Five Blockchain Use Cases for Healthcare Payers, Providers

Five Blockchain Use Cases for Healthcare Payers, Providers

This is a technology I am really excited about. The common wisdom and current case uses are an underpinning of cryptocurrencies, such as Bitcoin and Ethereum. While this is important, only secondary to the technology highlighted below and from the base article.

 

Blockchain may offer a solution to these issues by keeping all members of the community instantly updated on where a provider is allowed to practice, whether or not she is accepting new patients, and what new affiliations she has formed.

This is important, because of current mHealth initiatives, such as CMC Virtual Visit, requires you to physically be in North Carolina, though the system servers both Carolinas. That has to change.

Administrative tasks such as claims processing and underwriting may also benefit from a blockchain approach, since managed permissions make it easier for payers to assess the validity of a claim, manage pre-authorizations, and ensure that providers are meeting the criteria laid out in their value-based contracts.

“Smart contracts could automate these processes and decrease the time and resources needed to execute the terms and conditions [of value-based contracting],” the report says.  “And because smart contracts are decentralized and cannot be changed, all parties can be confident that terms will be consistently executed.”

Pages from CMC Mercy Wound Care 10062017_Redacted_Page_1I continue to get notice of bill payments, similar to an actual bill image to the left, despite my plan being straightforward, at least as I know about it. Possibility to save much headaches and time wasting.

Blockchain would nearly eliminate this as rules can be set; such as “only render services covered under Medicare” to a particular patient. This removes the doubts about all parties getting compensated.

 

Enhanced security and transparency may also drastically reduce the amount of fraud that slips through the defenses of public and private payers.  When entities must have current and authenticated identities before a transaction is approved, the ability to push suspect claims through the reimbursement process is diminished.

Payers with access to a patient’s complete medical record and all of the individual’s approved providers would be more able to identify suspect claims or payment requests that do not match the patient’s documented conditions or normal care habits, explains Deloitte.

Source: Five Blockchain Use Cases for Healthcare Payers, Providers

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Marcus Welby M.D. had it right all along

marcus_welby_intro_screenFor those too young to remember, this was an ABC series that ran from 1969-1976. Though the program had house calls as part of its outreach, this was not the main point of the series. Having said that, wise people understand what is old tends to come back as new again to a different audience. With Sen. Bernie Sanders (I-VT) announcement (PDF) of Medicare-for-all sponsored legislation being first an impetus to cover everyone with healthcare and second to do so cheaper than the current system, all opportunities to flip the current fee-for-service payment model are welcome; that is if your ox is not gored by doing so. Right now, the throwback concept of House Calls is limited to the most intensive patient care clients, as is the case with most test programs. Hey, it’s 2017, it is known what works and what doesn’t by now; let’s just get on with it.

Personally, I have a chronic leg situation that has alternating bouts of treatment. If home visits from Nurse Practitioners at a minimum and Doctor’s based on need were truly funded, the system and my condition would be greatly improved.

This is not an isolated cause, despite it being new to me. Another organization in Virginia is employing a provision of the Affordable Care Act named Independence at Home. It is a project that involves 14 practices and consortia with the closest branch being a group in Durham (NC). A team-based approach to care that involves physician assistants, pharmacists, social workers, and other staff (Daniel Farmer, 2016), I would be interested to know what the other staff is; one way it can be enhanced is the utilization of Electronic Health Records that are clean and functional.

via Bringing Back House Calls to Cut Spending on High-Risk Patients

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EHR & our healthcare system, match made somewhere?

EHR & our healthcare system, match made somewhere?

Electronic Health Records are a good thing, except when they are not. Being disabled, medical professionals are a major part of my life. Interactions with them, for the most part, can’t be avoided. I consider myself a geek and reasonably wise to electronic communication means. I even have a working knowledge of HIPAA and all that entails. Coming to grips with the utter lack of EHR implementation at the consumer level is difficult to deal with. One of the providers has a reasonably popular medical specific web portal. It’s not very functional, but it exists. Another group is part of the region’s largest system. My mind struggles with the concept of a total lack of confidence in modern medical communications and associated technology. Having a secure HIPAA compliant communication portal, app, or even Whatsapp, which is 100% encrypted, suitable for transferring files that can be imported into the record keeping that all facilities are mandated by law to control. As the nation nudges toward a single payer system, despite current politics, inefficiencies become sore wounds and costly. The lack of portable EHR with a common format for the secure interchange of data will come back and bite the clients who are in no position to weather the outcomes. Nobody, not even TPTB, wins in that environment.

Recently, I had a doctors appointment with my family physician. What is interesting about this event? He carried a tablet with a keyboard dock with him as he discusses with the patient. All of our conversations are transcribed and available for reference. The rest of the office only has the standard technologies; desktop computers, printers, faxes, that sort of thing. I printed out the most recent list of medications, and the staff either scanned or typed the information in their systems; couldn’t tell which, and it didn’t occur to me to ask.

As I was researching this post, there are few events in life that haven’t happened to someone else, this being no exception. As early as five years ago, this entered my view:

Healthcare facilities need to work with providers to make it easy for them to deliver excellent care. This includes having ready, instant, and continuous access to complete patient records – access resulting from compatible EHR systems and dependable computer networks. Standards must be set and enforced that allow compatibility across systems. A start has been made in this direction, but it needs to progress quickly yet carefully (Tong, 2012)

If any of my interactions are any guide, these lessons were not learned nor executed. And that is a shame really. Anything close to a potential utopian solution must have the free and fair interchange of Electronic Health Records while automating as much of the nonclinical minutiae of the American Health Care system; even if it remains a continuation of the Affordable Care Act.

