Things You’ll Learn:

• FHIR APIs have the potential to transform various healthcare processes beyond prior authorization. Use cases include inpatient reviews, population identification within EMRs, and leveraging augmented intelligence for enhanced insights.
• Breaking down silos and fostering collaboration between payers and providers is essential for true transformation. Open communication and shared goals are key to creating a more interconnected healthcare system.
• A culture of curiosity and bravery is necessary for embracing innovation and driving change.  Healthcare organizations should encourage experimentation and learning from both successes and failures.
• Investing in robust data exchange infrastructure enables organizations to leverage the power of augmented intelligence. 
• The ultimate goal of healthcare innovation is to bring joy and improve the experience for all stakeholders.

Resources:

• Connect with and follow Anna Taylor on LinkedIn.
• Learn more about MultiCare Connected Care on their LinkedIn and website.
• Connect with and follow Heidi Kriz on LinkedIn.
• Discover more about Regence on their website!

Listen to Anna’s and Heidi’s interview on The Dish on Health IT podcast here!

Transcript:

Rachel Schreiber: 

Hello and welcome to the Spark, a view of innovation in healthcare. I'm Rachel Schreiber, your co-host, and in this episode we're speaking with Anna Taylor, AVP population health and value-based care at MultiCare Health System. And Heidi Kriz, director of Medical Policy and Medical Management at Regence Health Plans. So I first heard about your collaboration on using FHIR for prior auth at VIVe in 2022. I was really impressed with what you're doing and then the conversation that the two of you had on the Dish on Health IT podcast was really interesting. So if any of our listeners want to go back, that podcast is still on and available. So I'm really excited to hear more about what you're working on. And it's been about a year to two years since I last heard about what you've been working on, and I know you've got some great results. I'm really looking forward to our conversation. And today I'm also joined by Joe Rostock, Chief Information Officer at Avaneer Health. 

Joe Rostock: 

Thanks Rachel, welcome to the Spark. Anna and Heidi, we really appreciate your time. We're really interested in hearing about your approach to innovation in healthcare and what you've learned from it. But before we talk about that specifically, let's go into your personal passion in healthcare as we like to call it. What's your spark? Anna, let's start with you. 

Anna Taylor: 

Thanks Joe, and thanks for having us here today. We really appreciate the opportunity to speak with all of you. My spark comes from something that I think has been inside me for a really long time, which was I felt like I needed to leave the planet a little bit better than I found it. And I have since I can remember felt that way that I have to do something. I got to work hard and make something happen. And when I was young, my mom reminds me that the two things I wanted to be in life were a teacher or the president of the United States. So you put those, mush those things together and you get this, which by trade I'm a UX engineer and trained in human-centered design, and I just have a true passion to help people and to make things the best experience that you can ever have. 

I'm the person who goes into any place or restaurant or bank and I'm like, Ooh, if they moved that over there and this here, then it would be this and the people would be so happy. And so I'm constantly thinking about ways to make experiences better and more joyful because that's what I really want to leave on this planet is just the joy of life and being human. And I think it's a real beautiful thing. And the other thing that gets me up in the morning is I love working with people. I love seeing them succeed. I love bringing teams together and watching them achieve great things. And you cannot change the planet without a team of people. So I just have this passion to watch people discover new things that they might have a talent for and then give that gift back to the world. So those are the two things that really get me up in the morning, get me going, and you can apply those to many things. Healthcare is what I fell into, I'll say accidentally, but I don't think it was the mistake or anything. I think it was my destiny to be here, be here. So that's what my spark is. 

Joe Rostock: 

That's fantastic. Thank you. Heidi? 

Heidi Kriz: 

Thanks for having us on the podcast. Really excited to share our story and a lot of what we're doing today and catch you up since we launched in 2022, the FHIR-based prior auth workflow. My spark is really around the fact that I love healthcare, I love nutrition, I love using evidence to inform practice. So I started off early wanting to be a dietician, and so that's where I started my career. I worked inpatient and in an outpatient clinic and really loved being part of the healthcare system and seeing the impact that it has on people's health and wellbeing and really quality of life at the end of the day so they can leave their best life. Through that work. My spark really came in using evidence to inform practice and policy, and that's where I really started to jump off and think about a different career in healthcare from being a dietician and to getting my master's in public health and thinking about how do I really impact a population versus an individual patient that I might've been seeing at that particular time. 

So my Spark got really excited when I knew I could go back to school, get a master's in public health and really work on a population level impacting healthcare, but also really largely trying to impact policy and other things that could really move the nation. And so it was really interesting for me to start working at Regence and really being involved in the prior authorization process and seeing just how administratively burdensome it was for everybody involved. It's burdensome for the health plan as well. So that was my spark. I started to think outside the box and I love to be innovative. I love to think of different ways to do things and like Anna said, love to work as part of a team. When you have a team of people around you, it's amazing what you can accomplish. 

