Doctors and hospitals may have upped the provision of healthcare services but the administrative aspects of healthcare have remained mired in labour intensive processes that often require manual intervention. For instance, payers must use myriad commercial and custom systems to automate various aspects of healthcare transaction processing that have gaps and require manual intervention or additional coding.
Smart contracts present a simpler, more efficient and lower-cost solution because they enable self-executing business rules that payers embed on a blockchain and trigger automatically based on events that occur in a transaction. When any event in the healthcare transaction lifecycle is completed, the blockchain ledger is updated.
In the thick of this is Change Healthcare, which processes nearly 14 billion healthcare transactions and $2.0 trillion in annual healthcare expenditures for 2,100 government and commercial payer connections, 5,500 hospitals, 900,000 physicians, and 33,000 pharmacies worldwide.
The company is collaborating with TIBCO Software to build what it claims is the first smart contract system for healthcare. It plans to use TIBCO’s smart contract developer project, Project Dovetail, to enable health plans and their financial partners to easily develop and deploy smart contract-based processes that automate events across the healthcare transaction processing lifecycle.
It is intended that payers will be able to use this new platform to build healthcare transaction-related smart contracts on the Intelligent Healthcare Network to increase the efficiency of healthcare transaction processing (including claims adjudication and payment processes) and improve providers’ revenue cycle performance with faster resolution and remittance. Change Healthcare and TIBCO also plan to provide a developer environment aimed at creating the next generation of healthcare transaction applications that utilize blockchain and smart contracts.
Change Healthcare’s chief technology officer, Aaron Symanski, the collaboration with TIBCO is only part of its larger initiative to simplify and standardize healthcare transaction processing and help move the industry to real-time adjudication on the Intelligent Healthcare Network.
“By bringing smart contracts to claims processing, payers can share a standardized approach that lets them easily write, visualize, test, audit, and implement smart contracts for automating healthcare transaction processes,” he added.
The collaboration will aim to leverage Project Dovetail, a development framework to allow payers and financial institutions to build smart contracts governing healthcare transaction processing. Dovetail gives users access to a model-driven environment that promotes the creation of smart contracts that can run on any blockchain or cloud platform, and thus increases agility, flexibility, and time to market.
Nelson Petracek, global chief technology officer at TIBCO said the goal of the collaboration is to move aggressively toward the goal of real-time adjudication, while ensuring compliance and helping streamline healthcare transaction processing for all stakeholders.