Blockchain technology at Change Healthcare Distributing value for a better healthcare future Aaron Symanski, CTO asymanski@changehealthcare.com Blockchain 2018

Building on the shoulders of giants. Blockchain adoption is part of a transformation that’s already underway in healthcare. 1960s – 1970s: Computers: Expensive mainframes and storage drove hardware innovation, smaller computers and departmental software; data silos 1980s -1990s: Networks: Personal computers, distributed computing and vast communication networks drive competition and consolidation; EMRs 2000s – 2010s: Mobility: Digitized records face mobility and portability demand / security consequences; data analytics and outcome based reimbursement emerge. 2010s-onward: Automation: Full automation requires high integrity data and a resistance to attack…enter blockchain PROPRIETARY & CONFIDENTIAL

Why is blockchain technology so compelling? We all want a future where information is: Immediately available Identical everywhere it is stored Has a complete history Is immutable And is user-centric – “controlled” by the contributor PROPRIETARY & CONFIDENTIAL

Our Intelligent Healthcare Network™ Healthcare Transactions Change Healthcare at a glance Business Overview Our Intelligent Healthcare Network™ 5,500 Hospitals 2,100 Payer Connections Large, independent, health technology and services company $3.5 billion in annual revenue 15,000 team members in 35 states and ~4,000 contractors Supports all major stakeholders across the healthcare system Investing for the Future, Today Blockchain, Artificial Intelligence, Communities, User Experience… 117,000 Dentists 1 in 5 U.S. Patient Records 800,000 Physicians $2.0 trillion Healthcare Claims 600 Laboratories 12 billion Healthcare Transactions PROPRIETARY & CONFIDENTIAL

Hyperledger, a Linux Foundation Project, and Change Healthcare

Blockchain, Hyperledger, and Change Healthcare Blockchain adoption benefits from thoughtful, open source development. Openness ensures scalability, accessibility, resiliency, and innovation. Blockchain protocol governance Node management Consensus mechanisms Smart contract language and libraries Identity frameworks PROPRIETARY & CONFIDENTIAL

Why Hyperledger Fabric? Modular & Extensible Architecture Applicability across industries especially healthcare Flexible Consensus Model High transaction volume & throughput Choice of consensus algorithm Fine-grained access control supports privacy needs Multi-Channel for greater privacy and segmentation Smart Contracts (Chain Code) support Go and Java Ability to support currency (we might want this some day) Open Source PROPRIETARY & CONFIDENTIAL

Intelligent Healthcare Network™ with Blockchain featuring Claims Management Transparency

Transaction Processing Workflow Change Healthcare Intelligent Healthcare NetworkTM with blockchain Payer Blockchain Ledger Using Hyperledger Fabric, a blockchain framework implementation hosted by Change Healthcare Transaction Processing Workflow VOLUME 50 Million Transactions/Day PERFORMANCE 550 Transactions per second Provider PROPRIETARY & CONFIDENTIAL

Intelligent Healthcare Network™ with Blockchain featuring Claims Management Transparency "A rose by any other name would smell as sweet“ We’ve augmented our high-performance network with blockchain, establishing a platform that we will expose and leverage for many other innovative use cases/products in the future The first feature or application deployed on the platform provides visibility / transparency into the claim lifecycle Intelligent Healthcare Platform featuring Claims Management Transparency Application Features with Blockchain Data & Rights Management Intelligent Healthcare Network Claims Network

Intelligent Healthcare NetworkTM with blockchain featuring claims management transparency Claims Network Claim Processing Workflow Payer Assurance Reimbursement ManagementTM Provider 1 Claims submitted for payment by Provider 2 Claims Network workflow writes claim lifecycle events to blockchain 3 Blockchain events trigger Claims Network workflow activity 4 Claims submitted to Payer for processing 5 Blockchain maintains real-time immutable record of claim lifecycle 6 Provider accesses claim status from blockchain via API Claims Network Components Blockchain Components Customer Components Claims Hyperledger Fabric Claim Submission Remittance Blockchain Network

Adoption will come in phases. Value Payments and financial services Fraud Detection Consumer End-Users Consumer Software Development Mobile applications Transaction Auditing Stakeholder Adoption Process automation Identity authorization Insurance claims Enterprise End-Users Enterprise Software Providers Data validation Exchanging clinical data Role-based access control lists Digital Assets Clinical records registries Smart Contracts IT Infrastructure Node management Today 1-3 years 3-5 years

Four types of blockchain solutions at Change Healthcare Enterprise applications and services We will offer integrated and novel blockchain applications and data processing services. Enterprise blockchain infrastructure We will offer a path from private to permissioned to eventually open blockchain networks. We are in production with the first phase. Consumer application services We will connect our customers patient and consumer facing technology to blockchain technology Open blockchain infrastructure and resources We will invest in, develop, and contribute to the adoption of open blockchain infrastructure, as it is vital to the long-term value of this technology.