Blockchain Leaders Share Details on Phase-One Provider Data Management Initiative

Aug. 27, 2020
In the Alliance’s phase-one work, participants used its blockchain functionality to identify up to 88 percent of necessary demographic data corrections across the members’ shared data for address mismatches and inactive locations

Late in 2018, several major healthcare stakeholders announced their intentions to join the Synaptic Health Alliance, a group that wanted to explore how blockchain technology could improve healthcare data quality and reduce administrative costs.

The Alliance—originally formed by Aetna, Humana, MultiPlan, Optum, Quest Diagnostics and UnitedHealthcare—now has 11 members, whose joint goals are to specifically explore how blockchain technology could help ensure that the most current healthcare provider information is available in health plan provider directories. At the time, officials noted that “Providing consumers looking for care with accurate information when they need it is essential to a high-functioning overall healthcare system.” The project’s leaders have pointed out that 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 across the healthcare system acquiring and maintaining provider data.

As such, Synaptic believes that blockchain technology provides an excellent opportunity to explore how collaboration can help transparently share information, automate mutually beneficial processes and audit interactions. “There isn’t a source of data that’s national and has a broad scope of 100 percent accuracy,” Kyle Culver, director, emerging technologies at Humana, says in a recent interview. “Because of that, we needed to collaborate together to better understand [which organizations] had quality data, and how we can quickly get quality data when something has been changed. A lot of the activity in our first stage was focusing on sharing data, looking at what the overlap was, what the opportunity is within that overlap, and then moving more into how we can share work,” Culver says.

In the coalition’s pilot project work, Synaptic members used its blockchain functionality to identify up to 88 percent of necessary demographic data corrections across the members’ shared data for two of the most common errors in provider directories: address mismatches and inactive locations, which refer to sites where providers were once seeing patients and are no longer doing so, according to officials.

Mike Jacobs, technology fellow and senior vice president of engineering at Optum, says that when the Alliance was first formed, the thesis was that they’d be able to reduce costs and improve quality by sharing provider data across the blockchain. “When we first started, we wanted to make membership compelling, so the [provider data management] use case was one of the first ways to make [that happen]. We wanted to maintain a low barrier of entry in terms of how much it might cost to join the Alliance, what the legal requirements would be, and who would be leading the effort. We didn’t want to have a dominant presence by any one entity, but instead have a distributed leadership approach,” he says.

In regard to the low barrier of entry, one key lesson learned from putting the collaborative together, Jacobs notes, was to start with a memorandum of understanding, and then use that as a way of getting started, as well as to iteratively figure out what works and what doesn’t before actually memorializing the agreement in a more formal alliance agreement. “While some other alliances might start with a governance or agreement-first approach, our lesson learned was that we made progress while we were building that final legal contract,” he says.

Currently, Jacobs explains, there are six teams that comprise the Alliance, starting with an operations team that helps run the organization and an executive team that ultimately makes the large strategic decisions. The day-to-day execution team is responsible for tracking progress of the projects, which are all being built on a utility that a technology team is building. Then there is a business stakeholder team that is focused on creating the best business value, providing critical feedback into the direction of the projects. Finally, there is a marketing and communications team that has shared results and experiences at conferences.

Leaders of the Alliance believe that the potential of blockchain in healthcare “is staggering given the need to improve and streamline how healthcare data is managed and ensure security.” Specific to provider data management, they contend that industry stakeholders can work together to leverage blockchain technology to help ensure that data is accurate and sharable for reliable use across the healthcare ecosystem.

Explaining the specifics of blockchain technology for this specific work, Jacobs says that it’s being used in combination with a distributed file system called the InterPlanetary File System (IPFS). One lesson learned, Jacobs recounts, “was that you don’t want to put a lot of data on the blockchain, but rather information about transactions. Information is being exchanged via the IPFS.”

One reason why this technology is uniquely beneficial to this particular use case, he adds, is that this specific business problem is one that’s a shared business problem across multiple enterprises. “There is somewhat of a distrust among competitors that results in a reluctance to agree on a centralized single entity controlling a single solution approach,” he notes. Rather, Jacobs continues, “This distributed technology allows us to provide the freedom of each organization to manage their own technical infrastructure by themselves, while simultaneously participating in the collaboration across enterprises without depending on a single entity running either the infrastructure or the alliance. So that reduces that barrier of entry in collaborating on business problems because each organization has control of its own destiny when it comes to the data, how it’s used, business continuity concerns, data availability, recoverability, latency issues, and all sorts of things that enterprises are concerned about when using a centralized service from a third party.”

Jacobs acknowledges that one challenge with the project has been that technical staff with experience in blockchain technology “are exceedingly expensive and rare. So we had to grow our skills within our existing staff,” he says. Another challenge, he notes, has been the group’s “ignorance around the capabilities of the various technologies. We’re on our fourth technology choice now,” he admits. Along the way, he recalls, the group faced several technology barriers, such as fearing that it won’t scale to a national level, or that it wouldn’t technically scale from a network standpoint, or that they weren’t getting enough support from the software supplier, leading them to move onto another option. “And it really has to do with the lack of maturity in the technology and how fast it’s moving. We’re dealing with very early and evolving technology, so it’s a bit of a moving target,” Jacobs says. 

Nonetheless, leaders of the Alliance believe that they intimately understand the key aspects of building a consortia of healthcare companies that can deliver value in different ways. Building a collaborative culture among several different companies with different ideologies can be challenging, but Jacobs and Culver believe they’ve figured out a way to make it work. Next up for the group, says Culver, is moving from the Texas market, which was the original focus, to other geographic areas such as Colorado, Florida and New York. According to the group’s leaders, “We recognize that in order to build an effective solution, the Alliance and blockchain network will need more participants from the healthcare industry. As we move forward with our pilot project and open the Alliance to other organizations, we will look forward to adding those with similar attributes.”

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