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Da Vinci Project: FHIR Meets Value-based Payments

by Brian Murphy | August 13, 2018

The Da Vinci Project could turn payers and providers from adversaries into partners.

While healthcare frets and obsesses about the state of exchange between providers, payers have been relatively slow to embrace modern ideas about data movement. On the federal level, Blue Button 2.0 lets Medicare beneficiaries download or authorize the download of their own health data. This federal program has generated a lot of interest, signing up roughly 500 organizations and 700 developers at last count. Claims data on 53 million beneficiaries spanning 4.5 years is available for authorized developers and applications. Commercial payers have yet to emulate such an approach. However, there are indications that they are beginning to take notice and act.

Da Vinci Project Addresses Payer-provider Interaction

The Da Vinci Project is a new private sector initiative to address the technical requirements for FHIR-based data exchange among participants in value-based care (VBC) programs. Its general goal is to help payers and providers with techniques and ideas for information exchange that contribute to improved clinical, quality, and cost outcomes. More specifically, it wants to facilitate the creation of use case-specific reference implementations of FHIR-oriented solutions to information exchange challenges in value-based care.

The Da Vinci Project is a relatively new project in from Health Level 7. Its founders represent organizations with experience across a range of VBC business challenges and the FHIR standard. Currently, it has the support of 27 organizations, including 11 payers, 10 health IT vendors (including 3 EHR vendors), and 6 providers.

Making coverage information REST-accessible and granular could vastly improve on the flurry of phone calls, faxes, and EDI-based document exchange that bedevil hospitals and physician offices.

Da Vinci aims to deliver implementation guides (IG) and reference software implementations for data exchange and workflows needed to support providers and payers entering and managing value-based contracts and relationships. FHIR implementation guides are roughly analogous to an IHE profile in that they define actors and actions in a defined use case. In this instance, the idea is to help providers and payers operationalize their complementary processes in value-based contracts.

Initial Use Cases

Da Vinci at one time contemplated creating nine use cases. It eventually narrowed this focus to developing IGs for two that have particular VBC relevance:

30-Day Medication Reconciliation 

Medication reconciliation is a time-consuming part of patient encounters anywhere on the care continuum. Post-discharge, this capability can reduce the incidence of adverse drug events and head off re-hospitalizations. The objective of this project is to create a simple workflow that allows providers to attest that a medication reconciliation is complete.

Coverage Requirements Discovery 

Coverage requirements discovery enables a provider to request payer coverage requirements in their clinical workflow. In-workflow coverage details can make point-of-care decision making about orders, treatment, procedure, or referrals more efficient. The ability to make both clinical and administrative decision mid-encounter and with a patient minimizes the non-clinical cognitive burden on providers. By reducing denials and delays administrators can be freed for other patient-specific work. As prior authorization becomes more common in value-based payment programs, providers could save time if such information were more readily available to them.

Both IGs will be balloted in HL7’s September Ballot Cycle, and Da Vinci is actively encouraging people to comment. Da Vinci team members will be on hand to help implementers interested in these two initial use cases at HL7’s September Connectathon in Baltimore, MD.  It has also begun working on requirements for a third use case, Documentation Templates and Payer Rules.

Blue Button Still Leads

While the data scope of this effort is not nearly as broad as Blue Button’s, which provides access to a patient’s claims history, it is a reasonable first step. Making coverage information REST-accessible and granular could underpin applications, vastly improving the flurry of phone calls, faxes, and EDI-based document exchange that bedevil hospitals and physician offices. Hopefully, this effort is a leading indicator of better access to commercial payer data to come for patients and providers.

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