In a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest — Blockchain: Transformational Technology for Health Care — is reprinted below. To see all of his blog posts, click here.
It’s happened to all of us. You get sick and go to the doctor’s office, where they inform you they don’t have your information and you have to fill out the same forms again. If you work in a doctor’s office, you’ve spent way too much time attempting to get a claim paid for a patient. If you’ve had a pending claim, it’s not an easy process to solve.
As the leader of a health and well-being company, progress is being made thanks to the use of electronic medical records, but health care claims validation and processing is complex because health care is complex. A whole series of validations is required, and multiple third parties are acting on behalf of other entities. It’s a complex, interwoven web of information requests, information verification and information sharing.
To top it off, we’re expecting hospitals, health plans and provider groups to easily exchange all their siloed data so the claims process can run more smoothly. Yet the biggest issue in health care Information Technology (HCIT) is interoperability. How do we share information via automated interactions between each other in a secure and effective manner?
The rise of Blockchain
Since the invention of databases in the 1960s, we have seen constant and frequent improvements to the technology that permeates our daily lives. Looking back at the significant changes in technology we have experienced, it is easy to appreciate the dramatic improvements to innovations like the personal computer and the internet.
Right now we walk around with super computers in our pockets – a mobile experience delivered through interoperability – that enable us to access and use information from sources around the world in real time. Blockchain technology is positioned to be the next dramatic innovation in health care, with a potential impact rivaling any of these other advances, and lessons can be learned from the embracement of Blockchain by the financial services industry.
Blockchain technology enables trusted transactions between participants without involving an intermediary. Removing the intermediary enables the two parties to interact directly without the overhead of including centralized authorities, like banks. Bitcoin is the first and most well-established Blockchain implementation. In a Blockchain, each of the participants has both the contract and the data needed to enable transactions to take place and be shared across the network, i.e., participants assembled via peer-to-peer connections utilizing Blockchain technologies to interface with a shared dataset.
Blockchain facilitates how the transactions are processed based on the logic in the contract and the data stored in the Blockchain. The Blockchain is independent of how the involved institutions and people connect; it’s a neutral forum where participants are acting in accordance to the parameters defined within the Blockchain.
The most common example of where Blockchain is being used is in the exchange of digital assets between untrusted and anonymous users. Currently banks and companies like PayPal will play the role of intermediary and allow users to exchange a fiat currency (i.e. dollars, euros etc.). This settlement process is typically not a near real-time process, and if the users are in different countries where currency exchanges need to occur, then even more complexity and time is added to the process.
If Blockchain is utilized, then the users’ agreement is translated into a smart contract that can be evaluated without an intermediary. Replacing the intermediaries with Blockchain increases interoperability and transparency while reducing transaction time, fees and fraud.
In Blockchain, constituents can access or create new contracts, creating an indelible record. This transparency and flexibility allows the community to iterate toward very powerful contracts that can be shared and provide a viable alternative for a multitude of activities where participants don’t even need to know each other but can trust the outcome of the Blockchain transaction. In the Blockchain, a history begins to wrap around contract activities, such as a payment. The idea is there is a mechanism that continues to feed and build this history.
The financial services industry has been one of the first to attempt to utilize Blockchain, given the challenge that financial transactions historically have taken days or weeks to process instead of minutes because back-end systems have not been updated to operate in a real time world. Take Digital Asset, a company founded by Sunil Hirani and run by CEO Blythe Masters. Digital Asset is working to use Blockchain to drive back-office efficiencies in “syndicated loans, U.S. Treasury repos, and equity shares in private companies.”
By focusing on reducing intermediaries, the company hopes to use Blockchain to “automate” trust. The interest from the financial services industry is so compelling that over fifty of the world’s leading financial institutions have banded together as a consortium to collaborate on how Blockchain can be leveraged to improve efficiencies across the industry. The potential efficiencies offered by Blockchain technologies have been projected to reduce banks’ overhead up to $20 billion per year for infrastructure alone by 2022. For health care, there is a similar opportunity at hand, reducing cost while improving the consumer experience.
Blockchain for health care
The health care industry is starting to examine how Blockchain technology could be used. Gem, a Blockchain company, announced a partnership with Philips to build a “private Ethereum Blockchain for use in the development of enterprise healthcare applications.” The American Enterprise Institute testified to Congress about the benefits of Blockchain to health plans.
