All rights reserved. Solve.Care Foundation

Transcription

1 Care.Coin An intelligent healthcare currency to reduce cost of healthcare administration and reduce fraud, waste and abuse All rights reserved. Solve.Care Foundation

2 Healthcare payments in US US spends $3,200 Billion on healthcare, every year

3 Where does the money get spent Most of the money is spent on payments for care (but not all)

4 3 rd party payment model is complex Verification of eligibility Verification of services Verification of Pricing Cost sharing Volume discounts Exceptions Multi-party payments

5 Healthcare payments lifecycle is too long Process of billing to payment takes weeks, often months

6 Healthcare payments lifecycle is too long Multiple payments Patient co-pay Insurance payment Patient responsibility Multiple reviews Medical necessity review Over billing review Service eligibility Quality of service Multiple adjustments Pricing Cost sharing Volume discounts Credits and advances Deductible adjustment

7 Fraud, Waste and Abuse is rampant Research estimates that a $100 Billion of Medicaid spend are wasted A public program such as the U.S. Medicaid costs $553 Billion annually with more than $100 Billion lost to inefficiency, over utilization and fraud, and $25 Billion is spent on information technology and program administration Root cause is that everybody is out of sync with others Multiple systems and data silos but no one talks to other Creates plenty of opportunity for sophisticated operators to cheat

8 Care.Coin is designed to address these problems

9 Care.Coin will optimize 3 rd party payments Escrow payment Automatic adjustment Commitment to pay Consent to audit Intelligent Health Currency Proof of service Proof of payment Proof of pricing

10 Care.Coin uses defined payment relationships Relationship centric payment model Care.Protocol defines and encapsulate relationship between parties Insurance and insured Patient and doctor Doctor and insurance Specialist and doctor Employer and employee Care.Coin automatically inherits the relationship rules for the transaction

11 Moves logic from centralized system to edge Care.Coin evaluates relationships in real-time Eligibility Pricing Necessity Relationships Proof

12 Care.Coin verifies and enforces rules Care.Coin enforces the relationship rules Verification at point of service Proof of service Commitment to pay Agreement to allow 3 rd party review Automatic adjustments

13 Care.Coin brings Proof of service to healthcare Proof of service is continuously computed metric based on events Schedule Consent Diagnosis Prescription Lab Referral Follow up Care.Coin enforces proof-of-service during payment cycle

14 Proof of service based review Different programs and stakeholders can compute it differently Insurance, patient, employer, Government agency Insurance company can use Proof of service in conjunction with Billed amount Past billing Now clients can evaluate healthcare payments based on Level of proof, not amount Relationship not episode

15 Care.Coin enables escrow based payments 3 rd payment administration can be replaced with payments in escrow Proof of ability to pay plus proof of service Consent to 3 rd party review and adjustments Care.Coin escrow logic for payment upon sufficient proof of service Insurance -> Doctor Patient -> Doctor Employer -> Employee Agency -> Patient Agency -> Doctor

16 Summary of key characteristics of Care.Coin Stable monetary value Guaranteed redemption Proof of service Adjustable administrative cost Immutable audit trail Access control Escrow

17 Care.Coin will change healthcare payments There will be little friction left in 3rd administration Fundamentally changes healthcare administration Saves the healthcare system hundreds of Billions, every year Automatic adjustment Consent to audit Proof of payment Escrow payment Intelligent Health Currency Proof of pricing Commitment to pay Proof of service

18 Care.Coin is integral part of Solve.Care Platform Care.Wallet Care.Cards Care.Coins Care.Protocol

19 Solve.Care platform has a mission 1. Reduce non-care costs from 30% to 3% 2. Decentralize healthcare and benefit administration 3. Engage and empower the patient 4. Reduce administrative burden on doctor and care providers 5. Ensure accurate and timely payments for service, or quality or both 6. Make fraud, waste and abuse, very difficult if not impossible 7. Bring transparency and accountability to the entire lifecycle

20 Visit us at Solve.Care to learn more It is time to revolutionize the biggest part of US economy by employing a new approach. It is time to replace archaic systems and administrative processes with an intelligent, decentralized platform that is efficient, effective, affordable and can be configured by clients and community to support every care delivery and benefit model Pradeep Goel, CEO of Solve.Care is passionately committed to replacing the current model with one that serves us much better. He is applying his decades of experience with software, systems, healthcare, benefits and government programs to make it happen. All rights reserved. Solve.Care Foundation