Arizona Care Network, an accountable care organization, will pilot a blockchain platform developed by Solve.Care with the aim to improve clinical outcomes, relieve administrative burdens and reduce waste.
"We manage a growing number of value-based contracts. To be successful, we need immediate access to actionable health data for our providers," said David Hanekom, MD, CEO of Arizona Care Network. "We also must support timely payment to our providers."
Solve.Care employs blockchain technology as well as cloud computing and cognitive learning capabilities into a system designed to improve healthcare delivery and benefits administration. The platform addresses the core need to coordinate all parties by using a decentralized approach that delivers all relevant information to the right party exactly when needed, according to the company.
The proprietary platform will serve as the foundation for smart applications Arizona Care Network will deploy throughout its network of 5,500 physicians and 250,000 patient members.
Blockchain allows information to be automatically updated across all participants of a chain, reducing or eliminating dependence on a centralized clearinghouse. This ensures that information is timely and accurate. Arizona Care Network is evaluating and implementing several use cases focused on delegation of greater authority to patients and physicians.
Arizona Care Network will go live with the Solve.Care platform in June.
In Phase 1 of the pilot, Arizona Care Network physicians will have a Care.Wallet, through which Arizona Care Network will distribute its provider rewards and incentives. This improves the transparency, timeliness and accuracy of the financial distribution, said Debra J. Stevens, executive director of marketing and communication at Arizona Care Network.
"In Phase 2, we envision expanding the Care.Wallet to patients/members," Stevens said. "Each insured family will have a Care.Wallet, an app that automatically and continuously synchronizes all their data from the underlying chain. The patient/member can access their benefit information on the app, including deductible, co-pay, co-insurance and out-of-pocket expenses."
Patients can use a Care.Card app – essentially a digital ID card – to easily share that information with the physician. This allows patient and physician wallets to automatically negotiate convenient appointments and share benefit plan information by exchanging appropriate Care.Cards through the wallet.
The underlying chain gives the physician assurance that the patient's benefit information is current and fully accurate, even though it was received directly from the patient, via their Care.Wallet. This eliminates the usual back and forth verification calls.
"If the primary care provider needs to refer the patient to a specialist, the referral is recorded on the chain and all specialist wallets can respond to that need," Stevens said. "Care coordination between patient, PCP and specialist is achieved through shared blockchain that replicates all data across their wallets. And physicians can be paid directly using a digital payment token issued by the insurer and transferred from patient to physician wallet in real time."
The value of the payment token will be calculated based on services rendered and eliminates the need for many billing and pricing steps between physician and insurer, she added. This delivers price transparency to all parties and more timely revenue cycle management for practices, she said.
"Technology was supposed to streamline administrative systems to make healthcare safer and more efficient; but one of the biggest headaches for physicians is the necessity to use so many different solutions and none of them talk to each other, which delays updates, or misses them altogether," said Ed Clarke, MD, chief medical officer at the Arizona Care Network. "This can adversely affect patients and their health. Practices have bought all these technology solutions but they sometimes create more problems."
The Arizona Care Network platform created by Solve.Care will alleviate many of these problems associated with healthcare administration and reduce the wide range of functions required to administer health benefits in a more efficient and cost-effective manner, Clarke added.
Largely used in the financial industry in the past, blockchain technology – a distributed ledger approach utilized in real-time transactions – holds the promise of streamlining healthcare administration. The Solve.Care platform allows organizations to create, store and share administrative and financial records via a network of personal devices that do not rely on a central entity to control the data.
The Solve.Care platform updates all parties in the "chain" in real time. So doctors' offices can use the application to check patient eligibility and benefits details, coordinate care across parties and locations, and eliminate delays in payer reimbursement, the company said.