management technology for therapeutic cannabis

www.advancecons.com

Registration, Transaction Verification and TrackingMedical Marijuana or Therapeutic Cannabis

May, 2014

2 www.advancecons.com

Effective administration of therapeutic cannabis programs includes systems and procedures for:

Eligibility Registration Treatment Management

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• Demographi

cs• Outcomes

Purchase by Patient

Purchase by Care Giver

Proprietary and Confidential Intellectual Property of Castlestone Advisors, LLC


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 LocationMerchant Code, Transaction Code, Time Stamp

(via credit card network infrastructure)

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?



Anti-Shopping: these data are matched versus existing claim and certification records looking for duplicates, multiples, matches


Health Insurer’s Analytics(Can include PMP-like analytics)

Card Swipe DetailsCard Number: 5424176022824317Name: Mitchell ClarkHealthPlan ID# 6789bProvider ID# 0077464Swipe Terminal ID9443C3002846

(registered to Dr. Byron Black)Date of Transaction:1/15/14Time of Transaction 10:06:23

Claim DetailsRecipient Name Mitchell ClarkName: Mitchell ClarkHealthPlan ID# 6789bProvider ID# 0077464Provider Name:Byron Black, MDDate of Service:1/15/14


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.



Card Swipe Details- Doctor’s Office

Card Number: 5424176022824317Name: Mitchell ClarkPlan ID# xxx-xx-6789Prescriber ID# 0077464Prescriber Name:Richard Howard, MDRx Date: 1/15/14Order Code: 11551

Claim Details Recipient Name Mitchell ClarkName: Mitchell ClarkHealthPlan ID# 6789bProvider ID# 0077464Provider Name:Byron Black, MDDate of Service:1/15/14

Dispensing At the Treatment Center: Castlestone verifies the patient/care giver ID & certification for the technician prior to filling

Card Swipe Details- Treatment Center

Card Number: 5424176022824317Name: Mitchell ClarkPlan ID# xxx-xx-6789Supplier ID# 0088444Supplier Name:ABC Clinic, Trenton NJDate: 1/15/14Order 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



When referred, the doctor and/or the patient/care giver can be contacted before the transaction is approved


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)


Doctor keys trans. code for Schedule II prescription



There are many types of health claims fraud for which real time verification and analysis is key to remediation

- 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

¹ Source: Fraud Examiner’s Manual 2013

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 shopping



Cost and Implementation Considerations

• 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



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



CastleStone’s request of therapeutic cannabis plan managers

1. Make real-time recording of certifications and their fulfillment a requirement 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



Contact Us


Doug BrockwayAdvance ConsultingCastlestone New England

(617) [email protected]

www.advancecons.com

CIO Advisory | Program Management | Business Development Jeffrey LestonPresident Castlestone Advisors LLC

(212) 874-4390 [email protected]

mailto:[email protected]

http://www.advancecons.com/


Appendix

Other presentations and reports you may find of interest include:

Title LinkFraud 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


http://slidesha.re/1pCGh98

http://slidesha.re/1nNb9OL

http://slidesha.re/1vlGGeU

http://slidesha.re/1nQ5JkD

management technology for therapeutic cannabis

Healthcare

card id

terminal code

transaction code

healthplan id provider

order code

bprovider id

terminal locationmerchant

prescriber id