Decentralized Network: How Does It Work?

In a previous blog, we discussed a new approach to interoperability that doesn’t require data to be requested, aggregated, and validated each time it’s used or shared. Unlike a traditional network design, a decentralized network enables healthcare stakeholders to access continuously refreshed, always current data in real time with permission, allowing them to communicate, transact, and collaborate with any other network participant. Innovators can deploy solutions on the network for participants to subscribe to and use. And they can do it without building separate connections to each entity.

In this blog, we discuss how a decentralized network works to enable more effective collaboration, drive innovation, and improve the healthcare experience.

How does a decentralized network work?

On a decentralized network, participants have their own private, secure cloud-hosted environment as their home base. This home base is populated with a prepackaged suite of utilities and services that can be used to create, deploy, and subscribe to solutions on the network, eliminating interoperability challenges and making collaboration easier. This means organizations can spend less time and financial resources deploying and implementing solutions.

An excellent example of how a decentralized network works is the real-time claim adjudication process. This workflow includes:

• A provider submits claims directly to a network payer from their home base instead of through their traditional clearinghouse pathway.
• The network’s real-time adjudication (RTA) solution automatically examines each claim’s details against the payer’s RTA criteria.
• If the claim is “clean” and deemed processable by the payer for RTA, the claim will be automatically directed to the payer’s designated RTA endpoint.
• If the claim is not processable by the payer for RTA, it will automatically be directed to the payer’s traditional clearinghouse endpoint.

The ability for stakeholders to transact directly with each other transforms the business of healthcare, modernizing how it operates and ultimately, can lower the cost of administering healthcare.

How do data security and immutability work on a decentralized network?

On a decentralized network, participants always have control over who can access their data and how that data can be accessed. This is made possible through services that manage and unlock access to permissioned data based on the use case.

When participants join the network, they must register their clinical or administrative data associated with members, patients, and practitioners and given a person ID, a unique network identifier. When the network detects other organizations who share data for the same person ID, data-sharing authorization policies are automatically evaluated to determine if access to data is permissible. Where authorization is approved, data is shared directly and securely between network participants. The network itself does not see or store the data that is shared between participants.

The authorized transactions between network participants are trackable, auditable, and immutable through a blockchain node within each participant’s home base. This effectively lowers issues of distrust, friction, and data hoarding between payers and providers.

How does a decentralized network further innovation?

Taking a new product from an idea to launch to implementation can be faster and more straightforward over a decentralized network, leading to a faster ability to demonstrate value and scale. Using a set of common services in their home base, innovators can collaborate, develop, and deploy new solutions over the network without having to build a separate connection to each customer. Solutions can be optimized to support direct participant connectivity, which enables them to be deployed in a distributed method to each participant’s home base. Network participants can discover, offer, and source solutions right on the network without the need for a third party to act as a central data authority.

In this way, a decentralized network becomes the perfect conduit for a marketplace for innovators that features an exchange of solutions, helping bring new products and services to market faster. The network also promotes financial transparency, which can transform claims adjudication workflows and reinvent the way payers and providers work together.

How does a decentralized network improve the patient experience?

The administration of healthcare—those back-end processes like coverage discovery, prior authorization, and collections—are highly complex and often involve inefficient, manual, error-prone workflows that can impede a patient’s ability to receive timely access to care and know how it will cost. A decentralized network provides an entirely new way to administer those processes by:

• Leveraging FHIR for standardizing data
• Allowing real-time, permissioned access to accurate data for all healthcare stakeholders
• Enabling processes that used to take days or weeks to be completed within seconds or minutes
• Eliminating time-consuming, manual, error-prone workflows
• Giving providers the information they need when and where they need it to provide high-quality patient care

In Part III of our blog series, we will share top use cases for a decentralized network along with case studies of a decentralized network in action.