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Hyperledger Project Healthcare Working Group (HCWG) Payer Subgroup Meeting August 21, 2018

Resources: Chat: ​​channel/​healthcare-wg ​(you can use your LFID to login) Github: ​​hyperledger Wiki: HCWG Wiki: Public lists: Meetings:

Linux Foundation Antitrust reminder:

  • 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
groups/healthcare/2018_08_21_payer_notes.txt · Last modified: 2018/08/24 19:00 by Jennifer DeVivo