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The high costs for treatments and drugs, clumsy administrative processes and poor coordination of care are three main causes of alarm in the health sector. A long-time industry professional, Pradeep Goel, has made a commitment to try and do better. In a recent interview with Forbes collaborator Jefferson Nunn he shared some of his ideas for a new approach to health care.
Few things in life have less power to get sick. Not only is it physical discomfort, but there is the unsettling uncertainty of whether, when or how we will be fine. Fortunately, it is less and less a question of whether there is a treatment or a specialist for the condition. Specialized and advanced medical centers are available throughout the United States and internationally. Drugs cover a wide spectrum of diseases and new ones are continually being developed. Alternative treatments are also increasing in popularity and prevalence. In short, if a person is not well, there are generally several avenues to follow for treatment.
The questions that keep the sick at night now revolve around the following:
& nbsp; "Will I be able to afford the care I need?" and "Will I receive the treatment in a timely manner?"
These are the discouraging themes of many health conversations. Incredibly high costs and inefficient processes often represent insurmountable barriers between a sick person and well-being. Although we should not expect to be able to be effortless, it certainly should not be so boring or inaccessible that we get discouraged. It's stressful enough to be sick to start with.
Although progress continues in medical research and technology, the health system itself has proven to be an impediment to well-being. This is particularly true in the United States, where health costs are run without control and simple activities are being bogged down by obsolete administrative processes. Furthermore, despite the fact that maintaining healthy patients is in the interest of insurance companies, suppliers and employers, they can not work together to effectively promote well-being and prevent disease. & Nbsp;
The health system soon falls
Exorbitant prices
The price of pharmaceutical procedures and products is a significant problem in the United States where & nbsp;per capita expenses& nbsp; on health care are almost twice what they are in other developed nations. CNBC reported that the same treatments are often two to three times the cost in the United States compared to other developed countries. For example, the average magnetic resonance in the United States exceeds $ 1,000, while in Australia it costs $ 350.
Theories of why costs are so high in the United States include that the United States has more specialists who earn more money than in other countries and that the use of care rates is higher in the United States. However, as reported by CNBC, these theories were resized by Harvard Studio of the Chan school.
The study found that the use of care is similar among the 11 developed countries analyzed and that the number of specialists in relation to GPs was similar. The study acknowledged that doctors earn much higher salaries in the United States, although researchers have indicated this fact as an area to be examined when trying to reduce health care spending.
Pharmaceutical products are also drastically more expensive in the United States and prices rise frequently and without justification. At the start of this year, CBS & nbsp;reported& nbsp; on the death of Alec Smith, a diabetic who failed to get health insurance through his employer. He could not afford to buy insulin, since the cost had risen to over $ 1,000 and he died of diabetic ketoacidosis, the same condition that insulin would have prevented.
In the case of insulin, the turbid abyss of pharmaceutical prices becomes very evident. As a prescription drug, insulin has been around for almost a century and producers do not have to pay royalties. However, prices continue to rise and a generic version is not available.
Senator Susan Collins & nbsp;described& nbsp; the price of insulin as a "complicated network of transactions" that makes it extremely difficult to determine why the cost of the drug is so high and why patients who need discounts and discounts to afford it do not see the help.
Avik Roy, a & nbsp;Forbes& nbsp; taxpayer, shed light on the reality of drug prices, stating, "in the absence of competition, [drug] producers often charge the highest prices they think they can justify in court. "Roy explains that while intermediaries, or pharmaceutical performance managers (PBMs), are often held accountable for rising drug prices, drug manufacturers are setting prices." PBMs are hired to research the drugs. efficacy and cost effectiveness of various drugs and therefore to encourage the use of the most effective drug at the lowest price According to Roy, PBMs have actually helped to keep prices up dramatically.
Discounts and discounts
However, drug makers have found a way to influence PBMs and get patients on their more expensive versions of a drug through discounts and discounts. Discounts are a gray area when it comes to prescription drugs, although they undoubtedly influence insurance prices and premiums. In order to promote the use of their brand name, expensive use of drugs of a generic version, a drug manufacturer can offer discounts. These discounts are split between PBMs and insurance companies. Insurance companies may therefore require less co-payment from the patient, making the drug affordable at high cost.
