Aetna, Ascension join industry blockchain pilot to improve network directory data

By | December 6, 2018

Dive Brief:

  • Health insurance giant Aetna, newly merged with CVS Health, and Ascension have teamed up with five other healthcare companies to test the use of blockchain technology to fix provider network lists. 
  • The so-called Synaptic Health Alliance will help to pilot a blockchain-enabled initiative to improve data quality and trim time and costs associated with changes to provider demographic data. Humana, UnitedHealthcare, UnitedHealth Group’s Optum, MultiPlan and Quest Diagnostics launched the alliance in April.
  • The news comes as a recent CMS report found nearly half of Medicare Advantage organization online directories contain at least one provider location inaccuracy. 

Dive Insight:

Inaccurate network directories are a source of headaches for providers, payers and patients. Without accurate information, patients risk choosing a doctor who is out of network and not fully covered by their health plan. They may not realize the doctor is not accepting new patients or Medicare patients, or that the office relocated to a new site. That can lead to surprise medical bills, where patients receive bills for unanticipated costs incurred when care was provided outside their insurer’s network.

For payers, directory errors can also take a financial toll — plans that fail to keep directories updated face fines of up to $ 25,000 per error per physician and up to $ 100 per physician for errors in plans sold on HealthCare.gov. 

Nearly 49% of MA organizations listed provider directory locations with at least one inaccuracy. Within each directory, the share of locations with inaccuracies ranged from 4.6% to 93%, with the average being 45%, according to CMS. 

Of the 52 MA organizations reviewed, 28 had errors regarding location between 30% and 60% of the time. The inaccuracies included providers who were not at the location listed, incorrect phone numbers and information indicating a provider was accepting new patients when in fact they were not.

Meanwhile, physicians are inundated with requests from health plans to update their directory information. According to the American Medical Association, the average doctor is affiliated with 12 health plans and faces rigorous data audits from each of them.

Keeping directories accurate and updated costs about $ 2.1 billion annually, according to industry estimates.

The blockchain alliance’s pilot uses a multi-company, multi-site, permissioned blockchain, which allows each member to determine how its nodes are deployed, according to a new white paper. “[Ethereum-based] Quorum nodes use the go-ethereum client to maintain transaction data that is visible to all network participants as well as private data that is visible only to parties of private transactions,” according to the paper. “Private transactions are enabled through the Constellation extension of Quorum.”

The initial pilot includes the development of a blockchain exchange marketplace and application, a model for incentives to spur participation and an administrative cost savings mode to measuring results.

Ascension, the nation’s largest Catholic health system, brings a provider perspective to understanding the difficulties in maintaining updated directories. Aetna has more than 22 million health plan members.

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