Mitigating Cybersecurity Events with a Decentralized Network

Ransomware attacks like the one that happened to Change Healthcare in February of 2024 have grown more frequent in healthcare, with 460 attacks in the U.S. in 2023. According to the Department of Health and Human Services, threat actors have become increasingly aggressive in the healthcare sector, targeting both “known and unknown weaknesses in a victim’s environment.” The U.S. Department of Health and Human Services (HHS) suggests ransomware generally moves laterally throughout a network so segmentation can help limit its impact by containing the event within a single segment. This built-in segmentation is one of the benefits of a decentralized network.

What is a decentralized network?

Typical system architectures are designed with a central server through which all information and actions are processed. Conversely, decentralized networks are designed to use multiple distributed nodes, each acting in the same capacity as a central server while still managing its own information and connecting with other nodes.

In a decentralized architecture, if any single node on the network encounters an issue, it can be taken offline or isolated.

How does a decentralized network work?

On a decentralized network, participants have their own private, secure cloud-hosted environment. It’s populated with a prepackaged suite of utilities and services that connect, collaborate, and transact directly with other participants on the network. This eliminates the need to establish and maintain multiple single-use, point-to-point connections.

A decentralized network enables data to be securely shared, with the appropriate permissions, between participants without exposing the data to an intermediary. Because the data is not centrally aggregated, it remains in the control of each participant. Though the network provides an auditable record of data exchange between participants, the network itself never stores or accesses the data.

A decentralized network eliminates the need to deal with numerous custom, proprietary integration requirements for APIs and third-party platforms.

The benefits of a decentralized network

On a decentralized network, participants control how, with whom, and for what purpose data is exchanged. In this way, a decentralized network speeds the rate of data exchange while keeping data secure between all network participants. Other benefits include the following:

Provides increased data integrity, immutability, and traceability.
Enables data originators to control who has access to their data and how and when it can be accessed.
Data is always available when and where it’s needed without having to be requested, aggregated, and validated.
Data can be provided in any format or standard, and normalized when used on the network
Participants experience a reduced need to manage multiple interfaces and stand-alone connections.
As the network grows, data becomes more valuable.
Due to its design, participants can leverage the network for unlimited use cases.

How Avaneer Health’s decentralized network is different

Avaneer Health’s robust data governance model is a primary pillar of the Avaneer Network^TM and platform. The network’s decentralized architecture ensures that participants always remain in control of how, when, and by whom their data is accessed. Solutions available on the network are installed to each participant's network environment, eliminating the need to send their data to someone else’s cloud.

Unique capabilities of the Avaneer Health Network

Bring your own key. Participants can maintain adherence to their organization’s security requirements by bringing their own encryption keys to the Avaneer Network, ensuring their data is under their control.
Access control. Attribute-based access controls (ABAC) and configurable authorization controls enable participants to control what data is exchanged with their trading partners.
Secure environment. Network participants receive a private, secure environment provisioned with HIPAA-compliant health data storage and communication services.
Localized and in the cloud. Applications offered on the Avaneer Network are localized and operate where the data is stored.
Transparency in data access. All network activity is HIPAA-compliant, logged, and auditable.
Deny-by-default security architecture. No communication to any other participant or any Avaneer Health service is allowed unless explicitly turned on by the owner, providing security throughout the data layer, networking layer, and application layers.

A decentralized network in action: Avaneer Coverage Direct

One of healthcare’s most onerous, error-prone administrative processes is determining patient insurance coverage. Issues in this process can lead to denials, delayed reimbursement, write-offs, and surprise patient bills. Avaneer Health is simplifying the entire process with Avaneer Coverage Direct^TMby giving payers and providers near real-time coverage information that is always accurate, up to date, and available within their environment.

Because the Avaneer Network has a decentralized architecture, when any change is made to a member’s/patient’s coverage data, Avaneer Coverage Directautomatically determines missing, conflicting, and incorrect coverage details, and immediately updates all permissioned payers and providers on the network. In this way, Avaneer Coverage Directincreases transparency and data accuracy, without the data having to be sent or accessed outside of the network.

Because the Avaneer Health network is decentralized, payers and providers always retain control over their data; Avaneer Health does not see or store the data that is shared between participants.

Avaneer Health’s decentralized network allows payers and providers to share coverage and other types of transactional data without having to hand it over to clearinghouses and other third-party vendors and without having to build and maintain multiple, complex, single-use connections. Patient data is kept safely within the network.

The time to act is now

Cybercrimes targeted at healthcare systems are on the rise and organizations need to do all they can to prevent and protect against these threat actors. Decentralized networks can play a key role in doing just that.

Want to learn more about Avaneer Health? Contact us.

