The vision for blockchain and healthcare is for patients to own and control their own health records and provide access to care providers and insurers. But that goal seems a long way off. As a starting point, US health insurers agreed to collaborate to share data about healthcare providers. An EY/Humana whitepaper published yesterday sets out a vision to create an incentivized marketplace for provider data.
As a patient, if you have health coverage and want to visit a doctor, you need to know which health providers your medical plan covers. So your health insurer has to keep a list of all the relevant doctors, dentists, hospitals and other medical providers. The process of maintaining these lists is called provider data management (PDM).
Seventeen to twenty medical insurers approve a typical healthcare provider. And most insurers have relationships with many hundreds of healthcare providers, and they each have their own list of providers.
The information about the providers includes necessary things like registration numbers, address, and phone numbers. But it also contains details about the doctors and their specialties.
The data is somewhat dynamic. A clinic might move premises and staff change. Often. Let’s assume an insurer reaches out to a practitioner once a year to update their details. That data is almost guaranteed to be out-of-date before they check the next year.
As a patient that could be quite a big issue. You might go to a clinic, and the doctor with the specialty no longer works there.
In 2016 the Centers for Medicare and Medicaid Services (CMS) reviewed 5,832 directory entries. They found that forty-five percent had at least one error. As a result, CMS announced a plan for penalties for inaccurate information.
It’s not just the inaccuracy there’s also a significant cost. EY used a conservative $12 average cost per provider per year for a health plan with 500,000 providers in the network giving a figure of $6m.
So far, the majority of enterprise blockchain solutions seem to stick to conventional business models. Some believe this ignores the innovation opportunity presented by blockchain.
Yesterday EY released a whitepaper in conjunction with Humana which is the product of ‘thought leadership’ work done by the two companies late last year. After completing the work, the consortium of Humana, UnitedHealthcare, Multiplan, and Optum created the alliance. The document lays out ideas for further discussion by the coalition and the broader industry. So this is not necessarily the route the alliance will adopt.
The whitepaper presents the idea of a data marketplace and examines whether it should be altruistic like Wikipedia or incentive driven. Given there are multiple data providers – Multiplan and Optum are both in this business – the altruistic path has the problem of deciding which data entry is the correct one. Each insurer and each data provider will have their own ‘version of the truth’.
Instead of altruistic, the paper proposes an incentive driven marketplace where there are buyers and sellers of data as well as data validators. The buyers are the health plans or insurers, and the sellers are the PDM data vendors or the health providers themselves.
There’s no mention of the word ‘token’ in the whitepaper, but an incentive driven marketplace based on blockchain makes tokenization likely. Hence this is novel for an enterprise solution.
Just a first step
The paper points out that in the health industry, provider data is pretty low risk compared to other data. Hence it makes an excellent starting point.
The whitepaper concludes: “The future promises to bring the exchange of higher-value, higher-risk data types in the underlying utility data marketplace. With an established, proven data market infrastructure, we will have a better chance of succeeding with more sensitive, impactful data types including, for example, personal health information.”