Hyperledger Project
Healthcare Working Group (HCWG) Payer Subgroup Meeting
August 21, 2018
Resources:
Chat: https://chat.hyperledger.org/channel/healthcare-wg (you can use your LFID to login)
Github: https://github.com/hyperledger
Wiki: https://wiki.hyperledger.org
HCWG Wiki: https://wiki.hyperledger.org/groups/healthcare/healthcare-wg
Public lists: https://lists.hyperledger.org
Meetings: https://wiki.hyperledger.org/community/calendar-public-meetings
Linux Foundation Antitrust reminder: https://www.linuxfoundation.org/antitrust-policy
Arrange for SME next week to talk about auth process in detail
Slight variation in plans cause people to get different treatment for the same ailment
Is this a good use case for blockchain or not?
Blockchain opportunity
Two channels
Public channel
Private channel
Simplify view
Medication pre auth
IVF pre auth required
Dr Request payor pre auth
Requires supplement information to decide whether medically necessary and give pre auth
Reject - we need more info
More info comes in
Pre auth given
When approved or not approved, you go to get service, you have a strong record it was pre approved, no hold up in payment
Way to speed up pre auth process, one thing you could do is a link of record or hash of records submitted
We need to know more about the process and how it derails
How do public transaction help me?
How is blockchain better than a regular database?
I’m a patient waiting, instead of looking every day I get a payor provided blockchain app that I can register
myself to and once that transaction has happened I’m notified on my distributed application
Authorization for certain lab test
Auth goes in smart contract
Lab provides results for that patient
Instant payment instead of normal cycle
Traceability / any better than a trigger on an Oracle database
Data inherently immutable then that makes more sense for blockchain that a central database wouldn’t have
Prevent medical fraud is at the top of the needs
Prior auth is a hot topic, everyone is sick of broken process
Slower they have to pay the longer they get to live on the money
If they deny authorization, then no pay
Even if it’s just in limbo, who benefits from this, not the patient, it’s the payor who benefits from how complicated it is
Having a public ledger doesn’t seem to have a benefit
Immutability seems to have some benefit
Does chain code bring a compelling benefit?
We really need a SME to get depth to the process
Pain points with insurers is identifying patients between separate systems
Universal ID
ID a person across health care systems, does exist as a blockchain
25 step process to identify patients, so many combinations to say, yep we own that patient
Value based care is huge
Next steps - get and SME for pre auth and one for Value based care
Need to start solidifying
Create a framework to get to the next level
Get the right problem to be solved first
Define workflow, develop methodology