Automating Palliative & Hospice SMART on FHIR Prior Auth

The Unique Prior Auth Landscape in Palliative & Hospice Care

Palliative and hospice care relies on timely access to services, from hospice election and specific levels of care (such as GIP-level care or continuous home care) to palliative medications and durable medical equipment (DME). Delays in prior authorization for these high-volume categories can directly impact patient comfort and quality of life. The administrative burden of securing approvals often diverts clinical resources from direct patient care, creating friction in an already sensitive care environment.

Overcoming Manual Workflow Bottlenecks in End-of-Life Care

• **Context-Switching Cost:** Clinicians and coordinators frequently navigate away from the EMR to external payer portals or standalone PA software, disrupting focus on patient charts.
• **Manual Context Transfer Errors:** Manually retyping or copy-pasting patient demographics, member IDs, and clinical notes for hospice election or medication requests introduces transcription errors, leading to rejections.
• **Documentation Gaps:** Gathering and attaching comprehensive clinical documentation for hospice levels of care or DME often involves screen-scraping or manual pulls, creating inconsistencies.
• **Inconsistent Outcome Write-Back:** Prior auth decisions and statuses are often manually entered as free-text notes in the EMR, making them unstructured, difficult to query, and prone to oversight.

Klivira's SMART on FHIR Solution for Palliative & Hospice Prior Auth

Klivira leverages SMART on FHIR to embed prior authorization directly into your EMR's clinical workflow, eliminating the need for context-switching. Our solution launches within your EMR (e.g., Epic, Cerner, athenahealth, MEDITECH), automatically pulling patient and encounter context via FHIR R4. This ensures that requests for hospice levels of care, palliative medications, and DME are initiated with accurate, real-time clinical data, streamlining the entire approval process.

Key Benefits of SMART on FHIR for Palliative & Hospice Workflows

• **Reduced Clinician Burden:** Prior auth requests are initiated without leaving the EMR, minimizing administrative overhead and allowing care teams to focus on patient needs.
• **Automated Data Transfer:** Patient and encounter context, including details for hospice election or GIP-level care, are automatically transferred from the EMR via SMART launch parameters and FHIR R4 reads, eliminating manual errors.
• **Structured Outcome Write-Back:** PA decisions and status updates are written back to the EMR as structured FHIR resources (DocumentReference, Communication, Task), ensuring queryable and consistent record-keeping.
• **Accelerated Approvals:** By reducing manual steps and errors, the platform helps expedite approvals for critical palliative medications and services, ensuring continuity of care.

Seamless EMR Integration and Da Vinci PAS Conformance

Klivira's platform conforms to the SMART App Launch IG, enabling deep integration with leading EMRs such as Epic, Cerner, athenahealth, and MEDITECH. We read US Core resources directly from the EMR's FHIR endpoint, ensuring comprehensive clinical context for prior auth submissions. Furthermore, Klivira executes the Da Vinci PAS stack, including CRD for coverage discovery and DTR for documentation assembly, to ensure that palliative and hospice prior auth workflows are aligned with industry-leading standards for efficiency and interoperability.

Ensuring Continuity of Care for Palliative & Hospice Patients

By automating prior authorizations with SMART on FHIR, Klivira directly supports the continuity of care for palliative and hospice patients. This approach ensures that essential services, from hospice election to specialized medications and DME, are approved efficiently, aligning with evidence-based protocols for end-of-life care. Our system handles per-EMR resource variability internally, providing a consistent user experience regardless of the underlying EHR system.