Insurers Test Blockchain To Manage Provider Data

The blockchain is making inroads into healthcare.

Earlier this week, five healthcare firms operating across the U.S. insurance landscape said they’re launching a pilot program that will help boost the management of healthcare provider data.

The five organizations include insurers Humana, UnitedHealthcare, Quest Diagnostics, Optum and MultiPlan. (Optum and UnitedHealthcare are part of UnitedHealth Group).

Under the terms of the pilot, blockchain will be used with the hopes of improving data quality while reducing administrative costs focused on healthcare provider demographic data.

Through insurance mandates, providers’ directories must be updated with that demographic information, but inaccuracies and inefficiencies abound. The record trail is far-flung and often duplicative.

The firms, in announcing the pilot, said this week that physicians, information service providers, managed care organizations and health systems maintain separate copies of healthcare provider information. Reconciliation offers up a challenge, then, and the costs are high, as the industry spends $2.1 billion across the continuum of care maintaining that data.

The pilot will, as the companies said, set about testing the premise that improvements can come about through “sharing provider data inputs and changes made by different parties across a blockchain, potentially reducing operational costs while improving data quality.”

In comments provided to PYMNTS, Pam Walker, senior director of marketing and communications at MultiPlan, said the Centers for Medicare & Medicaid Services found in its second round of online provider director reviews — completed during the September 2016 to August 2017 timeframe — that 52 percent of the provider directory locations listed had at least one inaccuracy.  Those inaccuracies, for example, might include incorrect phone numbers or physical addresses, or even erroneously indicating that a provider is accepting new patients.

Mike Jacobs, senior distinguished engineer with Optum, said that “as this information changes, it often takes several calls and emails from the payers to verify the updated data. This results [in] redundancy and inefficiency as health plans reach out to the same providers to request and verify information.”

Inaccuracies can result in significant financial penalties, as insurers can be levied fines of thousands of dollars per day, the sources stated.

Walker told PYMNTS that “we believe that a permissioned blockchain is the most suitable approach for our pilot. A permissioned blockchain will enable the alliance to confidently manage participation on our blockchain while providing us the flexibility to install the blockchain across our alliance member enterprises … In order to measure the true value of this approach, the alliance intends to use a geographic subset of production data in that assessment.”

The alliance companies, Walker explained, will publish white papers and present at conferences throughout 2018.

Jacobs stated that “through the pilot, we hope to evaluate several incentive or economic models to ensure a self-sustaining network. These may range from an altruistic sharing at first but could also include subscription models or a data marketplace within the alliance.”