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Does Blockchain Solve Provider Data Quality for Payers? Not Really


Jeff Rivkin

Research Director of Payer IT Strategies IDC Health Insights

Blockchain was the buzz at last year’s HIMSS, and it appears its potential was overhyped at the time. This year, there was a full pre-conference day for blockchain at HIMSS19, and multiple vendors addressed the topic in their presentations. The hype continues, and now consortiums and related promises abound.

In January, the second large multi-party blockchain initiative in the healthcare insurance industry was announced. Several large health insurance companies, including Aetna, Anthem, Cigna, Sentara Healthcare, and Healthcare Service Corporation announced a collaboration with PNC Bank and IBM to utilize blockchain technology. Earlier, the Synaptic Health Alliance launched in April 2018 with Humana, MultiPlan, Quest Diagnostics, UnitedHealthcare, and Optum. Aetna joined the Synaptic Health Alliance in December along with the Ascension health system.

Okay, so now the Big 5 insurance companies and some major vendors and others have aligned in a conceptual consortium or two. It remains to be seen how, or if, these initiatives will best leverage blockchain technology. But as these initiatives pick up steam with significant industry players, the traditional thinking is that there will be noteworthy blockchain-related developments in the healthcare insurance industry to evaluate, probably in the areas of provider data and claims.

With provider data-quality initiatives, however, it will not be soon.

Provider Data-Quality Challenges

Some point to the creation of consortiums as a breakthrough. It is true that blockchain effectiveness is a result of the network effect, meaning that the value of a blockchain-powered solution increases as the number of participants using the solution increases. However, that network effect paradigm assumes that all parties have clear roles, authorities, sequence, workflow in the chain, and trustworthy sources of data. Blockchain works for supply chain businesses because of its relatively linear nature, and the clear business mandate that all should work equally and egoless in a supply chain, in a dependent trusted path.

Provider data quality has no clear linear dependency or authorities. Updates come from many, many sources randomly. There is no timetable for update. There is no clear stewardship as to who owns what attributes. There is no clear mandate to work egoless—and some even feel there is competitive advantage to “keeping my data.” Clearly, this is not a culture of trust.

Experience shows that all multi-party collaboration is tough, both technically and organizationally. Blockchain is a technology concept that describes an immutable, distributed, database structure. A blockchain implementation provides a platform for multiple parties to transact with one another, without the need for third-party validation, creating a ledger of record that is by design more secure than other approaches. Great!

Not so great is the progress towards addressing governance problems of data ownership, stewardship, access, and rules of secure distribution. It can be foreseen that 2020 HIMSS will have sessions on these topics; as if a conference can answer issues of ego, legacy process, and/or “not-invented-here” organizational mentalities.

The Elusive Truth

Similarly, it’s not so great that the industry has not addressed the lenses or scenarios of “what relevant truth is.” The truth of a provider being “actually at a location at a specific date” (for network adequacy) versus “potentially at a location” (for claims validation) versus “at the location at specific future days” (for directory participation) seems to have been glossed over so far. These lenses are real. There is no universal truth for provider locations; all this “truth” needs context to be relevant.

Lastly, it also seems that blockchain advocates have conflated the technology of provider data synchronization with the problem of provider data quality. It’s fine to set up a (blockchain) structure where all (multi-party) can see what one or all has posted; it is quite another matter to ensure that the (data) posted is indeed correct. Only with coordinated multiple input sources, real-time update, closed-loop validation, constant monitoring, and a dedication to serious data management can data quality be ensured.

Blockchain, if it scales, can help ensure secure, consistent answers across the healthcare ecosystem, and for that the collaboration of these industry giants should be applauded—lightly.

Now, can someone develop the governance and best practices around making the data accurate, relevant, and complete? That requires industry standardization, deep cooperation, hard plumbing, and more importantly, organizational orchestration…and that takes much more than an announced consortium.

About Jeff Rivkin

Jeff is responsible for research coverage on ACA/HIX Healthcare Reform, payer business and technology priorities, constituent and consumer engagement strategies, technology and business implications for accountable care, risk, quality-based payment, and incentive programs, among other trends and technologies important to the payer community.

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