MedCity Influencers, Health IT

Unlocking interoperability for digital transformation with a blockchain-powered network

Payers, providers, financial institutions and tech innovators – often known as “frenemies” – need to set aside their old competitive spirit and come together as one team for the healthcare industry to be truly interoperable.

blockchain, digitization, digital health ledger, ledger

Two of the biggest buzzwords in the healthcare industry these days are “digital transformation” — and for good reason. There’s lots of room for improvement! The patient experience needs to be improved, processes need to be automated, and the cost of administering healthcare needs to be lowered. Digital transformation is a path towards achieving these goals – just like it has been in other industries – but many hospitals, healthcare systems, payers and vendor organizations struggle with where to start on this journey.

Each organization has very specific needs, so evaluating various systems and vendors can be incredibly overwhelming, especially when it feels like the options are endless. And while there certainly isn’t a one-size-fits-all approach to digital transformation, there is a solution that could help both evolve the industry and be a springboard for digital transformation within organizations — a blockchain-enabled network of interoperability.

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The basics of blockchain

Blockchain technology may seem intimidating, but when you break it down in simple terms blockchain is a digital collection of transactions that are tracked and recorded across a decentralized network. Think of it as a database or spreadsheet which multiple participants have access to in real-time. Every transaction is recorded and connected to the transaction that happened before it and after it. They are then connected in a chronological manner, which creates the “block.”  New Blocks of data connect to previous blocks of data, which ultimately create the chain. Hence, blockchain.

This allows for an unprecedented synchronization of data across participants creating a single source of truth.  The potential to enable cross-organizational workflows and the ability for participants to transact digitally across a network in real time with higher levels of security and transparency is incredibly powerful.

Another key aspect of blockchain is permanency. Once a transaction is committed to the chain, it cannot be deleted. Users can only add to the chain via a new block, which ultimately creates a historical, linear and immutable record of events or transactions. Changes cannot be made to the ledger unilaterally – network participants need to validate changes prior to a new block being created, which mitigates opportunities for fraudulent activities. More so, this decentralized approach allows for data parity, which is critical in a data-heavy, regulated industry like healthcare.

Working together is the way to achieve interoperability and transformation 

One of blockchain’s greatest characteristics is that it provides an unprecedented level of transparency and openness, so that each participant can be held accountable and responsible for acting with integrity towards its community. But as we know, the notion of transparency, openness, and trust is new to healthcare, and for blockchain to work in healthcare, a fundamental shift of mindset is needed to build a community with common goals. Payers, providers, financial institutions and tech innovators – often known as “frenemies” – need to set aside their old competitive spirit and come together as one team for the healthcare industry to be truly interoperable.

Collaborating can deliver tangible, mutual benefits for both payers and providers alike. For instance, there is a significant opportunity to simplify some of the core and repetitive administrative-related tasks that occur throughout many touchpoints in the healthcare industry’s ecosystem such as eligibility, prior authorization, coordination of benefits, provider information and claims status, among others. A blockchain-based network of payers and providers creates the opportunity to reimagine many of these traditionally non-value added activities. Furthermore, when payers and providers work together to create joint processes and execute on a shared network, inefficiencies can be eliminated.

One use case that demonstrates how blockchain can streamline the administrative process includes the sharing and updating of provider demographic and banking information with payers in a secure environment. Often, the administrative processes behind the management of provider information are manual and disjointed so that when a change is made, significant effort is needed to update the information across stakeholders. This can not only impact timeliness of payments, but also increases opportunity for fraud. With a distributed network that leverages blockchain, when a validated change is made to a provider’s data, all parties with appropriate permissions can automatically receive the updated information – resulting in faster and more accurate payments.

Let’s start by working together

Blockchain technology can help provide a foundation for a newfound level of trust in the healthcare industry.

The next step is for all stakeholders – payers, providers, patients, financial institutions and developers – to collaborate on building this network together to achieve efficiency and true interoperability in healthcare. With a single network that connects the industry, healthcare will be better positioned to meet its customers’ expectations and business goals.

Photo: Pixtum, Getty Images

Tom Walsh currently serves as SVP, Treasury Management Innovations, and has more than 20 years of experience in the financial services industry. Walsh’s primary focus has been on the development and deployment of healthcare revenue cycle solutions and is now leading the exploration of blockchain technology at PNC. He served in a variety of finance roles at National City Corporation (acquired by PNC Bank) including Corporate Banking Business Unit CFO; Manager of Forecast and Budget; Manager of Funds Transfer Pricing; and Corporate Financial Analyst. Walsh has a B. S. from Miami University in Oxford, Ohio and an MBA from Case Western Reserve University in Cleveland, Ohio.

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