Blockchain is showing promise as a way to improve data-sharing between payers and providers. Payers, providers, and patients all encounter issues with verification of benefits and checks on medical eligibility. Solving those problems will benefit everyone.
Sponsored Content Provided By Optum
How blockchain could ease frustration with the payment process
Optum Advisory Services
Big problems, bigger partners
The core challenge is access to shareable, current, complete data. That's no small task. To take on this enormous challenge, major health care companies are exploring the use of blockchain for potential solutions to data-exchange issues.
Blockchain technology can help create a regularly updated record of transactions or other information, securely tied together using cryptography. One pilot project focuses on sharing provider information for the directories that health plans maintain.
First step: Provider directories
All health plans are required to maintain up-to-date provider directories. Each health plan must make this data available to members as part of the credentialing process. But the Centers for Medicare & Medicaid Services found half of directory locations had at least one inaccuracy.1
Additionally, efforts to maintain provider directories cost about $2.1 billion annually.2 Many plans collect the same information from the same providers but don't share or collaborate on the information they gather. That means health plans are duplicating effort and still might not have completely accurate information.
The theory being tested right now is that health plans can use blockchain to create a standard way of sharing information about providers and networks, to reduce errors and cost.
Provider directories are a great test case because the work relies on relatively simple demographic data. If payers and providers get into the habit of sharing provider demographic information, and if the efficiencies of blockchain are proven, then the healthcare industry can start to test the theory that blockchain could be used for more complex problems like sharing information about benefits and eligibility.
Next Step: Benefits and eligibility verification
Blockchain could be a critical piece of the puzzle in streamlining verification of benefits, medical eligibility, and prior authorization, potentially making it faster and easier to make decisions. It could provide a way to protect information, but also allow it to be accessed in a secure way.
If you can create a shared, secure network among a trusted group of payers and providers that conforms to antitrust and privacy laws, you could avoid the back and forth that goes into chasing down eligibility and benefits verification. The result is more efficiency in a competitive marketplace. But that only scratches the surface of what the payer and provider relationship could be.
Where we need to be going is a richer exchange of information between the two sides. I'm hopeful that new technologies, like blockchain, can create a secure, more efficient mechanism to share information about healthcare transactions.
Modernize the infrastructure
The use of blockchain and other new technologies does pose some challenges for health plans, including the potential need for more technical capabilities.
As health plans deploy new transactions and new technologies, it's important to consider core legacy systems and address questions like:
- What kind of quality tests do we need to apply?
- How do we accept data?
- What kind of vetting will need to be done before data can be shared?
- Will the answers differ by transaction?
By answering questions like these, IT leaders can measure how well their current infrastructure supports their goals and put together a plan to fill the gaps. IT leaders can focus on incremental changes that move their organizations forward at their own pace. The goal is to share information in a manner conducive to each party's own digital workflows and systems.
By sharing information in a secure, efficient, technology-driven way, the industry can start to reduce total cost of care and remove health system friction.
If we, as a healthcare industry, can support and encourage more strategic relationships, using technology to facilitate better sharing, there could be wide-ranging benefits at every stage of the health care payment continuum.
Pain point number 1 is a lack of access to complete and current data that supports checks on medical eligibility and verification of benefits. Explore the five key pain points in the Optum Payment Nexus and read about collaborative solutions for addressing each one.
About the Author:
David Chennisi, Senior Vice President of Optum Advisory Services. David is a key leader in Advisory Services, with more than 30 years of experience in the health care industry. His teams are responsible for systems implementation and integration projects spanning core administrative claims adjudication, medical management, business intelligence/data warehouse, and customer relationship management applications. Prior to Optum, David served as CIO at Texas Children’s Health Plan.
Sponsored By:
Sponsored Content