically Integrated network (CIN) of independent & MultiCare Health System clinicians services across the entire social medical model of care. Under this entity 350,000 lives are served within 30 value based contracts.
Unlike the traditional "fee for service" health care model – where each visit, service, test and procedure has a separate cost – MCC's foundation is built first and foremost on providing patient centered quality care at an appropriate cost. Specific measures are used to determine how well doctors, hospitals and other providers are keeping healthy people healthy, effectively treating illnesses, and helping people better manage their chronic conditions. In this way, all the participating providers share the responsibility of providing patient centered, high quality, efficient, cost-effective care.
MCC has established a comprehensive Clinically Integrated Network (CIN) comprised of doctors and other health care providers, as well as hospitals, clinics and other health care services, such as imaging, labs and pharmacies. The CIN includes independent health care professionals in the community, as well as MultiCare employed providers totaling over 5,100 clinicians providing services across the continuum of care. www.multicareconnectedcare.com
About the HL7 Da Vinci Project
As an HL7 FHIR Accelerator, the Da Vinci Project is a private sector initiative comprised of industry leaders and health information technology technical experts who are working together to accelerate the adoption of HL7® FHIR® as the standard to support and integrate value-based care (VBC) data exchange across communities. The Da Vinci Project focuses on minimizing the development and deployment of one-off solutions between partners with a goal to help all clinicians and health plans to better deliver clinical quality, value and care management outcomes. The core focus of phase one of the project is to deliver implementation guides and reference software implementations to the public for data exchange and workflows necessary to support providers and payers entering and managing VBC contracts and relationships. To learn more about the Da Vinci Project, visit www.HL7.me/davinci.