Change Healthcare's Vision for Real-Time Settlement [2021]

Captions as YouTube publishes them, usually machine-generated, so names such as Daml and Canton can be misheard.

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   all right well we're going to get started now so thank you everyone for joining today's webinar change healthcare's vision for real time settlement we are excited to have you all here before we get started we do have a few housekeeping items we'd like to go over the first being that this webinar will be recorded and after today's presentation we'll be sure to send a follow-up email with that recording the second is that we will have a

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   question and answer session at the very end of the webinar where you will have a chance to ask questions as it pertains to the solutions we're discussing today if we do not get to your question at the end we will be sure to send a follow-up email and answer any questions offline all right and with that said i'd like to introduce today's panelists so we have corey todaro he is our senior product manager

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   for healthcare digital asset uh he will be discussing damil and how daml is um helping shape some of the solutions that change healthcare is building we have shiv gopalkrishnan he is the general manager for network solutions at change healthcare and she will be discussing what change healthcare has been building and and innovating on and then emily bailey is the product development director at change healthcare and emily will be

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   showcasing the instant claims settlement solution that change healthcare is building and with that said emily i will pass the mic over to you thanks lauren hi everyone so um today we're going to be sharing our our vision for real time settlement at change healthcare and i just want to to share that this is an early stage uh solution that we're putting together and some of what we're talking about today is still subject to change so just keep

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   that in mind as as we get through all of this i'm really excited to have you guys here so if you are not familiar with change healthcare we are one of the largest independent technology companies in the healthcare industry we connect over 1 million physicians to 2 400 insurance providers we process 1.5 trillion dollars in health care claims annually and our network is is comprised of about 15 billion health care

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   transactions annually and i share these metrics in order to communicate the the breadth of our network and change healthcare is is largely thought of as a as a network infrastructure provider that has a robust software and analytics and services business that is powered by this network so we see blockchain technology and dlt as primarily uh an infrastructure innovation in how networks are designed and we believe

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   that it will fundamentally transform how services and applications are are built in the future so it's exciting to be a part of this team and and to be working on blockchain technology at change healthcare because we have the ability to create true market transformation with this innovation so i'm going to turn it over to corey now to introduce digital asset good morning everybody uh thanks for attending today very excited

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   to to talk about um the work that's been going on um we're gonna be talking a lot about smart contracts today i thought that's the foundational layer uh that supports the work that's going on at change healthcare and so i wanted to briefly introduce digital asset and demo but talk more abstractly about how smart contracts can improve business processes smart contract is a is a loaded term uh in in the technology space uh associated with with blockchain going

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   back five six years now um it's not very descriptive of what it can accomplish though and so i wanted to take the time especially to discuss what we mean by smart contracts and what we mean by the nature of the application on the solution that's being developed and so and it's most easy to discuss it of course in terms of the health care industry which of course has complex workflows

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    and the complexity of those workflows um below id the complexity of the industry itself with lots of individual players either providers individual physicians within those provider organizations entities like change healthcare who provide an essential role in in the passage of the medical claim um from provider on to insurance company or a variety of insurance companies um the insurance companies themselves

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    have their own systems all of these entities have their own data silos and their own data systems and their own way of doing specific things even though those those business processes may be seeking to accomplish the same goal they do it independently of each other and so that creates a lot of complexity what we call a lot of friction in that business process which often has manual breaks the fax machine is still at least part of the royal family of healthcare

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    uh even if uh electronic electronic means of communication and payment uh are continually on the rise it also requires a lot of reconciliation so reconciling our version of what we see with other entities versions of what they see be that the provider change uh the clearinghouse the insurance company itself around the status of a claim around the status of a treatment the content of the treatment the justification for the treatment uh etc and so all of this friction creates very complex and very expensive

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    infrastructure to support those workflows smart contracts as a means of deploying distributed multilateral applications and what do i mean by multilateral we usually say something like multi-party where we have these independent entities these independent enterprises who are relying on a single piece of shared software to complete that complex workflow but multilateral adds a nice layer in

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    there which i think is very important for today's conversation in that change healthcare itself has a lot of different players or parties who are handing off a medical claim who are performing specific functions on a medical claim as part of the overall service that change provides to its clients and so smart contracts can unite not only independent business processes or data silos within

