Humana, Multiplan, Optum, Quest Diagnostics, and UnitedHealthcare on Monday launched a cooperative pilot program that aims to apply blockchain technology "to improve data quality and reduce administrative costs" associated with provider directories.
Daily Briefing is published by Advisory Board Research, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group. UnitedHealth Group separately owns UnitedHealthcare.
It's a big challenge for health care insurers and providers to maintain authoritative, up-to-date directories of all providers participating in a given insurance network. Right now, each organization houses separate copies of the data, and outdated or inaccurate information runs rampant. These inaccurate provider directories can result in delayed and unpaid claims, as well as additional administrative work for providers and staff, Forbes reports. CMS also penalizes insurers that have inaccurate directories.
Overall, according to the organizations launching the pilot, reconciling mismatched provider directory data can cost as much as $2.1 billion per year.
About blockchain and the pilot program
Blockchain is an emerging technology that allows decentralized communities to establish a shared, trusted, permanent record of transactions. Its decentralized approach and tamper-resistant features have attracted broad interest within health care.
According to Forbes, the latest pilot program aims to improve the accuracy of provider directories by capitalizing on blockchain's ability to create a secure, distributed provider directory that is updated in real time. "The idea is that we use a blockchain as a way to streamline the back office operations of the payers," Mike Jacobs, senior distinguished engineer at Optum, said of the program.
Specifically, the program will:
- Assess how to use blockchain to ensure all participating organizations have the most current data in their provider directories;
- Examine how using blockchain to share information can boost accuracy, improve care access, and hone administrative processes; and
- Test whether "sharing provider data inputs and changes made by different parties across a blockchain … [can reduce] operational costs while improving data quality."
The program will run through the end of the summer, and the organizations plan to share the results of the pilot in the fall, Forbes reports.
Jacobs said of the initiative, "Our effort to improve the quality of care provider data is a pragmatic and potentially effective way to leverage technology to help those we serve. We envision the possibility of effecting change at scale—supporting our mission of helping make the health system work better for everyone."
David Murtagh, VP of operations at MultiPlan, added, "With increasing state and federal requirements relating to provider data maintenance and quality, tackling the high cost and redundancy in this space is a logical starting point. … We're looking forward to exploring how blockchain technology can make the process more efficient while reducing costs, ideally to build investments that can enhance the provider and patient experiences."
Separately, Lidia Fonseca, CIO at Quest Diagnostics, said, "We are connected to more than 650 [EHR] platforms and a majority of health systems and physicians in the U.S., so we bring a unique level of insight into how to connect people and organizations across health care." She added, "We see this as an opportunity to provide a national critical infrastructure so we can improve the quality of the data and make the whole system more efficient and reduce costs" (Arndt, Modern Healthcare, 4/2; Japsen, Forbes, 4/2; Kent, HealthITAnalytics, 4/2; UnitedHealth Group press release, 4/2).
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