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Could Blockchain Improve Accuracy of Provider Directories?

By Gregory A. Freeman  
   May 02, 2018

An alliance of five healthcare organizations will run a blockchain pilot to create a provider directory. If successful, the approach could lead to cost savings.  

Two health plans and three healthcare companies are combining forces and using the latest technology to improve what consumers think should be a fairly straightforward task – telling them what healthcare providers are covered by their insurance.

If successful, the approach could lead to cost savings across the board.  

The blockchain pilot involving Humana, UnitedHealthcare, Optum, Quest Diagnostics, and MultiPlan is the latest example of how the pressure of creating value-based care is spawning innovative partnerships, says Ben Pajak, strategy lead with Willis Towers Watson.

The participating organizations are piloting a blockchain program aimed at helping payers optimize their mandated provider directories.

The alliance is thought to be the first national one to use blockchain, a technology originally developed for the digital currency Bitcoin. With blockchain, information is held on a shared database that is constantly updated; if one participant updates a data set, that updated information is available to all participants immediately.

"Today, UnitedHealthcare may make an update in its directory, but Humana didn't get that change in the status of that provider so their separate directory is not updated," Pajak says. "It's about combining forces in a way that decreases the work for everyone involved while improving the quality of the data."

CMS wants accurate directories

The health plans are looking for help from technology such as blockchain because the Centers for Medicare & Medicaid Services now requires them to provide consumers with accurate information on providers and imposes fines if they don't.

CMS completed its second round of Medicare Advantage online provider directory reviews between September 2016 and August 2017 and found that 52.2% of the provider directory locations listed had at least one inaccuracy, including the provider was not at the location listed, the phone number was incorrect, or the provider was not accepting new patients when the directory indicated that they were.

Across all provider directories, the percent of locations with inaccuracies ranged from 11.20% to 97.82%. The majority of the directories (37 out of 64) had between 30% and 60% inaccurate locations.

Gregory A. Freeman is a contributing writer for HealthLeaders.

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