Rachel Schreiber: 

That's really great. Thank you. I love that. I want to be a teacher or president, Anna. Awesome. Alright, Joe. 

Joe Rostock: 

Yeah, so let's dig into the solutions that you're working together on a little bit. And I think one thing we could all agree on is given the complexities in healthcare, it takes collaboration and it takes working together to really figure out what's the best solution and what the impact of that solution is going to be. So we'd like to hear about how your teams specifically are collaborating on administrative processes to drive better outcomes. So Heidi, let's start with you. 

Heidi Kriz: 

We started down this pathway, I would say really heavily in 2017, really thinking through all the different ways we exchange clinical data between a payer and a provider. And there's so many different ways we do that. And in addition to that, there's different data standards. We make the providers go out to different portals for different reasons and leave their native workflow. For us, we could see the administrative burden that some of the processes were having on our providers, but also we have to intake that data in different formats and from different places as well. So it sits on both sides of the fence of just a lot of opportunity to make change in this space. For us, we started with prior authorization because we felt like that was an absolute area that needed change. And at the end of the day, that impacts the people, the patients, the members on the health plan, how do we get them care as fast as possible? 

And that was really, I'll use the term spark again in our organization. So our CEO at the time really challenged us to say, how do we have our members get the care they need and not have to feel the prior authorization process? And that was what triggered us to really start down the path of prior authorization, but also at the same time realizing that as FHIR was coming on board and the DaVinci project was starting, we've got a huge opportunity right now in this point in time to really lead the nation. And like I talked about, there's a team of people coming to the table to really solve for this and it's much bigger than just prior authorization. But that's where we had chosen really to start. We have a couple of use cases, I'll let Anna maybe speak to the other use cases that we have as well using FHIR. 

But for us we could see that if we could really meet the provider where they're at in their native workflow and have that direct connection, we can really start to automate the process and really build off of that foundation and then use FHIR for other use cases because at the end of the day, it takes the payer and the provider coming to the table together and collaborating. If one of us comes and the other one does, we don't move the needle at all. That's great. Anna I'm going to turn over to you to maybe talk about a couple of the other use cases. That'd be awesome. 

Anna Taylor: 

Yeah, I'll talk about those. But I'll also share that this was an opportunity for two separate businesses to share an operational process. So much like we do that in the grocery store, banks share an operational process with grocery stores in trading, financial trading, all of the companies that it takes to verify do things, they're collaborating in this space to make those business transactions happen. They're sharing operational workflows instead of being siloed identities, they're coming together to say, Hey, if we want to give our service our customers in the best way, we got, this is something we're not going to compete on, which is trading your money or whatever. So one of the most important things in healthcare that we don't do a lot of is that. We don't collaborate. We are a walled garden sometimes when it comes to where our data is stored and how it works. 

And this was a business problem when it comes to providers taking on financial risk. In order to do that, we have to collaborate with more parties than we have before because care just happened inside your garden. Now care is happening out in the community and it takes a village to maintain somebody's an individual’s health. So it's really a shift in mindset to think about sharing operational processes with all the stakeholders in the healthcare ecosystem. And those other use cases we're putting into place are also quality measures exchange. So in order to trade our data to tell our health plans that we're closing care gaps and making sure people get their mammograms and their colonoscopy screenings, we have to tell them through data. And that data is usually exchanged in flat files of many different flavors and kinds. And so we worked together with Regence to figure out how we would exchange that using the same technical infrastructure that we did with prior authorization. And again, that came back very fruitful for us. And so we are really excited about continuing to put those use cases in place and also scale those use cases in what we call a networked buyer modality. 

Joe Rostock: 

That's great. So Anna, I'd like to stick with you on this next question. So the work you're doing is transformational. I think you can see that in the results that you're achieving. Many times these kinds of changes within organizations are competing with other priorities in the business. Looking within your company specifically, how are you able to make the shift to make this a priority and over and above everything else that's happening in the business, get their attention, everyone's attention and the support you needed to do it? 

Heidi Kriz: 

Great question because it's something I actually don’t get asked that very much so thank you. I think that it's an important one because the first thing we did was I've worked for MultiCare a long time. So I have friends who I would call and be like, Hey, what do you think about this? You think I could do this? Kind of that team I'm talking about of people who want to learn with you and also see if we can enhance the business and really care about our success as an enterprise too. So the first thing that happened was we identified this business problem, but trading data and population health is really hard and it's not sustainable. And if we're going to do this and succeed in it, we got to get better at trading data. So first there was a business problem, then we said, Hey, oh, these partners, Regence, wants to talk to us about trading data differently. 