The problem is that the insurance company is unnecessarily paying for a more expensive version of the drug, and while the patient does not pay a higher co-payment, the insurance company is putting out more money because the drug is more expensive. This helps drug producers rake in money, but does not translate into a benefit for patients or insurers. In fact, it leads to higher premiums, which, as in the case of Alec Smith, prevents many patients from obtaining coverage.
Desperate times require … a holiday?
Exorbitant costs for medical procedures and prescription drugs have led to an increase in medical tourism. Medical tourism refers to the crossing of international borders for medical treatment. It has become quite common that some insurance companies offer advantages for medical tourism.
For citizens of the United States, Mexico and Canada are common destinations for treatment. Even by including travel costs such as airfare and accommodations, many people are able to afford cross-border medical care that they can not afford at home. For example, a common procedure such as bariatric surgery costs & nbsp;between& nbsp; $ 20,000 and $ 25,000 in the United States. In Canada, the same costs as surgery & nbsp;between& nbsp; $ 11,500 and $ 15,500. In Mexico, & nbsp;cost& nbsp; of the procedure can be $ 4,300.
Pharmaceutical tourism is another idea of the concept of medical tourism. Drugs often cost a fraction of their US prices in Canada and Mexico. Some insurers have taken note of the trend and are trying to put it into practice also for their economic result.
The & nbsp;Salt Lake Tribune& nbsp; recently described a Utah insurer & nbsp;new approach& nbsp; to reduce the costs of prescription drugs. PEHP, the insurer, is helping those who need high-cost specific drugs to get them at a lower cost. The company will pay for a patient's air travel to San Diego and ground transportation from there to Tijuana, Mexico. & Nbsp; PEHP also offers patients $ 500 in cash. For a multiple sclerosis drug, the 90-day refueling savings reach over $ 13,000, outpacing travel costs and $ 500 for the insurer. The PEHP offers advantages for pharmacy tourism to those who take 13 different high-cost drugs used to treat diseases such as MS, autoimmune disorders and Crohn's disease.
Administrative problems and bureaucracy
Health insurance is often touted as the remedy to make health care accessible. However, even those with high insurance and at an affordable price are not guaranteed timely or headache-free assistance. If a deferral or pre-authorization is required, treatment may be delayed for weeks. According to CNBC, in a survey conducted by US professionals, "a significant portion of physicians call the time they lose for matters related to claims for compensation and reporting of clinical data as a serious problem."
Patients also suffer from this reality. Once the referral is granted and in the specialist's office, many patients find themselves repeating the same symptom and medical history score they gave to their primary care physician, whose assistant typed it diligently into a digital recording system. Unfortunately, if that system or plant is not associated with the next one, the whole process must be repeated, requiring time and resources.
These inefficiencies translate into significant loss of money. The Harvard Chan School study attributed a significant part of the disparity in spending between the United States and other countries to higher administrative costs. Administrative costs represent only 1-3% of healthcare spending in other countries, while in the United States administrative costs come to 8%.
A health veteran weighs
The current health care system would certainly not be described as patient-centered, efficient or value-based, but such a system is possible, according to Pradeep Goel, CEO of Solve.Care. Goel has spent more than two decades in the IT sector of healthcare systems, during which he has created 4 IT companies in the healthcare sector. He has participated in national and state health records initiatives and has been at the forefront of the development and implementation of data systems for patient data management. He then faced the challenge of making multiple systems communicate with each other in ways that can improve patient experience and outcome. In the end, Goel realized that simply collecting and digitizing data would not destroy the convoluted system.
In fact, he came to know the frustrations of seeking specialized treatment on a very personal level when his son was diagnosed with a series of medical complications. Even with his knowledge of the industry and involvement on several fronts, the task of coordinating care for his son was monumental. It has become a full-time job for Goel's wife to manage child care.
At this point, Goel realized that a revision, a review would be needed to restore patients' power to control their care and information, and encourage stakeholders to act quickly, efficiently and effectively. Recently, Goel was interviewed by Forbes contributor Jefferson Nunn on his perspective on the health care system and its future.
A new vision for health care
High rate, bureaucracy and inadequate coordination of care are three main concerns for the current health system. & Nbsp; As someone who has "seen health care from a consumer, employer, TPA, care, clinic and HIE", Goel has a unique perspective on how the system works and does not work. It is currently channeling this knowledge and experience into the development of a blockchain-based platform for health care administration and benefits.