3 ways IT leaders can improve the business transactions of healthcare

Most healthcare IT leaders have already laid out their priorities for 2024 and a recent report by Bain & Company finds that revenue cycle management, clinical workflow optimization, and patient engagement are top priorities. To address the challenges in these areas, healthcare leaders have significantly increased investments in technology and now consider IT a “strategic priority,” citing its ability to enhance revenue and reduce costs by “streamlining labor-intensive processes.” These include subset areas like “revenue integrity, charge capture, and complex claims.”

Organizations can modernize their tech stacks to drive savings and reduce administrative burdens. We have identified three central areas of opportunity: data platforms and interoperability, automation, and AI.

Data Platforms and Interoperability

For all our efforts towards interoperability, data remains siloed across the healthcare ecosystem and continues to be difficult to access in the delivery of care. This is why our industry is still highly reliant on APIs and third-party aggregators to share data. While healthcare is making headway with industry-wide data exchange initiatives and the increasing adoption of industry standards like FHIR®, both initiatives require a great deal of work, money, and IT resources.

Today, there are cloud-based data platforms that create a new kind of interoperability where payers and providers can share information without building and maintaining individual connections. These platforms enable data to be continuously refreshed and current, eliminating the need to question accuracy or integrity. These platforms include advanced technological components such as AI, machine learning (ML), and robotic process automation (RPA) meaning participants reap the rewards of greater interoperability without making substantial infrastructure investments.

Avaneer Health’s network and its platform are designed for interoperability, applying a modern, secure infrastructure that leverages the FHIR standard for data exchange. Thus, payers and providers communicate and transact directly, eliminating the need for third-party solutions and reducing the number of transactions needed to support operational workflows. Because the platform enables permissioned and audited data sharing without data aggregation, data owners have more control over their data.

Automation

We’re all familiar with the amount of financial waste in our industry, much of it related to inefficient manual administrative processes. While industry leaders have talked about the need for automation for years, today’s modern technologies hold much more promise than those of the past. Robotic process automation (RPA) is a prime example.

RPA works by mimicking repetitive processes through rule-based tasks. “A set of scripted processes can access applications and data sources using structured data and logic to automate decisions according to predefined business rules and conditions.” In this way, RPA eliminates the potential for human error in manual processes while also increasing productivity with fewer staff.

RPA is ideal for many patient access and midcycle processes like scheduling, coverage, and eligibility verification—all of which can impact the patient experience. RPA can also help with coding and can flag documentation requirements for prior authorizations and medical necessity as well, helping to reduce delays in care and denied claims, streamline revenue cycle processes, and optimize reimbursement.

Artificial Intelligence (AI)

According to a new study by KLAS Research and the Center for Connected Medicine, 79% of health executives surveyed said that "AI was the most exciting technology in healthcare.” It seems each day we hear of new clinical and administrative use cases for AI. But when it comes down to choosing the appropriate application in our own organizations, the decision should be made by measuring both short-term and long-term gains and weighing them against available resources and capabilities. Organizations must ask themselves which applications are quick wins, and which will take more time and effort. Both need equal attention.

Just 6% of IT leaders surveyed say they have a strategy in place for using generative AI, although 50% say they are or will be planning one soon.

One ingenious application of generative AI that could be considered a quick win is its use in responding to patient messages in the patient chart. We’ve heard a lot recently about the unmanageable number of emails providers receive each day from patients. While some health systems have begun charging patients to send messages to their providers via MyChart, others are testing AI as a way to answer more common questions. One approach gives patients a tool and then punishes them for using it, while the other seeks to solve the problem with innovation. This is an excellent example of how AI can be used to facilitate better care while also improving the patient experience and reducing stress on providers.

Longer-term applications of AI include better risk prediction for disease stratification, faster clinical trials, improved disease diagnoses, and better outcomes. But these more complex applications will only be beneficial if organizations can deploy them in a cost-efficient, timely, and easy-to-scale manner.

Healthcare systems have invested heavily in legacy systems that don’t typically play well with modern technologies. Bolt-on solutions and multiple APIs are required just to share information with other providers and payers. And managing these systems consumes most of a health systems’ IT budget, leaving little room or resources to integrate AI applications and models cost-effectively.

Avaneer Health can Unlock the Full Potential of IT Investments

Interoperable data platforms, automation, and AI have the potential to genuinely transform our industry by enhancing patient experiences, improving outcomes, and significantly reducing clinical and administrative inefficiencies. But fully realizing these benefits requires a new kind of network through which these innovative technologies can be leveraged. That network is here today.

The Avaneer Health Network is a secure, permissioned, and decentralized network. Once a participating payer or provider connects to the network, they never have to establish a direct connection to any other participant. Data remains decentralized, and participants can control how and with whom they collaborate. Through an authorization process, their data can be shared with anyone on the network whom they have approved to receive it. Once the connection is established, data can flow freely and in real time, eliminating interoperability barriers and allowing genuine data fluidity.

