Healthcare payments re-imagined with blockchain

the healthcare industry suffers from an inability to share and exchange information due to complicated agreements between shareholders the outcome is an inefficient outdated healthcare payment process that leads the millions of wasted spent resulting from claimed errors and disputes now imagine a world where all parties in a business network have access to the same information that means there's one version of the truth which is always in sync IBM blockchain solutions can enable just that simply defined blockchain is a shared distributed ledger that facilitates the recording of transactions and asset tracking for anything of value the shared ledger allows all parties to monitor and analyze the status of an asset in near real time enabling end-to-end tracking there are four key dimensions of blockchain one shared ledger an append-only distributed system of Records shared across a business network to smart contracts which are business terms both embedded and executed in a transactional database three consensus in which all parties agree to the validity of a transaction and committed to the blockchain for privacy so that transactions are secure authenticated and verifiable in this video we'll cover three significant challenges within the healthcare payment process and how blockchain can work to alleviate these issues one major pain point today is pre-authorization process this is an extra step required by some insurance companies before they decide if they want to pay for certain services determining if a given expense our event is medically necessary and covered by a members insurance policy can be a slow process for many reasons such as one the involvement of multiple stakeholders to the variance in amount covered based on the payer provider relationship three processes that are typically complex and involves several manual steps and four errors due to poor communication and technology now here's how blockchain will speed up and streamline pre-authorization with blockchain a single ledger shared among the healthcare stakeholders contains the patient's entitlement and smart contracts which encode the pre-authorization conditions this automates information collection and sharing allowing for real-time determination of benefits some advantages of using blockchain for pre-authorization include one improve cash flow due to faster transaction settlement to timely treatment of the patient three accurate payment to the provider and four reduced administrative costs and less double record-keeping another major pain point today is dealing with claims submitted for a patient who has either lost coverage or switched insurance companies in a perfect world all healthcare providers would validate a patient's current insurance status prior to an appointment but that's not always the case many times validation is not completed because the process is simply manual and time-consuming or because they trust that the patient will tell them ahead of time the claims process is initiated when a patient visits a provider after that provider renders service a claim as submitted to the patient's health insurance the insurance then processes that claim and notifies the other parties of its decision in this scenario if the claim is rejected due to issues with the patient's insurance status when the patient has no insurance at all the healthcare provider must then try to recover the out-of-pocket cost of the service already rendered which is very difficult to do and in the case of an outdated patient's insurance record the provider must then update that claim and submit it again this time to the correct insurance company both outcomes result in abundant overhead costs and can cause long delays in the overall health care networks revenue cycles here's what health care payments would look like using blockchain by storing patient profiles in pairs member information with blockchain technology the provider can check the patient's current insurance status validate their coverage in real time and avoid providing medical services to an uninsured patient similarly if a patient's insurance changes between visits the healthcare provider has access to this information already be a blockchain they can avoid submitting a claim with the wrong insurance provider thus eliminating the need to resubmit another major pain point today is pended or denied claims due to missing or inaccurate information such as patient name subscriber information diagnosis and procedure codes the term clinical attachments is a concept surrounding the need for additional clinical information when a payer is adjudicating a healthcare claim the basic premise is that sending a claim without all supporting data is time-consuming costly and challenging for all parties involved luckily a blockchain enabled planes process provides transparency in the claim requirements and reimbursement rules for all parties if the agreements between providers patients payers and government regulators were agreed upon and then stored via smart contracts on the blockchain providers would know exactly what information is needed prior to submitting claims proper data format requirements stored on the blockchain would enable providers to easily format the claim data to ensure that all information is entered correctly this clarity reduces or eliminates claims being returned due to insufficient information thus saving time and effort for all parties involved in conclusion it's very clear that blockchain will play an increasingly significant role in healthcare IT and bring beneficial disruption and new efficiencies to every stakeholder in the ecosystem it is vitally important that healthcare organizations understand and explore blockchain technology today to ensure that they are ready for the changes sure to come tomorrow


  1. Have you heard of the existing blockchain-based insurance coins like Etherisc ($DIP) or PAL Network ($PAL) ?

  2. how do patients access their own health records? Do they have to maintain a copy of the ledger?

  3. Definition of Privacy is wrong, so who exactly will want this?

  4. You talk about the PRIVACY where you say Transactions are secure,authenticated and verifiable, what about the safety of the digital asset? How is that protected?

  5. All parties agree to the a validity of a transaction and commit it to Blockchain. What happens if 10 people involved in a transaction of which 2 people do not approve it? And if other further transaction are solely dependent on this transaction to be executed first??

  6. Can agree on the point of SMART CONTRACTS … But that can happen within the current technology itself. Its a matter of writing code on a "if-then" principle seamlessly interconnected with participating applications through APIs. So other than a fancy word, what special stuff is a SMART CONTRACT??

  7. The basic explanation itself is flawed. If it was an append-only distributed system of record shared across a business network, then why would bitcoins get lost just because one exchange crashed/was hacked?? It would have been available at another point within the distributed ledger system as propagated.

  8. I really enjoy this content. The base principles behind this concept are very impressive. I have two issues. Firstly I hear Healthcare and saving money however I never heard anyting about increasing efficacy of treatment. Patient survival and overall user experience of healthcare can be dramatically evolved with such a concept. Secondly Giving the ease of creating artificially intelligent systems in today's current climate the integration of a i and blockchain technology is nothing but inevitable. Collecting data is not only big business but it is the most effective way to increase efficacy of multiple systems. The AI is capable of processing information at a much greater rate than a human being with big data in mind the growth of and need to process data will increase exponentially over the next 10 years the processing power of today's computers pales in comparison to even the smallest stand-alone systems of tomorrow.

    Enclosing my advice to you. Is put the life of the Patients First Above All Else. Focus On Healing and not cost savings. Just as email is less expensive then mailing a letter of course processing the information on the blockchain will be less expensive. A simple AI will be able to tracking and determine best treatments for longevity of human life.

  9. digitization of information assets

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