Blockchain, the technology behind cryptocurrency, is tested in many sectors as a means of improving existing systems. The features that make it attractive in so many areas include transparency, decentralization, immutability and smart contracts. The health system, with its infamous centralization, the prevalence of fraud and abuse and bureaucratic shortcomings, could clearly use a dose of what the blockchain can offer. Goel believes a triple approach is needed to improve health care. He has declared,
"We do better clinical results, we do not limit ourselves to lower administrative costs, we have to do it regardless … But we can also improve and improve clinical outcomes and then make accurate payments in real time, and those three pillars are worth it, because each of them has a huge impact on its own, but if you can interact, if you can make those three work together, then it's really the revolution we've all been waiting for. "
Goel emphasizes the need to move from a cost-based system to a value-based system, if health care will have the opportunity to be effective and accessible to those in need. A value-based health care would ask how and where money could be spent to achieve optimal well-being and disease prevention. The current cost-based model is one that expects something to go wrong and then looks for the cheapest way to solve it. As has been discussed, this is not the most effective approach from a cost or welfare point of view.
Define and improve relationships between stakeholders
One component of Goel's vision for an improved system is defining relationships between stakeholders, which states that blockchain can help you achieve. The platform and the system that Goel provides connect providers, insurers, employers and patients in a way that have never been connected to manage care and benefits.
Its concept for a redesign of health care is largely based on the idea that if there are adequate channels of communication between stakeholders and those parties can communicate in real time, many of the delays and costs caused by an inefficient administration can be eliminated from health care. system. Furthermore, if transparency enters the health space, there is less chance of fraud and abuse. By automating various aspects of health care such as insurance verification, referrals and scheduling appointments, all save time and money.
Once the relationships are defined, the stakeholders are better able to communicate efficiently, which means that assistance can be provided more efficiently. Currently, patients can wait weeks for treatment authorization and referrals. Suppliers often await payment from insurance companies. The insurance companies await the verification of the treatment by the suppliers. With the use of blockchain, shares and transactions are recorded in real time and visible to relevant stakeholders simultaneously and instantly. A supplier can register treatment that can free an insurer's payment for that treatment in real time. A patient can see that a supplier has sent a referral and see when the request has been approved and so on.
Health portfolios
Smart portfolios that synchronize and communicate with each other are Goel's answer to streamline health processes and improve results. Through the smart portfolio, secure communication channels are possible and the coordination of care gets a much needed impulse. The wallet approach facilitates direct transactions and communications between interested parties, such as between patient-physician or provider-insurer. In essence, it replaces the costly and inefficient administrative health care arm and puts the administration in the hands of the stakeholders.
Health portfolios would be compatible with a variety of decentralized applications that communicate from wallet to wallet. All stakeholders, be they patients, suppliers, insurers or employers, would have portfolios. Each individual selects relevant applications for him or her and with which to synchronize the application.
Goel imagines applications not only to improve the patient-provider relationship function, but all other relationships, such as the employer-broker. Some use cases for applications include eligibility and awarding, managing chronic conditions and more.
Coordination of care
Since the existing data systems in the health sphere do not communicate with each other, there is no coordination of assistance. Encouraging effective assistance and opening communication channels among stakeholders are two paths to improve results in Goel's opinion. As Goel pointed out in the interview, it is in the best interest of insurance companies and employers to encourage well-being, a concept that seems to have been lost in the drive for profit.
For example, an insurer will spend less on preventive and supportive treatments than in a pregnancy and childbirth caused by avoidable complications; it is in the best interests of the insurer to encourage a pregnant woman to make healthy choices throughout the pregnancy. As such, the insurer could communicate with a pregnant woman via app to remind her of the controls and provide nutritional support. The company could also send funds to the women's wallet to cover transportation to and from the clinic. The app would facilitate easy planning between the woman and her provider and her visits would be recorded and verified immediately for immediate payment via blockchain.
Coordination of care in medical tourism is also improving in Goel's approach. While the platform would not control industry prices, it can help patients see their options and make alternatives such as medical tourism more viable. Goel cites "a lack of transparency, coordination and continuity" as the most pressing issues with medical tourism and explains how a platform based on blockchain and wallet can mitigate these problems. The accreditation of a structure could be verified through the platform and the apps will be used to document the treatment and progress. Since treatments are recorded on the blockchain abroad, the patient's primary care physician could remain up-to-date. The insurer could verify the treatment and release the payment.