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    an enterprise they allow that application to work across enterprise boundaries with other entities with other separate enterprises as well that creates the opportunity for synchronization for those parties to share a single source of truth to avoid expensive reconciliation processes uh in essence to improve the business process to such a state that we can begin to innovate and offer fundamentally new services and value

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    to clients and customers which is i think the topic for today is a great example of that how it improves efficiency on the one hand but on the other hand it also enables um the the innovation to provide a new source of value for clients and customers and for the ecosystem itself next slide emily so how are we doing this how are we building or how is change building smart contracts

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    to accomplish its goal today and it's doing that with the technology called damo digital asset is the creator of daml damil is an open source distributed application platform and language which enables enterprises to very easily build these rather complex applications which have to work across those enterprise boundaries which have to synchronize the multiple parties and do so at the scale uh and the security and regulatory compliance requirements

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    um that that that enterprise demands so it's an enterprise-first uh platform and it enables entities like change healthcare to very simply write these applications and we we do that by focusing on the 20 of the application code which is vital for the business process in almost any application stack about 80 percent of the code is very important but it has very little to do with the specific business process you're trying to model it has a lot to do with security and has

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    a lot to do with data persistence and data storage networking etc demo removes all that from the developer's concern and allows them to define the business process specifically the rights and obligations of each of the parties who have a part in a in a complex multilateral business process the rest of it the eighty percent is abstracted away from the developer and is handled by the demo engine and

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    what we call a demo driver to remove that uh that burden um from application development so it accelerates application development it also makes it very readable and reasonable for a subject matter expert to reason about what the application is doing without having to uh to be a developer yourself and so we find that it really improves productivity in that subject matter experts and

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    development teams can work very closely around the design of the business process that is going to be addressed in the in the solution itself the other important thing it does is it provides a flexibility around how the network or how the multilateral network is configured when we talk about blockchain or dlt we often imagine a multi-party network of nodes not to get into network topology but what demo fundamentally offers and i think uniquely in the market

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    is the availability of a lot of different persistence layers for the enterprise to choose whether that's centralized databases whether that's blockchains and dlts with that some of the new emerging interoperable network configurations and allows the enterprise to choose that stack to configure that stack based upon the business needs of the solution the functional requirements of the solution itself

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    rather than try to start from a a i t network perspective and then shoehorn the business process into that architecture and so it gives a lot of flexibility for the enterprise to to configure the stack in the way that best meets the business needs that best meets the security qual requirements um and the scale and security features of of their of their industry and of their business fundamentally demo is open source so demo.com

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    you can download the the software development kit and begin to explore the demo ecosystem it's much more than just a smart contracts language their api configurations iam configurations and tooling everything that an enterprise would need to stand up a multilateral distributed application next slide and finally what about digital asset the company itself not only our main product being demo and its technology stack uh that open source technology stack uh

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    but digital asset works very closely with enterprises who are are launching into this space this multilateral distributed application space uh to enable those uh those enterprises to capitalize on the benefits of the new technology very quickly um so we can offer that experience and that expertise uh given that that we created the technology itself to help uh generate the most value in the quickest amount of time

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    we could also bring partners to bear and we're very eager to work with very closely with enterprises as they build out their applications we've done extensive work in market infrastructure for capital markets um hong kong exchange australian securities exchange we're very very happy today to discuss the uh the innovation that change healthcare is accomplishing with this technology

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    and we we we're very excited to look forward into a broadening use of of damo in the healthcare industry not only around financial infrastructure but also in some of the clinical data infrastructures that underlie and ride alongside that find those financial transactions as well as in the pharmaceutical space which have a similar set but very distinct problems around data silos

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    data standards as well as reconciliation and essentially multi-party problems so digital asset can be a partner for enterprises to help them accomplish their goals in short order with an innovative technology thank you great corey thanks for the great setup here folks it's probably not a big surprise to you when i say health care costs in the u.s are rising they're already high to begin

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    with but let's unpack that for a second right and it's important to understand the workflow that's happening today in the market now once a patient is seen by the provider and you all have been there you know there are several steps that happen between the payer and the provider before a claim gets fully adjudicated and reimbursed the provider now each of these steps that you see