Healthcare leaders have realized not just the need, but the immense potential of investing in technology. To get the most from those investments, they’ll need to be able to integrate and deploy those technologies in a way that makes them usable across the entire ecosystem. Once all the pieces are in place, we will truly be able to simplify the business of healthcare.

Learn how Avaneer Health can help your organization achieve optimal results from your IT investments.

FHIR® is the registered trademark of Health Level Seven International and is used with the permission of HL7. The use of this trademark does not constitute a product endorsement by HL7.

Closing gaps in interoperability could improve healthcare outcomes

The need for greater interoperability is escalating due to an increasingly sicker population. According to the CDC, 60% of Americans have a chronic disease, while 40% have two or more. As our nation ages, these numbers will likely increase as older individuals typically have more chronic conditions that require more—and more complex—care. Chronic disease is the leading driver of our $4.1 trillion annual healthcare spend. Effectively managing patient care, especially for those with chronic conditions, requires continuity across the care continuum and that continuity isn’t possible without closing gaps in interoperability first.

The disconnect

According to HealthIT.gov, 32% of individuals surveyed who had seen a provider in the previous 12 months experienced a gap in care due to ineffective information exchange. Nearly 20% had to bring a test result with them to a provider appointment; 14% had to wait an unreasonable period to get their results; 5% had to have a test or service redone because the data from the first test or service wasn’t available; and 5% had to provide their medical history more than once because the provider couldn’t find their existing chart. This lack of access to timely, accurate information is one of the primary reasons for gaps in care, a negative care experience, higher costs, and poorer outcomes.

Post-acute care

Consider the impact of interoperability gaps on patients recently discharged from a hospital to a post-acute care facility. The Agency for Healthcare Research and Quality (AHRQ) reports that 20% of patients discharged from a hospital experience an adverse event after just three weeks. The report finds that 40% of patients are discharged with test results still pending. The same percentage is discharged with orders for a “diagnostic workup,” but often without a way to close the loop on whether that workup occurred. This may be why 99% of providers choose a post-acute provider that offers interoperability over one that does not. This is likely driven by value-based care models that penalize readmissions and poor outcomes.

Coverage accuracy and insight

Another example of how gaps in interoperability cause gaps in care involves the accuracy of coverage information. Now that patients are responsible for a larger portion of their healthcare costs, they need price transparency. While many providers offer patient responsibility estimations, those estimations are often incorrect. One study found that 79% of providers are unable to correctly estimate a patient’s out-of-pocket costs due to inaccurate price and coverage information. When patients don’t know the ultimate cost of a service, they may be more likely to put it off or skip it altogether. For providers participating in value-based care and population health initiatives, this lack of benefits and coverage information can impact outcomes and, thus, reimbursement. It can also increase denied claims and create issues in the revenue cycle, leading to cash-flow challenges and delayed or inaccurate reimbursement.

Poor financial transparency can also impact the patient experience and patient satisfaction scores. One study found that 60% of patients would consider changing providers due to incorrect estimates or unexpected bills. When a patient overpays, it can take months to get a refund. And when patients pay less than they owe, they can be hit with a surprise bill they weren’t prepared to pay.

A different way of sharing data to reduce gaps in interoperability and gaps in care

While we’re making headway with initiatives like the Trusted Exchange Framework and Common Agreement (TEFCA) and the increasing adoption of industry standards like FHIR®, they require a great deal of work, money, and IT resources for healthcare organizations. However, a recent innovation is advancing interoperability in ways previously thought impossible. It begins with a digital ecosystem and decentralized network built on a platform and data fabric architecture.

Once payers and providers connect to the network, they can connect with any other payer or provider on the network to share information, and they can do it without building and maintaining multiple connections. Instead of having to aggregate data, it is always available and accessible in real time. Information is continuously refreshed and current, eliminating the need to question accuracy. And because the network is cloud-based and includes advanced technological components such as AI, participants benefit from greater interoperability without making huge infrastructure investments.

The network applies modern, secure infrastructure designed specifically to meet the needs of today’s healthcare businesses. Leveraging FHIR standards for data sharing, the network facilitates peer-to-peer communication directly between payers and providers without the need for third parties, thereby reducing the number of transactions needed to support operational workflows. And because the network enables permissioned and auditable data sharing without data aggregation, it gives data owners more control over their data.

A network and platform that simplifies the business of healthcare

As we start to close the gaps in interoperability, it’s the perfect time to reevaluate some of our long-standing beliefs about what’s possible within the revenue cycle. We don’t have to depend on data aggregation, numerous APIs for point-to-point connections, and third parties to conduct the business of healthcare. There’s a new way and it’s already used by some of the nation’s largest payers and providers.

Discover more about Avaneer Health, Avaneer Coverage Direct, and how it can help your organization close interoperability gaps to reduce gaps in care. Let’s simplify how healthcare operates together.