On hold
It is not acceptable for changes to be made to make the health system healthier and healthier rather than arbitrary rules, processes and treatments that are impersonal and generalized. & Nbsp; While for many years it seems to have changed little to improve the health system, it seems that blockchain technology and the shift to a value-based approach may be the key to a more efficient, patient-centered and cost-effective healthcare system.
How does it work
Blockchain tokens with smart contracts will be presented to NDIS (National Disability Insurance Scheme). Participants and service providers will be able to make payments based on pre-defined conditions specified in the smart contract, such as who can spend it, when it can be spent, and on what.
Those who participate in NDIS need highly personalized payment conditions. The app helps participants find, book and pay for services from NDIS service providers, without having to do all the paperwork.
"Programmable money is an opportunity to re-imagine how we think about money and how payments work through the economy," he said& Nbsp;Sophie Gilder, Head of the CBA Experimentation and Blockchain, Innovation Lab. It is clear that the potential of this technology for NDIS is enormous and ranges from increased empowerment to participants, reduced administrative costs for businesses and greater visibility for the government.
An additional report on the project will be released in November of this year, where drawings, advantages and limitations of the test with suggestions for other future applications will be detailed.
It is clear that CSIRO is examining the immense potential of blockchain technology and wants to exploit it for the benefit of people around the world in general. Previously, Data61 and the University of Sydney had joined together to create the next generation& Nbsp;Red Belly Blockchain& Nbsp;able to process 30,000 cross-border transactions per second.
Also CommBank is not new to blockchain innovations. In August of this year, he helped to fix the first in the world& Nbsp;blockchain bond& Nbsp;issued by the World Bank and raised about $ 81 million in the process.
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The high costs for treatments and drugs, clumsy administrative processes and poor coordination of care are three main causes of alarm in the health sector. A long-time industry professional, Pradeep Goel, has made a commitment to try and do better. In a recent interview with Forbes collaborator Jefferson Nunn he shared some of his ideas for a new approach to health care.
Few things in life have less power to get sick. Not only is it physical discomfort, but there is the unsettling uncertainty of whether, when or how we will be fine. Fortunately, it is less and less a question of whether there is a treatment or a specialist for the condition. Specialized and advanced medical centers are available throughout the United States and internationally. Drugs cover a wide spectrum of diseases and new ones are continually being developed. Alternative treatments are also increasing in popularity and prevalence. In short, if a person is not well, there are generally several avenues to follow for treatment.
The questions that keep the sick at night now revolve around the following:
"Will I be able to afford the care I need?" And "will I receive the treatment in a timely manner?"
These are the discouraging themes of many health conversations. Incredibly high costs and inefficient processes often represent insurmountable barriers between a sick person and well-being. Although we should not expect to be able to be effortless, it certainly should not be so boring or inaccessible that we get discouraged. It's stressful enough to be sick to start with.
Although progress continues in medical research and technology, the health system itself has proven to be an impediment to well-being. This is particularly true in the United States, where health costs are run without control and simple activities are being bogged down by obsolete administrative processes. Furthermore, despite the fact that keeping patients in good health is in the interest of insurance companies, suppliers and employers, they can not work together to effectively promote well-being and prevent disease.
The health system soon falls
Exorbitant prices
The price of pharmaceutical procedures and products is a significant problem in the United States, where per capita health care expenditures are almost double that of other developed nations. CNBC reported that the same treatments are often two to three times the cost in the United States compared to other developed countries. For example, the average magnetic resonance in the United States exceeds $ 1,000, while in Australia it costs $ 350.
Theories of why costs are so high in the United States include that the United States has more specialists who earn more money than in other countries and that the use of care rates is higher in the United States. However, as reported by CNBC, these theories were resized by Harvard Studio of the Chan school.
The study found that the use of care is similar among the 11 developed countries analyzed and that the number of specialists in relation to GPs was similar. The study acknowledged that doctors earn much higher salaries in the United States, although researchers have indicated this fact as an area to be examined when trying to reduce health care spending.
Pharmaceutical products are also drastically more expensive in the United States and prices rise frequently and without justification. At the beginning of this year, CBS reported the death of Alec Smith, a diabetic who was unable to obtain health insurance through his employer. He could not afford to buy insulin, since the cost had risen to over $ 1,000 and he died of diabetic ketoacidosis, the same condition that insulin would have prevented.
In the case of insulin, the turbid abyss of pharmaceutical prices becomes very evident. As a prescription drug, insulin has been around for almost a century and producers do not have to pay royalties. However, prices continue to rise and a generic version is not available.