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    are taking place in siloed systems and ultimately result in an enormous amount of waste just to give you some numbers the total administrative cost for payers and providers put together to manage these claims range roughly between 12 to 16 of revenue and if you do the math that's roughly 400 billion dollars right in addition to that the providers have to wait almost 40 days sometimes even more

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    to get reimbursed for the service they've already delivered so if you do the calculation on cal work cost of working capital that's about a billion 100 billion dollars there now look needless to say this is a highly inefficient process and a poor experience for all parties involved the providers the payers and most importantly the patients right so especially the providers right as they continue to

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    grapple with the long-term challenges that this whole pandemic has thrown at them and the disruption that's caused in the healthcare system this is becoming a big big sore pain point for them now we are taking an integrated platform approach to solve this problem to go to the next page our goal is to deliver a retail-like experience in healthcare financial transaction now what does that really mean it really means two things one is we want to enable

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    a real-time transactions real-time claim transaction between provider payers and the patients that's one part of it and the other part of it is we want to do it at half the cost in fact these two things go hand in hand you eliminate the waste things go faster costs go down and this solution really leverages several of our products that we already have in the market that are pair or provider facing

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    to deliver these outcomes for all parties involved now let me give you a couple of key examples like for providers what we're doing is we we certify each claim through the solution by performing rigorous quality checks and we're making real-time payments by pricing these claims very effectively these payments can come either directly from the pair if a pair is on our network or through a financial entity in the middle to create the same experience for real-time payments now on the payer side we deliver clean

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    came claims that are ready for adjudication and supporting clinical data first time every time so look you can see how the solution to operate at scale has to be a multi-party system multiple providers working with multiple players and blockchain is a very elegant solution for this particular problem especially you know when there's a trust deficit between these parties and you'll see later

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    in the presentation how we're leveraging the digital asset smart contracts and the ledger api to record some of these these claim lifecycle events through this whole value stream now we believe that this new approach will really help accept providers accelerate their transition to value-based care as well while maintaining the support needed for their patients and caregivers which is

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    extremely important let's go to the next slide now as a company we're pacing a very very big bet on this so not only do we have near-term execution plans but we also have a long-term vision on how we're going to really evolve the solution over time so currently in our first horizon we're focused on delivering capabilities around payment accuracy risk management and delivering real-time b2b payments between the provider and the payer transactions as we move to horizon 2 we're going to deliver

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    more components around efficiency and analytics what does that mean it's simplifying claim generation process it also is going to encompass the b2c the patient component their responsibility to the payments as part of this and as we go to the nirvana state if i say horizon 3 which is our goal to create a autonomous frictionless network a multi-party settlement and payment solution

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    with has potentials to get into tokenization and securitization of risk pools etc so look folks we are early in the build cycle right now with this product but as we've talked to some of our customers there's been just a tremendous amount of interest from providers and payers so we see a huge potential for the solution as we as you evolve this in the market now to go deeper into what we're building and how we're accomplishing that i'd like to pass the ball to my colleague emily bailey

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    emily over to you hey emily you are on mute right now just as a hands up um sorry guys um can you hear me now yes that's perfect thank you so um as you can see we have a um a very big vision for how we see this network transformation taking place over time so what we're going to talk about today is where we are in in this process so the user that we have in mind at this stage is the claims analyst

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    this is an individual like andre here who is typically employed by the health system by a provider system or by a third service that handles claims on claims and payments on behalf of the provider so their responsibilities include submitting the claim for payment following up with denied or pending claims and managing the overall work list of claims that have been submitted and the responses that um they are receiving on on the

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    individual claims and and their goals are to reduce the amount of time that these claims are sit in accounts receivable and uh to increase the throughput of claims that can be processed and to increase the accuracy around the payments that are being that are received against those claims so um just to kind of break that down for the non-health care um attendees we have what what this really equates to is is going back to the time the time it takes for a typical claim to be processed around 40 days

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    um there any error or um or issue that arises against a claim can increase the amount of time it spends in uh in accounts receivable and if a payment is received on a claim that is inaccurate see if they're an over underpayment that can create additional work on the provider side that equates to loss of revenue so in addition to their goals around uh streamlining the claims process they also want to make sure that when a claim is submitted the first time that it's correct so

