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Could Blockchain Improve Accuracy of Provider Directories?

Analysis  |  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.

The blockchain technology will enable all five organizations of the alliance to obtain the provider information at the same time. The companies have not released details of how they will implement the technology.

"I wish we had more intel on exactly what they're going to do, but I think they're still pulling all of this together," Pajak says. "The fact that they're using blockchain is innovative and intriguing, and now we have to wait and see exactly what they're doing with it."

Errors frustrate consumers, increase costs

The alliance is an offshoot of the pressure health plans are experiencing to provide better value and less cost, Pajak says.

One of the headaches consumers face is inaccurate information about which doctors are covered in their network, which can lead to surprise medical bills and being locked into plans they otherwise wouldn't have chosen, Pajak says.

"Provider directories have not been accurate in recent years and that means it has been somewhat misleading to consumers when they were picking their plans in open enrollment. Some people choose their plan based largely on whether their particular physician is in that network, and by the time they find out the directory was inaccurate, they're stuck in that plan for the rest of the year," he explains.

"The same problem occurs once you're in the plan and you need to see a specialist, for instance, and you consult the online directory to determine who you see. The information in the online directory often is incorrect and that leads to consumer frustration, added expense, and sometimes compromises quality of care if people are discouraged from seeking the care they need," Pajak says.

Consumer engagement at stake

The blockchain pilot could lead to cost savings for the participating organizations, as well as employers, by making it possible for consumers to make more informed decisions about their healthcare.

They can't do that without accurate directories, Pajak notes.

"For consumers who are trying to do the right thing and follow this advice from their health plans and their employers, their expectation is that the data is accurate," he says.

"When they go to the provider they think is in-network and then weeks later they receive a bill for out-of-network services, you end up with effects that go beyond just the initial hit to the pocketbook of that consumer. The experience undermines the whole effort to promote value-based care and get people involved in that decision-making, because people talk to their friends and family about their bad experience," he says.

If the pilot is successful, using blockchain to address the provider directory may be just the first step, Pajak says. Once the insurers prove the concept with improved accuracy in the directory, the technology also could be used to address cost transparency, he says.

Healthcare is one of the few business transactions in which the consumer often does not know the actual cost of the service until afterward, Pajak notes, despite much lip service in recent years about improving transparency.

Efforts to improve transparency have been hampered by the same sort of data-gathering burden that results in incomplete and inaccurate provider directories, he notes.

"If you take the blockchain technology beyond the provider directory and address transparency, that's where you really have the potential to affect costs in the future," he says. "Having insurers collaborate like this to build a single ledger of providers is something that we could build on in the future and do greater things."

Gregory A. Freeman is a contributing writer for HealthLeaders.

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