ajeet-yadav/blockchain_insurance_settlement

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BlockChainUIDemo

Problem Overview:

Claims settlement is one of the most complex tasks to manage for all stakeholders involved i.e. payers, providers and ultimately patients. The industry for billing and insurance management is projected at a hefty $ 300 b. The inefficiencies with claims settlement can be further broken down into two categories:

1. Costs

   a. Significant manual effort required to keep information updated and regulated - industry employs significant number of people to serve this purpose

   b. Legal settlements post processing - healthcare, as an industry, pays more than $10 b + in settlements every year, related to false claims, late fees etc.

   c. Absence of real time communication between payers, providers and manufacturers lead to information loss, culminating in missing information in flow and subsequently leading to revenue losses

2. Time

   a. Patients in particular suffer a lot with to and fro between physicians and pharmacies due to inefficient communication. For e.g. – copay information is not clearly communicated

   b. Communication gap b/w providers and payers leads to time delay in settlement processing, stock procurement etc.

What actions are required to solve these challenges?

Interoperability b/w stakeholders i.e. payers, providers and patients etc. need to be improved - Every stakeholder should look at the same information at a given time Real time communication - if all players in the process speak with each other real time, a lot of inefficiencies could be culminated Better means to audit processes - if time stamped, non-repudiated information could be collected, audits process could be extremely simplified Improve overall security and trust in the system – With all involved parties speaking at the same time in the healthcare ecosystem, high trust and security has to be enabled

Why blockchain?

Believe it or not, blockchain technology has answers to all the problems related to the settlements industry. Four key forces of the technology that will help resolve challenges:

Smart contracts – Automated, self-executing contracts could ease out the entire settlement process, highly limiting the need of manual intervention Transparent transactions – Non-consensual transactions are not executed on blockchain, only consensual transactions would be recorded and processed on blockchain@ Transaction trails – Blockchain transactions are time stamped and anonymzed with cryptographic security features, making the audit trail transparent and highly secure Real time communication – Nodes on a blockchain speak to each other real time and the network is in a constant update mode. As such, losing information in flow is NOT possible on blockchain infrastructure

What have we done in Quest?

We’ve built a perfectly working MVP on the ethereum private blockchain. The product demos a simple contract settlement process involved between three players i.e. patients, payers and providers. The prototype is fully functional where a claim is settled in real time with consent of all the three parties involved. Once the parties consent, the automated smart contract is executed whereas in case the parties do not consent, the settlement does not progress.

What’s for the future?

This technology could be further customized to enable intricacies of contract management processes + improved UI and offered as a solution to a wide variety of clientele in the healthcare space.