Achieving fluid data interoperability has been a complex and challenging goal for the U.S. healthcare system. The result of which has led to excessive administrative costs, delays in providing care, and significant patient frustration.
According to the Centers for Medicare and Medicaid Services, U.S. healthcare spending grew 9.7% in 2020, reaching $4.1 trillion, or $12,530 per person. This is forecasted to grow to $6.2 trillion by 2028, which will only exacerbate the current spending trajectory, leading to an overburdened healthcare system and less satisfied patients. However, addressing data-flow inefficiencies across the industry could help in a variety of ways – most importantly, by saving tens of billions of dollars annually (McKinsey).
It’s time for healthcare to catch up to other industries by transitioning from disconnected data silos that prevent interoperability to a connected network infrastructure. Payers, providers, patients, and vendors — entities that historically have encountered barriers for collaboration – can now come together with a technology enabled, secured platform so that communication and data sharing can happen seamlessly, as it does in other industries.
What exactly is needed for this to happen across the healthcare industry? In short, an “internet 3.0” for healthcare – a nationwide permissioned network infrastructure through which healthcare organizations, patients, and other key stakeholders can access accurate information in real time. A participant-based, distributed network that is based on blockchain technology serves as a health utility network and eliminates the need for point-to-point connectivity by creating an environment of “connect once to many.”
Imagine this: permissioned network participants have access to the data needed to administer healthcare, streamline processes, and expedite access to care while enhancing the consumer experience, reducing administrative waste, and improving outcomes. Network participants can also increase consumer loyalty, lower physician and staff burnout, while reducing technology and operational costs.
Leveraging the power of blockchain, the network has a verifiable trust layer for joint processes between participants. Because of that agreed upon, verifiable trust function, counter-party risk of data sharing can be significantly reduced. Each participant on the blockchain knows, with a certified verification, that the other parties are “good actors” and agree to interact with each other using built-in, automatically enforced standards. No other intermediary is needed to guarantee the integrity of the data or transaction.
Ultimately, this network shifts the need to exchange data by facilitating data access. The switch from exchanging to accessing gives providers, payers, and other healthcare stakeholders – including patients – the ability to know demographic, coverage, eligibility, clinical, payment, and other actionable information automatically and in real time. Furthermore, additional innovative solutions can be efficiently deployed and accessed on the network, equipped by marketplace functionalities to enable faster monetization and adoption.
By enabling every permissioned party associated with a patient’s care to have timely access to accurate data, there can be significant reduction in care delays, errors, duplicate testing, and so much more —including cost of care. For revenue cycles, this can mean that payers, providers, and collaborators can have real-time data to significantly decrease fraudulent claims, claim rejections and delayed reimbursements. The potential cost reduction from eliminating waste, removing administrative burdens and improving the industry’s overall efficiency has the potential to be significant.
Implementing and using blockchain will require a new strategy for payers and providers—one based on a new mindset of co-opetition. While embracing this new mindset may be a big hurdle to overcome, it’s clear that fluid, permissioned data access between patients, providers, payers, and vendors is essential for delivering quality care and an optimal patient experience. This is where blockchain shines and will make an impact on the healthcare experience in this decade. Decentralized digital ledgers that hold accurate and immutable data are essential to doing business. In short, blockchain is a catalyst for making interoperability possible in the healthcare industry.
About Mary Butler-Everson
Mary Butler-Everson is senior vice president of Healthcare Product Innovation for PNC Treasury Management. Butler-Everson and team are responsible for identifying, developing and launching new products and services to continually advance the real-time availability and security of moving data and dollars between payers, providers and consumers. PNC is one of seven healthcare-related organizations that helped created and committed funding for Avaneer Health, a fully interoperable, participant-based network developed for and by the healthcare industry.