Hyperledger Wiki Archive - read only

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

• We need more SME information about the pre auth process
  • More complete picture what happened inside the payor when going thru the steps for approval and denial
  • Process re-engineering outside of Blockchain
  • Many process issues we’ll end up getting into
  • Is it possible to codify the approval and rejection steps more automatically
    

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
  • Coverage question, not blockchain question
• 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
    • Menu - your approval plus your insurance plan allows you to see these providers at this percentage of coverage
      • Patient choose dr and has service
      • Link record of approval and demonstrate service has been rendered, get payment instantaneously
      • Ideally it’s a smart contract
• Way to speed up pre auth process, one thing you could do is a link of record or hash of records submitted
  • What exactly are we managing? Data remains outside the chain
  • First transaction on blockchain - request from known provider for known patient for known service submitted - immutable
• We need to know more about the process and how it derails
  • Is there a benefit for transactions to be public on demand?
  • Query on chain for auth for services I’ve asked for
  • Patient results
• 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?
  • Convoluted process all stakeholders want to get thru faster, payor has to pay interest when too slow
• We really need a SME to get depth to the process
  • Every payor is focused on the first pass rate, in an automated untouched pattern can I get this approved or denied without delay
• 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
  • History is lost with patient movement between providers / payors
• 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