How Blockchain Will Transform Practitioner Credentialing

By: Anthony D. Begando

Credentialing is a complex, costly, and time-consuming process mandated throughout the healthcare industry to ensure that a practitioner can competently deliver (and be compensated for) patient care within a specific clinical setting.  Today, the process largely consists of organizations independently collecting, verifying, and analyzing information pertaining to an individual’s background and experience.  These artifacts include education, employment, and clinical assignment histories, licensure and certification histories, on-going training, insurance coverages, and the like.  While several accreditation bodies define guidelines for performing this work, it is the ultimate responsibility of a healthcare organization to define and follow their own internal processes that are both compliant with those guidelines and their own specific needs.   Consequently, most healthcare organizations redundantly perform this work for each practitioner with whom they seek some form of professional relationship.  It is common for practitioners to maintain independent credentials data sets with 15-25+ organizations (e.g., hospitals and health systems, payers, networks) concurrently.

In healthcare delivery environments, practitioner recruitment, staff appointment, and insurer contract enrollment processes often take 4-6 months to complete– with credentialing and payer enrollment weighing heavily on the process timeline.  In hospitals alone, is estimated that for every day a physician’s employment or contracting is delayed, the organization forfeits $7,500 in net revenues.  Further, as healthcare moves rapidly into expanding delivery models such as telemedicine, direct-to-consumer, and outpatient specialty care, credentialing-oriented delays are direct impedances to growth for many firms.

The emergence of enterprise-level blockchain technology creates a unique opportunity to address the cost, complexity, and timeframe associated with this work.  The fundamental reason why healthcare organizations repetitively and redundantly perform the collection and verification of credentials information is that there lacks a trusted and reliable forum to request and receive verified credentials information.  Blockchain will change that.  Through the establishment of a network connecting practitioners, primary sources, and consumers of credentials information, a utility can be created which captures credentialing transactional data and, where authorized, makes that data available for consumption by all other future requestors of that same information.  Recognizing that this greatly simplifies an often complex process driven by artifact types stemming from thousands of sources of information, consider the following simple example:  A cardiologist is employed by a hospital for five years.  She was appointed to the medical staff and awarded privileges to practice a defined set of clinical procedures relevant to her practice area.  She resigned, in good standing, and moved to another hospital in another state.  For the remainder of her career, every delivery system, payer, network, practice group, and the like for which she seeks a professional relationship with will independently request verification of this employment episode, her privileges, and her standing upon termination—likely resulting in scores or even hundreds of redundant requests for this employment verification.

A blockchain-based utility would record and confirm, on the first requested verification, the provenance (source) of the information, the information contained within the verification itself, the result of the verification, and a formulaic key confirming that the information has never changed from its initial issuance.  For example, Anne Smith (a NAMSS accredited credentialing specialist) from XYZ Hospital (a Joint Commission accredited hospital) provided the employment verification and privilege delineations for Dr. Monica Ortiz to Bill Jones from Big Payer (working at an NCQA accredited firm) who confirmed the verification.  The utility blockchain records and confirms the source and reliability of that data eternally.  As such, every future request for that information would leverage the initial verification and have no need to repetitively request that data from XYZ Hospital ad infinitim.  Similar processes could be employed for both publically available sources (e.g., licenses, certifications, OIG sanctions) of information and private enterprises.  In time, the vast majority of historically verified transactions could be disseminated to requesting organizations and substantially reduce the level of costly repetitive reverification that pervades the industry today.

The future of blockchain in healthcare is immense.  This particular use case presents an ideal opportunity to solve a years-old problem that affects nearly all aspects of the industry.

1 reply
  1. Mike Rapp says:

    Having worked in healthcare in a niche, the implications of this are immense as it relates to UX: Is there anyone at your company who is in charge of customer experience? I would love to meet them.


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