Change HealthcareChange Healthcare and TIBCO Software (TIBCO) are collaborating to build a smart contract system for healthcare. It will use the Change Healthcare Intelligent Healthcare Network blockchain technology and TIBCO’s Project Dovetail smart contract developer tool.

The platform aims to enable health plans, and financial partners, to develop and deploy smart contract-based processes which automate events across the healthcare transaction processing lifecycle.

Aaron Symanski, Chief Technology Officer, Change Healthcare
Aaron Symanski, Chief Technology Officer, Change Healthcare

This collaboration with TIBCO is part of our larger initiative to simplify and standardize healthcare transaction processing and help move the industry to real-time adjudication on the Intelligent Healthcare Network,” said Aaron Symanski, Chief Technology Officer, Change Healthcare. “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.

The problem

Today, payers for healthcare must navigate a myriad of commercial and custom systems to automate various aspects of healthcare transaction processing. Many of these have gaps or require manual intervention or additional coding.

Smart contracts present a simpler, potentially more efficient and lower-cost solution because they enable self-executing business rules:

  • payers embed these rules on a blockchain
  • the rules trigger automatically based on events that occur in a transaction
  • when an event (in the healthcare transaction lifecycle) completes, the blockchain ledger updates.

The size of Change Healthcare’s Intelligent Healthcare Network is relevant. It reaches:

  • 2,100 government and commercial payer connections
  • 5,500 hospitals
  • 900,000 physicians
  • 33,000 pharmacies.

In the fiscal year ended March 31, 2018, it facilitated nearly 14bn healthcare transactions with a $2Tn value. The collaboration’s objective is for payers to use a new smart contract-based platform to build healthcare transaction-related smart contracts to:

  • increase the efficiency of healthcare transaction processing (including claims adjudication and payment processes)
  • improve providers’ revenue cycle performance
  • deliver faster resolution and remittance payments.

Change Healthcare and TIBCO plan to provide a developer environment which aims to:

  • provide a next generation of healthcare transaction applications
  • utilise the blockchain and these smart contracts.

TIBCO and Project Dovetail

Beyond Change Healthcare’s Intelligent Healthcare Network blockchain, the collaboration will leverage Project Dovetail. Project Dovetail, slated for public availability in the near future, provides a development framework to enable payers and financial institutions to build smart contracts governing healthcare transaction processing.

With Project Dovetail, users will gain access to a model-driven environment. This facilitates the creation of smart contracts that can run on any blockchain or cloud platform. The effect is to increases agility, flexibility, and time to market.

Nelson Petracek, Global Chief Technology Officer, TIBCO
Nelson Petracek, Global Chief Technology Officer, TIBCO

We’re excited to be collaborating with Change Healthcare, a company that is driving innovation in healthcare transaction automation,” said Nelson Petracek, Global Chief Technology Officer, TIBCO.

The powerful combination of our smart contract development project and Change Healthcare’s Intelligent Healthcare Network incorporating blockchain technology will empower payers to move aggressively toward the goal of real-time adjudication, while ensuring compliance and helping streamline healthcare transaction processing for all stakeholders.

Enterprise Times: what does this mean

Enterprise Times has written about criteria for assessing whether a blockchain initiative is likely to succeed. This Change Healthcare and TIBCO collaboration, from afar, would seem to satisfy most of these criteria.

In addition, US healthcare – just by being so dispersed and with so many players (as with international supply chains) – offers an opportunity to deliver efficiencies. However, success can only occur if enough participate in the Change Healthcare Intelligent Healthcare Network – which has always been the challenge in healthcare. Conservatism rules, even at the (literal) expense of those who have to pay for it.

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