Imagine our country without interstate highways, where each city must build its own roads to every other city. Traveling between two cities would be easy enough but traveling between 100 cities would be a nightmare. And the money and time needed to create such a micro-network infrastructure would be monumental. Yet, this is the scenario playing out every day in healthcare as hundreds of payers, providers, and vendors build one-to-one pipelines with each other to exchange data. Even then, the data has to be aggregated, normalized, validated, and combined to form a single data set, which results in numerous silos of aggregated data. It’s a far cry from true interoperability.
We need a brand new way of administering healthcare. Today, we’re trying to address our interoperability issues with workarounds, bolt-on technologies, and more APIs. To truly fix healthcare, we have to take a step back and reimagine a new way. We need to come together and look at the problem through a new lens — from the perspective of the patient and with the patient in the center. After all, healthcare is human…not merely a business process.
Reinventing the system
Instead of hundreds of one-to-one pipelines, wouldn’t it be better to have a one-to-many, decentralized, peer-to-peer network that connects all stakeholders across the country, allowing them to access information in real time? Like an interstate highway that enables true mobility without limitations, a one-to-many network enables true data fluidity. Such a network provides a conduit—a superhighway—through which payers, providers, and vendors can access the data they need when and where they need it.
An exchange is not the same as a decentralized network. The former requires data to be aggregated and validated. The latter enables full access to immutable data wherever that data lives—without the need for aggregation.
In such a network, each permissioned participant acts as a node on the network. All nodes have access to the same information at the same time and can use or reuse the data with other participants for varying purposes. And because the network is decentralized, no node can tell any other node what actions it can or cannot take, or with which entities it can or cannot share data. No single entity has the ability to control, delete, or change what other entities do.
Another benefit of this type of network is that it provides ultimate security in that there’s no longer a need to reconcile data. Each permissioned participant is the author of its own data instead of sending it to a third party (centralized); the data remains in the participant’s control (decentralized). And each participant is able to reuse the data for different purposes.
There are dozens of use cases already identified for a decentralized network, although the potential is limitless. Coverage verification is a great example. Through a decentralized, peer-to-peer network, payerswould be able to develop the rules, processes, and analytics that provide greater standardization and insight into primary, secondary, and tertiary coverage for network participants. Through a series of preconfigured coverage pathways—or data channels—with automated workflows, coverage data would be continuously refreshed, validated, and discoverable. When a discrepancy exists, such as missing or inactive coverage data, the network could automatically inform the payer so that the information can be updated. Without a single transaction being created, the most up-to-date coverage information would always be available for any permissioned participant to access.
Prior authorization is another example. What is often an excruciating process for providers could be completed within minutes instead of days or weeks, eliminating delays in care. Prior authorization requirements would be instantly available, giving providers the ability to submit their authorization data in real time right over the network. No more back and forth between the provider and payer while patients wait.
These are just two examples that highlight the value of data fluidity. This goes way beyond automation, exchanges, and aggregation. It’s an entirely new way of doing business.
Even beyond clinical and administrative use cases, a decentralized network enables the creation of a platform of innovative and collaborative services, and a common set of tools that enhance interoperability. Hundreds of entrepreneurs enter the healthcare industry each year with an innovative idea about how to disrupt and fix healthcare’s many problems. Most don’t succeed because they weren’t prepared for the complexities our industry presents. They quickly discover that there are myriads of issues that must be addressed before they can deploy their own solutions. It’s unfortunate that hundreds of brilliant ideas go unfulfilled each year, ideas that have unlimited potential.
The fact is that true disruption can’t happen when data is isolated or aggregated in individual pipelines. A platform of services allows innovators to easily access and collaborate with other innovators, and to more quickly and effectively deploy new solutions to the marketplace. In this way, the platform becomes the foundational element of our industry’s first intentional architecture for healthcare.
Henry Ford once said, “If everyone is moving forward together, then success takes care of itself.”
The transformation has already begun
At Avaneer Health, whose founding members include Anthem (now Elevance Health), Cleveland Clinic, CVS Aetna, HCSC, IBM Watson Health (now Merative), PNC Bank, and Sentara Healthcare, we are building that network, platform, and solutions to accelerate change and lead the change to reimagine how healthcare is administered. We’ve created common utilities to ensure vital collaboration and encourage creative thinking and problem solving. We have engineered a digital ecosystem leveraging truly innovative technology that will give participants the confidence to share critical data in a way that removes traditional barriers, optimizing efficiency and laying the foundation for a completely new experience for all.
Core to our mission is to invite developers and innovators to the network to utilize our platform to accelerate the scaling of solutions for digital health, revenue cycle, analytics, value-based care, SDOH, and more. The Avaneer Network facilitates the ease and speed of connecting to multiple stakeholders across the ecosystem to enable co-creation and encourage trial and testing, supporting speed to market of much-needed innovations.
The journey forward
Data fluidity, not data aggregation, is the key to unlocking the true potential of healthcare. Instead of building more one-to-one pipelines, we need to think bigger.
While Avaneer’s focus is on reengineering the now fragmented and inefficient processes of healthcare administration, we will never lose sight of the ultimate recipient of all that we do—the human being who deserves to receive the care they need, when they need it. Unencumbered by layers of inefficient processes, together we can strive to reinvent the patient experience for good.