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    so their pain points really include this highly manual process of uh orchestrating claim responses across a fragmented incompatible system of applications uh i think one way to think of this is that the claim itself is not a data object it's not a a type of um information set that is shared across each of these systems it's really a process that that isn't really represented as in a single source of truth or in a

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    single uh format that all of the systems can interact with today and uh this this creates a great deal of latency that the analyst has to work with so what we're sharing here is a mock-up of the user experience or user interface that we have envisioned for the real-time settlement engine this view is a work list of the claims that have been submitted to the real-time settlement engine it

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    is measuring a uh the claims that have been uh paid out in in this work list and what the average payment uh equates to it also captures the integrity check success and the percentage of claims that pass through and pass the integrity check and and so this is tied to the rework that would be included if a claim has doesn't pass the integrity check it has errors the claims that don't pass these checks

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    are not paid but the claims that pass their integrity check and eligibility and payment accuracy uh we provide an instant settlement uh or a real-time settlement against the the claim with some level of variance that is uh to be included in the true up process on on the back end uh the next view here is a dashboard that displays some analytics uh for more of an administrative view

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    an overall view of the revenue that is being collected off of the claims in this work list so this provides the analyst or potentially their their manager a view of revenue over a three to nine month projected time or over the year and gives them an idea of what their collection rates are and uh and what their liquidity is against the claims that are being processed so if we take a look under the hood um we can see how this uh application could be powered

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    by the real-time settlement engine so uh this is a bit of an architecture diagram that that attempts to sort of explain what's happening in in the demo layers of the application and um and what's happening in the application layer so when a claim is submitted by a provider to the real-time settlement engine it goes through a series of modules that provide a real-time settlement so the first module is a claims integrity module which includes a variety of

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    revenue cycle management applications that check for the in the integrity and the structure of the claim to make sure that there are no errors that would cause it to be rejected by a payer and once the claim passes the integrity check it is um recorded to the ledger or the demo layer uh via the ledger api as a validated claim and then from there the payment accuracy model will price the claim and uh and

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    determine the patient responsibility and this initiates the settlement module and transitions the validated claim to a priced claim in the settlement module a settlement uh amount is generated and an 835 uh response is also generated with a payment posted which would transition the price claim to a settled claim on the ledger and initiate a true up process and the true up process the response from that

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    would also be recorded on the ledger so um there are a couple things uh going on here aside from just the state changes that we're recording on the ledger we also um in the application layer this is a bit of a simplified view but change healthcare has a large number of applications that we're integrating with daml uh via the ledger api in order to uh process the claims integrity check and the payment accuracy component including

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    the payment accuracy model that we built for the solution and so we want to make sure that that those applications are integrated with demo and are able to uh be orchestrated in a multi-party uh workflow orchestration so for the user experience this is a real-time response but what's happening under the hood is a combination of state changes that are being recorded on the ledger and um contract templates that are being uh

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    created or contracts that are being created from templates that are stored on the ledger so i'm just to summarize that the uh the way we're using damilin at this stage of the experiment is for claims life cycle management it's to capture the transition of the claim from one state to another and uh we do have a subset of claim validation rules that are also written in daimle which is a really interesting way to use diml to create a shared state of the logic or the rules that a claim has to be

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    checked against in order to be proven valid and we also have a number of bots in the ledger api that are orchestrating the applications from the healthcare environment the healthcare industry environment uh to the distributed ledger environment so uh going back to shiv's vision how we see blockchain technology and dlt uh complementing this vision at this stage in time we're really focused on automating workflows using smart contracts and deploying the dlt environment in the

56. 26:11

    cloud and at the next horizon we will be expanding our application of digital assets and integrating ai and ml to improve payment accuracy and our our third horizon explores tokenized settlement and asset asset-backed exchange and uh this is sort of how we see the technology being incorporated into the vision over time um if as you might have picked up from listening to us talk about this a great

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    deal of financial risk can be centralized by the solution if we don't explore a system that has this multilateral multi-party autonomous network and we think that digital asset exchange is going to be a necessary component into allowing financial institutions and insurance providers to directly integrate with the system and that in order to provide that type of uh streamlined experience we need to standardize the claims process using

