Fixing provider directories a low-risk way to test blockchain, report suggests

Dive Brief:

  • A new white paper from EY Advisory and Humana highlights how distributed ledger technologies, including blockchain, can improve the quality of provider data while reducing costs and duplicative efforts.

  • The report suggests that improving routine administrative activities, such as provider data management, is one way to reduce inefficiency and waste in the healthcare industry.

  • A crowdsourced provider data marketplace could enable payers and third-party data sources to improve provider data quality, which is often riddled with outdated information, according to the report.

Dive Insight:

U.S. healthcare organizations spend $2.1 billion each year to maintain provider data and 75% of it is duplicative. That’s partly because payers and other industry stakeholders can’t maintain high-quality data in a heavily siloed industry, according to the report.

Blockchain offers the chance to collaborate on a program to release data stuck in silos.

Using provider directories is also one low-risk way to test out blockchain. Provider directories are often wrong. CMS has said 52% of Medicare Advantage online provider directories are incorrect and the agency is hoping greater oversight will improve the situation.

That won’t improve payer network provider information for commercial plans, though. Payers maintain individual provider data for their in-network providers, which duplicates efforts and opens up a higher chance for mistakes. However, the white paper said payers are increasingly working together to collaborate on increased efficiencies for PDM services. That includes increasing the provider directory quality.

Going with a crowdsourced provider data marketplace will “more efficiently distribute the effort and cost” and reduce duplicative efforts, according to the paper. Blockchain technologies, including distributed ledgers and smart contracts, allows for data exchanges and connect multiple healthcare stakeholders. That has the chance to “address current friction points” as well as reduce inefficiencies and improve standards.

“Marketplaces have disrupted status quo and delivered value and efficiencies to customers in every industry, including healthcare. We now have the technical capabilities to apply a marketplace model to PDM,” according to the report.

By starting with provider data maintenance, healthcare could test blockchain and lead to a technical foundation to share other types of more sensitive data.  

Humana is already working with MultiPlan, UnitedHealth Group’s Optum, UnitedHealthcare and Quest Diagnostics on a pilot blockchain project to fix provider network lists. That project looks to figure out how payers’ provider directories can offer the latest information.

Humana and UnitedHealth aren’t the only payers that see blockchain’s potential. A 2017 Black Book Market Research survey found three-fourths of payer executives are either thinking of deploying or in the process of implementing blockchain technology.  Also, 29% of hospital executives and 82% of payers claimed a working knowledge of blockchain in the 2017 third quarter.

Many of these officials also see blockchain’s potential for improved interoperability. The survey found that at least nine out of 10 people surveyed among payers, medical group managers and IT specialists see the promise of blockchain. More than two-thirds of hospital officials (70%) also see the potential of how blockchain could address connectivity issues and data sharing, according to Black Book.

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