The healthcare industry has made great strides in sharing clinical information, especially across geographic regions and peer-to-peer connections.One Report Research by CHIME and KLAS shows that nearly two-thirds of vendor organizations investing in interoperability are satisfied with their progress and report that they “often or almost always” have access to the records they need. The report also stated that the most valuable methods of accessing patient data are public HIE (39%), national networks (36%), and direct messaging (31%); FHIR adoption rates are highest using large EHR providers; and, FHIR The top use cases for APIs are patient-facing tools (31%), clinician support tools (27%), and patient record exchange (24%).
As the industry continues to gain momentum in clinical interoperability, it is time to expand our horizons to include another value of interoperability: the smooth and direct exchange of management data.
Administrative processes and data costs rise
Examples of management complexity are diverse, including having to fill out forms repeatedly, re-key existing data into multiple systems, and manage data via fax transmissions or worse, manual phone calls. In most cases, managing complexity is part of the billing and insurance related (BIR) process. These procedures attempt to answer the following questions:
- Is this patient eligible for this service?
- Can we verify the exact benefit?
- Does this service require prior authorization?
- Is this provider certified?
- Is this provider part of the correct network?
We spend approximately $42 billion annually on administrative transactions, according to 2021 CAQH Index Report. The cost per manual eligibility and benefit verification transaction is $16.07, while the cost per manual pre-authorization transaction is $14.49. These costs include the labor required to conduct the transaction, but do not include the cost of collecting information for the transaction or subsequent.
Considering the 831 million manual eligibility and benefit transactions and 62 million manual prior authorizations made by payers and providers annually, the total cost of these two transaction types alone is staggering.
What if there was a way to make all this information readily available to all stakeholders through a secure and neutral network? The time, effort and resources currently required to manage these transactions can be significantly reduced.
The good news is that technologies like blockchain can help enable this type of interoperability, securely, in a timely manner, and much easier than you might think.
Management interoperability without data aggregation
A healthcare network powered by blockchain could allow data to be stored and transmitted over a peer-to-peer network without centralizing the data into a single storage system or even requiring an intermediary at all. This means that data stored in a hospital or payer system can remain there so that each entity can maintain control over its information systems. They will securely expose the data and allow users to discover it based on the permissions they set.
Once information such as eligibility and benefits is requested, the ID keychain and master index will locate the information, match it with available data, and deliver it to the requester. A neutral network operator can provide certification, network security and compliance.
Such a network could also reduce IT costs by enabling revenue cycle management companies, telehealth platforms and other solution providers involved in the healthcare business to connect over the same network. This would eliminate the need for payers and providers to build and maintain gateways with multiple systems. Even in addition to cost savings, reducing system touchpoints should significantly reduce the likelihood of security breaches.
better way
Payers and providers spend almost $496 billion Annual bills and insurance related costs. Much like clinical interoperability, greater administrative interoperability can help eliminate many of these costs, freeing up much-needed investment resources. Leveraging a secure network powered by blockchain should be part of every health system’s strategic plan to increase efficiency and reduce costs for better continuity of healthcare.
Photo: James Bray, Getty Images
