USE CASE / HEALTHCARE (Payers/Insurers)

Improved Health Outcomes for Members

Healthcare industry payers struggle to provide transparent care plans and enabling ways for members to engage. Modernization of access control technology could help facilitate data exchanges for personalized member engagement, faster claims and enhanced health outcomes.

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Context

Aidan is a 38 year old father of two boys who enjoys spending his weekends getting outside and being active with his family. Six months ago, on his cycle commute into work, Aidan got into a bicycle accident. As a result, he broke his tibia, and sprained his wrist. He was in a cast for the first 3 months but since then has begun physical rehabilitation. His rehabilitation plan consists of regular visits to his physician, physiotherapist, chiropractor and acupuncturist. There were delays in the start of his treatments due to a lag in providing the required health information and a lack of transparency in which providers and treatments were permitted/approved through his insurance provider, ultimately leading to extra treatments as a result of this delay.

Additionally, as a busy working dad, he struggles to keep track of and stay on top of the paperwork involved in claiming the cost of his visits back to his insurance payer.

Problem

Member

Aidan can’t keep up with the paperwork involved in receiving claim reimbursements from his insurance payer for his rehabilitation visits and treatments, and therefore isn’t receiving timely repayments.

Payer/Insurer

Insurance payers are looking for ways to drive personalized care management plans, engage with members and improve health outcomes, with the ultimate goal of reducing their costs.

Healthcare Providers

Aidan’s circle of care, which includes his physician, physiotherapist, chiropractor and acupuncturist don’t have a means to connect. Since they are limited by current silos of data and outdated system architecture blocking access to his data, they must rely on Aidan to communicate updates to them regarding his other treatment efforts.

Solution

A digital identity-based mobile experience for empowering members with trusted access to their health information, as well as the option to easily provide access to their health information to their payers and healthcare providers. Once a member is registered into the system with their digital ID, they are enabled to use a range of digital services, including the ability to control consent to share their personal health information (PHI) between healthcare providers.

Payers can take advantage of new technologies to fully automate core processes such as claim submissions, strengthen their partnerships with providers, and reposition themselves at the center of the healthcare landscape.

Aidan, who is managing his post-accident rehab plan, will be able to access his entire health record and share files and information on the progress of his rehabilitation amongst all of his healthcare providers. He’ll have the option of finding care easily through the platform. This will allow for a connected and efficient treatment plan, which will in turn allow him to recover and participate in outdoor activities with his family sooner. He’ll also be able to upload claims easily and track them digitally, and therefore benefit from faster turnaround times on reimbursements.

With a connected approach, payers will benefit from automated claims processing, enhanced member health, and a reduced cost structure.

IDENTOS technology to support

The IDENTOS health stack includes:

Federated Privacy Exchange (FPX)
Zero knowledge access network designed to easily connect a community of users to any number of data and digital service providers

Digital Wallet
Personal digital wallet that grants users SSO access and management of explicit consent directives.

Community Navigator
A configurable mobile app designed to enable, protect and connect the digital journey for users.

With the IDENTOS health stack, tap into:

  • Opportunity for value based healthcare - deliver value added services, apps, insights to members
  • Trusted digital ecosystems that are quick to launch
  • Seamless data sharing among members and partners with user-driven consent
  • 2-way engagement
  • Comply with ONC rules
  • Ensure privacy for users
  • Cost effective network that scales effortlessly

Modernize access technology, advance member connectivity

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