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    smart contracts and and in integrated applications and uh we need to perfect the uh payment accuracy model that we're using to price and and settle claims so um i think that concludes where we are with the presentation and and uh opens us up for some q a great thank you emily thank you shiv so we have a question as it relates to damo corey i'll let you go ahead and answer that the question was does demo have any ontological

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    representation of complex entities corey would you like to tackle that one sure that's that's that's a big question and i'm not really going to be able to get all to it but for the benefit of everyone in the audience um demo has a a first order uh term um in in the language itself it's and that term is party um party means essentially what you think it means uh party is an actor who um has choices available to them and choices

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    are also a first order uh first order citizen and demo when we build demo smart contracts we build a template of a business process in which parties have specific rights and obligations those rights and obligations are expressed in the availability of choices that they can exercise at a moment in time and that moment of time can change they might be able to exercise a choice once

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    something we call a consuming choice or they may be able to do it repeatedly something we call a non-consuming choice that that basic framework gives us the ability to to model very complex relationships between entities now parties could be a whole enterprise there may be transaction which change health care as an enterprise is a party to a smart contract or to a template within within daimle we can but there's no reason why it has to be so blunt

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    um it could be specific departments specific data um data sources within an enterprise and those choices and the rights and obligations expressed can can be very precise depending upon how you construct the template so i understand that of course in healthcare we have very complex entities and the relationships between those entities add an additional layer of complexity around who needs to do what at what

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    moment in time damo gives you a very robust vocabulary for expressing that in what i'll call human readable form where the parties are identifiable and understandable from the code the choices are very clear and outlined what each a party can or can't do at a given moment in time and of course the role of the ledger is to record each of those choice exercises immutably to the ledger so that we we all share a record

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    of what we've done uh with each other now importantly um for daml and for for enterprise adoption of smart contract technology privacy is a large concern on a lot of platforms uh contracts are visible to everybody and all choice exercises and all quote transactions on the ledger are visible to everyone on the network and demo has a number of ways um that fundamentally address that privacy issue

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    first off as a party in damo in a demo space solution you only ever have visibility into those contracts that are yours i.e business processes on which i am a party or a signatory too or which i've been granted observer rights that's another type of flavor of party that you can bring to the table i'm able to see things i'm able to see the entirety of the contract i'm able to see all changes that ever happened to the contract maybe i'm only able ever to see if a specific choice gets exercised

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    by a specific party in that workflow you have a lot of fine-tuned uh privacy controls within daml such that the specific data and the specific business terms of a of a business of a business relationship are not revealed um illegitimately to other parties uh who are not a party to that business process and so that helps you know enterprises meet their fundamental uh privacy uh and regulatory uh issues especially in healthcare which a medical claim is phi that

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    information can only be shared with a very limited set of parties um within an existing complex relationship and demo is an ideal tool to represent that the second area where privacy comes up is though is in network topology where this data is being stored and again data demo gives you a very uh a very wide array of choices um to uh to store that to meet regulatory and business requirements

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    uh but i i understand that there's some more questions coming in that can get more into that later question there great and as a reminder if we don't get to your question or you have additional follow-up questions we'll be sure to reach out offline so we had a few more come in um shiv i would love to hear your response on this one so what kinds of technology and business process changes would a provider and insurer need to make in order to become part of this network

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    a great question right so let me talk about the business process changes our goal as you see is to eliminate a lot of the steps that happen today in the workflow and be able to bring that into this engine that we're building so it's really to reduce the footprint of business workflow and it's also important for us and we've heard this loud and clear from providers and payers that they do not want to go to five different places to stitch together

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    the the complete story about where they are from their claims management total ar standpoint so it's extremely critical that we build integrations right back into the revenue cycle practice management solutions for these providers which we're doing right from the get go because that would be the way they connect downstream to their gl into the reporting system so in essence what we're building here is somewhat transparent to the customers to the end users it really helps

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    create this this uh this activation set of steps in the background if you may as far as technology is concerned uh what we're trying to do is in just insert ourselves between the pairs and the provider so for a provider the experience is they're sending us the 837s the claims essentially and then they get in real time or near real-time 835s and payments coming back from us into their uh into their core practice management and revenue cycle system so

