INSIGHT DRIVEN HEALTH BLOCKCHAIN WHAT S PROGRESS ARE WE MAKING IN HEALTHCARE APRIL 2018

Transcription

1 INSIGHT DRIVEN HEALTH BLOCKCHAIN WHAT S PROGRESS ARE WE MAKING IN HEALTHCARE APRIL 2018

2 WHERE IS PROGRESS OCCURRING? IDENTITY DATA LOCATION TRACK AND TRACE DATA RECONCILIATION Copyright 2018 Accenture. All rights reserved. 2

3 BLOCKCHAIN VIGNETTES TRACK AND TRACE OPTIMIZING VALUE BASED CARE DRIVING NEW REVENUE STREAMS IMPROVING THE BENEFICIARY EXPERIENCE MANAGING IDENTITY Copyright 2018 Accenture. All rights reserved. 3

4 TRACK AND TRACE Copyright 2018 Accenture. All rights reserved. 4

5 THE CHALLENGE - SUPPLY CHAIN MANAGEMENT Auto tagging, tracing and connecting of data provides compliance and verification Connecting a sensor that detects temperature during to shipments. The data is collected while the shipment is in transit. Smart contracts create an immutable ledger that verifies and proves the temperature was compliant throughout the shipment using the connected sensor Distributor IoT helps connect the physical world to Blockchain. Example: Sensors detect physical events such as confirming the arrival of the product with a non-tampered microchip. Traceability and authentication of product history Ownership records are maintained in the Block chain once the terms of transactions have been met Products are tagged and all movements are tracked. RFID chips, barcodes, unique identifiers, EPCIS transmissions are all examples of how a product can be tagged. Transaction is registered into the block chain with details of the product and transaction Smart contracts facilitates and verifies the performance of a contract Dispenser Verifies legitimacy of events Ability to Track and Trace Proof of Ownership Tagging of Product Ensures product has not been modified Copyright 2018 Accenture All rights reserved. Creates an immutable record of transaction with detailed attributes captured Automatically enforces agreement and compliance 5

6 THE IMPACT TRACK AND TRACE Enabling real time traceability and tracking of receipt across users VISION HOW IT WORKS Blockchain traceability provides the opportunity to precisely target drug recalls, and eradicate harmful counterfeit drugs from the supply chain BLOCKCHAIN APPLICABILITY 1 CONTRACT PACKING: Serial number application & management 2 WAREHOUSING: Serial number tracking & validation Shipper stacked on pallet Pallet Serial Nesting Labeled 2D Barcode Access Anonymity Real Time Safe-keeping Trust Open Source BENEFITS Real time notification of contamination within products through distributed ledger and IoT sensors. Identification of contamination at the lot level through serialization and robust audit trail, allowing supplier to contact consumer immediately & anonymously Prevention of counterfeit drugs from entering the supply chain through transparency and traceability Improves business, operational, and regulatory reporting resulting in cost efficiencies Unit packed into shipper box Shipper labeled with Nested Serial Numbers 2D Barcode Serial number decommissioning Copyright 2017 Accenture All rights reserved. 6

7 THE FUTURE BLOCKCHAIN AND CLINICAL TRIALS Future: Enabling Tracking and Tracing across multiple user groups VISION HOW IT WORKS A blockchain platform for clinical trials connects patients, site investigators, and allowing payers to view data Patient Data Access Clinical Trial Sites BLOCKCHAIN APPLICABILITY Access BENEFITS Anonymity Real Time Safe-keeping Trust Open Source Data from Connected Devices BLOCKCHAIN DIGITAL CLINICAL TRIAL Trial Sponsors Decentralized management of data across sponsors and sites in near-real time increases trial agility, shifting away from sole management of data by one sponsor (common at present) in potentially low-trust setting Audit trail of transactions creates visibility into data history and compliancereadiness (including visibility into data edits by permissioned users) Secure data collection from IoHT devices and communications with patients during and after trial Contract Research Organizations Copyright 2017 Accenture All rights reserved. 7

8 OPTIMIZING VALUE- BASED CARE 8

9 THE CHALLENGE - TYPICAL COMPLEX CONTINUUM OF CARE Acute Inpatient Rehabilitation Second Opinion John Care Delivery Optimization Remote Patient Management Rehabilitation Rico Inpatient care Dave Patient Paul Remote Nurse Nora Primary care Tom Outpatient Patient Discharge Optimization Remote Home Monitoring Paul None-Acute 9

