1. Delaware’s Blockchain Pilot

2. 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

3. 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

4. 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

5. 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).

6. Problem Lack of automated pre-­authorization
processes and real-­time reply causes
delays for approvals
Higher denials can adds to
administrative and operating overhead

7. 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

8. Smart Pre-Authorization

9. 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

10. 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

11. 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.

12. 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® )

13. Discussion