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    very little uh from they'll obviously need to adopt our capability but it sort of plugs in in the background without necessarily having to do any kind of change management and workflow changes there so uh hopefully that answers the question great thank you chev so emily now i have a question for you can you elaborate on tokenized settlements on the roadmap slide sure so um you know what i can share at this time is is we think that a natural um

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    evolution of this solution will include a settlement that is is a actual function of the network right now the network is really just uh capturing state changes of the claims process and responses from the true up process uh as change healthcare and the real-time settlement engine interact with payers but as we add more capabilities to the real-time settlement engine and the underlying blockchain network uh we think that being able to settle the claims

74. 34:58

    on the network is a necessary function and and something that's just a logical um a logical evolution of the solution and um we also think that that having a feature like this will will uh open us up to new risk models and new financial uh models that will enable us to have uh payers and financial institutions be direct participants of the of the network so um at this point in time we we aren't working with a a tokenized

75. 35:31

    settlement function but it's certainly on the roadmap great thank you uh next one on here so shiv are you building out contracts in the system meaning are you building a contract management system to allow for processing yeah so what we're doing is two things to be able to really price the claim accurately we are leveraging a contract management solution that we already have at change healthcare which is being used widely by a lot of pairs and providers so we have access to some of that

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    in addition to that we're also building a model uh leveraging historical claims data sets to understand between pairs and providers for specifics you know procedure codes how do these claims typically get priced now in addition to that we are also injecting capabilities like understanding patient responsibility where are they in their deductible cycle through accumulators so we can really parse out out of the allowable payment amount what portion needs to go to the pair and

77. 36:34

    what neat portion needs to go to the patient so there's a lot of pieces underneath moving parts underneath this whole engine but it really stems from that now as far as smart contracts are concerned we are leveraging in digital assets capabilities to be able to build certain rules as smart contracts because as you can as you can all sort of appreciate these are rules that payers take very seriously they're proprietary in some cases and we want to make sure that there's clear ownership and control over these

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    rule sets however all providers need to be able to subscribe to those rules and be able to execute them on their contract or on their claims rather so they can get you know appropriate and high high accuracy outcomes so that's where smart contracts come in and then as i said for contract management for the payer provider actual contract we're leveraging the capabilities we already have

79. 37:29

    great thank you chef we um we have another question as well so early alerts for management of risk-based contracts so are you going to be building a multi-party coordinated care management system um and how would we be building solutions for the patient care side or how would this plug into that that's a great question i think that's another big problem that the healthcare system as a whole is facing we are limiting our scope right now to the post visit or right after the visit

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    value stream if you may in solving that problem but there are other parts of our company that are focused on the broader picture on how do we how do we really create that experience for the patients as well so not the short answer is we're not doing that as part of the scope of this program great thank you okay uh another question that we have is can you speak to some of the downstream benefits of real-time settlement to parties on the ground so healthcare providers and patients and how is the day-to-day experience changed and or improved from the

81. 38:34

    solution yeah so let me give you uh an analogy right you go out and seek buy a product or service uh in a retail setting you you purchase the service or the product you receive the product and service you pay for it all parties are even you know the the vendors received their payments in near real time and and the the buyers received their service that's a completely different model than

82. 39:00

    what's available in healthcare today right it's just so much cycle time between the service time and the payment time which is really what we're going after so the experience we would see here is that we're shooting for and there's obviously going to be steps that we have to take to get to that end state is a patient goes into a clinic for care as the as the encounter of that patient provider is completed in the

83. 39:24

    and the notes are closed out we immediately process in in real time uh the the clinical notes to be able to build a claim uh check the integrity of the claim price the claim and understand what's going to be the patient's responsibility what's the payer's responsibility before the patient potentially even leaves the the premises of uh of the healthcare setting and then be able

84. 39:48

    to pay those components back to the provider uh in in as real time as possible so it's gonna it's gonna has the potential let me put it that way to kind of really transform uh and bring retail like truly retail-like experience into healthcare yeah if i can just piggyback off of that some of the things that i can imagine from having a more retail like experience in healthcare as a consumer are the the reduced experience for the patient where they receive a bill

