Ken Kleinberg, Practice Lead of Innovative Technologies at Point-of-Care Partners (POCP), and host of The Dish on Health IT kicked off the episode by welcoming co-host Jocelyn Keegan and our special guest, Gabriela Pelin, Chief Innovation Officer with Avaneer Health. This episode will feature a discussion on how Avaneer Health is establishing a trusted network to streamline health care processes, the technology they're using that significantly includes blockchain and the vision they have for the industry. Ken explains that he first met the folks at Avaneer, a couple of HIMSS conferences ago and he’s been excited about the work they're pioneering ever since.

Jocelyn Keegan, Payer Practice Lead at POCP introduced herself explaining that she is a devoted change agent focused on getting stuff built and done for real. She went on to say that her focus, at POCP is on interoperability, prior authorizations, and the convergence of where tech standards and product strategy happens. Jocelyn also conveyed that she is the program manager for Da Vinci Project, which is probably one of the most expansive FHIR accelerators to date. Jocelyn explained that she is excited to hear from Gabriela and the work that Avaneer is doing, especially with the introduction of technologies like blockchain into the space. 

Guest, Gabriela Pelin thanked Ken and Jocelyn for having her on and expressed excitement to be part of the podcast. She began introducing herself explaining that her career seemed to constantly land her in the middle of transformation or innovation. Gabriela went on to say that luckily, over the past three and a half years, she stumbled over blockchain technology. She discovered that blockchain is a fascinating technology that enables people to work together. Her drive for innovation was immediately stoked and she was propelled to understand it. She went on to explain that Avaneer has many people at the table from very influential payers and providers who are all very interested in how to make progress in applying blockchain in healthcare. 

Ken then asked Gabriela to give a high-level overview of Avaneer health, their founders, participants, targeted use cases, and the network being established. He explained that he thinks most listeners will likely be wondering if Avaneer is like a clearing house or other entity already out there.

Gabriela explained that the founders of Avaneer talked for a long time with founding network members about the purpose of the work, why the network needed blockchain and what about the industry needed to change. Each discussion brought them back to wanting to improve the patient experience and outcomes because each person either has been, will be or have a loved one that is a patient and that it was imperative to improve the overall experience and outcomes because all people deserve better. 

Gabriela went on to explain that the health care market is notorious for discrepancy in interests between the different players in the market, and they don't necessarily naturally work together to solve broader, industry problems. Avaneer wanted to create a network that would allow these stakeholders to come together to fix these issues for all patients and their families. 

Avaneer wants to reimagine the industry, and all of the steps in the back-office administration and care delivery so that we can accelerate healthcare, Gabriela explained that this is how they came up with the idea of connect once and consume many solutions, many use cases and connect direct. Moving forward, Avaneer wants payers, providers, pharmacies, clearing houses, really anyone needing to exchange clinical and administrative data to be part of this all-inclusive network so that everybody can connect directly, and we can make a difference for people.

Ken then asked for Gabriela to list founders and members, and to describe some of the use cases Avaneer is tackling first.

Gabriela explained that Avaneer has payers like, Anthem, Aetna, CVS, and HCSC. Those organizations are considered visionaries in terms of the different projects they take on to move the market and make a difference for their members. Cleveland clinic, known for its innovation in the industry, is also a member. She explained that Avaneer members so far are early adopters and that there are also members from the financial and broader technology industries participating like PNC Bank and IBM. The participation of these non-healthcare companies brings a different point of view and an important balance throughout the journey. Gabriela closed her commentary about members by affirming that it's good to have a diversified group since Avaneer wants to be all inclusive,

Gabriela then went on to explain the initial use cases Avaneer is tackling. Coverage and eligibility data is one of the first things Avaneer will be tackling to make sure that all parties have access to a patient’s coverage information, information related to services performed by whom and when and that everyone has access to the same copy of the same information. 

Gabriela explained that if everybody's on the same page and the communication is direct, then you can cut steps between what is your eligibility, what are your benefits, and here is the payment from the insurance company. Avaneer believes this can be accomplished, even if it’s a difficult process, by using blockchain. 

Ken turned the floor over to Jocelyn to comment on her thoughts about what Avaneer is trying to accomplish. 

Jocelyn expressed excitement about the network and the use of blockchain. She explained that through her work with Da Vinci and in her projects at POCP, she’s recognized that the claims database is the only place considered a source of truth and there isn’t currently a lot of transparency with the patient and the provider about what a patient's specific benefits are at a specific point in time. Jocelyn then asked Gabriela to talk about what this kind of transparency would look like in the real world for payers, providers, and patients and to explain what these initial Avaneer projects really look like. 

Gabriela stated that the work is still new but that the technology stack has been deployed. Avaneer founding members are focused on completing the technology stack and getting a few applications running this year. Once that goal is met, Avaneer wants to open the network to the market. 

Ken asked for more details about the technology Avaneer is using whether blockchain, FHIR or cloud. 

Gabriela explained that the industry has been moving towards the cloud at a steady pace even if it’s only really picked up steam over the last couple years. The core Avaneer architecture is cloud-based as a basic layer and network management layered over to ensure its scalable and increased traffic can be routed over time. Additionally, the information that can be allowed or should be disallowed based on HIPAA rules must be programmed in based on roles network members will assign to their employees. Blockchain as a service is the other part that allows members to build on basic blockchain but ensures that everyone has agreed to the same process. She observed that Avaneer is learning from the work of Da Vinci regarding how to get multiple stakeholders to agree to a joint process. 

The discussion moved to talk about FHIR, the HL7 Accelerator program and other standards development happening and how more stakeholders seem to be coming together to collaborate and contribute to standards development to solve these bigger more complex issues which is ultimately going to move the industry forward. 

Ken then shifted the conversation back to TEFCA and other organizations like Carequality, the eHealth Exchange, CommonWell and asked Gabriela to describe how Avaneer compares or fits in with these initiatives. 

Gabriela explicated that they are appreciative that the industry has made progress with the initiatives Ken named and that Avaneer sees them as supporting the traditional point to point connection. This approach enables one transaction between willing parties, whereas Avaneer is trying to solve for this problem of payers and providers constantly having to review every single solution that they want to implement on their system. So Avaneer is building this network to allow one connection to consume many services. This would allow members to essentially review security and other connection considerations once and then perform transactions or use solutions as needed. Gabriela reminded Ken and Jocelyn that they are still in the stage or proving their approach works.

Ken followed up by asking whether Avaneer is considering becoming a QHIN under TEFCA. 

Gabriela said that Avaneer met with ONC. And that during those discussions it became clear that HIEs are using technology from 20+ years ago and Avaneer wants the opportunity to build new solutions from scratch instead of patchworking into already old and deteriorating technology systems. 

Jocelyn then asked Gabriela how she would want listeners to the podcast to get involved or figure out how to align with Avaneer or adopt something like blockchain. Basically what actions could listeners take to take bigger leaps in leveraging new technologies? 

Gabriela responded by explaining that Avaneer is happy to talk to organizations and offer practical advice but for the time being they are very much heads down trying to prove the network is viable. Onc