10 THE IMPACT CROSS-PAYER VALUE-BASED DATA SHARING Increasing the quality of care in real time Communicate with providers in realtime about incentives available to them for specific patients Identify care gaps in real-time and resolve them quickly Shepherd patients more quickly and efficiently into appropriate care programs Cigna Plan No. Problem List Demographics Care Plan NON-EXHAUSTIVE Beneficiary Identity Biometric Identity Security Certificate Aetna Plan No. Medication List Demographics Referral Summary Includes visibility to all providers across the patient s care continuum Guide physicians to improve clinical decision-making at the point of clinical care Security Certificate Humana Plan No. Demographics Diagnostic Test Results Radiology Results Copyright 2017 Accenture. All rights reserved. Biometric Security 10 Identity Certificate

11 THE FUTURE VALUE BASED DATA PLATFORM Creating a common view of quality and resource utilization data Member Payer A Login and get claims data API Blockchain Tx1 Tx2 Tx3 Retrieve index from prior Payer Hash of claims + member ID written to chain Value Based data model allows providers and payers to share a common view of quality and resource utilization data Hash of claims + member ID written to chain Clarity about the quality incentives available to them Prescriptions validated in realtime from the providers system Elimination of scanning and faxing documents Faster reimbursement for treatments Additional revenue incentives tied to quality of care delivered Member Payer B Login and get claims data API Copyright 2017 Accenture. All rights reserved. 11

12 DRIVING NEW REVENUE STREAMS Copyright 2017 Accenture All rights reserved.

13 THE CHALLENGE PAIN POINTS IN REVENUE CYCLE MANAGEMENT Main Issues Overstatement Patients are overcharged because information is not available in real time to determine benefits and caused by inconsistencies throughout claims lifecycle Contracts & Benefits (pre-processing) Contract Changes Incorrect balances because policy changes do not sync up with ledgers Claims (processing) Claim Adjustments Prior claims adjustments are difficult to track; dollars are incorrectly backed out Collection (post-processing) No Single Source of Truth RCM process is tracked separately by each stakeholder can result in Poor Beneficiary Experience Experience is negatively impacted as patients struggle to understand bill Out of Balance Health system understanding of revenue is out of balance across providers and payers Authorization Determining policy coverage with multiple stakeholders and variances is challenging Retroactive Changes Complexity with handling retroactive changes due to multiple databases Variability in Data Synchronization Some parties share records real time while others use a batch process Increased Admin Cost Millions in wasted spend due to claims adjustments and disputes Copyright (c) 2017 Accenture. All right reserved. 13

14 THE IMPACT REVENUE TRANSPARENCY Many RCM processes become easier to manage when transparency and data integrity are improved DECENTRALIZED TRANSACTION LEDGER DATABASE AUTONOMOUS VALIDATION & CONSENSUS CRYPTOGRAPHICALLY SECURE TRACEABILITY Claim is tagged at all movements and is tracked. By tagging a claim there is a shared holistic view of all claims adjudication activity IMMUTABILITY Claims and other transactions are registered into the blockchain with detail for all to see COMPLIANCE Smart contracts facilitate and verify the regulatory performance of claims and authorization decisions v ENCOUNTER v v SUBMISSION ADJUDICATION PAYMENT v v v v v DATA INTEGRITY Information securely shared across a larger ecosystem, increases speed and viability of encounter data sharing SECURITY Detection and auditing of events to ensure that all parties are aware when decisions are made FINAL VERIFICATION Ownership records are maintained in the Blockchain and can be viewed providers, payers and beneficiaries 14

15 THE FUTURE - OPTIMIZING THE REVENUE CYCLE Blockchain can orchestrate key points in the revenue cycle management process for payers Granularity Automate business rules for eligibility Risk Management Simulation Receipt & Registration Member Eligibility Benefit Determination Fee for Value Capitation Automation Scale Experience Provider Eligibility Demographic Validation Shared Accumulators Transparency Shared view Copyright 2017 Accenture All rights reserved. 15

