OnDemand: Effective Strategies to Promote Payer-Provider Collaboration
Duration: One Hour
Effective Strategies to Promote Payer-Provider Collaboration
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.
• Health Care Professional
• Health Care Decision Maker
• Health Plans
• Health Systems
• 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
Rajesh Godavarthi, MCS, PMP
Associate Vice President of Technology and Interoperability
Rajesh “Raj” Godavarthi is MCG Health’s Associate Vice President of Technology and Interoperability. Mr. Godavarthi has been with MCG since 2002, and he oversees a team of software developers and architects that are building the key interoperability solutions that are outlined in MCG’s roadmap for the future. His team also helps develop, enhance, and maintain MCG’s evidence-based clinical decision support software currently used by nine of the largest U.S. health plans and over 2,250 hospitals.
In addition, Mr. Godavarthi is MCG’s primary representative in the HL7 Da Vinci Project. MCG has been an Associate Member of this consortium since 2019, and Mr. Godavarthi has led our efforts to support industry stakeholders developing new HL7 FHIR standards which will allow for improved interoperability and communication between payers and providers. In September 2021, Mr. Godavarthi was named the co-lead for the HL7 Da Vinci Project’s burden reduction use cases in prior auth support (PAS), coverage requirement discovery (CRD), and documentation templates and rules (DTR). In July 2021, he became a member of the WEDI Prior Authorization Subworkgroup. WEDI (Workgroup for Electronic Data Interchange) is a formal advisor to the U.S. Secretary of Health and Human Services (HHS). They are a leading authority on the use of health IT to efficiently improve health information exchange, enhance care quality, and reduce costs.
Prior to MCG, Mr. Godavarthi was the Development Lead at the world-renowned actuarial firm of Milliman. He has also served as a consultant for technology teams at Intel, Citigroup, and MCI, co-developing enterprise software products for web, desktop, and reporting solutions.
Mr. Godavarthi earned his Master’s in Computer Science (MCS) (Computer Applications) from Osmania University, and his undergraduate degree in Mathematics from Acharya Nagarjuna University. In addition, he achieved Project Management certification from the University of Washington.
Heidi Kriz, MPH, RD
Assistant Director of Medical Policy and
Prior Authorization (PA) Transformation Business Lead
Regence Health plans (Cambia)
Heid Kriz leads and manages the evidence-based medical policy process and decisions at Regence, including prior authorization and utilization management programs.
Heidi completed her Master of Public Health at Barry University in Miami, Florida with a focus in epidemiology and healthcare administration and is a Registered Dietitian. For over 15 years, Heidi has worked in the field of evidence informed health policy with state Medicaid programs and more recently with Regence Health Plans. Heidi has managed and extensively published health technology assessments for 12 different state Medicaid programs at the Center for Evidence-Based Policy at Oregon Health & Science University. Additionally, Heidi has played a key leadership role in prior authorization transformation at Regence since 2018. Heidi serves as the Chair and Business Lead for the Prior Authorization Program which encompasses technology and data automation to promote timely, evidence-based care for its members.
Anna Taylor, MS
Director of Operations
Multicare Connected Care
Anna Taylor is the Director of Operations for MultiCare Connected Care and leads the operational team in the day-to-day functions of the MCC governance committee structure and stewards the business side of the value-based technology platforms and their interoperability functions. She oversees the performance measurement for MCC's organizational key performance indicators, strategic framework, and operational program management.
Anna has been with MultiCare Health System for the 11+ years and has held positions in the Institute for Learning and Development, Information Services & Technology, and Strategic Planning. She holds a B.S. from the UW School of Engineering in Technical Communication and a M.S. in Clinical Informatics and Patient Centered Technology from the UW School of Nursing.
In her most recent role, Taylor was the program manager for MCC. Working with the business side of value-based care technology platforms and directing the program management of the Accountable Care Organization.
Anna is a Senior member of the Board of Examiners for the Baldrige Performance Excellence Program. When Anna is away from her desk she enjoys spending time with her family on the slopes in the winter and sea side in the summer.
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:
Ann Taylor None
Heidi Kriz: None
Rajesh Godavarthi is employed by MCG Health, an organization which licenses evidence-based clinical guidance.
Additional Planning Committee Members:
This program was developed in part by NCQA staff.
- 1.00 Participation
- 1.00 PCMH CCE