These new additions to the Synaptic Health Alliance demonstrate an increasing belief among insurers that blockchain will improve the accuracy and exchange of critical healthcare data

Is blockchain technology ready for widespread use within healthcare? New developments show a growing interest among major health insurers to incorporate blockchain technology into their ongoing operations. As this happens, clinical laboratories will need a strategy, since a large proportion of all health data is made up of medical laboratory test results.

Dark Daily previously reported on how blockchain technology—with its big data and systemwide integration to existing healthcare provider directories—could alter how clinical laboratories obtain/store testing information and bill/receive payment for services rendered. We also covered how blockchain could enable insurers to instantly verify beneficiary’s coverage and attain interoperability between disparate electronic healthcare record (EHR) systems, including laboratory EHRs.

Now, insurers Aetna and Ascension have joined founding members UnitedHealthcare, Multiplan, Quest Diagnostics, Optum, and Humana in the Synaptic Health Alliance (SHA). These organizations formed SHA last year to “leverage [blockchain] technology to facilitate reaching across industry and competitive lines, creating a provider data exchange—a cooperatively owned, synchronized distributed ledger to collect and share changes to provider data,” according to the organization’s website.

What should be on the minds of every hospital and independent medical laboratory administrator is what will be required to engage in information exchange with such a distributed, non-centralized provider ledger.

What is Blockchain and How Does it Apply to Healthcare and Diagnostic Providers?

The SHA defines blockchain as “a shared, distributed digital ledger on which transactions are chronologically recorded in a cooperative and tamper-free manner [such as a] spreadsheet that gets duplicated multiple times across a network of computers, which is designed to regularly update the spreadsheet.”

Though the SHA’s efforts are still being tested, medical laboratories and pathology groups should note how Quest’s “physical relationship” with healthcare providers—as Jason O’Meara, Senior Director of Architecture at Quest Diagnostics describes it—gives the blood company an advantage. “The first day a practice opens up, they need internet, a telephone provider, and they have to have a diagnostics provider,” he told FierceHealthcare.

“Each of our organizations expends a tremendous amount of energy and effort trying to get this data as good as it can be,” O’Meara continued. “The challenge is—when we’re doing this in independent silos—it leads to duplication of efforts.”

O’Meara notes that while health plans collect needed information for months after a new practice opens, Quest often knows of these new locations “several weeks in advance” because new locations need supplies and the capability to order diagnostic tests from day one.

This physical-relationship advantage applies to all clinical laboratories, because they often are the first to know—and provide supplies to—new provider offices.

This informative video describes three ways blockchain will change healthcare. Click here to view the video or click on the image above. (Photo/video copyright: The Medical Futurist.)

Trimming Costs through Redundancy Elimination

Federal regulations require healthcare providers and payers to maintain frequently updated directories of care providers and services. These directories are then used across and between health networks to determine service availability, coverage options, and other critical elements related to obtaining care and reimbursements.

The Council for Affordable Quality Healthcare (CAQH) estimates the cost to maintain such directories is as high as $2.1 billion annually. Yet, even with that level of spending, a January 2018 Centers for Medicare and Medicaid Services (CMS) audit found that 52% of Medicare Advantage Organization (MAO) provider directories contained at least one error, FierceHealthcare reported.

The errors include providers who:

  • “Weren’t at the location listed;
  • “Didn’t accept the plan at that location;
  • “Who weren’t accepting new patients despite the directory saying that they were; and,
  • “Incorrect or disconnected phone numbers.”

In other words, CMS found that in its own MAO directories, about half of the information enrollees need to make important healthcare choices is either incorrect or out of date!

The SHA intends to change that by using blockchain to create a shared, up-to-the-minute accurate resource with interoperability between all participating providers.

By allowing alliance participants to consolidate directory updates, the system could eliminate silos and drastically reduce time and money spent applying updates to directories individually at each provider.

“We want this to be a public utility that every health plan and provider can participate on,” O’Meara told FierceHealthcare. “There’s no other technology we’re aware of that would allow for that type of robustness.”

Other Efforts to use Blockchain in Healthcare

In January, HealthPayerIntelligence (HPI) outlined another strategic initiative similar to the SHA involving Aetna, Anthem, Health Care Service Corporation (HCSC), IBM, and PNC Bank to create a “health utility network” using blockchain technology “to improve data accuracy for providers, regulators, and other stakeholders, and give our members more control over their own data.”

Lori Steele, Global Managing Director for IBM Healthcare and Life Sciences, told HPI that“blockchain’s unique attributes make it suitable for large networks of members to quickly exchange sensitive data in a permissioned, controlled, and transparent way.”

She continued, “The fact that these major healthcare players have come together to collaborate indicates the value they see in working together to explore new models that we think could drive more efficiency in the healthcare system and ultimately improve the patient experience.”

As medical laboratories continue to endure the financial pressures of healthcare reform, blockchain appears to offer yet another way to increase efficiencies, improve accuracy and accountability, and exchange data between disparate information systems.

While many possible uses for this technology remain in proof-of-concept and pilot-testing phases, pathologists and medical laboratory administrators looking to stay ahead of trends will want to keep up with blockchain as it continues to mature.

—Jon Stone

Related Information:

Aetna, Ascension Join Blockchain Alliance Targeting Provider Directories

Blockchain Collaborations in Health Care Continue to Grow

CMS: Errors Continue to Plague Medicare Advantage Plans’ Provider Directories

The Synaptic Health Alliance: A Look at How Blockchain Technology Could Improve Provider Data Quality

Humana, UnitedHealthcare Launch Blockchain Pilot Focused on Provider Directories

New Blockchain Collaboration Launches with Aetna, Anthem and HCSC

Aetna, IBM Launching New Blockchain Healthcare Network

Aetna, Anthem, HCSC Back Healthcare Blockchain Initiative

Aetna and Ascension Join Synaptic Health Alliance Blockchain Pilot for Healthcare Provider Data

Improving Provider Data Accuracy: A Collaborative Approach Using a Permissioned Blockchain

Blockchain Technology Could Impact How Clinical Laboratories and Pathology Groups Exchange Lab Test Data