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Blockchain could help improve physician directories, but trust among health plans likely must come first

The health care industry spends an estimated $2.1 billion a year to maintain physician data.1 Despite this substantial annual investment, physician directories are often inaccurate.

Some health plans are exploring blockchain as a possible technology that could solve this problem. While I agree that blockchain holds tremendous potential to improve the accuracy of directory data, I see trust as a barrier that will likely need to be overcome first. Specifically, health plans should be willing to share physician data with each other.

What is blockchain? Blockchain is essentially a living list of linked digital records that is owned and managed collectively, rather than by a single entity. Through blockchain, multiple health plans, physicians, and hospitals would be able to update information that would be available to all subscribed participants. For example, if a physician adds a new phone number, all participating health plans will see the update at the same time. As a result, the health plans and their network physicians could see lower administrative costs and save time.

CMS review finds errors are common
Last summer, the US Centers for Medicare and Medicaid Services (CMS) reviewed 6,841 physicians at 14,869 locations that were listed in online physician directories used by Medicare Advantage plans. The agency found that more than half (52 percent) of all entries had at least one inaccuracy (e.g., wrong address, incorrect phone number, outdated information about whether a physician was accepting new patients).1

Accurate physician directories can be important to all health care stakeholders. Health plans need to be sure they have a physician office’s current address so that claims can be paid on time. Health plan members need to know which doctors are in the network, and which ones are accepting new patients. Through the directory, patients can also see which languages are spoken in the physician’s office, and if they offer convenient hours. Nearly 90 percent of physicians say it is important to be accurately represented in physician directories, according to a survey of 700 physicians conducted by the AMA.

Why is it so difficult to maintain accurate information? The challenges extend beyond just fixing an incorrect phone number on a website. There is often little coordination between the health plans and physician offices, and accurate information can get lost in the shuffle. Consider a physician who moves to a new office. The administrative staff might need to contact 10 health plans and give the new address to each one of them. At the same time, some of those health plans might be reaching out to the physician’s office to ask for the new address. Here’s another challenge: Nearly 40 percent of physicians continue to use fax machines to update directory information, according to the American Medical Association (AMA).

In blockchain, trust might trump tech
Lately, there has been a good bit of buzz around the idea of using blockchain to improve the accuracy of physician directories. In April, Humana, UnitedHealth Group and a few other organizations announced the development of a pilot program that would test the ability of blockchain to reduce errors in their directories. Deloitte is assembling a small consortium of our client health plans to pilot a strategy of sharing physician data through a blockchain.

For such arrangements to work, health plans will need to share data with each other. In this competitive landscape, health plans often do not trust their competitors. They also tend to treat all information about network physicians as proprietary. This includes even basic and publicly available information, such as a physician’s name, specialty, address, and phone number.

There is nothing strategic about this information, and there is likely no reason that health plans should be reluctant to share it. Participants involved in any sort of blockchain consortium should understand the benefits of sharing information. Each health plan also should agree that if it receives updated information from a physician the information will be updated on the blockchain.

While blockchain could make it easier for physicians to keep their basic information up to date, information might not be the same for every health plan. A physician, for example, might decide not to accept new patients from one carrier that pays lower rates than its competitors.

Blockchain holds great promise to potentially solving the expensive and vexing problem of maintaining accurate physician data, and directories. However, this promise can likely only be realized through trust and a willingness to collaborate among the all stakeholders.

1 https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/index.html
2 Health Plan Week/UnitedHealth Group

Author bio

Bobby is an experienced leader in Deloitte Consulting LLP’s health care technology practice. Bobby is a health care expert and has experience leading large scale technology-enabled business transformation initiatives, and is a seasoned trusted advisor to health plan business and technology leaders. Bobby has significant experience in setting the IT strategy and roadmaps needed for transformation, and driving delivery across the health plan value chain and core administration areas, primarily in the provider domain. He leads the provider data, network, credentialing, and contract management initiatives, addressing the need for health care organizations to define and implement a future state ecosystem.