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.

Reinventing the Back Office to Deliver on the Patient-Centric Promise

Healthcare organizations have talked for years about the importance of the patient experience. Yet, they've experienced several challenges that have kept our patient-centric promise from becoming a reality.

The promise of a patient-centric ecosystem has been the topic of discussion for years. However, healthcare organizations have experienced numerous challenges that have kept our patient-centric promise from becoming a reality. Most people have at least one personal story about a time when our ability to receive timely care for ourselves or a loved one was inhibited by an outdated, ineffective administrative process.

Consider the patient who has recently changed health plans. She wasn’t feeling well and made an appointment to see her primary care provider. When she arrived at the office, she realized she hadn’t yet received her insurance card from the new health plan. She also remembered that when she signed up for her new plan, she canceled her secondary insurance coverage. She thought the coverage might still be active through the end of the month but wasn’t sure. She didn’t have that card either as she didn’t think she’d need it any longer.

Because of the lack of information, the front desk staff had no way of knowing what the patient’s new insurance would cover, what her co-pays and deductibles were, or whether the secondary insurance might still pay a part of the visit. The patient was told she would need to pay the entire amount of the visit up front and then work it out with her insurance companies on her own after the visit.

It is unfortunate that our healthcare ecosystem is so dependent on a patient’s memory and a physical insurance card to be able to ascertain a patient’s primary and secondary coverage information, along with their financial responsibility. These issues can also impact claims processes and increase manual work for both providers and payers. This is just one of many examples of how administrative processes make it difficult to deliver on the patient-centric promise.

Where’s the disconnect?

These administrative processes need to be improved. We know the answer: healthcare systems need to become more interoperable. While we have made progress, research from the ONC shows that in 2019, more than one in every three physicians still relies solely on fax (paper or electronic) or standard mail to share patient information like ultrasound results with providers outside their organization. In fact, just 34% engaged in bidirectional electronic sharing of patient information. Why?

A significant challenge to achieving interoperability is that healthcare’s current data-sharing infrastructure is built upon one-to-one connections. These connections are expensive and resource-heavy to implement and maintain. The result is a lack of transparency that has caused distrust between payers and providers. At the same time, providers are faced with increasingly complex payer requirements that are hard to keep up with, which adds to their already overwhelming administrative load.

A new way forward

These issues could be mitigated or eliminated through a new type of interoperability that allows all healthcare stakeholders to easily connect to a single, decentralized network and then access, in real time, the needed information without the request/respond processes of today. In a world where this type of interoperability exists, the provider in the above scenario would have been able to easily discover the patient’s new coverage information and find out whether her previous secondary coverage was still in effect—all either before the patient arrived or while she was checking in.

In a fully interoperable healthcare system, data wouldn’t need to be requested, aggregated, and validated each time it’s needed. Instead, it would be continuously refreshed, always current, standardized, and always accessible via a secure and direct peer-to-peer network.

Imagine a coverage solution where every authorized participant would have accurate insurance coverage information through a decentralized peer-to-peer network of payers and providers. Leveraging formats such as FHIR, all data would be standardized and ready to be accessed in their EHR. Payers and providers benefit from improved transparency and reduced costs while patients/members benefit from reduced delays in care and fewer surprise bills. This type of immediate data access would eliminate the payer-provider friction that has plagued our healthcare system for far too long—friction that ends up creating a poor patient experience, reduced outcomes, and increased costs for all.

Delivering on the promise

At its heart, all healthcare is human. At the center of every procedure, every diagnosis, and every transaction is a human being who expects to be treated with dignity in moments when they are most vulnerable. The only way we will be able to meet that expectation is by improving the back-end processes that support and facilitate high quality care. But that requires us to completely reinvent how healthcare is administered. It’s the only way we will truly transform the care experience.

We invite you to join Avaneer Health as we work to simplify the business of healthcare and deliver on the patient-centric promise. Learn more by contacting us.

It’s time to redefine what we mean by interoperability and reimagine what it could be

Redefining healthcare interoperability

Interoperability. It’s a term that’s been widely discussed in healthcare. While at its core, the term refers to connectedness between systems or products, the implications are much broader. And therein lies the opportunity. Healthcare needs a more encompassing definition of what interoperability could mean on a grander scale.

For example, we talk about interoperability within a single health system or a single geographic region or between entities. But the backbone of today’s definition of interoperability is still the traditional API. And this is an issue—a roadblock, really. Besides the lack of clarification and standardization within federal legislation and mandates, provider and payer organizations are struggling to achieve compliance via APIs, especially regarding privacy and security. Further, implementation and maintenance are proving to be a significant burden on IT leaders since each connection requires building a separate API to meet each entity’s requirements. It’s a drain on resources and finances—both in short supply right now.

