Helping Shape Data-Exchange Standards through Da Vinci

Moxe recently joined the Da Vinci Project, and we’re in good company: Today, there are over sixty payers, providers, and technology partners working together to help shape data-exchange standards for value-based care.

Why now? 

We’ve seen a lot of momentum and increased output from the Da Vinci Project, especially around prior authorization. Although it’s not required, CMS’s Interoperability and Prior Authorization Final Rule (CMS-0057) recommends payers to implement the Da Vinci project’s prior authorization Implementation Guide in order to comply with the rule, which takes effect on January 1, 2027. 

The Project is moving out of theoretical conversations into a “let’s get this stuff done” phase–a phase where we can significantly contribute as a Best in KLAS facilitator of payer-provider data exchange.

In short, we joined Da Vinci now because we feel it’s the right time to take our 10+ years of real-world data exchange experience to help influence the future of interoperability.  

What we bring to the Project

One area of focus is Clinical Data Exchange (CDex): We’ve been doing this work as a neutral intermediary between payers and providers since 2015. My hope is that our deep experience and understanding of both payer and provider workflows will help the workgroup close the gap between theoretical standards and practical application. 

While implementation guides are heavily focused on FHIR, we also know that most payers are not yet capable of broad adoption of FHIR across use cases. Many still rely on CCD or PDF formats. One of our goals is to help the Project understand what the transition from legacy document-based exchanges to FHIR-based exchanges might look like, keeping both the payer and provider experience top of mind. 

As we join the Da Vinci Project team, we also want to champion the provider experience when exchanging data with health plans because we know that helping interoperability move from theory to real-world adoption requires trust, transparency, and allowing providers to maintain control over what data is shared.

Personally, as a patient in our healthcare system, I’m excited to bring my professional experience with Epic, Kaiser Permanente, and Moxe to the table to hopefully improve the patient experience and continue to be one of the many voices pushing for prior authorization automation. I think many of us have been in the frustrating situation of waiting for a treatment that advances our wellbeing, is needed to jumpstart recovery from an injury, etc. because we can’t schedule the treatment/procedure without prior authorization. 

My hope is that the Project’s work around the prior authorization process will bring meaningful change for the patient experience and health outcomes soon.

A bright future 

I commend the Da Vinci project on the great work they’ve already done. When I think about my biggest hopes for the Project in the next year or two, number one is that we find a way to get real adoption of the prior authorization Implementation Guide. Exchange standards for prior authorizations have been around for many years, yet adoption remains low. Getting people to actually implement the standards and use them for cases beyond just the basic use cases–I think that’s the Project’s clear next finish line.

As we look beyond prior authorization, we hope to get involved in future work groups related to Digital Quality Measures and risk adjustment to further support value-based care. Most experts agree that moving to value-based care makes sense. Data liquidity, however, is essential in order to do so. Once data starts to move more fluidly, we can start to look at value-based care for acute stays, speciality care, and other areas that have largely remained on a fee-for-service model.

One reason I’m optimistic about the Da Vinci Project’s potential is that it brings together competitors–including payers, providers, and vendors–from across the healthcare network to all work on a common problem: burden reduction. Beyond just cooperation, the Da Vinci Project fosters intentional, meaningful collaboration between parts of the healthcare ecosystem that have historically often worked in siloes. Working together towards burden reduction ensures standards are developed based on real-world understanding rather than in a vacuum.

Why Da Vinci matters to our partners

The Da Vinci Project matters to our partners because burden reduction matters to both payers and providers. Both sides of the data exchange equation win when data is able to be exchanged more fluidly, efficiently, and securely. 

We’re excited to have a place at the table and partner with other Da Vinci Project members to advance data-exchange standards that will both reduce the burden for payers and providers and meaningfully move the needle towards value-based care.

Have questions about Da Vinci or something else related to data exchange on your mind? Connect with us!