WellCare, Spectrum Health join new blockchain effort focused on provider credentialing, directories

Add Wellcare, Anthem and Spectrum Health to the list of healthcare organizations intrigued by blockchain. (Getty/ismagilov)

Two national insurers and a Michigan health system are joining a new pilot project aimed at simplifying physician credentialing with blockchain technology.

WellCare and Spectrum Health are among the founding participants in a pilot project launched by ProCredEx, a new company backed by Hashed Health, which specializes in blockchain and distributed ledger technologies for healthcare.

National Government Services, an Anthem-owned federal contractor that processes Medicare claims for the Centers for Medicare & Medicaid Services (CMS), has also joined the pilot program alongside The Hardenberg Group and Accenture.

The organizations want to leverage blockchain technology to streamline the physician credentialing process. Anthony Begando, ProCredEx's co-founder and CEO, says the distributed ledger technology will allow providers to verify when certain information was last confirmed by another provider. If it works, it will reduce time spent verifying simple information like licenses, medical school and residency completion.

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Currently, that credentialing process takes between six and eight months for one physician, according to Begando, and hospitals forfeit up to $7,500 a day in net revenues during that time. Begando admits he’s not sure how much time a blockchain solution can save, but he hopes to have a better idea with help from companies like WellCare and Spectrum.

Ultimately, a faster process could reduce the $150,000 hospitals lose for each month a physician is still being credentialed. Spectrum Health’s Vice President of Medical Affairs Matthew Denenberg also noted that the solution could solve challenges tied to the system’s “expansion into growth areas such as telemedicine and outpatient care.”

Giles Ward, the chief operating officer of Hashed Health, spent a decade in the dialysis business before joining the company and saw firsthand the difficulty of physician credentialing.

“We could build a clinic faster than we could credential a doctor who was practicing in a competing clinic across the street,” he told FierceHealthcare.

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Payers, meanwhile, see an opportunity to use blockchain to improve physician directories, which are notoriously plagued with inaccuracies. The technology would allow insurers to update and verify physician information, much of which is associated with credentialing data.  

Insurers appear intrigued by this possibility. Earlier this year, Humana and UnitedHealthcare were among a handful of companies that said they were teaming up on a blockchain project to improve provider demographic data. Last year, a survey showed that 70% of payers believed they would integrate blockchain technology by 2019.

Begando admits there is “a ton of noise around blockchain,” but says the group has a narrow focus and interest from dozens of other large organizations.

“We’re using blockchain because it creates software-driven trust, and in our use case, trust is the apex of the problem,” he said. “If we can leverage blockchain to say, ‘This document is real and relied upon,’ we won’t have to spend two months finding it.”