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Dive Brief:
- The health insurance giant Aetna, recently merged with CVS Health, and Ascension have collaborated with five other healthcare companies to test the use of blockchain technology to correct the provider network listings.
- The so-called Synaptic Health Alliance will help drive a blockchain-enabled initiative to improve data quality and reduce the time and costs associated with changes in provider demographics. Humana, UnitedHealthcare, the UnitedHealth Group Optum, MultiPlan and Quest Diagnostics launched the alliance in April.
- The news comes when a recent CMS report found that almost half of the online directories of the Medicare Advantage organization contain at least one accuracy in the location of the provider.
Dive Insight:
Inaccurate network directories are a source of headaches for suppliers, payers and patients. Without accurate information, patients risk choosing a doctor who is out of the network and not completely covered by their health plan. They may not realize that the doctor does not accept new patients or Medicare patients or that the office has moved to a new site. This can lead to surprise medical expenses, where patients receive invoices for unexpected costs incurred when the care was provided outside the network of their insurer.
For payers, directory errors can also take a financial toll – plans that fail to keep the updated directories face fines of up to $ 25,000 per error per doctor and up to $ 100 per doctor for errors in plans sold on HealthCare. gov.
Almost 49% of MA organizations have listed provider directory locations with at least one inaccuracy. Within each directory, the share of locations with inaccuracies ranged from 4.6% to 93%, with an average of 45%, according to CMS.
Of the 52 MA organizations examined, 28 had errors concerning the location between 30% and 60% of the time. The inaccuracies included suppliers who were not in the listed position, incorrect telephone numbers and information that indicated that a supplier was accepting new patients when they were not.
Meanwhile, doctors are inundated with requests from health plans to update their directory information. According to the American Medical Association, the average doctor is affiliated with 12 health plans and must face rigorous data checks from each of them.
Keeping accurate and up-to-date directories costs around $ 2.1 billion a year, according to industry estimates.
The blockchain alliance pilot uses a multi-site, multi-site, multi-site blockchain, which allows each member to determine how their nodes are distributed, according to a new white paper. "[Ethereum-based] Quorum nodes use the go-ethereum client to keep transaction data visible to all network participants and private data only visible to parts of private transactions, "according to the newspaper." Private transactions are enabled through the Quorum Constellation extension. "
The initial pilot project includes the development of a market and a blockchain exchange application, a model for incentives to stimulate participation and a way to save administrative costs to measure results.
Ascension, the nation's largest Catholic health system, offers a supplier perspective to understand the difficulties of keeping up-to-date directory. Aetna has more than 22 million members of the health plan.
