KLAS Highlights Innovative Partnerships for Health IT Interoperability

Collaborations between payers, healthcare organizations, and health IT vendors can help drive interoperability for improved care outcomes.

The 2023 KLAS Points of Light report celebrates successful partenerships that have reduced costs and improved the patient experience. Overall, KLAS selected 25 collaborations for a 2023 Points of Light award.

“It is our aim to help payers, healthcare organizations, and vendors collaborate more effectively to resolve some of healthcare’s biggest points of friction,” the KLAS authors wrote.

While the collaborations targeted various areas, the most common centered on:

1. Interoperability between payer and provider organizations
2. Prior authorization
3. Value-based care

“Transparent data sharing between payer and provider organizations is critical to the success of value-based care initiatives,” the report noted.

The collaborations focused on interoperability were able to give both parties access to a more comprehensive view of patients’ health for care coordination. These partenerships also improved the accuracy of quality measure submissions, contributing to lower costs and higher reimbursements.

Partenerships that automated prior authorization processes helped drive efficiency by eliminating administrative burdens.

These collaborations leveraged strategies like artificial intelligence and clinical decision support to standardize the submission process, reduce manual workflows, and improve data exchange. The initiatives also helped increase visibility of patient coverage and improve speed to treatment for patients.

The report found that initiatives focused specifically on value-based care required technology investment.

“The partnerships that focused on this area upgraded their technology stacks to include care coordination systems and data analytics tools, improving access to real-time data and outcome and utilization patterns to allow them to accurately assess patient risk, reduce costs of care, and inform HEDIS quality measures and Star ratings,” the KLAS authors wrote.

They noted that in these collaborations, stakeholders had to be willing to learn new workflows and technologies to support and sustain bundled-payment programs.

The report outlined four key lessons learned from the 25 case studies.

1. Build Partnerships of Trust and Collaboration: Focus on common ground and have a collaborative mind-set. Foster open communication throughout all phases of the initiative.
2. Choose Proactive Health IT Partners That Offer Robust Technology: Leverage technology that is sustainable and scalable; vendors need to create technology that works with SMART on FHIR, CDS Hooks, and non-FHIR APIs, the report authors said.
3. Create the Groups and Governance Structures Necessary for Success: Establish governance groups comprised of representatives from all relevant stakeholders.
4. Utilize Data to Drive Improved Outcomes: Understand the data needed to meet CMS requirements and HEDIS quality measures in value-base care contracts. Benchmark your performance against other healthcare organizations in closing quality care gaps.