Q&A: Improving data standards and interoperability in oncology

EviCore is collaborating with CodeX to transform oncology-focused prior authorization processes between payers and providers.

Steve Jobs once said that “innovation distinguishes between a leader and a follower.”

His words certainly ring true at EviCore, the medical benefits management arm of Evernorth Health Services, where innovation is a collaborative effort that doesn’t happen in a vacuum.

One of the core people responsible for leading the charge is Heather Trimble, vice president of product strategy and growth. Trimble was recently appointed to the steering committee for CodeX, a member-driven online community designed to advance data interoperability across oncology, cardiovascular health and genomics through high-quality, computable data and improved industry standards. For its part, EviCore is a collaborator in a radiation oncology-focused pilot meant to automate and expedite prior authorization processes between payers and providers.

We sat down with Trimble to talk about the CodeX partnership and how it fits within EviCore’s broader efforts to engage with emerging technologies to improve patient outcomes and provider experiences.

Would you start by telling us about what your team does?

Our product strategy and growth team acts as the innovation arm for EviCore and our role within Evernorth. I view us as the leaders in technology — whether that’s artificial intelligence, natural language processing or machine learning. We’re pushing the envelope on ways to transform utilization management.

Our number one priority at EviCore is to put the most up-to-date clinical knowledge into the hands of providers and patients. My team is working to deliver that core competency in innovative ways. Everything we do is centered on delivering fast, appropriate care for the patient.

Last year Evernorth announced its participation in a radiation oncology-focused pilot project with CodeX. How’s that pilot going, and what are the future opportunities for collaboration?

The oncology pilot is going well so far. It’s focused on improving the exchange of prior authorization information between payer and provider systems via electronic health records. In phase one, we’re using test cases to improve the workflow — essentially all of the interactions that happen when a patient receives care — and in phase two, we’ll be testing the workflow in a real-world setting. The pilot is focused on breast and prostate cancer, and we’ll eventually expand to additional areas of oncology as well as cardiovascular and genomics, two areas Evernorth already participates in today, so there are exciting opportunities there.

Why is the goal of advancing interoperability critical for patient outcomes?

Interoperability is simply the ability of computer systems to exchange and appropriately use data. It’s critical because that data — and the terminology we use around it — is the foundation for everything we do in patient care. If stakeholders use different languages and terminology in their systems, it makes it more difficult and burdensome to get things done and ensure patients get affordable care in the right place at the right time. That’s essentially how we’re doing prior authorization today — but through CodeX, we’re working to get the health care industry to speak the same language.

You were just named to the CodeX steering committee. Why is it important for us to be engaged at this level?

We joined CodeX to help drive better communication across the health care ecosystem and bolster our ongoing efforts to deliver the most medically appropriate care possible by optimizing prior authorization.

One key way CodeX is doing that is by creating a common data language — one shared way to talk about breast or prostate cancer, for example — that can be adopted across the health care industry. By doing this, we can help improve care delivery and outcomes, while lowering the burdens associated with the processes. To make this vision a reality, CodeX is bringing stakeholders from across this process together to create use cases to help us collectively navigate through this incredibly complex ecosystem. Because Evernorth sits at the intersection of communication among payers, providers and patients, we play a critical role in helping determine what this common data language should be to help ensure evidence-based care is being delivered as seamlessly as possible.

What are the benefits you see from your work with CodeX and the broader efforts of your team?

I truly believe we can transform the way health care is delivered. That’s what my team is focused on every day, and our work with CodeX is one important component in our broader efforts. EviCore is putting serious time, resources and energy into these innovative efforts because we know it can help deliver better patient care.

See how our solutions can help
The EviCore onConnect suite integrates medical and radiation oncology, radiology, genomic laboratory utilization management, and claims payment integrity with our comprehensive oncology solution. Members receive direct support from experienced oncology nurses and community oncologist support from National Cancer Institute physicians to empower the best outcomes for patients and payers.