By Aaron Symanski, CTO, Change Healthcare

Aaron SymanskiYou’ve probably heard the word bandied about and wondered, “What’s all the fuss about ‘blockchain’?” Simply put, blockchain is an open, continuous, and secure ledger stored online that can’t be altered. Its users can track supplies and transactions on blockchain, sharing information among multiple stakeholders while recording transactions between parties efficiently and in a verifiable, permanent way.

The financial and logistics sectors have used blockchain for years to record information, and now the buzz around healthcare focuses on how blockchain can solve some of the industry’s biggest headaches. So where are the specific opportunities for our industry?

Blockchain is proving its value daily, and one of its biggest strengths is in its audit capabilities. For example, think about pharmaceutical products that need to be maintained at a certain temperature, and to ensure they’re not counterfeit and really were made by their manufacturer. Blockchain can assure both.

Those are the easy fits, but think about the next step in healthcare information. For the financial industry, it’s about the visibility of the information being stored and available on blockchain to everyone. With personal health information, it’s a different matter. We’re seeing information being stored away from the chain, but the chain is used to affirm that the information is correct. We’re seeing variations of blockchain where the information itself can be stored. A good deal of creative and innovative thinking is being done around this space.

There are other direct applications that aren’t as exciting because they don’t deal with protected information, but they’re very straightforward and that’s a lot of where our interest is: making that process of healthcare more effective and allowing clinicians to spend more time with patients instead of paperwork. Still, there are some hurdles to overcome.

One of the biggest challenges for blockchain in healthcare is overcoming the hype. Those who utilize it are being really innovative and creative in coming up with ideas about what blockchain can do for us if it had additional capabilities. We need to separate out where the real blockchain value-add opportunities are, and what pieces require more work and significant change to leverage the technology.

One of the more interesting possibilities is that the chasing and reconciliation processes will begin to separate. About 80% of the work we do with chase deals with comeback, due to misspelling or typos in the record. With blockchain, that will be separated from the more challenging claims that need chasing—the ones that require human involvement. Are we doing bundling or unbundling? Do we have multiple providers? Are the cases more complicated with multi-year and multi-origin information? We see straightforward processes being peeled away from the organizations via blockchain, so they can use their existing resources for more challenging issues.

We’ve seen many of the standards around communication and reconciliation go away in other industries with blockchain. The organizations work their way down the value chain killing off the low value issues first, and leaning toward the high value where you need people involved to put all the puzzle pieces together. What you’ll see is a reduction in cost per case, cost per issue, and cost per event.

When you start moving your simple processes to automation, and know your counterparts are actually communicating and looking at everything the same way you are, it builds stronger partnerships. Whether you’re a hospital provider or payer, there is a lot of expertise for these processes that will be adding a good deal of value.

The Challenge Ahead

One thing that blockchain doesn’t do for us, which needs to be done for interoperability, is defining the language of how information is stored and used. Are we referring to blood pressure and height in the same way? How do ICD-10 and other different languages come together? Once you and I know we are conversing in English, we can easily store that information in a record. If one of us was speaking French and the other Chinese and we were trying to put the questions and answers in the right place—that’s challenging.

Blockchain is a very effective storage mechanism. What it brings to interoperability is information about where things are stored, and creating a conversation about what information we actually want to exchange and store.

But we can also learn some lessons from what our friends in the financial field experienced with blockchain. There is a huge amount in healthcare that defined the movement of value and dollars, and payments and the reconciliation of those payments. Were the payments appropriate based on the service provided? Was the payment made? Those ideas have parallels in finance. Do we agree on the terms of the contract? Has the payment been made on the contract? However, when we look at personal health information, it gets interesting.

How can we commission what information on the chain can be seen? No financial firm wants competitors to see all their work, all their payments and customers. Healthcare will be looking at blockchain with a respectful eye and with its own viewpoint. The main lesson coming out of finance right now is that blockchain works well when there is an asset with multiple parties interacting with the asset, and the asset is tracked on the blockchain. When healthcare looks at using the blockchain against that lesson, it crystalizes about what it means to be on the blockchain.

Change Healthcare has worked with the technology and done our own improvement process. Right now we feel it’s creating the right examples of where blockchain makes the most sense, where all parties find value. We are seeing a regulator partnering with an asset manager, or asset manager partnering with private equity.

The most direct use of blockchain available to healthcare today is moving into reconciliation, claims adjudication, and revenue cycle management opportunities where we have highly trained, engaged smart people, allowing them to do other things within the organization. I think the next step after that, as interoperability separately solves, is how do we create that level of patient information so in the moments of treatment, my information and your information are available? But I really think the immediate potential is in allowing us to reduce the cost of healthcare by reducing reconciliation and back-office pieces. That will allow providers to spend more time with patients.

Ten years from now, we will see healthcare very much as a plug-and-play infrastructure where information is correct, it is distributed, and its access is well controlled through entitlements and security. When I think of 10 years from now, I see myself walk into an immediate care clinic in a city I’ve never been in before, and allowing that organization to have access to the appropriate pieces of my healthcare record as I determine it.

I envision being able to look at my phone and see that my insurance company cleared a set of claims; I’ll see my portion and their portion of the bill, and one view will show the different providers involved in my care in one frame so I can understand the bill quickly. I can understand my responsibility and your responsibility, and I can agree to make that payment. I have a more complete, holistic picture with my interactions and experience with healthcare. It’s blockchain, doing what we intended.

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