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Payers, providers peg blockchain to improve demographic data

An initiative to assess how blockchain technology can be used to improve the veracity of healthcare data is gaining new participants.

Health insurer Aetna and Ascension, the nation’s largest Catholic delivery system, have announced they are joining the Synaptic Health Alliance, a pilot program that’s studying how blockchain technology could benefit the healthcare industry.

This past April, five health insurers and clinical laboratory Quest Diagnostics launched the Synaptic Health Alliance to assess how blockchain technology could be used to ensure the most current provider information is available in health plan provider directories, thus making it easier for consumers to have the right information when seeking care.

Aetna brings its 22 million insurance members and will contribute to building innovative solutions with alliance partners. Ascension brings a provider view to the complexities of contributing to accurate care provider directories.

“By working together with organizations across our industry, rather than through unique and separate data collection solutions, we can enable members on their journey to good health as well as be a partner to care providers,” says Paul McBride, vice president of network strategy and provider experience for Aetna.

State and federal laws require that insurers maintain directories with information on physicians and other types of providers.

In addition to Quest Diagnostics, the original members included Humana, MultiPlan, Optum and UnitedHealthcare.

With estimates that more than $2 billion is annually spent acquiring and maintaining provider data, the pilot program explores how blockchain can be used to share data to unveil administrative cost savings for payers and providers while improving the quality of provider data, which will enhance consumers’ experiences.

In a white paper, participants note that bad provider data hurts all stakeholders, while health plans are especially vulnerable as they can face penalties of as much as $25,000 per day per beneficiary or be banned from new enrollment and marketing if their directories have high error rates. Patients finding that the insurance information they have on physicians, locations, hours, services and other metrics are wrong can undermine confidence in an insurer.

Further, because payers and providers often maintain separate copies of provider data, when discrepancies are found efforts to reconcile them are time-intensive and costly.

Aetna headquarters in Hartford, Conn.

Blockchain, however, enables creation of a synchronized and shared source of provider data through a decentralized and distributed ledger across a peer-to-peer network, according to authors of the white paper.

Transactions are recorded chronologically in a cooperative and tamper-resistant manner and updates entered by any party on their record are replicated immediately across all the other parties’ copies.

Also See: Work beginning on blockchain needs good healthcare use case

When updates to a transaction are entered and accepted, the updates amend, rather than alter, those transactions. All transactions and updates remain visible and unchanged, providing a real-time audit trail and ensuring data integrity.

Provider data management issues that the Synaptic Health Alliance will first tackle include dependency of the healthcare system on accurate provider data; the pervasiveness of inaccurate provider data; the negative impact of widespread provider data errors on consumers; the inefficiency of current provider data management processes; the non-proprietary, non-competitive nature of provider demographics and, therefore, the low barrier to sharing and comparing data across companies.

More information is available here.


Joseph Goedert

Joseph Goedert

Goedert is senior editor of Health Data Management, a SourceMedia publication.


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