Senator Susan Collins described the price of insulin as a "complicated network of transactions" that makes it extremely difficult to determine why the cost of the drug is so high and why patients who need discounts and discounts to afford it do not see the # 39; help.
Avik Roy, a contributor to Forbes, sheds light on the reality of drug prices, stating that "in the absence of competition, [drug] producers often charge the highest prices they think they can justify in court. "Roy explains that while intermediaries, or pharmaceutical performance managers (PBMs), are often held accountable for rising drug prices, drug manufacturers are setting prices." PBMs are hired to research the drugs. efficacy and cost effectiveness of various drugs and therefore to encourage the use of the most effective drug at the lowest price According to Roy, PBMs have actually helped to keep prices up dramatically.
Discounts and discounts
However, drug makers have found a way to influence PBMs and get patients on their more expensive versions of a drug through discounts and discounts. Discounts are a gray area when it comes to prescription drugs, although they undoubtedly influence insurance prices and premiums. In order to promote the use of their brand name, expensive use of drugs of a generic version, a drug manufacturer can offer discounts. These discounts are split between PBMs and insurance companies. Insurance companies may therefore require less co-payment from the patient, making the drug affordable at high cost.
The problem is that the insurance company is unnecessarily paying for a more expensive version of the drug, and while the patient does not pay a higher co-payment, the insurance company is putting out more money because the drug is more expensive. This helps drug producers rake in money, but does not translate into a benefit for patients or insurers. In fact, it leads to higher premiums, which, as in the case of Alec Smith, prevents many patients from obtaining coverage.
Desperate times require … a holiday?
Exorbitant costs for medical procedures and prescription drugs have led to an increase in medical tourism. Medical tourism refers to the crossing of international borders for medical treatment. It has become quite common that some insurance companies offer advantages for medical tourism.
For citizens of the United States, Mexico and Canada are common destinations for treatment. Even by including travel costs such as airfare and accommodations, many people are able to afford cross-border medical care that they can not afford at home. For example, a common procedure such as bariatric surgery costs between $ 20,000 and $ 25,000 in the United States. In Canada, the same intervention costs between $ 11,500 and $ 15,500. In Mexico, the cost of the procedure can be as low as $ 4,300.
Pharmaceutical tourism is another idea of the concept of medical tourism. Drugs often cost a fraction of their US prices in Canada and Mexico. Some insurers have taken note of the trend and are trying to put it into practice also for their economic result.
The Salt Lake Tribune recently described a new approach by a Utah insurer to reduce the costs of prescription drugs. PEHP, the insurer, is helping those who need high-cost specific drugs to get them at a lower cost. The company will pay for a patient's air travel to San Diego and ground transportation from there to Tijuana, Mexico. PEHP also offers patients $ 500 in cash. For a multiple sclerosis drug, the 90-day refueling savings reach over $ 13,000, outpacing travel costs and $ 500 for the insurer. The PEHP offers advantages for pharmacy tourism to those who take 13 different high-cost drugs used to treat diseases such as MS, autoimmune disorders and Crohn's disease.
Administrative problems and bureaucracy
Health insurance is often touted as the remedy to make health care accessible. However, even those with high insurance and at an affordable price are not guaranteed timely or headache-free assistance. Se è necessario un rinvio o una pre-autorizzazione, il trattamento può essere ritardato per settimane. Secondo CNBC, in un sondaggio condotto da professionisti statunitensi, "una parte significativa dei medici chiama il tempo che perdono per le questioni relative alle richieste di risarcimento e la segnalazione di dati clinici come un problema grave".
Anche i pazienti soffrono di questa realtà. Una volta concesso il rinvio e nell'ufficio dello specialista, molti pazienti si ritrovano a ripetere lo stesso punteggio di sintomi e anamnesi che hanno dato al loro medico di base, il cui assistente lo ha digitato diligentemente in un sistema di registrazione digitale. Purtroppo, se quel sistema o impianto non è associato al successivo, l'intero processo deve essere ripetuto, richiedendo tempo e risorse.
Tali inefficienze si traducono in una significativa perdita di denaro. Lo studio Harvard Chan School ha attribuito una parte significativa della disparità di spesa tra gli Stati Uniti e gli altri paesi a costi amministrativi più elevati. I costi amministrativi rappresentano solo l'1-3% della spesa sanitaria negli altri paesi, mentre negli Stati Uniti i costi amministrativi arrivano all'8%.
