Hashed Health and the Gateway to Health Provider Data Management

[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” text_align=”left” css_animation=””][vc_column][vc_column_text]Hashed Health is embarking on a number of gateway projects that demonstrate the essential promise and essential functions of distributed ledger technologies for the healthcare market.

 

One of our first gateway projects is an example of the blockchain’s ability to improve “data liquidity,” highlighting the ability of distributed ledger solutions to make secure data sharing a reality among a wide array of transactional partners.

 

The State of Health Provider Data Management

 

Providers must be credentialed and approved to treat patients, write prescriptions and receive payment. The process of synchronizing which providers are credentialed for certain payers and patients is a mess. Often times, over 20 percent of the data in a payer’s directory is incorrect. Imagine what it would be like if that same percentage of addresses in Google Maps was incorrect.

 

The reason this is so hard is largely because the current process of confirming provider credentials, granting physician privileges and enrolling physicians in payer networks is managed in many different systems and many different times. When you compound that across thousands of physicians for a payer or a large provider network, it leads to big headaches and wasted dollars that are eventually passed along to the consumer.

 

For physician practices, networks and health systems, the lengthy process of provider credentialing is costly. A majority of credentialing processes take in excess of 120 days. These delays have a direct financial impact, impeding the ability of a physician to provide services and receive payment for those services. Provider credentialing is the first step and is directly related to revenue cycle processes.

 

For health plans, the process of enrollment is likewise lengthy and cumbersome, varying from as little as 60 days to over 180 days. Beyond enrollment, health plans face significant regulatory risk over the quality and accuracy of the provider data contained in their directories. It is estimated that 12 to 18 percent of directories are incorrect or out-of-date. Over 20 states have regulatory requirements for health plans to frequently maintain accurate physician directory information under penalty of fines and other levies. In addition to states, CMS similarly requires directory maintenance. Beyond regulatory penalties, bad provider data can cause delay in claims processing and inaccurate payment denials. The scale of this problem is not insignificant, as it is estimated that 30 to 40 percent of all provider files have inaccuracies.

 

To compound the problem, these processes are rife with inconsistent data formats and workflows. On top of that, remember that these manual processes are largely duplicative, requiring providers and payers to submit largely the same data to multiple entities and to resubmit to maintain their credentials and enrollment status in many systems. It’s a messy, cumbersome and ultimately costly process that has real consequences for billings, regulatory enforcement, physician engagement and, ultimately, patient care.

 

Distributed Health Provider Data Assets        

 

Hashed Health’s gateway project moves beyond the current trend of “digitizing” the collection and management of health provider data. From electronic forms to centralized data stores, current efforts are streamlining the manual process of health provider data collection by replacing them with digital interfaces. However, centralized approaches fail to cope with the fractured nature of the U.S. health system with a dizzying array of health plans, provider practices and health systems. What is required is not another centralized, universal data store but rather a decentralized transactional layer allowing providers, health systems and health plans to share updates and corrections of provider data files.

 

Hashed Health has built a test chain to demonstrate the essential benefits of a decentralized transactional layer.

 

The core function enables plans and individual providers to create and exchange “digital data assets” which can be securely distributed to network members via a permissioned, distributed ledger system. By “tokenizing” provider updates, the system creates trackable data assets which can be distributed to multiple network participants. The reporting of the all asset changes to the distributed ledger ensures that health provider data is up-to-date and consistent across multiple entities as well as internal, siloed data systems. The proposed solution architecture builds upon the current “data store” model, introducing a “transactional” model that enables greater liquidity of data.

For the purposes of a technical demo, Hashed Health employed Hyperledger’s Fabric v0.6platform. Fabric demonstrates a number of compelling properties well-suited to enterprise solutions, including a robust member services and permissioning layer and multiple peer roles, enabling confidential transactions. We look forward to the further development of these and other features as Fabric v1.0 is released in Spring 2017.

 

Looking Forward

 

Beyond the immediate use case of health provider data management, this technical demo serves as a foundational step in a larger healthcare blockchain ecosystem. The process of securely identifying providers and issuing certificates allowing blockchain activity enables a broader range of use cases requiring secure provider interaction.

 

If you or your organization is interested in collaborating on this project, Hashed Health is actively recruiting healthcare enterprises to engage in collaborative work groups on proof-of-concept and pilot projects of blockchain-enabled solutions to what have become intractable problems for our industry.[/vc_column_text][/vc_column][/vc_row]

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