And I'm like, yes, because I have a business problem for which I need to trade data in a different way. So we said yes, and then those colleagues that I said took that yes thing to said, yeah, I think this could work. And that work turned into a small pilot to say, let's try to solve this business problem in this small way. It costs me about $15,000 to try this pilot out. And that particular pilot was around quality measure exchange. So one quality measure, which was 30 day post discharge med reconciliation. And we exchanged that using a FHIR payload to give that data on a more frequent basis to Regence so that they knew what our gaps in care were on a more frequent basis too, which enabled us to know who we're calling, not duplicating resources. And then as a part of being in a value-based care contract, you get reimbursed for closing those gaps in the model. 

So overall, that whole piece of technology and implementation gave us about $17,000 back in financial reconciliation when it came to that value-based contract. And so $15,000, 17, I'm already paying for the development. That development can be used again year over year. And we submitted that to our company's best practice system, which is called the President's Award and won the award. And because of that attention, it was enabled to get funded through other partnerships that we had and other payers who are interested in exploring trading data in this way. So because we had some enterprise buy-in that, Hey, you did all that without touching the provider workflow and bothering us, I'm like, yeah, it's data trading. Yes we did. Can you do that with other things? And so the trust was earned with the enterprise and we were able to start collaborating with other business units like Rev Cycle to get prior authorization off the ground and explore if the same return on investment came through that methodology, which it did prove itself out to do the same type of return and probably even more in efficiency. 

Joe Rostock: 

That's a great success story. Heidi, what are your thoughts on this within Regence Health Plan? 

Heidi Kriz: 

Yeah, for us, I talked about it a little bit earlier, but just to jump off of where I had started, we really do serve our members right, first and foremost. So for us it was really about the member story and how do we get them care that they need, if not instant, as fast as possible. And so that was really where everything started for us and that was really the value for Regence was really focused on the member, but by the way, it's administratively burdensome for the health plan and the provider, so it's just a win-win for everybody. When we started down this pathway of prior authorization, I think through the preauthorization work, what was really exciting is you can use these fire APIs for many different use cases, not just prior authorization, but what it allowed us to do is really from a leadership level, from the very top down influence the organization to say, this is truly transformational. 

This is going to make the process better for everybody. And by the way, we can start to do this with other use cases, just as Anna was saying, that impact the health plan and ultimately the operations, but most importantly the member. And so I think prior authorization was really our jumping off point for the most part. And then we were able to do a few of these other use cases with Anna and a few other organizations too, and really start to move the needle as Anna said, with our leadership to say, there's value in this and we have to change how we do business today. And this is really the movement and we've got to get with other industries that do interoperability very well. Like Anna mentioned, the banking industry, healthcare has got to change and it's got to move that direction. So I think prior authorization was really that momentum and jumping off point in our organization to really start to educate our leaders on the value of using FHIR and the direction that we can go. And now we're able to start to talk about other use cases and then expansion and getting support for that. 

Joe Rostock: 

That's fantastic. Yeah, the complexities around the term interoperability are pretty persistent in healthcare, and I think the results that you're seeing are significant in the sense that it takes this intangible turn and makes it real, not just the interoperable capabilities, it's the results from it. What other use cases based on this ability that you've created, what other use cases are you thinking about that are based on FHIR, that are based on the results you've seen, what's a natural evolution of the work that you've started to dig into next? As I've heard you refer to it, replumb, the backbone of healthcare. What other use cases are you thinking about? 

Heidi Kriz: 

Well, I can start with that one. This is the electrical grid of the future. That's absolutely true for healthcare. As we think about the enhanced use of augmented intelligence, I'll call it augmented intelligence, not artificial is that if we want to plug those things into workflows, we have to have interoperability. So as we've been proving out, let's trade quality data, some basic ABCs of healthcare, let's trade identity data so we can match patient records. Let's trade different use cases that are basic foundational provider data. You need these basic types of data exchange in order to calculate in healthcare. And our augmented intelligence is a calculator. And the reason why it's an amazing calculator is it can calculate immense amounts of data in times that humans can't. It absolutely enhances our human capabilities. And if we want to be able to give and feed those machines to help us understand different insights that we might not always be as humans and the way we compute information, we have to be able to get it there efficiently and effectively and securely. 

And as a part of the smaller use cases we put into place, like exchanging lists of populations or registries, exchanging lists of quality data exchanging prior auth, we're also looking into exchanging surveillance data. So we have chronic disease management compliance that we have to report on. We might have to report on available beds. We might have to report on covid, the next pandemic, which I hope not to live through. I think that's going to be way past my time, hopefully. But it's the way for which we compute and in order to take advantage of the compute power that's available to us today, we have to get more efficient at trading data. So we've really invested at MultiCare in an infrastructure that enables us to do these API trades and have restful APIs with data at scale on cloud-based computing systems so that we're enabled to do this for all the use cases of the future. 

