Management technology for therapeutic cannabis
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Describes existing, robust technology that provides management foundation for medical marijuana/therapeutic cannabis environments - clean and verified transactions, substantive protections and controls against fraud.
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Management technology for therapeutic cannabis
- 1. Registration, Transaction Verification and Tracking Medical Marijuana or Therapeutic Cannabis May, 2014 www.advancecons.com
- 2. Effective administration of therapeutic cannabis programs includes systems and procedures for: Eligibility Registration Treatment Management 1 www.advancecons.com Clinic Patient • Provider Exam • Symptoms • Qualifying Condition Care Giver • Background Check Certification Criteria HHS Registry • Patients • Caregivers • Clinics • Renewals and on-going eligibilities • Prevention of Shopping • Doctors • Care Givers • Clinics • Inventory • Reporting • Inventory • Trends • Demographics • Outcomes Purchase by Patient Purchase by Care Giver Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 3. Provider Exam With Castlestone - At the Doctor’s Office the patient, the doctor, the location, the certification type and time are verified 2. Data on Card ID, Terminal Owner, Terminal Location Merchant Code, Transaction Code, Time Stamp (via credit card network infrastructure) 2 www.advancecons.com 1. . Patient and doctor swipe card Doctor keys trans. code for therapeutic cannabis prescription Castlestone runs rules against each swipe, in real time, e.g.: • Is that swipe terminal in our database of providers? • Is that swipe terminal a medical merchant code? • Has that card been reported lost or stolen? Are there restrictions? • Has that card been swiped today at another location? • Has the card holder already been issued a certification for therapeutic cannabis? Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 4. Anti-Shopping: these data are matched versus existing claim and certification records looking for duplicates, multiples, matches 2. Data on Card ID, Terminal Owner, Terminal Location Merchant Code, Transaction Code, Time Stamp Health Insurer’s Analytics (Can include PMP-like analytics) 3 www.advancecons.com Card Swipe Details Card Number: 5424176022824317 Name: Mitchell Clark HealthPlan ID# 6789b Provider ID# 0077464 Swipe Terminal ID9443C3002846 (registered to Dr. Byron Black) Date of Transaction:1/15/14 Time of Transaction 10:06:23 Claim Details Recipient Name Mitchell Clark Name: Mitchell Clark HealthPlan ID# 6789b Provider ID# 0077464 Provider Name: Byron Black, MD Date of Service:1/15/14 1. . Patient and doctor swipe card Doctor keys trans. code for Schedule II prescription 4. Notification of existing certification stolen card, Or other flag; can be checked on portal 3. Claim Matching • Recipient name • HealthPlan ID • Provider ID • Etc. Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 5. Dispensing At the Treatment Center: Castlestone verifies the patient/care giver ID & certification for the technician prior to filling 4 www.advancecons.com Card Swipe Details- Doctor’s Office Card Number: 5424176022824317 Name: Mitchell Clark Plan ID# xxx-xx-6789 Prescriber ID# 0077464 Prescriber Name: Richard Howard, MD Rx Date: 1/15/14 Order Code: 11551 Claim Details Recipient Name Mitchell Clark Name: Mitchell Clark HealthPlan ID# 6789b Provider ID# 0077464 Provider Name: Byron Black, MD Date of Service:1/15/14 Card Swipe Details- Treatment Center Card Number: 5424176022824317 Name: Mitchell Clark Plan ID# xxx-xx-6789 Supplier ID# 0088444 Supplier Name: ABC Clinic, Trenton NJ Date: 1/15/14 Order Code: 11551 • Verifies provider exam • Verifies certification information • Verifies treatment center • Attests that physician order came from physician office • Location verification of treatment center • Time of fulfillment • Blocks order after fill of proper quantity (prevent alteration) • Blocks fill within time parameters Clinic Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 6. When referred, the doctor and/or the patient/care giver can be contacted before the transaction is approved 2. Data on Card ID, Terminal Owner, Terminal Location Merchant Code, Transaction Code, Time Stamp 3. Claim Matching • Verify terminal code • Verify medical merchant code • Lost or stolen card? • Previous time and location of swipe • Existing Cert. for cannabis?, etc. 4. Approve, Deny or Refer 5. On referral, verify before taking action, guide to counseling , or take other action as appropriate Health Insurer’s Analytics (Can include PMP-like analytics) 5 www.advancecons.com 1. . Patient and doctor swipe card Doctor keys trans. code for Schedule II prescription Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 7. There are many types of health claims fraud for which real time verification and analysis is key to remediation Castlestone's Impact • Verify face-to-face visit/authorization with doctor, record certification • At the clinic, verify where, when and who filled the order; control diversion and doctor 6 www.advancecons.com - Fraud Scheme¹ – 1. Billing for services not rendered (12% of all fraud) 2. Misrepresenting dates of service 3. Misrepresenting locations of service 4. Misrepresenting provider of service 5. False of unnecessary issuance of certification drugs - Remediation - 1. Eliminate “phantom” patients and providers 2. In real time, verify and analyze time and date 3. Verify and analyze locations in real time 4. Verify providers in real time 5. Verify and validate of physician in real time shopping ¹ Source: Fraud Examiner’s Manual 2013 Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 8. Cost and Implementation Considerations 7 www.advancecons.com • Card Creation – Castlestone creates/activates/deactivates and manages cards based on guidelines. Plan Sponsor existing card manufacturing contracts can be used if they are compatible – Patient cards can be dispensed by doctors with on-line registration in the doctor’s office • Hardware cost for plan & providers – NONE. Uses existing credit card terminals or, if treatment centers do not have, Castlestone can provide wireless terminals with direct connections to the system (this option provides more robust messaging, printing and other functions) • Network costs for plan & providers – NONE. Uses the existing credit card networks from provider offices for transactions • Systems & programming costs – Simple data exchange of new/change/delete participants, and customization of plan rules • Cost Structure – Design and programming & card cost – Hosting (data base & monthly hosting and management) – Monthly per-member transaction fees Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 9. 8 www.advancecons.com Typical Results • Set up completely implemented in 60-75 days, depending upon client resources • All technical milestones (transaction capture, claim matching, file and interface implementation) exceed goals for speed and performance • When used for fraud prevention ROI ranges from 125%-200% and can significantly exceed this Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 10. CastleStone’s request of therapeutic cannabis plan managers 1. Make real-time recording of certifications and their fulfillment a requirement 9 www.advancecons.com of the process 2. Use these approaches to verify the identities of the doctors, patients, care givers and clinics involved in any given transaction 3. Use these approaches to refer questionable transactions and provide coaching and counseling or appropriate disciplinary action 4. Use the data captured as the foundation of a robust reporting and trend analysis capability Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC
- 11. CIO Advisory | Program Management | Business Development Jeffrey Leston 10 www.advancecons.com Contact Us Doug Brockway Advance Consulting Castlestone New England (617) 834-0067 dbrockway@advancecons.com www.advancecons.com Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC President Castlestone Advisors LLC (212) 874-4390 jeff.@castlestone-llc.com
- 12. 11 www.advancecons.com Appendix Other presentations and reports you may find of interest include: Title Link Fraud Prevention for Health Insurers http://slidesha.re/1pCGh98 Doctor Shopping and Prevention http://slidesha.re/1nNb9OL CMS Pilot/Test of VisitEye http://slidesha.re/1vlGGeU Management Tech. for Therapeutic Cannabis http://slidesha.re/1nQ5JkD Corporate Wellness http://slidesha.re/1qQf6Fi Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC