Effective Strategies to Promote Payer-Provider Collaboration

May 4, 2022

Effective Strategies to Promote Payer-Provider Collaboration

Payers and providers often face challenges regarding appropriate clinical documentation, authorization request turnaround times and basic information exchange (interoperability) between EHR and utilization management systems. Ultimately, the quality of member/ patient care is affected by these challenges. Implementing informed and effective care strategies and tools to speed processes and reduce administrative burden of authorizations supports the goal of a successful health care journey for patients and  providers. This session focuses on real-world implementation of the HL7® Da Vinci Project’s FHIR® standards and AI to drive point-of-care authorization decisions. Speakers will show how these approaches can promote payer-provider collaboration, encourage health IT innovation and improve member/patient outcomes while reducing unnecessary costs. 
MultiCare Connected Care, Regence Health plan and MCG Health—three member organizations of the HL7 Da Vinci Project—implement real-world examples for improved interoperability by combining FHIR standards with AI technology to improve the member/patient experience and achieve better clinical outcomes. Technology leaders from these organizations will discuss their journeys and what they learned along the way, and will share successful strategies to help other payers and providers on the same path.

Target Audience

•    Health Care Professional
•    Health Care Decision Maker
•    Consultants
•    Health Plans
•    Health Systems
•    Hospitals

Learning Objectives

•    Analyze steps for preparing a health care organization to implement EHR-enabled authorization automation technology, new HL7 Da Vinci FHIR standards and AI solutions
•    Explain how success is defined after implementation (ROI points) and how it affects the quality of care delivery
•    Examine tactics for implementing changes with multiple partners (including EHR and UM system vendors)
•    Evaluate how organizations can begin the process and how they can plan incremental updates to support long-term success that ultimately benefits members/patients

Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 PCMH CCE
Course opens: 
Course expires: 
Event starts: 
05/04/2022 - 2:00pm EDT
Event ends: 
05/04/2022 - 3:00pm EDT

Rajesh Godavarthi

This live course grants 1.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours.

Disclosure of Relevant Financial Relationships

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:



Additional Planning Committee Members:


This program was developed in part by NCQA staff.

Available Credit

  • 1.00 Participation
  • 1.00 PCMH CCE


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