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The first health insurance company to master blockchain will 'rule,' expert says

Blockchain will eventually connect payers not only to providers, but to pharmacists in an end-to-end transaction from first encounter to post-op.

Susan Morse, Managing Editor

Blockchain brings at least three advantages to payers, according to Arun Ghosh, KPMG's blockchain leader.

First, it gives them the ability to keep a record of transactions.

Secondly, blockchain can be augmented to connect payers to the EHR.

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And it can be used to automate time-consuming tasks, such as claims adjudication and prior authorization.

In the broader landscape, blockchain can connect payers not only with providers, but to distributors and pharmacists in an end-to-end transaction from the first encounter to post-op care.

"The first payer that gets this, rules," Ghosh said.

One company, Myndshft, has tweeted that it has this capability today. 

The biggest roadblock to this smooth pathway of information sharing is trust.

"First, there must be trust, and the appetite from providers to share with payers," Ghosh said.

The desire is already there for single access. Many providers have outdated data storage in their revenue cycles, or their electronic health records are fairly siloed.

In the claims system, blockchain can create cryptographically secured medical records.

An agreement written into the code in smart contracts can manage prior authorization across a distributed, decentralized blockchain network.

"We can now underlay systems with a layer of blockchain," Ghosh said. "The proof of concepts are over, we're moving to a pilot stage. We're not using to scale as yet."

Ghosh recommended that insurers starting out in blockchain begin with a low-risk option that realizes returns within 12 weeks. This is because blockchain must be seen as driving value, whether in cost savings, better fraud protection, a boost in transparency or an improvement to administrative functions.

"We strongly advise to start within the four walls of the enterprise with claims, in which one or two parties control the outcomes," he said.

Change Healthcare recently did this with a new cloud-based, blockchain-enabled network deployed on Amazon Web Services that allows for secure financial transactions through the claims process.
Payers and providers can track in real time the status of claims submissions and remittances. There is an immutable, auditable and accessible record, reduced administrative costs and near real-time claim adjudication, Change said.
Provider directories are another area ripe for blockchain.

Maintaining up-to-date health plan provider directories is critical, complex, challenging and mandatory.  Federal and state laws require that health plans maintain directories containing basic information about physicians and other healthcare providers.

Industry estimates indicate that $2.1 billion is spent annually acquiring and maintaining provider data, according to information provided by Optum, which launched a pilot project in April to take on this challenge.

Optum began the Synaptic Health Alliance pilot project with four other companies: Humana, MultiPlan, Quest Diagnostics and UnitedHealthcare. In early December, it added Ascension, the large, Catholic health system, and Aetna, which just merged with CVS Health.

"UnitedHealthcare invests billions annually in data, analytics and innovation …" said Phil McKoy, chief information officer for UnitedHealthcare. The insurer's participation in the blockchain alliance is part of its broader approach in the use of technology for healthier lives, he said.

The pilot is exploring how blockchain technology can be used to  share data, show potential administrative cost savings, improve provider demographic data and improve the consumers' healthcare experience.

"Blockchain is the trigger that brought us together, but the collaboration to solve widespread healthcare problems is our real goal," said Mike Jacobs, senior distinguished engineer at Optum. "We envision the possibility of effecting change at scale – helping to make the health system work better for everyone."

Twitter: @SusanJMorse
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