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Medicare Spending on Telehealth Increases, But Barriers Remain

By Eric Wicklund

August 28, 2017 — Healthcare providers may be using more telehealth and telemedicine than ever before, but Medicare Is still a significant barrier to growth.

An analysis of the Centers for Medicare and Medicare Services’ 2016 payments for telehealth and telemedicine shows a strong uptick in total reimbursements, claims submitted and originating site claims, but the total is still a small fraction of CMS’ total payments of $600 billion-plus and nowhere near what the federal government anticipated spending some 15 years ago.

That difference between actual use and potential use is pushing a groundswell of support to change how CMS reimburses for digital and connected health technology. Aside from several letters calling on CMS to loosen the purse strings, more than a half-dozen bills have surfaced in Congress seeking those changes.


Notable for its absence is the patient’s home. Medicare does not reimburse for telehealth or telemedicine services provided to a patient at home, hindering many mobile health and remote monitoring programs.

 

The current cost of the service.

And therein lies the problem. People on all sides of the political spectrum can agree that the US Government does not always use common sense in making regulations and rules. This is one of those times. If the goal of medical treatment is positive outcomes at less cost, seems to me that telemedicine is one of the tools to achieve this. There is a disincentive to do that, especially if the goal is a single-payer system where most would have Medicare/Medicaid and everyone would have some form of healthcare plan/insurance. To someone on a fixed income, even the amount listed (actual price for the service, fewer insurance considerations) is a barrier to treatment.

 

 

Source: Medicare Spending on Telehealth Increases, But Barriers Remain

What Rep. John Conyers’s sweeping single-payer health care bill would actually do

 

North America and UK current systems. Canada is a national network of province systems. 

You can’t fault the Democrats and Liberals for trying. After all, the base (which includes me) is finished with half-measures. I am among them, though I’m not quite ready to go all-in for the total government system. My preference is that everyone who is not covered by an employer or Veterans Affairs coverage is eligible for Medicare with everyone 200% or less of poverty level eligible for Medicaid. Medicare isn’t perfect, and I have some issues with it myself, but it is certainly better than the alternative. If I say, Carolinas Healthcare, it’s in my operating interest to take care of patients that are done now in the Emergency Rooms, without having to worry about them getting paid or trying to collect on folks that will probably never pay it back, due to chance or choice.

H/T Vox.com

While Republicans were trying and failing to repeal Obamacare, Democrats in Congress were quietly lining up behind a single-payer health plan that, as written, would fundamentally reshape American health care for every single person in the country.

That plan has now gained the backing of 60 percent of House Democrats, the most support a single-payer plan has ever enjoyed in Congress, and Sen. Bernie Sanders (I-VT) is planning a national campaign for a similar proposal in early September.

But by its author’s own admission, the House single-payer plan — Rep. John Conyers’s (D-MI) HR 676 — may not be ready for legislative prime-time. For instance, it contains only a skeletal outline of how to raise the trillions of dollars needed to achieve the universal, free coverage it wants to give every American.

But the bill is the sudden rage among the Democratic base and its congressional officials, aligning the party with a piece of legislation whose scope and speed would likely be unrivaled by any recent law in the Western world, according to four health care experts.

Source: What Rep. John Conyers’s sweeping single-payer health care bill would actually do

FDA Announces New Steps to Empower Consumers and Advance Digital Healthcare

I wondered out-loud in a draft version of this blog post the following:

I cannot tell if this is the career politician FDA speaking or what, and frankly, this shouldn’t be an issue with any administration, but it sure is with this one.

Upon further review, this is the type of announcement was expected and favored; and consistent with the history of the FDA Commissioner, a political appointee of POTUS45. I fully understand the temptation to speed the process up of software when it comes to medical capabilities. This process has been thought carefully, but two things stand out for me.

  1. HIPAA is the law of the land when it comes to digital medical records. This is a complicated system; that is where we are. How does this idea of a pre certification tie into these requirements? Blog posts on this subject here, here, here, and here.
  2. All of this is moot if the majority of citizens can’t access it due to not being covered under Medicare and Medicaid; the very constituency that can be best served by digital medical options in software including telehealth initiatives.

As for point #2, the rules for current Medicare reimbursement are found here (PDF) and are in my opinion, lacking. A change of mindset when it comes to payment overshadows any other aspect of our current system. In my ideal health care system, there would be Medicare for all with the private insurance market to fill gaps similar to Medicare Supplement policies of today and to “jump the line” in services for a fee. Digital medical options, such as Telehealth and Software based Medical Case Management would be included in the base Medicare and Medicaid plans.

FDA Announces New Steps to Empower Consumers and Advance Digital Healthcare [Official]

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The U.S. Could Adopt Universal Basic Income in Less Than 20 Years

Any discussion of Universal Basic Income must also include Universal Healthcare. Medicare and Medicaid are the primary vehicles to make this happen. It’s worth the time and effort to read, study, and explore these concepts with an open mind. Also, with the political leadership, this can happen within the next 5 years, but that will be a long-shot as politics as sport reigns supreme in Washington.

Scott Santens is a writer and advocate of universal basic income for all. He is the moderator of the Basic Income community on Reddit and Founder of the BIG Patreon Creator Pledge. His writing has been featured in the Atlantic and Huffington Post.

Source: The U.S. Could Adopt Universal Basic Income in Less Than 20 Years