85. 40:21

    several months later for four dollars and 25 cents because a reconciliation has taken place and and now suddenly this is owed to the provider um we want to create a more of a streamlined uh experience for all of the counterparties involved with with an episode of care that can close out the the payment agreement and the the claims process um within a matter of of days versus over a period of months and we can also uh look at over and underpayments that that occur

86. 40:54

    and reducing that over time and um maybe in a more macro sense we think that by improving the liquidity for the service providers for the doctors and the clinicians that are involved with providing care if we can give them accurate payments at the point of care potentially over time we can reduce the cost of care by eliminating all of the complexity that contributes to the rising cost

87. 41:18

    of care that we're experiencing today great thank you emily okay we have another question as it relates to to patient care so um several people want to confirm can patients see the claims in one place or will it just be the providers and payers with this first federation yeah i can i can take that one it's in the first iteration it's going to be providers and payers um we do have a tremendous amount of focus as a

88. 41:54

    company putting on consumerization of healthcare and we have plans on how we could potentially integrate this into a patient's view of how they can see the the journey of their claims as well but initially as as part of our first mvp launch it will likely be focused on payers and providers great thank you shannon to um kind of a piggyback off of that we had a question come in about um how the claim pricing

89. 42:24

    works so this one of our attendees asked it sounded like you were pricing on behalf of the payer but then actually submitting it to the pair for actual adjudication then reconciling can you comment on that yeah no it's a it's a good question uh and really it's it's good because i think there are two models that we're going after we're starting with a provider first and a multi-payer solution which in

90. 42:48

    in that case we are really acting as uh as a as a payer's agent if you may so we are creating a payment based on the contracts that we have access to be able to then generate an 835 which is a remit and a payment back to the provider while the claim still goes to its normal processes with the pair and comes back as a final payment which we essentially reconcile like you articulated in your question now we also have uh conversations going

91. 43:21

    on with payers who want to play in this directly which in which case we are going to write directly plug into their adjudication systems and and be able to generate real-time adjudication in which case you know all the stuff happens in in real time without necessarily having to have a huge true up step in the middle so there are really two models to start off with we'll go with model one multi multipayer one provider and with a

92. 43:46

    screw up step and model two eventually will be when pairs are involved it'll all happen in real time great if i could just add this is corey this is one of the real benefits of dlt technology in damo specifically no matter which course is taken model 1 or model 2 or even the talk of securitization or tokenization true up multilateral clearing and settlement is really a challenge uh but with damol technology it's it's it's really well i wouldn't say it's easy necessarily um but it's it's

93. 44:19

    it's within the uh the core strengths of the technology itself to be to enable global composability if you look at step one in the claims integrity what change has done is really created an entity an asset for lack of a better word that is then globally composable in a wide variety of reconciliation and settlement systems whether that's directly through change health care or whether that's in conjunction with the payer

94. 44:41

    or other financial entities all of that is feasible and it can be done by global composability i mean that the asset can be carried to those those adjacent applications without the redesign of the core application and without having to redesign the entire stack and so you can add on additional pathways around that core asset that's created in that very first step that change is working on right now

95. 45:06

    um to to meet almost any eventuality or business opportunity great corey so we uh we'll end on this we have one more question and then we will wrap up we have quite a few uh more questions that we have we will be sure to follow up with with those um those participants on the webinar offline um a lot of them have to do with technical specs so we'll be sure to to follow up via email um and we'll be sure to reach out you can also reach out to anyone on the digital asset or change healthcare side team too and we'll be sure to follow up

96. 45:39

    with you um the last question though i wanted to pose for emily and it relates to the security within distributed ledger uh technology and blockchain um are we still nervous about how secure the ledger is uh and as it relates to personal healthcare information sharing of that data yeah so i think you know corey was was touching on on this a little bit earlier about the different ways that um demo can handle privacy and um that's one of the the reasons

97. 46:11

    that we chose damil for the solution is is the flexibility that we have and not just the network topology but in how we structure contracts such that that a party who is not uh permitted to view a contract cannot see the contract the only parties that can see a contractor parties that have been designated by that contract and so the the data rights that that are in place uh for processing these claims are inherited by the

98. 46:41

    applications that that are um a part of the the claims process that we've integrated with this and so um all that goes to say that within the uh contract template itself we have a lot of control over who can see what and then um with the network uh the digital the um the distributed ledger that we integrate with the solution uh we have a variety of ledgers to choose from and i do think there are some security concerns that we need to consider as we scale