Un veterano della salute pesa
L'attuale sistema sanitario non sarebbe certamente descritto come incentrato sul paziente, efficiente o basato sul valore, ma tale sistema è possibile, secondo Pradeep Goel, CEO di Solve.Care. Goel ha trascorso più di due decenni nel settore IT dei sistemi sanitari, durante i quali ha creato 4 aziende IT nel settore sanitario. Ha fatto parte delle iniziative dei record sanitari nazionali e statali ed è stato in prima linea nello sviluppo e nell'implementazione di sistemi di dati per la gestione dei dati dei pazienti. Ha poi affrontato la sfida di far sì che più sistemi comunichino tra loro in modi che possano migliorare l'esperienza e il risultato del paziente. Alla fine, Goel si rese conto che la semplice raccolta e digitalizzazione dei dati non avrebbe distrutto il sistema contorto.
In effetti, arrivò a conoscere le frustrazioni di cercare un trattamento specialistico a un livello molto personale quando a suo figlio fu diagnosticata una serie di complicazioni mediche. Anche con la sua conoscenza del settore e il coinvolgimento su più fronti, il compito di coordinare le cure per suo figlio è stato monumentale. È diventato un lavoro a tempo pieno per la moglie di Goel per gestire la cura del figlio.
A questo punto, Goel si rese conto che era necessaria una revisione, una revisione che avrebbe restituito il potere ai pazienti per controllare le loro cure e informazioni e avrebbe incentivato le parti interessate ad agire in modo rapido, efficiente ed efficace. Recentemente, Goel è stato intervistato dal contributore di Forbes, Jefferson Nunn, sulla sua prospettiva sul sistema sanitario e sul suo futuro.
Una nuova visione per l'assistenza sanitaria
L'alta tariffazione, la burocrazia e il coordinamento inadeguato delle cure sono tre principali preoccupazioni per l'attuale sistema sanitario. Come qualcuno che ha "visto l'assistenza sanitaria da un consumatore, datore di lavoro, TPA, assistenza, clinica e HIE", Goel ha una prospettiva unica su come funziona il sistema e non funziona. Attualmente sta canalizzando tale conoscenza ed esperienza nello sviluppo di una piattaforma basata su blockchain per l'amministrazione di assistenza sanitaria e benefici.
Blockchain, la tecnologia alla base della criptovaluta, viene testata in numerosi settori come mezzo per migliorare i sistemi esistenti. Le caratteristiche che lo rendono attraente in così tanti ambiti includono trasparenza, decentralizzazione, immutabilità e contratti intelligenti. Il sistema sanitario, con la sua famigerata centralizzazione, la prevalenza di frodi e abusi e le carenze burocratiche, potrebbe chiaramente utilizzare una dose di ciò che la blockchain può offrire. Goel crede che sia necessario un approccio triplice per migliorare l'assistenza sanitaria. Ha dichiarato,
"Facciamo i risultati clinici migliori. Let's not just make it administratively cost less, we have to do that regardless…But we also can improve and will improve clinical outcomes. And then also make the payments accurate in real-time. And those three pillars are worthwhile, because each of them singularly have a huge impact. But if you can interact, if you can get those three working together, then it's truly the revolution that we all have been waiting for.”
Goel points to the need to shift from a cost-based system to a value-based system if healthcare is going to have a chance at being effective and accessible to those who need it. Value-based healthcare would ask how and where money could be spent to achieve optimal wellness and prevent illness. The current cost-based model is one that waits for something to go wrong and then seeks the cheapest way to fix it. As has been discussed, this is not the most effective approach from a cost or wellness perspective.
Defining and improving relationships between stakeholders
One component of Goel’s vision for an improved system is defining relationships between stakeholders, which he says blockchain can help achieve. The platform and system Goel envisions connects providers, insurers, employers, and patients in a way they have never been connected in order to manage healthcare and benefits.
His concept for a re-design of healthcare is largely based on the idea that if proper communication channels exist between relevant parties and those parties can communicate in real-time, many of the delays and costs caused by inefficient administration can be eliminated from the healthcare system. Further, that if transparency enters the healthcare space, there is less opportunity for fraud and abuse. By automating various aspects of healthcare like insurance verification, referrals, and appointment scheduling, everyone saves time and money.
