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Blockchain Can Remove the Mess in Healthcare and Boost Consumerization

Posted by: Iyappan Rathina On August 11, 2017 04:55 PM

Blockchain Can Remove the Mess in Healthcare and Boost Consumerization Every time a patient visits a doctor or goes to a hospital, the cumbersome process of creating, maintaining and updating healthcare records inadvertently shows up. The need of the hour is to devise efficient systems that ensure the best outcome for patients by streamlining data sharing among various stakeholders.

As of now, be it healthcare administrators, staff or physicians, everyone ends up spending more time typing and clerical input than patient care. This calls for a system that does more than just gatekeeping and upkeep of digital transaction records. A shared ledger of digital medical transactions can put us on the right course of action. However, we need to be able to go beyond record keeping and embrace synchronization across a network of patients, insurance companies, and healthcare providers.

Among the many pain points experienced by insurance and healthcare providers is a lack of access to provider directory. Provider members are expected to meet all regulatory compliances regarding timely updating of directories.

Some of the regulations in place are as follows:

Qualified Health Plans Medicare Advantage Medicaid Managed Care National Association of Insurance Commissioners (NAIC)
At least Monthly Within 30 days Within 30 days At least Monthly

Often, the member information made available is either old or incorrect, leading to a denied or a rejected claim. It can bring a great deal of distress to member patients of the network who can be victims of common errors made by manual filing and documentation.

In a Provider Directory, members usually look for the following:

  • Whether the provider is in-network
  • Whether the address and location are correct
  • Whether they accept the incumbent’s insurance plan
  • What are the languages spoken
  • What is the hospital affiliation
  • What is the contact information

Blockchain acts as a perfect solution for hospitals, insurance providers, payers and patients alike, relieving them from the present mess when it comes to diagnoses, medications, and various medical services.

Patients expect healthcare providers to update their information at regular intervals. This is compounded by the fact that sometimes providers are required to maintain multiple directories. If the information is not updated, fewer members would visit these Providers, resulting in revenue loss. This is one of the main reasons compelling healthcare providers to exit ill-managed networks. This also increases the expense for patients when they go to a new provider.

With growing medical consumerization, patients are no longer just network members. They demand greater convenience similar to a digital shopping experience even in healthcare. Today, they would like to see more dynamic usability, preference tracking, smart filtering and updated information.

The latest innovations in Blockchain Technology can help create integrated healthcare networks of the future that reduce human intervention significantly. We are looking at a future healthcare synchronized by replicated databases that also bring unprecedented security benefits. Not only does blockchain help update Provider Directories by utilizing its decentralized consensus protocol, functions like smart contracts within Blockchains identify changes as and when a claim is submitted. Blockchain automatically reflects the changes across all relevant areas essential to providers.

If information such as network change is made in one claim, the information when accessed by others can be automatically accepted or rejected through smart contracts that bind them. This way, the directories are updated by multiple parties and the responsibility does not just lie with a single provider alone. By hacking one block in the whole chain, you can now automate orchestration of simultaneously hacking at every other block in the chain’s chronology.

About Author

Iyappan Rathina, Head of PreSales and Solutions of HLS, Tech Mahindra

Iyappan Rathina has over 23 + years as a Solution Architect and Business Consultant covering Payers and Providers globally. Designed, Conceptualized and created solutions focused on Patient Engagement that would improve the experience, Interoperability, automation to bring in efficiency and reduce human touch. Managed large offshore delivery teams covering P & L and operations focused on cost optimization and delivery excellence.

Tags: Connected Industries, Connected Platforms & Solution
 
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