The importance of medical provider credentialing and enrolment (that is, the processes by which healthcare facilities and insurers verify the training and education of medical practitioners, largely through primary research, prior to allowing such providers to bill for services) is, without question, paramount. With what seems like an ever-evolving landscape within the U.S. healthcare system – the most recent iteration including sharp focuses on value-based reimbursement and cost control – it is critical that the provider quality is traceable and transparent. Currently, the process is plagued with inefficiencies – after the physician is credentialed with a facility (which can take a number of months), insurers can take an incremental 90-120 days to complete the process. Additionally, significant administrative burden is placed on the practitioner, thus limiting the time they can spend with patients and increasing hospital / practice working capital requirements. Presently, a central database of current, easily accessible provider data does not exist, which leads to duplicative work each time a credentialing process is initiated. The recruitment and onboarding of high quality practitioners is perhaps the most critical part of a hospital’s supply chain. With doctor shortages being prevalent in many medical specialties and annual turnover rates of 6.8%, meaningful opportunity exists to increase patient-facing time by improving the quality and accessibility of provider data through digitization.
Enter blockchain, an “open, distributed ledger that can record transactions between two parties efficiently and in a verifiable and permanent way” . When applied to credentialing, all relevant documentation / inquiries would be placed into a ledger, which could then be accessed at any point in the future by a participating organization to which the practitioner grants access. Furthermore, the permanent nature of the ledger would limit the risk of post-entry fraudulent activity or tampering.
Earlier in 2017, the State of Illinois formed the Illinois Blockchain Initiative (“IBI”), a consortium of state and county agencies tasked with collaborating to explore innovations presented by distributed ledger technology. Hashed Health, a venture-backed innovator that leads a consortium of companies focused on accelerating blockchain applicability within healthcare (and whose member companies include Accenture, Change Healthcare, and others), has recently partnered with IBI to launch a pilot to explore the utilization of blockchain to improve the credentialing process in Illinois. With increased scrutiny on cost at both the federal and state levels, the ultimate goal of the effort is to demonstrate an ability to effectively manage credentialing in this manner to other states, in an attempt to eventually reach national scale.
While development efforts and “prototyping” are crucial, should success come, widespread adoption will not be without its challenges. Given that credentialing and enrolment involve multiple parties (practitioners, healthcare facilities, and payors), IBI should ensure that representatives from each stakeholder group are involved in the iterations. Historically, these have been manual, archaic processes, and a transition to a more technologically innovative solution will require a shift of mindset, significant investment in training and education, and a robust system to ensure compliance going forward (as the incremental value of this solution will only be realized if the ledger is appropriately populated and maintained). The stakeholder equation is further complicated by the fact the insurance market is comprised of both governmental and commercial organizations. While it is helpful that the pilot is being championed by both public and private sector players, achieving buy-in on a federal level early on will be critical to spur widespread adoption given the significance of Medicare and Medicaid across the country. Additionally, blockchain technology’s relevance to hospital supply chain and operations extends beyond credentialing, and its applicability should thus be explored broadly. As an example, opportunity exists to build on the recent proliferation of electronic health records (“EHRs”) by enhancing effectiveness and driving down costs.
The introduction of blockchain to the healthcare industry has tremendous potential, and credentialing is a great place for IBI and Hashed Health to start. That said, some questions regarding roll-out and applicability are yet to be answered. Is it realistic to expect widespread adoption of a new, collaborative technological solution in an industry in which each player has generally been operating in isolation? And, as the applicability extends beyond this specific use case, will it be possible to convince regulatory bodies to allow for the storage of patient data in blockchain ledgers, given that patient-related information is held to a particularly high standard by regulations such as the Health Insurance Portability and Accountability Act (“HIPAA”)?
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1 Pam D’Apuzzo, “The Evolution of Credentialing and Provider Enrollment,” BeckersHospitalReview.com. September 10, 2015, https://www.beckershospitalreview.com/finance/the-evolution-of-credentialing-and-provider-enrollment.html, accessed November 2017.
2 David Chou and Bell Wellman, “Reinventing Physician Credentialing with Blockchain,” Health Standards Blog, June 20, 2017, http://healthstandards.com/blog/2017/06/20/credentialing-with-blockchain, accessed November 2017.
3 ”Physician Turnover Jumps as Retirement Regains Its Luster” 2013, Trustee, 66, 5, p. 4, Business Source Complete, EBSCOhost, accessed November 2017.
4 Marco Insanti and Karim R. Lakhani, “The Truth About Blockchain,” Harvard Business Review, January 2017, https://hbr.org/2017/01/the-truth-about-blockchain, accessed November 2017.
5 Illinois Department of Innovation and Technology, “Blockchain in Illinois,” https://www2.illinois.gov/sites/doit/Pages/BlockChainInitiative.aspx, accessed November 2017.
6 “Illinois Opens Healthcare Blockchain Development Partnership with Hashed Health,” Hashed Health press release (Chicago, IL / Nashville, TN, August 8, 2017).