Joe Rostock: 

That's great. Fantastic. Both the clinical and administrative workflows are benefiting from this, obviously. Heidi, your thoughts? 

Heidi Kriz: 

Yeah, I would say that our thoughts are similar to what Anna said, very similar. I think our providers are very interested in prior authorization in this space as she talked about identifying populations that are in alternative payment models with us, and really being able to identify those within the EMR is another big use case that providers are interested in. So all the same use cases, it's just a matter of where do we prioritize and what do we do next? I would say the one more thing I would add in is we're evaluating doing inpatient reviews. So right now a lot of people are focused on elective prior authorization, but there's a lot of reviews that happen while somebody is in the hospital. So how do we take advantage of these workflows and capabilities and now add in that workflow as well for patients that are in the hospital and really try to be more transparent, upfront and collaborative in how we think about that hospital stay and ultimately what gets paid and not paid at the end of the day. 

Anna Taylor: 

That's great. Well that's exciting for me. We would love that, Heidi. 

Heidi Kriz: 

I know I'm working on it. 

Anna Taylor: 

Thank 

Joe Rostock: 

You both. 

Rachel Schreiber: 

So as a wrap up, what key phrase do you use to describe the vision of what you're creating both at Regence and MultiCare? 

Anna Taylor: 

My key phrase, and I have it in my slide deck when I present, is the future is now. It's a big exclamation point afterwards. 

Rachel Schreiber: 

Yes. 

Anna Taylor: 

I will tell you that as I present on this work and what we've done and accomplished, I think at the beginning people are very skeptical. They don't believe it. They say, oh, that's 10 years down the road. I actually got that comment last week from a provider, and I would say the future is now, we can really make a change right now. We've got the infrastructure, we've got the use cases, we can make a change. So let's all come to the table and start collaborating. We've all got to stop sitting in our silos and saying, 

Rachel Schreiber: 

Yeah 

Anna Taylor: 

You health plan need to do better. And the health plan saying, you providers need to do better. Let's come to the table, start talking to each other and start collaborating and really start to break down the silos, build trust so that we can create change. Because like I said, if we don't come to the table together, nothing is going to change. And that's what it's truly going to take. So for me, it's the future is now let's do it. We don't want to be the only payer in the northwest doing this. We want other payers to come to the table and we want other providers to come to the table. So future is now. 

Rachel Schreiber: 

That is so inspiring. I was listening to you and thinking this is so important and it needs to catch fire. Well, that's a really funny joke that I just made, but on an accident. But it does because we can't continue to operate this way. It's not scalable or we see it's not scalable and it's really difficult and complicated and it's impacting everybody negatively. So Anna, what is a key phrase for the vision of what you're creating? 

Anna Taylor: 

I would be remiss to say this isn't all for the patient. This is all for you, you guys on this podcast. For my two small humans, for my parents, for the communities we live in, this is all to bring that joy to healthcare for everyone who has to be in it. And that is all of us. And so my catchphrase is be curious and be brave because new things are going to come to healthcare all the time. This is just one more new thing. And instead of being fearful of something that's new, ask questions, see what it is. Be curious about what it could do for healthcare. Could it bring more joy? Could it make it better? And maybe it can't. Okay, well, you've proved, you've explored it, you learned something. And I think I know that's something Heidi and I share is a passion to learn new things and understand new things as all the time we spent together. 

And the other part is to be brave because we all have braveness in us and sometimes it does take risks to try new things. And with my team exploring and giving that permission to fail and fail fast is really important. And I think the same for the collaboration we have with Regence is we had to learn how to fail fast. Okay, that's not working. Let's try it this way. Alright, this is working and having that mindset and culture that it's okay to do that so that we can get to the best answer for the nation and for the people and the humans that are served by healthcare every single day. So be curious, be brave out there. You can do this, 

Rachel Schreiber: 

Be curious, be brave. That's really great. So I admire the work that Heidi and Anna that you're doing and the collaborative approach. I know that you could have maybe tried to figure out this on your own, but working together, you've clearly come into a way that's going to work better for healthcare. So I really admire that. And healthcare definitely needs more leaders like you and keep the work up and let's hope this catches on fire. 

Heidi Kriz: 

Thank you. pun intended, pun intended! 

Rachel Schreiber: 

Yes, pun intended. So if our listeners would like to keep up with your thought leadership can follow Anna Taylor and Heidi Kriz on LinkedIn. You can find them easily on that platform. And thank you for joining us today and continue that transformational work in healthcare 

Anna Taylor: 

Thank you so much for having us 

Heidi Kriz: 

Yeah, thank you for having us and helping us spread the word and the passion. It's important.