Instead of continuing to add fixes on top of a broken system, healthcare needs to create a new, better system—a system built with a new kind of interoperability.
Lack of interoperability has been the bane of healthcare for decades. That’s not to say there hasn’t been progress. In March of 2020, HHS announced that it had finalized two rules that would give patients “unprecedented safe, secure access to their health data.” The new rules can put patients in control of their data while increasing transparency and security.
This is fantastic news for patients and long overdue. But when will providers and payers achieve the same interoperability, transparency, and access to real-time data to help reduce administrative burdens, lower costs, and improve outcomes? While initiatives such as FHIR (Fast Healthcare Interoperability Resources) are making substantial headway, there are still barriers standing in the way. Concerns about security and trust combined with interoperability and operational challenges between payers and providers continue despite immense progress.
But there is new hope that an answer may be at hand and it’s coming out of the private, non-healthcare sector.
Seamlessly sharing data among multiple entities is a challenge that other industries have already solved. Zelle is a prime example. In the past, if an individual wanted to send money to another person, they had a number of options—all manual. They could wire the money through a financial institution for a fee. They could write out a check and send it through the mail. Or they could go to their bank and get a money order and send it to the recipient. Once received the recipient would have to sign the check or money order and take it to the bank, then wait. It could take days, sometimes more than a week, for the deposit to be validated and accepted. Even wired money can take three or more days to process.
Today, consumers can use Zelle. All they need to do is sign up for a Zelle account with their bank and begin transferring funds – with only a phone number or email from the recipient. With Zelle, funds move between financial institutions on a financial network with multiple parties seamlessly interacting. It all takes place through a single connection point.
It begs the question as to why a similar approach can’t be taken with healthcare data. In fact, it can. While medical clearinghouses already share claims data between providers and payers, they work in a closed, linear system. What healthcare needs is a single, secure network that acts as an intermediary and neutral party to govern access within each transaction—not just clinical transactions, but administrative transactions as well. The network needs to include:
The key is blockchain technology, which can help improve collaboration and increase trust among multiple stakeholders from different enterprises. First, blockchain can enable members to access information on a single network, to help alleviate redundancy and provide consistency of records. Second, it provides secure, tamper-evident storage of transaction data and permission-based access to stored information so that the information can be protected and more reliable, and its provenance can be verifiable.
Having a centralized location for the data means payers and providers don’t have to build and maintain multiple connections and expensive APIs with each other’s systems. Fewer touchpoints mean fewer opportunities for security issues, not to mention providing reduced IT costs and resources needed to manage those gateways.
“A blockchain-powered health information exchange could unlock the true value of interoperability”
First, payers and providers must agree to participate and to commit data to the cloud, allowing it to be discoverable based on permissions that are set by each party. Members of the network connect via the cloud, where the ID keychain and master index match requested data to available data, locate the information and deliver it to the requestor. Certifications, cybersecurity, and compliance are all managed by an outside intermediary.
With this type of network, healthcare could vastly reduce administrative burdens like eligibility verification and prior authorizations. All information could be available in real time, reducing the time-consuming back and forth faxes, emails, and phone calls seeking information. Payers benefit by having the ability to reduce fraud and abuse. Providers benefit from fewer denied claims for administrative reasons. Both can benefit from greater efficiencies, lower costs, and improved member/patient satisfaction. Patients can benefit from a reduction in paperwork and timely access to better coordinated care.
The 2020 CAQH report suggests that the healthcare industry could save $16.3 billion, or 42 percent of existing annual spend, by transitioning to fully electronic transactions
If we think of healthcare as an orchestra, payers and providers have their own sections but must play together to create the best outcome. And patients? They’re in the audience, watching what we do next.
The bottom line is that we all need to play together well with a focus on delivery of quality care for patients. But we can’t do that without trust and transparency. With blockchain technology, we now have the ability to make this long-sought-after dream a reality. According to Deloitte, “A blockchain-powered health information exchange could unlock the true value of interoperability.” Patients are waiting- the time to act is now.
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