Cross-Continuum Care Plan Synchronization

When a specialist can't access a recent test from a PCP, they order it again. This wastes $12-25B annually in the US alone. A shared, immutable record ensures all providers see the same diagnostic history.

• Real Example: A patient with chronic conditions sees 5+ specialists. Blockchain sync ensures an MRI from the neurologist is instantly available to the orthopedist, preventing a $2,500 duplicate scan.
• ROI Driver: Direct reduction in lab and imaging costs, improving margin per patient.

Manual prior auth processes cost $31B per year in administrative overhead and cause care delays. Smart contracts can automate verification against payer rules in real-time.

• How it works: A treatment plan is proposed on-chain. A smart contract checks it against the patient's insurance policy, automatically generating an approval code or a specific denial reason.
• Business Impact: Reduces administrative FTEs needed for phone calls and faxes, while accelerating revenue cycle by cutting claim denial rates.

Regulations like HIPAA require demonstrating who accessed what data and when. Centralized logs can be altered. Blockchain provides a tamper-proof ledger of every access event and care plan update.

• Compliance Benefit: Instantly generate proof for audits, reducing legal risk and potential fines. The immutable log shows the exact sequence of care decisions.
• Trust Builder: Increases patient confidence knowing their data trail is secure and transparent, enhancing brand reputation.

Poor handoffs between hospital and post-acute care (e.g., rehab, home health) lead to $25-45B in preventable readmissions. A synchronized care plan ensures the next provider has the correct meds, instructions, and goals.

• Process Fix: Discharge summary and home care plan are committed to the shared ledger. The home health nurse's mobile app shows the verified plan, eliminating fax errors.
• ROI Impact: Directly avoids CMS penalties for excess readmissions and improves patient outcomes, which is increasingly tied to reimbursement.

Outcome-based contracts require sharing trusted data across competing entities (hospitals, insurers, clinics). Blockchain enables multi-party agreement on performance metrics without revealing all underlying data.

• Use Case: A bundled payment for knee replacement. All providers (surgeon, hospital, PT) contribute outcomes to a shared ledger. The smart contract automatically distributes payments based on met milestones, eliminating disputes.
• Strategic Advantage: Unlocks new, profitable reimbursement models that are too administratively complex with legacy systems.

Patients are frustrated by filling out the same forms repeatedly. Giving them a verifiable health wallet with their care plan allows them to grant instant, revocable access to any provider.

• Experience Improvement: Reduces check-in time and forms, boosting patient satisfaction scores (HCAHPS).
• Operational Efficiency: Front-desk staff spend less time on data entry. Providers start with accurate, patient-verified information, reducing downstream errors.

When care plans are siloed, providers can't see recent tests or treatments. A permissioned blockchain ledger creates an immutable, shared record of all care plan activities. This reduces redundant MRIs, lab work, and specialist consultations.

• Real Example: A major U.S. health network pilot reduced duplicate diagnostic imaging by 17% in the first year, saving an estimated $4.2M annually.
• ROI Driver: Direct cost avoidance on high-margin procedures and improved facility throughput.

Manual prior auth is a $31B administrative burden. Smart contracts can automate rule-based approvals by verifying care plan steps against payer policies on-chain.

• Real Example: An insurer-payer consortium in Europe uses a blockchain network to process routine orthopedic and cardiology pre-auths in under 2 minutes, down from 5-7 days.
• ROI Driver: Cuts administrative FTEs, accelerates patient care initiation, and ensures 100% audit-ready compliance.

Patients are the constant in a fragmented system. Blockchain enables patient-centric data wallets where individuals grant time-bound access to their unified care plan across providers.

• Real Example: The MyHealthMyData initiative in Asia gives patients a portable digital identity. They share holistic care plans from hospital to home care, improving chronic disease management adherence by 22%.
• ROI Driver: Enhances patient satisfaction scores (HCAHPS), reduces readmissions, and creates new models for patient-generated health data.

The highest risk for care plan failure is at care transitions. A synchronized blockchain record ensures the discharge plan from a hospital is automatically actionable by the rehab facility or home health agency.

• Real Example: A value-based care organization tracks medication reconciliation and follow-up appointment completion in real-time across its network, reducing 30-day readmissions for CHF by 14%.
• ROI Driver: Directly protects shared-savings revenue and avoids CMS penalties under value-based purchasing programs.

Effective care plans address non-clinical factors like food and housing. Blockchain can create a tamper-proof log of SDOH referrals and outcomes, connecting clinical and community-based organizations.

• Real Example: A Medicaid managed care plan uses a private ledger to coordinate food pantry deliveries and transportation services for high-risk members, decreasing ER visits for ambulatory-sensitive conditions.
• ROI Driver: Lowers total cost of care for the highest-risk population, with a clear ROI for community benefit spending.

Today, care plans are faxed, emailed, or re-typed between hospitals, specialists, and home health agencies, creating errors and delays. A shared, immutable ledger acts as a single source of truth. Each update—like a medication change from a cardiologist—is instantly and verifiably available to the patient's home care nurse, reducing administrative overhead by 30-50% and preventing adverse drug events.

Managing patient consent for data sharing across entities is a legal minefield. Smart contracts can automatically enforce consent directives. For example, when a patient approves a new provider, the contract grants access to specific plan elements, creating a permanent, auditable trail. This reduces compliance risk and manual paperwork, cutting the time to onboard a new care team member from days to minutes.

A focused pilot delivers concrete metrics for your CFO:

• Reduced readmissions: Timely, accurate plan updates can lower 30-day readmission rates by 5-15%, directly impacting CMS penalties and bundled payments.
• Staff efficiency: Cut time spent on care coordination calls and data entry by 20+ hours per week per care manager.
• Audit readiness: Provide regulators with a cryptographically verified history of all plan changes and access events in seconds.

This isn't a 'rip and replace' project. A permissioned blockchain layer integrates with your existing EHRs and HIEs via APIs, pulling and pushing key data points. Start with a single care pathway (e.g., post-discharge for heart failure) with 2-3 partner organizations. This low-risk approach proves the model, builds partner trust, and creates a blueprint for enterprise-wide rollout.