Society aims to improve healthcare preauthorization processes

August 12, 2017

The Medical Society of Delaware has teamed up with healthcare services company Medscient to develop a solution to address the challenges posed by prior authorization requirements for patients and healthcare providers. The solution will use distributed ledger technology developed by Symbiont, the State of Delaware's technology partner in the Delaware Blockchain Initiative.

The medical society and Medscient will present a proof of concept of the solution at the Medicaid Enterprise Systems Conference Friday, Aug. 18, in Baltimore, with the long-term goal of implementing the system statewide to reduce delays and added expense often associated with prior authorizations.

"This is truly an exciting project," said MSD Vice President Andrew Dahlke, MD. "The distributed ledger is a transformative technology that offers a definitive solution to the problem of preauthorization that can benefit all parties - patients, doctors, nurses, hospitals and insurers."

Distributed ledger technology and smart contracts will execute rules agreed upon by caregivers and insurers to automate the preauthorization process, Dahlke said. This should reduce the need for phone calls, faxes and lengthy turnaround times that generate added expense for providers and insurers, and all too often delay badly needed patient care.

"The entire healthcare community agrees that preauthorization processes need improvement," Dahlke said. "We are confident that this proof of concept will not only address this particular pain point, but will lay the groundwork for streamlining other healthcare administrative issues as well."

The metrics of trust

The key to the technology is that it provides both insurers and care providers with a common data set of patient information on a distributed ledger, where it can be securely shared by all parties, said Vince Albanese, CEO of Medscient. The data is used to create smart contracts, which become the rules used to automatically make preauthorization decisions.

"Essentially, we are negotiating the metrics of trust between the parties," said Albanese. "We are coding agreed-upon rules of preauthorization in smart contracts that will in turn execute decisions that all parties can agree are appropriate and correct." He said the solution will provide automated prior authorization decisions more quickly, consistently and objectively.

Medscient is working with the medical society to document the current preauthorization landscape and capture use cases. The next step will be to model the future state of preauthorization, to envision what an automated environment will look like and how it will impact the involved parties. "This exercise is critical to negotiate the metrics of trust and to project the success of the POC," said Albanese.

Delaware taking the lead on innovative healthcare solutions

The State of Delaware has staked out an early lead and selected a technology partner in the distributed ledger ecosystem, which makes it an ideal venue for the project. "There will be a lot of talk about distributed ledger solutions at the Medicare conference, but thanks to the vision and proactive efforts of the Medical Society of Delaware and the Delaware Blockchain Initiative, we will be able to talk about real results," Albanese said.

"We are thrilled that the Delaware Blockchain Initiative is giving rise to a use case with real, tangible and meaningful benefits to the people of Delaware and beyond," said Andrea Tinianow, director of Global Delaware.