Skip to content
Search to learn about InterSystems products and solutions, career opportunities, and more.

Improving the Speed and Transparency of Authorizations through FHIR API–Enabled Data Sharing

KLAS Research: Points of Light Case Study

Executive Summary

KLAS points of light badge

Prior authorizations for referrals and clinical procedures are widely acknowledged as a significant pain point for all involved parties—payers, providers, and patients. Using implementation guides from HL7’s Da Vinci Project, the collaborators in this case study created bidirectional data exchange through a FHIR API that enables an automated, in-workflow authorization process. The pilot use cases have been successful, achieving improved efficiency, reduced costs, and—most critically— more timely care and improved patient outcomes.

Points of Light—Outcomes Achieved through Collaboration

Download the KLAS Research Points of Light Case Study to learn more about the collaboration between UC Davis Health, a Payer Organization, and InterSystems, Including:

  • Points of Friction—Challenges to Be Solved
    • High administrative costs associated with labor-intensive authorization processes
    • Siloed workflows and lack of transparency between payers and providers create churn and delay care
  • Action Plan—How the Collaborators Worked Together to Reduce Friction
    • Partnered on a pilot to automate authorization requests and approvals for therapeutic Botox treatments
    • Identified mutual business goals and success metrics
    • Established bidirectional, in-workflow data sharing between the payer and provider organizations
    • Obtained three-year CMS waiver exempting the collaborators from HIPAA requirements for electronic transactions
  • Lessons Learned—What Best Practices Can Other Organizations Replicate?
    • Develop a collaborative statement of work that includes all stakeholders (payer, provider, and IT vendor)
    • Start with a pilot and be clear about the commitment and availability of financial and human resources
    • Benefits can be gained without adding to already onerous administrative burdens
  • What’s Next?—Vision for the Future
    • Identify additional use cases and payer/provider partners
    • Prove to CMS that the project has reduced the administrative burden
    • Build a consent model

Other Resources You Might Enjoy

Take The Next Step

We’d love to talk. Fill in some details and we’ll be in touch.
*Required Fields
Highlighted fields are required
*Required Fields
Highlighted fields are required

By submitting your business contact information to InterSystems through this form, you acknowledge and agree that InterSystems may process this information, for the purpose of fulfilling your submission, through a system hosted in the United States, but maintained consistent with any applicable data protection laws.

** By selecting yes, you give consent to be contacted for news, updates and other marketing purposes related to existing and future InterSystems products and events. In addition, you consent to your business contact information being entered into our CRM solution that is hosted in the United States, but maintained consistent with applicable data protection laws.