16 IMPROVING THE BENEFICIARY EXPERIENCE Copyright 2017 Accenture All rights reserved. 16

17 THE CHALLENGE CHRONIC CARE MANAGEMENT Patients with chronic conditions undergo complex treatments across a variety of providers. A large ecosystem of partners (including payers) must work together for the patient. In today s process there is inherently lack of trust and visibility which adds no benefit to the beneficiary. How can we improve? A blockchain solution guarantees immutability of patient records, enables secure access to information across the larger ecosystem and introduces the ability to partner with other providers during pre-screening, track and trace patient data and securely share or restrict patient data. Value: TRACEABILITY Ability to Track & Trace patient data for full visibility SECURITY Verifies legitimacy of events and uses cryptography to control permissions COST REDUCTION Collaborative ecosystem reduces time and cost COMPLIANCE Automatically enforces agreement and compliance DISINTERMEDIATION IMMUTABILTIY Decentralized data network Immutable record of transactions PRODUCT SAFETY Easily accessible and real-time data enables faster prescreening Control over permissions and unique identifiers for patients Business-Driven Beneficiary-Centered Copyright 2018 Accenture. All rights reserved. 17

18 THE IMPACT TRACEABILITY OF CARE SERIALIZATION A beneficiary s activity can be tracked prior to admission. This activity data can be used to support pre-authorization and provider location IMMUTABILITY Transaction is registered into the blockchain with details on care delivered COMPLIANCE Smart contracts facilitates and verifies the performance of a provider INSIGHTS Patient-secured information can be made accessible to payers and other providers DAILY ACTIVITY SCHEDULING ENCOUNTER FOLLOW-UP COORDINATION DATA INTEGRITY Information shared across providers and payers securely facilitates information sharing with beneficiaries. Use of wellness and patient-generated health data can be traced on a blockchain and tied to events SECURITY Patient data is securely entered on the chain so that its location can be shared with other providers involved in care planning TRACK & TRACE Traceability and authentication of care for payers to conduct claims adjudication FINAL VERIFICATION Ownership records are maintained in the Blockchain once the terms of transactions have been met and can be shared with other providers involved in care coordination Copyright 2018 Accenture. All rights reserved. 18

19 THE FUTURE - TRANSPARENCY Provider and Payer Potential Larger ecosystem allows providers and payers better insights into patient history Beneficiary Potential Each beneficiary has a unique ID and can track movement using a wallet-like interface Beneficiary, Payer, Provider and Pharma Potential Tracks progress of medication adherence and care coordination Provider, Payer and Pharma Potential Sharing medication and clinical outcome patterns Provider and Payer Potential Doctor uses unique beneficiary ID and data insights to coordinate care. Payer verifies the treatment and measures quality. Copyright 2018 Accenture. All rights reserved. 19

20 MANAGING IDENTITY

21 THE CHALLENGE - SELF-SOVEREIGN BENEFICIARY IDENTITY 1 2 Health plans can attest to the identity of their members using existing channels 3 4 Patient consent is built on a decentralized network with plans trusting stated access rights 5 The concept of self-sovereign IDs is established Members can login with their Decentralized Identity (DID) creating a link between plans These assumptions establish the building block to establish record sharing over standard exchange protocols (e.g. FHIR, X12, etc.) Copyright 2018 Accenture. All rights reserved.

22 THE IMPACT - PROVIDER CREDENTIALING USING PROVIDER WALLETS TO CREDENTIAL ACROSS PLANS CURRENT STATE PROBLEM Requests for provider credentials are often duplicated across payers and practices resulting in unnecessary system costs and undue burden on credential issuers BLOCKCHAIN SOLUTION Storing and cryptographically signing credentials on the blockchain ensures members of the blockchain network have access and can trust the validity of provider credentials Off-chain On-chain Requesting Organization Provider Search Chain Add Credential to Provider Wallet Verify and Sign the Credential Requesting Organization Payer asks provider to provide credentials Provider submits and attests to credentials web interface Web interface finds the provider s wallet on the blockchain or creates a new wallet if not found Add the new credential to the provider s wallet and sends the provider wallet to credential verifier Credential verifier validates credentials and cryptographically signs the credential in the provider s wallet The requesting organization and future organizations can read the signed credential directly from the blockchain Copyright 2018 Accenture All rights reserved. Requires trusted registry of credential verifiers 22

23 THE FUTURE BENEFICIARY IDENTITY PERSONAL Unique to you and only you Biometric enrolment & deduplication application Mobile App 3 rd party app PORTABLE Accessible anywhere you happen to be Yosef Mihi PERSISTENT Data stays put PRIVATE The user is in control Accenture s Unique Identity Service Platform enrolls and de-duplicates users biometrics, linking them to the identity records management systems of the ID data provider Allows users to create a unique profile and provides capabilities through which they can securely manage and share their own data An application enables the 3 rd party organizations to capture, view, request and process the data shared by the user Copyright 2017 Accenture. All rights