A new blockchain alliance that wants to improve the accuracy of provider information just added two healthcare powerhouses to its efforts.
Aetna and Ascension have joined Synaptic, the blockchain-focused alliance launched earlier this year by UnitedHealth, Humana, Multiplan and Quest Diagnostics. The group, which now includes three of the nation’s largest payers and a health system that employs 34,000 providers, is focused on using the distributed ledger technology to improve the accuracy of provider directories.
Inaccurate directories have plagued payers for years. An audit released by the Centers for Medicare & Medicaid Services (CMS) in January found 52% of provider directories in Medicare Advantage plans contained at least one error. CAQH estimates the healthcare industry spends at least $2.1 billion annually to maintain directories, and as much as 75% of those costs could be offset with an “external source of truth.”
That’s part of what the organizations that founded Synaptic aim to tackle.
“Each of our organizations expends a tremendous amount of energy and effort trying to get this data as good as it can be,” Jason O’Meara, senior director of architecture at Quest Diagnostics, told FierceHealthcare. “The challenge is when we’re doing this in independent silos it leads to duplication of efforts.”
O’Meara says the group is still in a “testing phase,” and the addition of Aetna and Ascension brings two more industry giants with expertise in healthcare technology that are open to testing new strategies to improve the efficiency of healthcare.
Unlike payers that interact with providers digitally, Quest has a physical relationship, visiting physician offices all over the country to collect samples. That means the company is among the first to know when a physician switches locations or begins working in a new clinic.
Describing Quest as the “dark horse” in the group, O’Meara says while health plans are scrambling to collect information as much as 90 days after a new practice opens, Quest often knows “several weeks in advance” because new locations need supplies and the capability to order diagnostic tests from day one.
“The first day a practice opens up, they need internet, a telephone provider and they have to have a diagnostics provider,” he said.
Early data show pockets of opportunity
A pilot analysis by Synaptic’s founding members shows the organization may be able to capitalize on one particular pain point: discrepancies between active and inactive physician records.
Analyzing information on just over 100,000 providers in Texas accounting for more than 579,000 records, the group identified nearly 112,000 inactive records, often because a physician stopped working at one clinic and began working at another.
Those inactive records create a clear source of confusion. In nearly 20,000 instances, one organization identified a record as inactive while another organization believed the record to be active.
There are different solutions to this problem, including coordinated outreach to ensure health plans are aware of an inactive record. But blockchain technology could create a system of trusted data exchange that would allow multiple organizations to see when a physician no longer works a specific location.
In a new white paper (PDF), the groups say blockchain technology "enables the efficient creation of a synchronized, shared source of high-quality provider data" where "transactions are recorded chronologically in a cooperative and tamper-resistant manner, and updates entered by any party on their record are replicated almost immediately across all the other parties’ copies."
“We want this to be a public utility that every health plan and provider can participate on,” O’Meara said. “There’s no other technology we’re aware of that would allow for that type of robustness.”
But the organizations also want to create a stable business model, not a solution that relies on expiring grant funding that eventually dries up. O’Meara said the groups are still exploring whether to commercialize a solution, but “we do have to think about how to structure this that it continues to function in the long term.”
For Ascension, with its 34,000 providers across 21 states and the District of Columbia, streamlining the way that provider data are communicated internally and to insurers would help “tremendously,” says Gerry Lewis, the health system’s senior vice president and CIO and CEO of Ascension Technologies.
Lewis says provider directories are just the first step in a “100-step dance.” Ultimately he sees an opportunity to leverage a blockchain solution to share patient information.
“Healthcare has to have information that is liquid across the care continuum,” he said.
Editor's Note: This story has been updated to correct the number of records Synaptic reviewed as part of its Texas pilot project.