Healthcare Working Group (HCWG) Payor Subgroup Meeting
September 4, 2018
Chat: https://chat.hyperledger.org/channel/healthcare-wg (you can use your LFID to login)
HCWG Wiki: https://wiki.hyperledger.org/groups/healthcare/healthcare-wg
Public lists: https://lists.hyperledger.org
Linux Foundation Antitrust reminder: https://www.linuxfoundation.org/antitrust-policy
What are the key elements that can leverage blockchain and what problem would it solve to do that? *Segment 1: gathering the health records - other working group *Segment 2: once pre auth request submitted, there’s a lot of opportunity for harmonization of processes / improvement opportunities *Segment 3: One authorization has been obtained, smart contracts can be used for quick payments in conformance of authorization
I'm a provider and I want to ask permission to do X
Shared data set, send data once, remove resubmission process
Contracts built, automatic payments, additional function to say pre auth is flipping to a claim
Baby steps - visibility across the steps
Smart contract based on the insurance product,
Coordination of benefits - more than one insurance - need a better way to coordinate among payors
Problem of provider data, insurance companies have to keep track of providers, only good information 65% of the time. Need a blockchain phone book of doctors?
Pre auth owned by the patient, they know what each provider costs, out of network provider could validate the pre auth, allows patient to move around easier, prevent medical fraud, blockchain used to mark each transaction, evidence a procedure has been done
Fraud waste & abuse use case would interest any payor
Is the goal to create a tool that can propel use cases forward?
Next week - come back and discuss out of these use cases, what is a feasible piece of sub use case where we can start building some framework around it
Go through workflow process, break down the transaction, what might the asset look like?