The Synaptic Health Alliance tests blockchain technology as a data-sharing mechanism to improve provider directories and reduce the $2.1 billion associated industry cost.
Blockchain in healthcare has received a lot of hype as an innovation that could solve many industry issues, yet the technology has gained little real-life traction. That may be changing.
Six significant healthcare players—most of whom are fierce competitors—have been quietly working together to test a concept in which they are sharing data through blockchain to improve the accuracy of their physician directories. The tedious exercise of updating these databases collectively costs the healthcare industry $2.1 billion annually.
To address this issue and others, Aetna, Humana, MultiPlan, Optum, Quest Diagnostics, and UnitedHealthcare joined forces to create the Synaptic Health Alliance, a non-profit organization, which aims to solve the industry's toughest problems through blockchain technology.
HealthLeaders recently spoke with Alliance member Michael Kim, senior vice president and chief information officer, MultiPlan, who participated in a panel discussion this week about blockchain in healthcare at HLTH, the healthcare innovation conference underway in Las Vegas.
Kim shares a look into the work the Alliance has accomplished to date and the implications for the industry to reduce costs, enhance efficiency, and improve the patient experience. He also reveals insights into the roadblocks that impede more rapid adoption of this technology. Following are excerpts from that discussion, which have been lightly edited for space and clarity.
HealthLeaders: Why has blockchain been so slow to take off in healthcare?
Kim: It's a convergence of a number of different factors. Blockchain has been slow to adoption [due to] technology, business process governance, and culture within the healthcare industry.
[At Synaptic Health Alliance], we're still working through how to make the technology and use cases scalable at an enterprise level. There are some technology constraints, and we're learning that as we adopt our first use case. The second is really a question of process and governance. Healthcare companies are typically not interested in sharing data and information. At its heart, blockchain is about crowdsourcing, and we all need to participate and share for it to work. That's not typically how healthcare companies are oriented today. Also, given some of the regulations we have around HIPAA … and use cases that we're talking about, a lot of them have associated PHI (Patient Health Information). That's something that we're averse to sharing more broadly, so that's part of the reason as well.
HL: Tell me about the Synaptic Health Alliance
Kim: There are six founding companies. Over the next month, a flurry of new folks will join the Synaptic Health Alliance, and it will continue to expand. We all have philosophically agreed that we want to create a utility in the marketplace, and that it's a not-for-profit organization.
HL: What is your pilot blockchain project?
Kim: Our first use case is [managing] provider directory information, and we are starting off in Texas. Every single payer has to validate their provider directory information, [which includes information such as] the doctor's name, rosters, addresses, phone and fax numbers, and office hours. There's a [lot] of information that we all need to validate. [Separately, all payers] call providers for that same information over and over again. Today, about $2.1 billion is spent across the industry on this [endeavor].
HL: Why were provider directories selected as the pilot project?
Kim: We wanted to tackle something that was simple, that didn't have PHI tied to it. Also, there is zero competitive advantage associated with [updating provider directories] because all of this information is publicly available. Synaptic has decided to share this information across [all participating members]. If an update has occurred, we share that information [on the blockchain] so that [our] provider directories are more up-to-date and accurate. CMS is one of the big driving forces behind this. They've said the quality of provider directory information is very poor and they'd like to see payers improve it.
HL: Why is blockchain a helpful solution to address this?
Kim: [Essentially], blockchain technology is a ledger that tells you what updates are happening on that ledger. The data could be stored on it or it could be stored off blockchain. It [shares] a record of what data got changed by which individual on which date because of this reason. You see the history and what information was changed. There are two potential benefits: efficiency and effectiveness.
HL: What results have you experienced?
Kim: Approximately 16% of the calls that [MultiPlan] makes from our outbound call centers today result in a change to the provider directory. As we participate in the Synaptic Health Alliance, our productivity [in Texas] has increased [about] four times that number. About 60% of [those] calls result in changes and updates to our provider directory information. [Kim explains that during this initial phase, callers see that another company has updated information in the blockchain directory, but rather than accepting it, the update prompts them to call and independently verify the update.]
Over time, as we trust that the updates coming through the [blockchain made by other companies, MultiPlan] will no longer need hundreds of people to [update directories]. It's the same with other [participating members] who have thousands of people doing the same thing. Thus that $2.1 billion that we're all spending is going to dramatically reduce over time.
Our provider directory information is more accurate; therefore, CMS is going to be happy as are, hopefully, [the other members of the Alliance]. Ultimately, patients are going to benefit from this too.
HL: What next steps will Synaptic Health Alliance take?
Kim: The pilot will wrap up during the first quarter of 2020, so we're near the end of that journey. It has been successful, and I'm cautiously optimistic given the level of interest that we have and new participants coming [into the Alliance]. Ultimately, the more participants there are, the more likely this is going to be successful.
There are three parts to Synaptic's growth. First, we're adding new states to the pilot, and we have very aggressive rollout plans. Second, we're adding new members to participate in the Alliance. The third growth [initiative] is tied to additional use cases.
We haven't picked the next use case yet, but if we roll this out to a broader set of use cases, there are some really interesting implications. One of the use cases is eligibility in coordination of benefits. [Blockchain] could potentially dramatically improve that overall experience. Other use cases might address patient consent management, or scheduling and booking provider appointments. These other use cases are more provider- and patient-centric, but there's more sensitive information associated with them.
HL: What challenges have you experienced?
Kim: The biggest issue associated with leveraging blockchain to solve problems in the healthcare industry is governance and standardization. You have many large companies, all with different perspectives and different biases—whether it's intellectual property, ownership, business process, data fields, or definition of data fields. This is the biggest obstacle that we need to address.
For example, we wanted to include taxpayer IDs in the provider directory. But one of the participants said, "We can't do that because if it's an individual practitioner, we sometimes use their social security number, and I don't want that on the blockchain." Overcoming even definitional issues or trying to standardize definitions around provider directory data fields has been the biggest challenge and the reason we're moving so slowly.
HL: What have you learned from this experience that has broader implications for innovation in the healthcare industry?
Kim: We've got to take an incremental approach. We tackle one issue at a time. If we can't agree collectively as a set of organizations, we descope it. It would be great to have the taxpayer ID in [the blockchain], for example, but if we can't have it in this iteration, it's not to say we can't do it in the future. [Regardless], we are way better off today than we were yesterday. We don't have to solve for the universe, we just need to be better than we are today.
HL: Is there anything you want to say in closing?
Kim: While governance and standardization were challenging, on the positive side, we have partners that all want to contribute. We are trying to create an industry utility. It's been great working with the other partners because everyone wants to do good for the industry. It's been a fantastic experience for everyone involved because all the participants feel like this is a tectonic shift for the industry. If it's successful, it's going to have significant material implications that are going to provide benefits to many different parties.
“All the participants feel like this is a tectonic shift for the industry.”
Synaptic Health Alliance member Michael Kim, senior vice president and chief information officer, MultiPlan
Mandy Roth is the innovations editor at HealthLeaders.
Alliance members include Aetna, Humana, MultiPlan, Optum, Quest Diagnostics, and UnitedHealthcare.
One participating company improved productivity related to updating provider directories from 16% to 60%.
Process and governance are the primary roadblocks to adoption, says one Alliance member, along with the industry's aversion to share data and privacy concerns.