Once relationships are defined, stakeholders are better able to communicate efficiently, which means care can be provided more efficiently. Currently, patients may wait weeks for treatment authorization and referrals. Providers frequently wait for payment from insurance companies. Insurance companies wait for verification of treatment from providers. With the use of blockchain, actions and transactions are logged in real time and visible to the relevant stakeholders simultaneously and instantly. A provider can log a treatment which can release an insurer’s payment for that treatment in real time. A patient can see that a provider has sent a referral and see when the request has been approved, and so on.
Healthcare wallets
Smart wallets that can sync and communicate with each other are Goel’s answer for streamlining healthcare processes and improving outcomes. Through the smart wallet, secure communication channels are possible, and care coordination gets a much needed boost. The wallet approach facilitates direct transactions and communications between stakeholders, such as between patient-doctor or provider-insurer. In essence, it replaces the costly, inefficient administrative arm of healthcare and puts administration in the hands of the relevant stakeholders.
Healthcare wallets would be compatible with a variety of decentralized applications that communicate from wallet to wallet. All stakeholders, whether patient, provider, insurer, or employer, would have wallets. Each individual selects the applications that are relevant to him or her and with whom to sync the application.
Goel imagines applications not only to improve the patient-provider relationship function, but all other relationships, such as employer-broker. Some use cases for applications include eligibility and adjudication, management of chronic conditions, and more.
Care coordination
Since existing data systems in the healthcare sphere do not communicate with each other, care coordination is lacking. Incentivizing effective care and opening communication channels between stakeholders are two paths to improving outcomes in Goel’s opinion. As Goel pointed out in the interview, it is in the best interest of insurance companies and employers to encourage wellness, a concept that seems to have gotten lost in the push for profit.
For example, an insurer will spend less on preventative and supportive treatments than on a pregnancy and delivery wrought with avoidable complications; it is in the insurer’s best interest to encourage a pregnant woman to make healthy choices throughout the pregnancy. As such, the insurer could communicate with a pregnant woman via apps to remind her about check-ups and provide nutritional support. The company could also send funds to the woman’s wallet to cover transportation to and from the clinic. Apps would facilitate easy scheduling between the woman and her provider, and her visits would be logged and verifiable instantly for prompt payment via the blockchain.
Care coordination in regard to medical tourism stands to improve in Goel’s approach as well. While the platform wouldn’t control industry pricing, it can help patients see their options and to make alternatives like medical tourism more viable. Goel cites “a lack of transparency, coordination, and continuity” as the most pressing issues with medical tourism and explains how a blockchain and wallet-based platform would mitigate these issues. A facility’s accreditation could be verified via the platform, and apps would be used to document treatment and progress. As treatments are logged on the blockchain abroad, the patient’s primary care physician could stay up to date. The insurer could verify the treatment and release payment.
Looking forward
It is undebatable that changes are needed to make the healthcare system about health and care rather than about arbitrary rules, processes, and impersonal, generalized treatment. While for many years, little seems to have changed to improve the healthcare system, it appears that blockchain technology and a shift to a value-based approach may hold the key to a more efficient, patient-centered, and cost effective healthcare system.
How does it work
Blockchain tokens with smart contracts will be introduced to NDIS (National Disability Insurance Scheme). Participants and service providers will be able to make payments according to pre-defined conditions specified in the smart contract, like who can spend it, when it can be spent, and on what.
Those who participate in NDIS need highly ‘personalized payment conditions.’ The app helps participants find, book and pay for services from NDIS service providers, without having to do all the paperwork.
“Programmable money represents an opportunity to re-envisage how we think about money and how payments function across the economy,” said Sophie Gilder, head of CBA’s Experimentation and Blockchain, Innovation Lab. It is clear that the potential of this technology for the NDIS is enormous and ranges from greater empowerment for participants, reduced administration costs for businesses and greater visibility for the government.
An additional report on the project will be released in November this year, where designs, benefits, and limitations of the test with suggestions for other future applications will be put down in complete detail.
It is clear that CSIRO is looking at the immense potential of blockchain technology and wishes to harness it for the benefit of people throughout the world in general. Earlier, Data61 and the University of Sydney had teamed up to create the next generation Red Belly Blockchain that can process 30,000 cross-border transactions per second.
The CommBank also isn’t new to blockchain innovations. In August this year, it helped settle the world’s first blockchain bond issued by the World Bank and raised around $81 million in the process.