Furthermore, APIs are great at establishing connectivity, but aren’t the answer for delivering comprehensive interoperability. Healthcare data, which doubles every 70 to 80 days, still exists in disparate silos among thousands of databases spread across the country, even within individual enterprises. Building individual connections isn’t the answer.

While APIs provide individual connectivity between entities, they aren’t the hoped-for conduit that finally allows us to maximize the potential of the fast-growing landmasses of data we have available.

Going beyond APIs

What healthcare needs—and APIs can’t provide—is a data exchange infrastructure that acts as a network where participants can connect once and then have access to many. Instead of one-to-one connections, a true data interchange network provides a collaborative platform through which organizations can develop joint processes that help the healthcare community communicate more efficiently.

A decentralized, peer-to-peer network makes data interchange possible. Instead of pushing and pulling data through a single gateway between two entities, a network allows access to information among all participants. The potential number of use cases in this type of network is unlimited.

How a decentralized network works

A decentralized, peer-to-peer network enables all participants permissioned access to the same information through a single connection. The network provides secure, tamper-evident storage of transaction data, as well as permission-based access to stored information so that the information can be protected and more reliable and its provenance can be verifiable.

Source: istock

Payers, providers, and third-party vendors who want to participate must agree to allow the data to be discoverable. Members of the network connect via the cloud, where the ID keychain and master index will match the requested data to the available data, then locate the information and deliver it to the requestor. Certifications, cybersecurity, and compliance are all managed by an outside intermediary. Leaders from one of our founding members, Sentara Healthcare, gave their view of how decentralized networks can support transformation within healthcare organizations, read more in the article here.

Limitless benefits

A decentralized, peer-to-peer network offers unlimited opportunities to advance the quality and efficiency of healthcare delivery in our country. The term “transformative” is not hyperbole here; the potential to transform our industry goes as far as our imaginations can take us.

Accelerates innovation in healthcare delivery
Streamlines the cost and management of IT operations
Improves data access security
Promotes more effective, efficient collaboration between payers, providers, patients, and vendors
Simplifies and optimizes workflows and joint processes
Enables providers and payers to achieve shared outcomes
Reduces gaps in care and improves clinical outcomes
Enables a more patient-centric healthcare experience

An accelerated path to interoperability

The broad adoption of APIs and FHIR has been essential in enabling interoperability to move forward into the 21^st Century. Up to this point, it’s enabled incremental progress to move us closer to our goals. As technology evolves, we need to leverage a decentralized, peer-to-peer network to eliminate the need for multiple APIs while providing all healthcare stakeholders the ability to work together as a community to build the healthcare ecosystem of the future.

Unlocking the Full Potential of Healthcare

Imagine this: A healthcare ecosystem where payers, providers, patients, and partners can seamlessly connect to securely share information directly with each other, tearing down the barriers in healthcare. Also in this ecosystem, innovators can deploy and scale solutions that improve healthcare experiences by leveraging a network, standards, and processes that are developed collaboratively and can work for all. This is the vision behind Avaneer Health.

A conversation in 2017 sparked the vision between a small group of healthcare industry leaders who saw the potential for a new way of working together. They discussed how to create an ecosystem that facilitates collaboration, real-time data sharing, distributed governance, and common processes running in a trusted, permissioned, and secure environment wherein participants can transact with one another. The conversation grew to include an impressive group of innovative leaders from both payers and providers who shared the enthusiasm and vision of creating a healthcare network to enable direct connectivity between participants. This connectivity would include common data models, the latest in technology standards and infrastructure capabilities, modern security, and immutability that could be the answer to solving healthcare’s connectivity and interoperability issues.

Those early conversations led to the launch of Avaneer Health with support its initial founding members — Anthem (now Elevance), Cleveland Clinic, CVS Aetna, HCSC, IBM Watson Health (now Merative), PNC Bank, and Sentara Healthcare in June of 2021. These organizations put aside their individual views, competitive overlap, and individual interests, and committed to work together towards a common goal of advancing healthcare transformation. Avaneer Health is focused on creating a network with common infrastructure, interoperability tools, solutions, and a solution exchange capable of enabling the transformation of healthcare. The Avaneer Health team and the founding organizations continue to work together to co-develop joint processes and solutions. This type of collaboration creates opportunities for business models yet unimagined to help solve age-old challenges and unlock massive cost, process, and technology inefficiencies.

In an industry where new, innovative solutions often bring new complexities and have trouble getting to scale, Avaneer Health is working to create an ecosystem, a platform for collaboration, and a secure industry infrastructure that can help improve efficiency, and enhance outcomes, save billions in administration costs and, most importantly, improve patient outcomes and the overall patient experience. With the platform coming to life, we are now turning our attention toward growing the ecosystem of organizations that are committed to tearing down the barriers that have plagued healthcare for decades. Please reach out if you and your organization want to be part of the next generation of healthcare.

