In December, two major healthcare stakeholders—Aetna and Ascension—announced their intentions to join the Synaptic Health Alliance, a group that has set out to explore how blockchain technology could improve healthcare data quality and reduce administrative costs.
Aetna and Ascension are the latest two organizations added to the Alliance, which began in April 2018 with five prominent players—Humana, MultiPlan, Quest Diagnostics, and UnitedHealth Group’s Optum and UnitedHealthcare. These five companies first announced their intentions back then to specifically explore how blockchain technology could help ensure that the most current healthcare provider information is available in health plan provider directories. “Providing consumers looking for care with accurate information when they need it is essential to a high-functioning overall healthcare system,” officials said at the time.
Some of the Alliance’s key leaders will be discussing the pilot project next week at HIMSS19 in Orlando, and already, a whitepaper has been published by the group.
In a recent interview with Healthcare Innovation, Mike Jacobs, senior distinguished engineer at Optum, recalls that the different organizations involved in the Alliance were separately attending and presenting at various healthcare conferences, and it was during a lunch conversation between Optum and Humana in September 2017 that got the ball rolling on this specific project. “We started to discuss our mutual interest in this very specific use case [for blockchain]—provider data management,” says Jacobs. “And within the next three months, we had all five companies interested. A memorandum of understanding was signed by all the companies, and by January 2018 we were together laying out the foundational principles, goals, and governance approach.”
Why Provider Data Management?
The project’s executives attest that “maintaining up-to-date health plan provider directories is a critical, complex and challenging issue facing organizations across the healthcare system.” They add that federal and state laws require that health plans maintain directories containing basic information about physicians and other healthcare providers. Yet, industry estimates indicate that $2.1 billion is spent annually across the healthcare system acquiring and maintaining provider data.
From a blockchain-specific perspective, Jacobs notes it was important to first realize that the technology was best suited for problems that span enterprise boundaries. “We also concluded that we needed to find a low barrier of entry from a standpoint of use cases considering the nascent nature of the technology,” he points out. Given these two considerations, provider data management fit the bill.
Kyle Culver, principal blockchain architect for Humana, adds that when they were examining the many challenges around data access and the efficiency of data exchange in healthcare, specifically, the Alliance’s leaders began looking at blockchain as a solution that could enable some of those connection points, while injecting transparency and trust. “[We] thought it could [potentially] connect some of the silos in exchanging data. So looking at provider directories was a great stating point since they are public data and fairly narrow data sets to start with,” he says.
Noting the industry estimates which point to $2.1 billion being spent annually “to chase and maintain provider data, with about 75 percent of those costs believed to be redundant,” Jason O'Meara, senior director of architecture at Quest Diagnostics, attests that provider data management “is a real problem of inefficiencies and redundancies.” He adds, “By streamlining and spreading out this operational burden, we think there is a path to higher data quality for everyone in the industry, which will [result in] reduced friction overall.” O'Meara notes that maintaining provider data requires real effort such as making phone calls and sending emails and faxes, and “that’s a lot of friction that occurs between health plans and providers just to keep this information up to date. The administrative burden should be reduced,” he says.
According to the Alliance’s leadership, CMS (the Centers for Medicare & Medicaid Services) has pointed out that provider location and inactivation records are the hardest records to get right. As explained by O'Meara, every health plan has a provider directory with records on that directory indicating that providers work at different locations. Sometimes, a given provider could at more than one location. And when a provider starts serving patients at a new location, the administrative staff there generally wants people to know that this recently-employed provider is now accepting patients. So, as O'Meara outlines, the staff is motivated to have the provider listed on all the health plan directories so that members of the plans can seek care from these in-network providers.
But the flip side of this is when a provider stops working at a location, which is referred to as an inactivation of that record because the provider is no longer seeing patients at this site. “Those records are very challenging to actually pick up on and take down from your provider directory,” says O'Meara. “So that’s one of the core hypotheses that we were exploring last year, to show a path to value for the Alliance’s members—collaboration around identifying inactivations and our ability to respond to those effectively.”
Key Lessons Learned
In the whitepaper, the Alliance noted that through what it is calling the “provider data exchange” (PDX), Alliance members “would be able to actively share data with the aim of showing potential administrative cost savings for payers and providers while demonstrably improving provider demographic data quality and the experience of care for healthcare consumers.”
As such, the Alliance plans to build a permissioned blockchain that would let members view, input, validate, update and audit non-proprietary provider data within the network. As stated in the paper, “The pilot is examining whether sharing the administrative efforts related to provider data management lowers the individual share of that burden for health plans and care providers. It is also testing whether incentives could also be built in to motivate data sharing with everyone in the blockchain network, which would improve data quality and decrease data maintenance costs.”
So far, Jacobs says the lessons learned fall broadly into two categories: technical and cultural. “From a technology standpoint, it’s very important to understand what [blockchain] can really do. There is quite a bit of hype still floating around about what the potential is, but the reality is quite different. Beginning to understand precisely the current state of the technology is important so that expectations could be set around what’s possible,” he says.
And from a cultural perspective, Jacobs points out that multiple enterprises tend to be necessary in a successful deployment of a blockchain solution. As a result, when working with competitors, there are an array of culture thought processes that need to be adjusted to attain a comfort level in working with them, while also building a agree of trust to solve a mutual problem. “Once those companies come together, there is another cultural aspect; figuring out how to work together from a governance perspective,” Jacobs says.
Another key factor in the group’s work has been the type of blockchain chosen. According to the whitepaper, the Alliance’s technology team prototyped two blockchain technology stacks for the pilot, ultimately choosing Quorum, a J.P. Morgan project, which is an enterprise-focused version of the Ethereum blockchain.
Per the whitepaper, and the group’s leaders, the Alliance is deploying a multi-company, multi-site, permissioned blockchain. “Unlike a public anonymous blockchain, the Alliance consciously chose to deploy a permissioned blockchain. This is a more effective approach, consistent with enterprise blockchains,” according to the paper.
And as Jacobs points out, one of the objectives was to ensure that there would be maximum flexibility in the ability to accommodate any choice that an Alliance member made in terms of deploying its nodes based on its enterprise requirements. “We have elements of our blockchain on the Amazon Web Services (AWS) infrastructure, part on the Microsoft Azure infrastructure, and part implemented in private data centers. As we grow the Alliance, we want to make sure we are offering the maximum choice. It becomes an individual/corporate decision as to which avenue to take,” Jacobs says.
Next Steps
The group’s executives are currently laser-focused on the launch of their provider data exchange, although the Alliance governance structure has been set up to allow for exploring the application of blockchain technology to other use cases, if desired.
When asked specifically about a commonly-refenced use case in health IT circles—that blockchain technology might someday serve as a replacement for health information exchanges (HIEs)—O'Meara points out that the Alliance has not directly addressed personal health information data sharing yet, as there are lots of regulatory burdens associated with that, in addition to plenty of issues around security.
As far as how long it might be until blockchain becomes a consistently used technology in healthcare, the Alliance’s leaders are in agreement that we’re probably at least five years away. “Five years would be the earliest,” says Jacobs. “And that’s largely because there are a number of prerequisite problems that need to be addressed around identity—how we uniquely identify people on a blockchain, and also around data ownership in terms of patients owning their information.” O'Meara adds, “We will probably will see inroads [made] on more specific, narrower use cases first, but as far as widespread adoption, I would say a five-to-seven-year timeframe.”
