Four Insurers, Quest Developing Blockchain

Synaptic Health Alliance now using blockchain to improve accuracy of provider databases, directories

CEO SUMMARY: Organizations developing blockchain technology say it is a tamper-proof method of sharing data across networks and among providers, health insurers, and health systems. The Synaptic Health Alliance includes four of the largest health insurers, a health network, and Quest Diagnostics. Its first project, now in its second year, will use blockchain to create a common provider database that each collaborator can use to produce and keep provider directories up-to-date.

BLOCKCHAIN IS A NEW TECHNOLOGY that promises significant benefits if it can be successfully adapted to commercial purposes in the clinical laboratory industry. In healthcare, a collaboration of health insurers, Quest Diagnostics, and others is exploring ways that blockchain can improve how provider data is collected, shared, and used.

Two years ago, health insurers UnitedHealthcare, Humana, MultiPlan, and Optum, and the clinical lab company Quest Diagnostics, agreed to form the Synaptic Health Alliance to assess the feasibility of using blockchain to share data on healthcare providers. Since then, Aetna and the health system Ascension have joined the alliance.

Time-Stamped, Tamper-Proof

Blockchain is a time-stamped and tamper-proof log of activity that labs, other healthcare providers, and health insurers can share across a network of computers. Any tamper-proof technology is attractive to clinical laboratories, health systems, and health insurers to transmit data quickly and securely and to help prevent the data breaches four of the nation’s largest labs discovered earlier this year.

Synaptic Health Alliance’s first effort is to find ways to use blockchain’s data-collection technology to fix errors in provider directories and to cut the cost of keeping such data up to date.

“The Synaptic Health Alliance is a coalition of healthcare leaders who are collaborating to solve some of the industry’s toughest problems around the emerging technology called blockchain,” explained Brian LaPenna, Quest’s Vice President of Software Engineering and Design.

“Our first project was announced in April 2018 when the alliance started to tackle some of the high costs of healthcare provider data management,” he said. “We wanted to test the premise that administrative costs and data quality can be improved by sharing provider data among alliance members. We also wanted to know if changes the different parties made across the blockchain would facilitate the distribution of more accurate data.”

Clinical labs and pathology groups know the challenges health insurers face in keeping their provider directories up to date. Beneficiaries use these directories when choosing physicians, hospitals, and other healthcare providers.

Inaccurate directories can lead to surprise medical bills and other out-of-network charges for consumers who are confused when choosing providers from out-of-date directories. When consumers complain about such charges, state and federal legislators pass laws to prevent such problems.

“In this first pilot project involving a database of providers, we deployed a secure, decentralized, multi-cloud, and multi-enterprise blockchain network,” explained LaPenna. “We found there were immediate benefits in identifying inactive locations and mismatched addresses in shared provider directories.

“That was the main focus of that initial pilot project,” he noted “These findings showed that the alliance can do more work with provider directories in future phases of the project. In that way, we proved that we could have very good success using blockchain. Thus, the next step is to expand how it is used.”

Labs Typically First to Know

A focus on provider locations is important because clinical laboratories and pathologists are usually the first to know when a doctor or other provider opens a new office or moves from one location to another.

When a doctor sees his or her first patients, a lab test order almost always results. Therefore, labs are well positioned to help health insurers solve the problem of inaccuracies in provider directories.

“When you think about what happens when physicians or other medical professionals change their addresses, they also may change what health system or health insurer they’re affiliated with,” said LaPenna. “That information requires an update in the provider networks.

“Because labs can see that information and share it with health insurers, we can ensure that updates to the provider database are being made,” he noted. “In that way, insurers and health systems will have accurate information for their provider directories.”

To identify incorrect data, members of the alliance are sharing their directories and using blockchain to identify anomalies and other issues.

Matching Information

“When sharing their own directory information, members of the alliance can look to match the information each member has with the information that comes from other members,” stated LaPenna. “We’re trying to find either a positive or a negative match. The more positive matches we have, the greater the likelihood that we have accurate data.

“The reason we started with directory information (names, specialties, addresses, and phone numbers) is that it’s easier to confirm that type of information than it is to confirm each patient’s or each physician’s information,” LaPenna explained. “From there, we’ll proceed to sharing other forms of data.”

Sharing similar directory information among different health insurers and different provider organizations requires all companies sharing the data do so using the same format. To understand the problem, LaPenna suggested that sharing data can be foiled if similar data are entered randomly. When shared data are entered into matching fields, then those processing the shared information can proceed smoothly.

Sharing Information

“As long as the information is shared consistently so that mapping of the various fields can happen easily, then the individuals viewing that information among the different members of the alliance can share that data within their systems appropriately and will not need to manipulate or massage the data before or after sharing it,” LaPenna commented.

For clinical laboratories considering how they can use blockchain, LaPenna advised lab directors and pathologists to become aware of how blockchain is being evaluated today. “Clinical lab directors or pathologists should ask how their partners in healthcare are innovating and preparing for the future regarding blockchain,” he said. “They should ask how it can be applied effectively and what specific problems it can solve for them.

“The first questions to ask are: What are the specific benefits of blockchain in the healthcare environment and what is its potential for improving member and provider information,” suggested LaPenna. “Also, of course, is the important question of how can we use blockchain to remove costs from the healthcare system? That’s paramount, and blockchain has the potential to help do that.”

Clinical lab administrators and pathologists should use this intelligence briefing as a trigger to do two things. First, is to contact payers about their plans to use blockchain. Second, is to develop a blockchain strategy for their lab.

How Blockchain Works and How It Could Be Useful in Healthcare for Clinical Laboratories

BLOCKCHAIN TECHNOLOGY was among the technologies the inventors of Bitcoin used in 2009 when developing the world’s first open-source cryptocurrency.

For a definition of blockchain, the website TechTerms.com says the following: Each transaction added to a blockchain is validated by multiple computers on the Internet. These systems—which are configured to monitor specific types of blockchain transactions—form a peer-to-peer network. They work together to ensure each transaction is valid before it is added to the blockchain. This decentralized network of computers ensures a single system cannot add invalid blocks to the chain.

When a new block is added to a blockchain, it is linked to the previous block using a cryptographic hash generated from the contents of the previous block. This ensures the chain is never broken and that each block is permanently recorded. It is also intentionally difficult to alter past transactions in blockchain since all the subsequent blocks must be altered first [by other computers on the peer-to-peer network].

In healthcare, blockchain is a new and relatively untested technology. It may have value in preventing data breaches of consumer’s protected health information or to limit what hackers can get when they launch attacks on healthcare providers’ information systems.

In December, the alliance said in a news release, “Following its initial launch in April, Synaptic Health Alliance is deploying a multi-company, multi-site, permissioned blockchain.”

Permissioned Blockchain

In a report, the alliance said the choice to use a permissioned blockchain rather than an anonymous one is crucial to the alliance’s success. Permissioned blockchains have a higher level of control over access to the blockchain.

The members of the Synaptic Health Alliance can deploy blockchain nodes based on their individual requirements. Some members can deploy their nodes within their own data centers, while others are using secure public cloud services, the alliance said. Such flexibility is a key to growing the alliance’s blockchain network, it added.

Contact Brian LaPenna at 866-697-8378 or Brian.F.LaPenna@questdiagnostics.com.

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