1. Blockchain technology at Change Healthcare
Distributing value for a better healthcare future
Aaron Symanski, CTO
Blockchain 2018

2. Building on the shoulders of giants.
Blockchain adoption is part of a transformation that’s already underway in healthcare.
1960s – 1970s: Computers: Expensive mainframes and storage drove hardware innovation, smaller computers and departmental software; data silos
1980s -1990s: Networks: Personal computers, distributed computing and vast communication networks drive competition and consolidation; EMRs
2000s – 2010s: Mobility: Digitized records face mobility and portability demand / security consequences; data analytics and outcome based reimbursement emerge.
2010s-onward: Automation: Full automation requires high integrity data and a resistance to attack…enter blockchain
PROPRIETARY & CONFIDENTIAL

3. Why is blockchain technology so compelling?
We all want a future where information is:
Immediately available
Identical everywhere it is stored
Has a complete history
Is immutable
And is user-centric – “controlled” by the contributor
PROPRIETARY & CONFIDENTIAL

4. Our Intelligent Healthcare Network™ Healthcare Transactions
Change Healthcare at a glance
Business Overview
Our Intelligent Healthcare Network™
5,500
Hospitals
2,100
Payer Connections
Large, independent, health technology and services company
$3.5 billion in annual revenue
15,000 team members in 35 states and ~4,000 contractors
Supports all major stakeholders across the healthcare system
Investing for the Future, Today
Blockchain, Artificial Intelligence, Communities, User Experience…
117,000
Dentists
1 in 5
U.S. Patient Records
800,000
Physicians
$2.0 trillion
Healthcare Claims
600
Laboratories
12 billion
Healthcare Transactions
PROPRIETARY & CONFIDENTIAL

5. Hyperledger, a Linux Foundation Project,
and Change Healthcare

6. Blockchain, Hyperledger, and Change Healthcare
Blockchain adoption benefits from thoughtful, open source development. Openness ensures scalability, accessibility, resiliency, and innovation.
Blockchain protocol governance
Node management
Consensus mechanisms
Smart contract language and libraries
Identity frameworks
PROPRIETARY & CONFIDENTIAL

7. Why Hyperledger Fabric?
Modular & Extensible Architecture
Applicability across industries especially healthcare
Flexible Consensus Model
High transaction volume & throughput
Choice of consensus algorithm
Fine-grained access control supports privacy needs
Multi-Channel for greater privacy and segmentation
Smart Contracts (Chain Code) support Go and Java
Ability to support currency (we might want this some day)
Open Source
PROPRIETARY & CONFIDENTIAL

8. Intelligent Healthcare Network™ with Blockchain featuring Claims Management Transparency

9. Transaction Processing Workflow
Change Healthcare Intelligent Healthcare NetworkTM with blockchain
Payer
Blockchain Ledger
Using Hyperledger Fabric, a blockchain framework implementation hosted by Change Healthcare
Transaction Processing Workflow
VOLUME
50 Million
Transactions/Day
PERFORMANCE
550
Transactions per second
Provider
PROPRIETARY & CONFIDENTIAL

10. Intelligent Healthcare Network™ with Blockchain featuring Claims Management Transparency
"A rose by any other name would smell as sweet“
We’ve augmented our high-performance network with blockchain, establishing a platform that we will expose and leverage for many other innovative use cases/products in the future
The first feature or application deployed on the platform provides visibility / transparency into the claim lifecycle
Intelligent Healthcare Platform
featuring Claims Management Transparency
Application Features
with Blockchain
Data & Rights Management
Intelligent Healthcare Network
Claims Network

11. Intelligent Healthcare NetworkTM with blockchain featuring claims management transparency
Claims Network
Claim Processing Workflow
Payer
Assurance Reimbursement ManagementTM
Provider 1
Claims submitted for payment by Provider 2
Claims Network workflow writes claim lifecycle events to blockchain 3
Blockchain events trigger Claims Network workflow activity 4
Claims submitted to Payer for processing 5
Blockchain maintains real-time immutable record of claim lifecycle 6
Provider accesses claim status from blockchain via API
Claims Network Components
Blockchain Components
Customer Components
Claims
Hyperledger Fabric
Claim
Submission
Remittance
Blockchain Network

12. Adoption will come in phases.
Value
Payments and financial services
Fraud Detection
Consumer End-Users
Consumer Software Development
Mobile applications
Transaction
Auditing
Stakeholder Adoption
Process
automation
Identity authorization
Insurance claims
Enterprise End-Users
Enterprise Software Providers
Data validation
Exchanging clinical data
Role-based access control lists
Digital Assets
Clinical records registries
Smart Contracts
IT Infrastructure
Node management
Today
1-3 years
3-5 years

13. Four types of blockchain solutions at Change Healthcare
Enterprise applications and services
We will offer integrated and novel blockchain applications and data processing services.
Enterprise blockchain infrastructure
We will offer a path from private to permissioned to eventually open blockchain networks. We are in production with the first phase.
Consumer application services
We will connect our customers patient and consumer facing technology to blockchain technology
Open blockchain infrastructure and resources
We will invest in, develop, and contribute to the adoption of open blockchain infrastructure, as it is vital to the long-term value of this technology.