Delaware’s Blockchain Pilot
Background Pilot Blockchain technology to determine proof of concept in healthcare Pre-authorization use case was selected Goal – improve healthcare access by creating a chain of patient records that can be made available to insurers and medical care providers (distributive) Pilot results were presented at the Medicaid Enterprise Systems Conference held August 15-18 2017
The Players MSD - Medical Society of Delaware Medscient – solution to use distributed ledger technology developed by Symbiont DHIN - Delaware Health Information Network CSG Government Solutions
Use Case Prior Authorizations Use distributed ledger technology to create smart contracts Smart contracts are rules agreed upon by caregivers and insurers to automate the pre-authorization process Negotiate the ‘Metrics of Trust’ between parties Execute decisions on pre-authorizations that all parties have agreed to are appropriate and correct
The Goal Create a trustworthy mechanism to facilitate healthcare transactions while protecting the intellectual property and experience of all stakeholders. Leave data where it is (not devote time to defining new standards for interoperability or moving vast quantities of data).
Problem Lack of automated pre-authorization processes and real-time reply causes delays for approvals Higher denials can adds to administrative and operating overhead
The Cure (Smart Pre-Authorization) Automates the process for pre-authorization providers, reducing delays Eliminates the need for paper or faxed forms Reduces administrative overhead Increases medication adherence Introduces innovation and new workflows Creates efficiency
Smart Pre-Authorization
A small test group is formed: Proof of Concept A small test group is formed: One set of doctors One type of treatment First Gold Star Scores awarded
Win-Win Solution Doctors earn and continue to prove their exemption from pre-authorization. Data-driven accountability Results are more transparent Patients receive appropriate treatments Payers save money and manage risk
Pharmacy Example Smart Prior Authorization is a process used to determine whether you qualify for coverage using factors Express Scripts has on file, such as medical history, drug history, age and gender. If your history does not qualify you for coverage of a particular medication, a prior authorization is required to permit coverage.
Pharmacy Continued Step therapy (also known as smart prior authorization) For step therapy, for instance, certain medications may not be covered unless the patient has first tried another medication or therapy. The following examples are medications that are part of the step therapy process: – Forteo® – Revatio™ 7 – COX-2 inhibitors (such as Celebrex® ) – Injectable rheumatoid arthritis medications (such as Kineret® , Enbrel® , Remicade® , Humira® )
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