The Office of the National Coordinator for Health Information Technology announced a Blockchain challenge and is now “soliciting white papers on the technology and its potential use in health IT ‘to address privacy, security and scalability challenges of managing electronic health records and resources.’”
Financial to contractual relationships
Blockchain creates a permanent transaction history – based on contractual agreements – that could enable pre-approved entities (hospitals, health plans, physician groups, and pharma companies) to create transparent contracts (legal agreements) for the consumer.
Each completed transaction is ordered into a “block” that’s connected, or “chained,” together as transactions are processed. Over time, this transaction history becomes very powerful because it offers transparency that was not available when transactions were processed by a collection of companies with very little financial incentive to collaboratively share data.
Take a standard health plan/provider agreement, or in risk-based relationships, provider/provider agreements, where each provides the other with a paper contract. Each entity loads the agreement into their separate systems, and it defines their relationship. The payor also has a contract with each person who has purchased a health plan. Using Blockchain, the health plan and provider could translate the wide variety of agreements needed to contracts on the Blockchain so everyone has visibility, and clarity exists for both the provider and the member. So when a transaction is processed, the Blockchain checks the authorization, and everyone can view the status, history and next steps. This transactional payment information could also be connected with the clinical service details to provide a holistic view of the patient’s interaction. Storing the information to create this holistic view in Blockchain would create a foundation that enables interoperability and innovation across the industry.
When a transaction occurs via Blockchain (a health plan member goes for his or her annual checkup, a physician’s office submits a claim for payment or a primary care physician refers to a specialist) a payment is made based on the latest information in the Blockchain (deductibles, maximum out of pocket etc.), and the contracts are loaded for each party. These contracts would enable the Blockchain to understand the current state of the transaction and the responsibility of each party in order to facilitate an automated payment process.
An automated payment process is possible, but a lot of things that happen within that transaction need to occur to verify its authenticity. Blockchain creates a connectivity mechanism, so everyone can drop their contribution into it, and it manages the entire workflow. Most importantly, Blockchain streamlines the process and enables automation that will help reduce the costs associated with claims reimbursement, leading to accurate and timely reimbursement.
Contractual to clinical relationships
Blockchain allows for interoperability at a new level for health care. Electronic Health Records (EHRs) connect right into the Blockchain, where information is not just integrated into the EHR from the hospital, but from providers and specialists.
It’s about the history, and the consumer has the latest and greatest of their medical history. Providers can also see what’s affected them. But they don’t see everything.
A primary care physician could access a complete medical history of the member, while the radiologist could be limited to only the specifics he or she needs to perform the task at hand. For each, it’s about accessing the right data at the right time, and the Blockchain technology could enable this type of specific “need-to-know” medical history access.
• Competitors working together for the consumer. It’s the era of the consumer in health care. Individuals are using exchanges to select their health plans. Blockchain is all about removing barriers, and that focus will enable consumers to better manage their health. Take a person who changes jobs a lot. Say she decides to leave her health plan for Humana. If the vast majority of health plans participate in a Blockchain, this individual can ensure that her personal health information is easily transferrable to her new plan, thus eliminating redundancies and other duplicative measures.
• Blockchain will transform the whole health care claims process. Health plans and providers can have their contracts coded into the Blockchain network, which allows for automation and enables them to communicate in a consortium. There is no more back-and-forth haggling with the health plan about what was paid, why it was paid, or whether it should have been paid. With transparency and automation, greater efficiencies will lead to lower administration costs, faster claims, and less money wasted. Blockchain enables claims to be paid without an intermediary, since health plan members are connecting directly with their providers. These consumers can also access their permanent electronic health records in a secure fashion, enabling them to have a real-time understanding of their health.
• The Federal government achieves better access. An individual may have a Medicare plan from the government but have a private prescription drug plan from a health plan. If the government participates in a Blockchain, they will be able to have real-time access to the individual’s drug plan. This would enable the Centers for Medicare and Medicaid Services (CMS) to develop a more holistic understanding of how the consumer’s private prescription drug plan is impacting the medical cost for a condition.
The integration of Blockchain into the health care system still has a long way to go before its potential can be fully realized. The good news is that the health care industry has already started to embrace the transformational power of technology. Blockchain is another step forward in simplifying a health system so we can help usher in a new level of care. The promise of Blockchain is about putting the consumer at the center of health care, instead of the other way around.