Five healthcare organizations including insurers UnitedHealthcare and Humana, Optum, Quest Diagnostics, and MultiPlan are launching a blockchain pilot to help payers tackle mandated provider directories.
UnitedHealthcare and Optum are both part of UnitedHealth Group. Humana got involved through old-fashioned networking, according to Mike Jacobs, a senior distinguished engineer at Optum, who has been working on the test program for two years.
The pilot will start in late spring through the summer with results expected this fall.
“I think the alliance is one of the first, if not the first, national blockchain alliances for healthcare,” Jacobs said.
The program will apply blockchain technology to improve the quality of data and reduce the administrative costs associated with insurers getting up-to-date healthcare provider demographic data.
Insurers are mandated to get accurate information that is passed on to beneficiaries. The Centers for Medicare and Medicaid Services fines insurers if they do not have up-to-date provider directories.
Currently, each payer must go after the same provider information separately. One problem is that providers are often inundated with similar requests from dozens of plans.
It takes quite a lot of time and money for insurers to reach out to providers each 90-day cycle, Jacobs said. Sometimes it takes half-a-dozen times to reach a provider through calls, emails or even through faxed information.
Managed care organizations, health systems, physicians, diagnostic information service providers and other healthcare stakeholders typically maintain separate copies of healthcare provider data, which can result in time-intensive and expensive reconciliation processes when differences arise, Optum said.
An estimated $2.1 billion is spent annually across the healthcare system chasing and maintaining provider data.
The pilot will use blockchain technology for the five members of the alliance to share the curated information.
“So when one payer does the curation work, it could be potentially shared with the other payers,” he said. “This works for payers that have an overlapping provider population.”
At the beginning, the pilot is purely altruistic, Jacobs said. In the future, it could become a business model for others to buy the curated information.
For the first year pilot, providers will not be involved and their workflow will not change, Jacobs said.
Starting out, those involved in the pilot determined they wanted to use blockchain to solve a common business problem, rather than one using the personal health information of patients, and landed on the provider data management problem, Jacobs said.
Blockchain technology for healthcare has sprung from the bitcoin. Blockchain offers integrity and there are tamper resistant securities in place.
“As the blocks are added to the blockchain there is mathematics and encryption used to ensure there’s a secure linkage between logs,” Jacobs said. However, he said, “The same cybersecurity considerations are at play here.”
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