99. 47:13

    especially as we add payers and uh financial institutions as direct participants so in the current stage uh you know change health care is the administrator of this solution you know we're managing the ledger and um and we're working through um the payment accuracy and uh smart contract uh development around how to process the claim but once we start scaling the network we need to explore ledger implementations that enable uh not just privacy

100. 47:48

     uh within individual transactions across the ledger but data rights management between the entities and the companies that are coming to the table to provide the ledger with security so um demo has or digital asset has a variety of ledger integrations that they work with um which which will allow us to kind of experiment with the right uh the right implementation as we scale over time um and we're excited to explore those but this is something that um we are

101. 48:21

     aware of and and think that um is going to play a big role especially in how we structure the business agreements of a multi-party system as the scales but in general um we feel pretty confident in the innovations that have been made around a digital um distributed ledger uh designs and being able to to architect a dlt that can support private transactions that can support um multiple parties that are administers on the net administrators on the network

102. 48:52

     that are able to keep their transaction sets private while still providing uh integrity uh across a multi-party workflow um uh so i guess uh to summarize there you know to be continued as as we look at different ledger implementations for this solution and i'm certainly open to um ideas and feedback from this audience on uh on dlts that that have achieved levels of privacy that

103. 49:20

     that you're confident in as well if i could just add um you know i raised the issue of privacy earlier on in the presentation you know damil doesn't force the data rights view so that i can't access contracts that aren't mine i can't have access to choices i can't see what other people are doing that's at the application level the the storage level is is a separate question um and and demo will always enforce at

104. 49:44

     the application level data rights uh that are appropriate for health care such that i wouldn't be able to access anyone else's phi um non-baas wouldn't be able to gain access to that information either at the data storage level though it really depends on which ledger you're integrating gamma in with um you know a centralized database like a sql works within the parameters of our a lot

105. 50:07

     of current stacks within healthcare and that's an option with ammo you can go fully centralized you know i'm a trusted party uh i'm a baa to these entities i can hold that information on behalf of those other entities under the current regulation now multi-node networks where multiple parties are hosting nodes that has always presented a problem for healthcare because people who are not part of the application can't even store the

106. 50:31

     information whether there have been you know a lot of work on encryption schemes but again that that lessens the value of the smart contract because it essentially makes the smart contract dumber if it can't actually work with the data that's being represented now one unique opportunity that that demo does present and and this is just uh you know what what digital asset has available um you know separate from from the direction that changes we're looking at and you know network autonomy is down

107. 50:56

     the road yet so those conversations are still ongoing but i do want to mention canton canton is an interoperability protocol that digital asset has developed and what it enables is demo smart contracts to work with a unique storage system in which contracts are only ever stored on the nodes of those participants who are a party to the contract and so only parties who are party to the contract will ever have that data stored on their node if you're not a party to the contract

108. 51:22

     you see no network traffic your node receives no information it stores no information either and that is what i call the gold standard of privacy for dlt and healthcare and i just want to point out if you go to canton.io you can see a live there's a video and there's also a downloadable code demo which exemplifies this in a healthcare context in which we can not only preserve privacy by only storing the contract data on specific nodes of a contract i mean of a network but we can also prune the ledger

109. 51:55

     to satisfy advanced privacy requirements like gdpr where you can actually forget contracts in the past and remove them from nodes if that workflow is so authorized yeah thank you corey um canton is something that that we are pretty excited about on on my team at change healthcare um it is a bit of a future state for where where we are in our current solution um but those types of solutions are what we consider to be the right path for health care

110. 52:28

     understanding that there are significant uh regulations in place that we need to be compliant with but there's also business interests that need to be protected when it comes to data privacy that we're interested in protecting as well and i was asked to repeat that that's canton c-a-n-t-o-n dot io great well thank you everyone we had a couple additional questions that we'll be sure to answer offline please feel free to reach out again to the digital asset team

111. 53:02

     and or the change healthcare team and we'll be sure to to answer those questions thank you everyone for joining it was a pleasure to have you all here and we will send a recording of the webinar as well as a follow-up email to the group everyone have a wonderful rest of your day thank you thank you