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groups:healthcare:2018_08_21_payer_notes [2018/08/24 19:00] (current)
Jennifer DeVivo created
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 +Hyperledger Project
 +Healthcare Working Group (HCWG) Payer Subgroup Meeting
 +August 21, 2018 
 +Chat:  ​https://​​​channel/​​healthcare-wg ​ ​(you can use your LFID to login)
 +Github: ​ ​https://​​​hyperledger ​
 +Wiki:  https://​
 +HCWG Wiki: https://​​groups/​healthcare/​healthcare-wg ​
 +Public lists: ​ https://​
 +Meetings: ​ https://​​community/​calendar-public-meetings ​
 +Linux Foundation Antitrust reminder: https://​​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
groups/healthcare/2018_08_21_payer_notes.txt · Last modified: 2018/08/24 19:00 by Jennifer DeVivo