Blockchain in the revenue cycle: What healthcare needs to succeed

As a technology, blockchain is still nascent, particularly when it comes to applications in healthcare. Potential uses are starting to emerge, though, and one aspect that may be ripe for transformation by blockchain is the revenue cycle, particularly in the area of claims denials.

A quick refresher: Blockchain is a distributed ledger technology for storing data as an unchanging, and unalterable, series of records. It first came to prominence as the basis for cryptocurrency Bitcoin, in which it transferred value without an intermediary, like a bank.

That's one of the main tricks in its repertoire. It also provides a distributed ledger, ensuring no one can spend the same money twice. And instead of recording transactions in a central database -- in which funds are deducted from one account and added to another -- blockchain chunks digital records in blocks, which are then chained together with cryptographic keys. The chain then tracks the history of changes.

The participants each get a copy, and the content of each block is locked. If anyone deigns to alter the data, their copy of the chain will be broken, immediately and without subtlety.

Lynn Carroll, chief of strategy and operations for HSBlox, said denials management is quite possibly the first corner of the healthcare world to benefit from this emerging technology.

POTENTIAL BLOCKCHAIN APPLICATIONS

"When you think about utilizing machine learning capabilities to evaluate historical claims, you now have the ability to verify, in the form of a smart contract on a smart claim, the rules for adjudicating that claim in real time," said Carroll. "It can tell you if it's likely to be denied, and it can tell you multiple reasons, or I can automate those claims based on the outputs of the machine learning. Once a payer and a provider have a contract, codifying that on blockchain does two things: It automates it, and it allows you to follow the rules the two parties agreed upon to finalize a transaction."

If one moves that process to the front of the claims adjudication cycle, there now exists the ability to provide real-time transparency to the patient and the provider about the status. The claim may be finalized or financing opportunities may be presented to the patient, and the payer could potentially extract an additional discount from the provider for taking the risk.

Which means that if a claim is finalized in real time, there's an opportunity for the patient, provider and the payer to understand when the services are to be delivered and what the financial responsibility will be.

MOTIVATING STAKEHOLDERS

Blockchain success in healthcare, said Carroll, is measured by stakeholder participation. Those stakeholders have to be motivated.

"By definition, a blockchain initiative or program is a network in a bottle," he said, "with multiple participants that have the ability to shape information in real time. The motivation for the folks who participate in a blockchain initiative is the ability to have secure transactions, exchanging value. It could be financial, or it could be a contractual relationship to participate, but oftentimes there could be an information reason to participate."

Carroll offered the following example: Years ago, when a person had to reconcile their bank statement, there was a lack of real-time transparency and visibility when it came to determining the current balance. Then things started moving heavily in the direction of electronic transactions, but there were still scenarios in which people had to reconcile their bank statements after the fact.

Then along came mobile banking apps. These gave people the ability to have real-time transactions, even if they weren't finalized. A similar scenario can happen in healthcare, said Carroll.

"What you have is a whole host of transactions that have occurred typically under the hood, where the patient has not been able to see that information and make decisions in real time," he added. "When you think about the reasons stakeholders would participate, it's because it's in real-time and on a permission basis."

That's really what separates blockchain from its cryptocurrency origins. Permissioned access means the information won't be replicated in a public way.

HIPAA dictates that information can be disclosed between covered entities, and blockchain can help to ensure it gets handled in an appropriate manner.

"This gives more control," said Carroll. "If they have the ability to aggregate this information themselves and then share it with stakeholders like a physician, or in a case where they have multiple chronic conditions, they have much more visibility. Any information they share, they have full traceability of."

BARRIERS TO ADOPTION

As with any technology that makes its way into the mainstream of healthcare, interoperability has continued to be an industry challenge. These challenges are bound to recur as the industry moves to adopt more standardized data formats.

The concept of ubiquitous data sharing along the care continuum poses a challenge for the pervasive adoption of blockchain.

"As you can have motivated parties in a microcosm scenario that will share data and adopt standards with each other -- on what would be a smaller-scale use case to prove the value of the technology -- ultimately I think that shows the healthcare ecosystem would benefit from increased automation of processes, the reduced costs associated with that," said Carroll. "And the biggest benefit of that is real-time information sharing."

He anticipates a significant uptick in the use cases of blockchain in healthcare over the next three to five years -- distributed ledgers in particular. Pervasive adoption is likely to come later, perhaps in the next eight to 10 years.

"The technology is ripe for disruption," he said, "and as we continue to see more use cases, it will become more evident at a global level what the benefits of the technology are for healthcare, and probably more important, for full integration of patients into the ecosystem."
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com