Healthcare, Heal Thyself

We have the innovation and technology to do it, but are we ready to act?

By Stuart Hanson

Anyone who says innovation in healthcare doesn’t exist hasn’t been paying attention for the past 18 months. From the way providers large and small pivoted to telehealth to keep patients safe, to the way scientists from around the world came together to develop vaccines and treatment protocols, to the way public health agencies worked to provide mass distribution of the vaccinations—innovation and cooperation abounded. Was it all perfect? No. But it does show that we are capable of innovating urgently.

One area where innovation is clearly lacking, and has been for a very long time, is interoperability. It’s an issue that numerous companies, consortiums, agencies, and others have been trying to solve for decades. Regardless, the issue remains.

A personal story

In the midst of the pandemic, I needed an emergency eye procedure. I was lucky that my provider was able to quickly verify my coverage with my insurance company and I was able to get the treatment I needed. During my follow-up exam, I met another patient who also needed an emergency eye procedure. If he didn’t get it, he risked retinal detachment, a condition that could lead to blindness if not treated in time. While we were in the waiting room, the man told me that he had already been to the office twice before to have the procedure, but was sent home because the provider hadn’t been able to connect with the man’s insurance company to verify coverage. I don’t know what happened to the man, whether he got the surgery in time to avoid retinal detachment or whether his condition deteriorated.

This same scenario is played out all too often across our country. In a time when can share news in near real time with family and friends on Instagram, it can still take weeks or months to share critical administrative and clinical healthcare data between two entities whose actions—or inactions—can be the difference between life or death. Why?

The issue isn’t that we lack innovation to fix the problem. The issue is that we’re focused on fixing the wrong problem. We have entrepreneurs and tech giants entering the healthcare market every day, bringing with them new apps or solutions that promise to “transform” healthcare. But most of those solutions sit on top of the technical infrastructure, whereas the real problem is the infrastructure itself. A great telehealth app may streamline workflows or improve patient-provider connectivity, but new apps can be virtually impossible to bolt together with the provider’s billing system, clinical record system, or privacy and security controls. Although it may be great, innovative, timely technology that we desperately need, it’s yet another layer added on top of previous layers that sit atop an outdated, ineffective infrastructure—an infrastructure built primarily to support batch-based, one-way communications like EDI. It’s like building a yacht on top of a rowboat.

Network as a Service

If we want to create real transformation in healthcare, we need a new infrastructure blueprint—one that doesn’t add additional features on top of a fractured system. We need an infrastructure that starts from the bottom up. It exists, thanks to truly innovative companies that recognized the problem and realized that a viable solution is already available. In 2019, IBM, PNC Bank, Elevance (formerly Anthem), CVS Aetna, Cleveland Clinic, Sentara Healthcare, and Health Care Services Corporation came together to discuss how we could use new, innovative technologies to solve the systemic problems that have plagued our industry for too long: data sharing, data integrity, and trust. Together, they formed Avaneer Health.

The focus of Avaneer Health is leveraging innovative technologies to create a neutral network through which healthcare organizations, patients, and other key stakeholders can access accurate, timely information in real time—an Internet for healthcare.

How it Works

First, payers and providers commit data to the cloud and allow it to be discoverable based on permissions that are set by each party. Users can connect to the network via the cloud, where the ID keychain and master index locates the information requested and matches it to the data available, then delivers it to the requestor. The intermediary—Avaneer Health—provides certification, end-point validation, an immutable audit trail, cybersecurity, and compliance. Use cases include eligibility verification, prior authorization, and real-time access to accurate, complete medical records.

The network also connects with rich solution providers like revenue cycle management companies, telehealth platforms and others that are involved in care coordination or the business of healthcare. This eliminates the need for payers and providers to build and maintain connections with multiple systems. Fewer touchpoints mean fewer opportunities for security issues, not to mention reduced IT costs and resources needed to manage those gateways.

The Time to Act is Now

If the U.S. healthcare system were its own country, it would rank forth in GDP, right behind China but ahead of countries like Germany, India, and the UK. We spend between 25% and 30% more per person on healthcare than any other country. This might be okay if our outcomes were better, but they aren’t. I keep thinking of the man I met in the waiting room and wondering how much longer he had to wait or if he ever got the surgery at all.

We know the problem and we have the technology, innovation, and ability to solve it. The question is whether we’re going to act or if we’re going to continue to build layers on top of layers on top of layers. Our patients are waiting on us to make the call.