Patient-Centric Portable Benefit Wallet

Manual reconciliation of benefits across payers, providers, and employers is a major cost center. A portable wallet with a single source of truth automates eligibility verification and claims processing.

• Real Example: A large employer consortium reduced plan administration costs by 15% by using a shared ledger for real-time benefit status, eliminating calls and reprocessing.
• ROI Driver: Direct reduction in FTE hours spent on manual data entry and error correction between systems.

With patient consent, anonymized, aggregated wallet data becomes a valuable asset. This enables hyper-personalized wellness programs and provides insights to pharma and research institutions.

• Real Example: A health system used consented wallet data to identify at-risk populations for a chronic condition, launching a targeted prevention program that improved outcomes and reduced downstream costs by 22%.
• ROI Driver: Creates new revenue lines from data licensing and increases the effectiveness of member engagement spend.

Healthcare is governed by HIPAA, ERISA, and state regulations. An immutable blockchain ledger provides a tamper-proof audit trail for all benefit transactions, consent changes, and data access.

• Real Example: During a regulatory audit, a payer provided a complete, verifiable history of patient consent for data sharing in minutes instead of weeks, significantly reducing legal and compliance overhead.
• ROI Driver: Drastic reduction in audit preparation costs and mitigation of compliance violation risks and fines.

Duplicate claims, ineligible service billing, and identity fraud cost the system billions. A portable wallet with cryptographically verified identity and shared transaction history makes double-dipping and phantom billing nearly impossible.

• Real Example: A Medicaid pilot using a benefit wallet saw a 12% reduction in flagged fraudulent claims in the first year by preventing duplicate DME (Durable Medical Equipment) requests across state lines.
• ROI Driver: Direct recovery of lost funds and lower insurance premiums through reduced overall claim loss.

Frustration with complex benefits and portability drives member churn. A user-centric wallet gives members control and visibility, improving the experience and loyalty.

• Real Example: A health plan offering a portable wallet saw a 25% increase in member satisfaction scores (NPS) and an 8% reduction in voluntary disenrollment, directly protecting lifetime value.
• ROI Driver: Lower customer acquisition costs (CAC) and increased retention of high-value members.

VBC models require seamless data sharing and accurate attribution of outcomes. A portable wallet acts as a neutral data utility, securely sharing treatment histories and outcomes across the care continuum to correctly assign risk and reward.

• Real Example: An ACO used a shared ledger from member wallets to automate quality metric reporting and provider payout calculations, reducing administrative lag from 90 days to near real-time.
• ROI Driver: Enables participation in more profitable, risk-based contracts by solving the data interoperability hurdle.

The legacy pain point: Patient records are locked in provider-specific EHRs, forcing duplicate tests and procedures. This wastes an estimated $78 billion annually in the US alone.

The blockchain fix: A portable wallet gives patients a single source of truth for lab results, imaging, and prescriptions. Providers can access verified data with patient consent, reducing redundant diagnostics and cutting administrative overhead by up to 30%.

The legacy pain point: Manual, paper-based prior authorization and claims adjudication is slow, error-prone, and costs payers and providers billions in administrative labor.

The blockchain fix: Smart contracts automate verification against policy rules, creating an immutable audit trail. This can reduce prior authorization turnaround from days to minutes and cut claims processing costs by 15-25%, as demonstrated in pilots by major insurers.

The legacy pain point: Fee-for-service models are shifting to value-based care, requiring robust, verifiable data on outcomes and costs across the entire care continuum—data that siloed systems cannot provide.

The blockchain fix: The portable wallet creates a tamper-proof record of care events, outcomes, and associated costs. This provides the single source of truth needed for accurate risk adjustment, performance bonuses, and compliance in value-based contracts, reducing disputes and audit costs.

The legacy pain point: Centralized data repositories are prime targets for breaches, and proving HIPAA compliance across multiple systems is complex and costly.

The blockchain fix: Cryptographic consent logs and immutable access records provide a definitive audit trail for every data interaction. This simplifies compliance reporting and reduces the scope and cost of breaches by decentralizing data storage. The architecture inherently supports privacy-by-design principles.

The pain point: Patients moving between insurers or providers must repeatedly submit the same demographic and eligibility data, creating friction and administrative waste.

The blockchain fix: A portable, patient-owned wallet stores verified identity and coverage data. When a patient switches providers, they grant permissioned access to their verified record, eliminating redundant forms.

• Real Example: A pilot by a major US health plan reduced manual data entry by 70% for new member onboarding.
• ROI Driver: Cuts administrative costs per member by an estimated $15-25 annually.

The pain point: The manual prior authorization process delays care, frustrates patients and providers, and costs the US healthcare system billions annually in administrative overhead.

The blockchain fix: Smart contracts automate rule-checking against a patient's portable benefit plan. Providers submit requests digitally; approvals or denials are recorded immutably on-chain, creating a clear audit trail.

• Real Example: An alliance of hospitals and payers using a blockchain ledger reduced prior authorization decision times from days to minutes.
• ROI Driver: Projects 30-50% reduction in administrative labor for authorization teams.

The pain point: Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are often tied to an employer or specific insurer, limiting portability and creating 'use-it-or-lose-it' anxiety.

The blockchain fix: A tokenized, portable wallet holds funds and benefit allowances. Patients can seamlessly use these assets across any in-network provider, with smart contracts enforcing eligible expense rules.

• Real Example: Early fintech adopters are piloting blockchain-based HSAs that integrate with digital payment networks.
• ROI Driver: Increases patient satisfaction and engagement with benefit plans, reducing calls to member services.

The pain point: Value-based care contracts are complex, requiring manual tracking of dozens of quality metrics and outcomes before triggering payments, leading to reconciliation disputes.

The blockchain fix: Smart contracts codify the payment terms. Data oracles feed verified outcome data (e.g., reduced readmissions, completed screenings) directly to the contract, which automatically calculates and releases payments.

• Real Example: Sentara Healthcare partnered on a blockchain pilot to automate shared savings payments, improving transparency.
• ROI Driver: Cuts the payment cycle from 90+ days to near-real-time, improving provider cash flow and trust.