Health plan receives award for innovative use of technology to streamline authorizations and improve member care
SEATTLE, March 25, 2025 /PRNewswire-PRWeb/ -- , part of the Hearst Health network and an industry leader in technology-enabled, evidence-based guidance, has named a recipient of its 2024 . The nonprofit health insurer was recognized for its innovative use of the 's FHIR® standards to help automate clinical authorization processes, reduce administrative burdens on providers, and support timelier treatment for the 3.6 million people it serves in Idaho, Oregon, Utah, and Washington.
For its winning initiative, Regence embarked on a 7-year journey to transform prior authorization (PA) processes, promote evidence-based care, and reduce administrative burdens. By collaborating with its partners in the HL7® Da Vinci Project, Regence actively sought risk-sharing arrangements with its partner network, building trust through joint initiatives. Their efforts led to the nation's first scalable prior authorization automation technology. Prior to this achievement, outpatient prior authorization requests averaged a turnaround time of 1-5 business days.
In a recent data set, Regence reported:
- 94% of outpatient prior authorization inquiries received an immediate response, which empowered members and providers to take the next steps in the treatment journey
- After 90 days of adopting the new workflow, Regence's provider partner reported outpatient PA request processing time improved from 3-5 PAs per hour to 10-12 per hour (a 140-233% increase in productivity for the hospital system's PA request team)
In addition to these results, using HL7® Da Vinci Project's FHIR® standards helped Regence prepare for compliance mandates in the (CMS-0057-F) and for Washington state lawmakers' modernizing the prior authorization process through legislation in 2023.
"Regence is honored to be recognized by MCG," said Heidi Kriz, director of medical policy and medical management at Regence. "We launched our FHIR pre-authorization process with MultiCare Connected Care three years ago because we share a vision of applying technology and data to transform the healthcare experience. Bringing pre-authorization to the point of care reduces the burden on health systems managing patient data and promotes timely, evidence-based care and a more seamless experience for our members."
Anna Taylor, MS, CIPCT, the Associate Vice President of Population Health and Value Based Care at MultiCare Connected Care, said of the partnership with Regence: "Embedding pre-authorization in our native EHR system is a game-changer. Not only have we eased the administrative complexity of healthcare, but the ability to receive transparent and actionable data at the point of service accelerates care delivery and increases adherence. When providers can spend more time collaborating with their patients on treatment plans, they have a better chance of improving outcomes."
MCG Health President and CEO, Jon Shreve said, "We commend Regence on its successful transformation of prior authorization processes, showcasing a powerful partnership between payers and providers. This initiative sets a benchmark for others, emphasizing the impact of evidence-based guidance, technology, and collaboration in leading healthcare towards a more efficient and patient-centered future."
The 2024 Richard L. Doyle Award will be presented to the Regence team at MCG's annual in San Diego, California, on May 14, 2025.
About The Richard L. Doyle Award for Innovation and Leadership in Healthcare
The Doyle Award was developed to recognize organizations that make innovative use of MCG care guidelines and technology to help deliver effective healthcare. Dr. Doyle, the care guidelines founding editor, was a hospital chief-of-staff when he began creating clinical guidelines in the 1980s to help improve healthcare efficiency and quality at Mercy Hospital in San Diego. He later joined Milliman & Robertson and in 1990 published the first set of what was to become the care guidelines.
Judges for this award are independent healthcare quality experts, not currently associated with MCG. Applicants were judged on how well their projects supported the MCG mission to help drive effective care. Judges looked for evidence of improvements in healthcare quality and patient safety; patient/member satisfaction; staff efficiency, productivity, and satisfaction; internal/external communication; and effective use of resources.
About Regence
Regence serves more than 3.6 million people through its Regence health plans in Idaho, Oregon, Utah, and Washington. Each Regence health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit .
About MCG Health
MCG, part of the Hearst Health network, provides unbiased clinical guidance that gives healthcare organizations confidence in delivering patient-centered care. MCG's artificial intelligence and technology, infused with clinical expertise, enable its clients to prioritize and simplify their work. MCG's world-class customer service ensures that clients maximize the benefits of licensing MCG solutions – demonstrating improved clinical and financial outcomes. For more information visit .
About Hearst Health
The mission of Hearst Health is to guide healthcare organizations by delivering essential intelligence and software that improve the quality, safety and efficiency of care. Hearst Health has been innovating with care for more than 40 years, with a commitment to making a lasting positive impact on health. The Hearst Health companies — FDB, Homecare Homebase, MCG,  MHK, QGenda and Zynx Health — elevate care by informing and empowering participants across the health journey. To learn more, visit  and follow ´Ç²Ô L¾±²Ô°ì±ð»å±õ²Ô.
Media Contact
Arri Stewart, MCG Health, (206) 389-5405, [email protected],
SOURCE MCG Health
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