Healthcare Analytics, Population Health Management, Healthcare Big Data

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Blockchain Offers Promising Path to Better Provider Directory Data

Blockchain could be the key to reducing costs and administrative burdens associated with maintaining accurate provider directory data.

Blockchain in healthcare

Source: Synaptic Health Alliance

By Jennifer Bresnick

- As the volume of big data continues to increase exponentially and the pressure to reduce wasteful spending intensifies, healthcare organizations are broadening their search for secure and seamless data management strategies.

More and more frequently, organizations are finding that blockchain has the potential to solve many of the most challenging problems involved in managing administrative, financial, and even clinical data. 

The distributed ledger methodology, which has its roots in the world of cryptocurrency, is offering healthcare stakeholders an innovative new option for addressing mundane – yet vitally important – tasks such as maintaining up-to-date provider directories.

Provider directories are necessary for ensuring that the right staff members trained and licensed to deliver specific services at care sites for which they have current credentials. 

In addition to being critical for the reimbursement process, provider directories safeguard patients by preventing unqualified individuals from practicing in an incorrect manner.

READ MORE: Provider Data Management Offers Payers a Blockchain Use Case

But keeping the credentials and affiliations of millions of healthcare workers up to date is a daunting prospect for payers and providers.

Most credentialing and confirmation processes are still conducted manually, using good old fashioned phone calls and faxes to verify employment or check eligibility to provide reimbursable services.  As a result, telephone tag and human error consistently add time, frustration, and expense to an already-complex procedure.

Most states require monthly updates to provider directories, and many regulations stipulate that payers must regularly contact every single provider on the list to update their information.

As a result, providers may be required to field a never-ending series of calls from a dozen different payers, each asking the same questions and attempting to replicate the same information.

Every year, the healthcare system spending more than $2 billion acquiring and maintaining provider data, recent estimates show.

READ MORE: 55% of Executives Say Blockchain Is Poised to Disrupt Healthcare

Blockchain could drastically cut down on the confusion by creating a single source of truth for provider data and a shared, standardized framework for exchanging that data when necessary, theorizes the Synaptic Health Alliance.

The collaboration, launched in April of 2018, is exploring how to implement a blockchain-based approach to managing provider directory data that will foster trust and deliver accurate, timely data to every entity that needs it.

Synaptic’s founding members – Humana, MultiPlan, Quest Diagnostics, Optum, and UnitedHealthcare – believe that blockchain has significant potential to cut through the clutter created by existing data management strategies.

“The Alliance views blockchain technology as a means to a critical end: ensuring that data is accurate and sharable for reliable use across the healthcare ecosystem,” the Alliance said in a recent white paper.

“Thanks to the members’ large collective data volume and national footprint, this collaboration could prove the business value of cross-company data sharing in healthcare and, ultimately, help facilitate a significant positive impact in the healthcare market space.”

READ MORE: How AI, Blockchain Combine to Fuel Healthcare Big Data Analytics

The Alliance’s big data footprint is expanding even further, the group announced in early December, as two new market leaders join the coalition as founding members.

Aetna, recently purchased by CVS Health, and Ascension, the nation’s largest nonprofit health system, are adding their resources and expertise to the project.

Gerry Lewis, SVP and CIO at Ascension
Gerry Lewis, SVP and CIO at Ascension Source: Xtelligent Media

“We’re participating with the Alliance because the opportunity to share information securely and appropriately across the healthcare continuum is extremely important,” said Gerry Lewis, Senior Vice President and Chief Information Officer at Ascension. 

“If we can leverage blockchain to help exchange that information effectively between providers, payers, and consumers, then we would be able to make significant inroads with our ability to improve the experience of everyone interacting with that data.”

Solving the provider directory conundrum is an ideal test case for blockchain, Lewis told

“We’ve been trying to solve this problem with established technologies for a quite a while, but there are many points of friction,” he noted.  “There are so many different stakeholders, each with their own semantic ontologies, and that’s a very complex landscape to navigate.”

“Right now, both providers and payers are wasting a lot of time and capital on missing phone calls and correcting mistakes.  It’s in everyone’s best interests to see if there’s a better way to achieve alignment and get the right information at the time of care.”

Blockchain is likely to form at least part of that solution, Lewis believes.

“I don’t know if blockchain is going to be the right technology to solve this problem completely – that’s why we’re exploring and experimenting with it – but I do believe it’s going to help lead to more effective and efficient processes,” he said.

And multi-stakeholder organizations like the Synaptic Alliance will be crucial for identifying how blockchain can contribute to better experiences and more streamlined, simplified workflows.

“The timeliness of this data is very important,” Lewis stressed.  “Wouldn’t it be great if a patient checked in to an appointment, and you could immediately pull up their provider’s contracted payment information stored on the blockchain, and the service confirmation was instantly validated?  Wouldn’t it be great if we could provide that type of consumer-centric experience for both the patient and our administrative staff?”

“Blockchain has the potential to support that.  At the end of the day, blockchain could change the way we do business.  That should be a very exciting thought for healthcare.”

The Alliance is planning to pilot a permissioned blockchain, or a closed, invite-only blockchain community, that will allow members to view, validate, and update non-proprietary provider data within the network, the group’s white paper explained.  The pilot will focus on one geographic market, initially, to keep the scope of the initiative manageable. 

“The pilot is examining whether sharing the administrative efforts related to provider data management lowers the individual share of that burden for health plans and care providers,” the report continues.

“It is also testing whether incentives could also be built in to motivate data sharing with everyone in the blockchain network, which would improve data quality and decrease data maintenance costs.”

The Alliance hopes to make significant progress towards a workable solution in 2019, Lewis said.

“We are working on several use cases that we want to validate in the upcoming year, and then use those results to evaluate where we need to go next,” he stated.  “It’s important to be able to pivot quickly to the next possibility, and we believe the Alliance will play an important role in identifying those new opportunities with blockchain.”

For Ascension, participating in the pilot is a way for the health system to keep abreast of rapidly changing trends in the health IT space that could improve operations and reduce costs.

“Things are changing so fast that healthcare organizations must learn to be nimble and adapt quickly to new technologies,” said Lewis.  “They have to focus on creating positive experiences for their consumers: the goal is to think about the experience first, and then choose the tools and strategies that will improve the consumer journey across the entire continuum.”

“Clearly, spending is a challenge in the US, and we think there are opportunities to reduce some of the administrative waste that comes from having incomplete or inaccurate data. We believe that blockchain will help us do that while also making the economics work.” 


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