SBIR Phase II: A Blockchain Ecosystem for Encrypting Real World Data and Developing Artificial Intelligence to Optimize Pharmacy Prior Authorization
SBIR 第二阶段:用于加密现实世界数据和开发人工智能以优化药房预授权的区块链生态系统
基本信息
- 批准号:2200163
- 负责人:
- 金额:$ 100万
- 依托单位:
- 依托单位国家:美国
- 项目类别:Cooperative Agreement
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-05-01 至 2025-04-30
- 项目状态:未结题
- 来源:
- 关键词:
项目摘要
The broader impact/commercial potential of this Small Business Innovation Research (SBIR) Phase II project is to significantly reduce administrative inefficiency in pharmaceutical benefit management processing. The specific focus is on prior authorization processing, where payers and prescribers must reach a consensus on medical necessity. The project delivers a solution to optimize prescription authorization and provide more comprehensive patient histories for clinical authorization criteria fulfillment than other available products on the current health technology market. Lack of efficient access to reliable patient histories is the principal reason for delayed authorizations, resulting in delayed care access. A 2022 survey showed 93% of physicians reported that prior authorization often or always creates care delays; 82% reported delays that led to treatment abandonment. A secure yet progressively decentralized patient data transfer protocol would heighten transparency of clinical decision-making processes and also increase opportunities for patient engagement during prior authorization of medical prescriptions. Further, since administrative costs increase the cost of benefits, which in turn increases the cost of care access, the potential commercial impact is that payers who lower administrative costs will be better positioned to offer higher reimbursement rates for a greater range of quality treatment options, at increasingly lower cost.This SBIR Phase II project proposes to deliver a distributed ledger with smart contracts specific to the domain of pharmaceutical benefits. Since the cause of processing inefficiency lies with siloed and incomplete patient histories, this protocol resolves administrative inefficiencies through distributed ledger technology supporting fast and compliant encrypted health data sharing among prescribers, payers, and patients. Research objectives include: 1) automating criteria fulfillment to reduce administrative waste; 2) leveraging machine learning to automate simpler case reviews; and 3) designing a shared interorganizational processing protocol capable of adapting to an introduction of revised clinical standards. Smart contracts will be deployed to a distributed ledger infrastructure to formalize and enforce clinical standards as well as contractually specified financial rules and actuarial analyses at an interorganizational level. With smart contracts embedded in the authorization process to automatically curate more robust clinical histories over each prescription lifecycle, available real world data meeting contractually specified quality standards for clinical review will increase. Historical authorization data will feed back into incrementally complex cases, advancing artificial intelligence for authorization decision support. The expected result is improved real-time insight into clinical risk, affording payers the ability to financially and strategically adapt to patient needs with increasing precision and agility.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.
这个小型企业创新研究(SBIR)第二阶段项目的更广泛的影响/商业潜力是显著减少药品福利管理过程中的行政效率低下。具体的重点是事前授权处理,即支付者和处方者必须就医疗必要性达成共识。该项目提供了一种解决方案,以优化处方授权,并提供比当前医疗技术市场上其他可用的产品更全面的患者病历,以满足临床授权标准。缺乏对可靠患者病历的有效获取是延迟授权的主要原因,从而导致延迟护理获取。2022年的一项调查显示,93%的医生报告事先授权经常或总是造成护理延误;82%的医生报告延误导致放弃治疗。一个安全但逐步分散的患者数据传输协议将提高临床决策过程的透明度,并在事先授权医疗处方期间增加患者参与的机会。此外,由于行政成本增加了福利成本,进而增加了获得护理的成本,潜在的商业影响是,行政成本较低的支付者将更有能力以越来越低的成本为更广泛的质量治疗选择提供更高的报销率。这个SBIR第二阶段项目提议提供一个分布式分类账,其中包含特定于药品福利领域的智能合同。由于处理效率低下的原因在于孤立和不完整的患者病历,该协议通过分布式分类帐技术解决了管理效率低下的问题,该技术支持处方使用者、支付者和患者之间快速且合规的加密健康数据共享。研究目标包括:1)自动完成标准以减少行政浪费;2)利用机器学习来自动执行更简单的病例审查;以及3)设计能够适应修订后的临床标准引入的共享的跨组织处理协议。将在分布式分类账基础设施中部署智能合同,以正式确定和执行临床标准以及在组织间一级按合同规定的财务规则和精算分析。随着在授权过程中嵌入智能合同,以在每个处方生命周期内自动管理更强大的临床历史,满足合同规定的临床审查质量标准的可用现实世界数据将会增加。历史授权数据将反馈到逐渐复杂的案例中,推动人工智能为授权决策提供支持。预期结果是改进对临床风险的实时洞察,使支付者能够以更高的精确度和敏捷性在财务和战略上适应患者需求。该奖项反映了NSF的法定使命,并通过使用基金会的智力优势和更广泛的影响审查标准进行评估,被认为值得支持。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Mark Stephenson其他文献
Smoke on the water—Oral fluid analysis at sea
- DOI:
10.1016/j.forsciint.2017.07.028 - 发表时间:
2017-09-01 - 期刊:
- 影响因子:
- 作者:
Andrew Griffiths;Richard Leonars;Lenore Hadley;Mark Stephenson;Richard Teale - 通讯作者:
Richard Teale
Resisting arrest: Analysis of different prone body positions on time to stand end engage
抗拒:不同俯卧姿势的分析,及时站立结束交战
- DOI:
- 发表时间:
2023 - 期刊:
- 影响因子:0
- 作者:
Kristine Sanchez;J. Dawes;Mark Stephenson;R. Orr;R. Lockie - 通讯作者:
R. Lockie
Effects of vegetation on methylmercury concentrations and loads in a mercury contaminated floodplain
植被对受汞污染的洪泛区甲基汞浓度和负荷的影响
- DOI:
10.1016/j.scitotenv.2023.165864 - 发表时间:
2023-11-25 - 期刊:
- 影响因子:8.000
- 作者:
Wesley A. Heim;David Bosworth;Carol DiGiorgio;Mark Stephenson;Gary Gill - 通讯作者:
Gary Gill
Mark Stephenson的其他文献
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{{ truncateString('Mark Stephenson', 18)}}的其他基金
SBIR Phase I: Building Trust Between Patients and Providers: Adapting Blockchain Technology to Electronic Health Records Systems
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- 批准号:
1913663 - 财政年份:2019
- 资助金额:
$ 100万 - 项目类别:
Standard Grant
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