Evernorth, Varian Lead Interoperability Efforts Between Payers and Providers.
Evernorth This link will open in a new tab., the health services business of
Prior authorization is a process that improves patient health, safety and affordability by increasing adherence to evidence-based standards of care. Advances in the digitization of health care data, clinical workflows and real-time data exchange between providers and payors have created opportunities to make the prior authorization process easier and faster for all stakeholders. The CodeX pilot will build on this opportunity to improve care for people with cancer who need radiation treatment.
'We joined CodeX to help drive better communication across the health care ecosystem and continue to optimize prior authorization to meet the needs of providers, patients and payers,' said
Phase one of the radiation oncology-focused pilot concentrates on breast and prostate cancer and will build and test the exchange of prior authorization information between payer and provider systems using electronic health record test patients. Once validated, phase two will test HL7's minimum Common Oncology Data Elements (mCODE)-enabled prior authorization workflow in a real-world setting and eventually expand it to additional areas of oncology.
'As a cancer care company, one of our main focuses is on finding ways to accelerate the path from diagnosis to treatment,' said Ashley Smith, Vice President, Oncology Information Systems and Noona at Varian. 'That's why we're so enthusiastic about participating in this project-because patients stand to benefit in the future.'
Pilot results will inform how providers and payers can apply mCODE-enabled processes to their prior authorization workflows. Providers and payers will benefit from more efficient workflows and less administrative burdens, and patients will experience more timely access to care and improved treatment outcomes.
Clinicians, payers, prior authorization vendors and radiation oncology-specific EHR vendors can join the pilot project to help shape the standard for how prior authorization is implemented before prospective regulatory requirements take effect. Organizations joining CodeX can expect a unique level of influence in the areas of FHIR development, terminology mapping, clinical expertise and navigating the standards development process. Contact Steve Bratt This link will open in a new tab. or Kim Ball This link will open in a new tab. for more information.
CodeX members are leading health organizations across the care continuum. The following members are working with Evernorth and Varian on the prior authorization in oncology use case:
About CodeX
CodeX is one of the HL7 FHIR Accelerators This link will open in a new tab. driven by healthcare leaders and health information technology experts who are working together to accelerate the adoption of the HL7 Fast Healthcare Interoperability Resources (FHIR) as the standard to obtain high-quality, computable data for patient care and research. The initial core focus for CodeX projects was integrating a standard language for cancer data called mCODE, or the minimal Common Oncology Data Elements This link will open in a new tab., to support better, safer, faster cancer care, with lower burden and cost. CodeX recently announced efforts to leverage the CodeX/mCODE accelerator's experience within two new domains: Genomics and Cardiovascular.
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About Evernorth
Evernorth creates and connects premier health services offerings, including benefits management, pharmacy, care solutions, insights and intelligence. With an open approach to partnering across the health care landscape, we deliver innovative and flexible solutions for health plans, employers and government programs. Evernorth capabilities are powered by our family of companies, including Express Scripts,
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