- Humana, MultiPlan, UnitedHealth Group's Optum and UnitedHealthcare and Quest Diagnostics are banding together on a blockchain-enabled initiative to improve data quality and reduce time and costs associated with changes to provider demographic data.
- The pilot program will look at how blockchain can ensure health plan provider directories have the latest provider information.
- It also will explore the impact of sharing data across organizations via blockchain on data accuracy, administrative efficiencies, access to care and costs.
Network accuracy is a huge problem, both for patients and providers. Updating and verifying data can cost as much as $2.1 billion a year, according to the companies.
In a recent American Medical Association and LexisNexis Risk Solutions survey, 52% of physicians reported seeing patients each month with health coverage issues tied to inaccurate information about in-network doctors.
For patients, an inaccurate directory can lead to choosing an out-of-network doctor not fully covered by their health plan.
Patients may not know that a doctor doesn’t accept Medicare patients or has moved his or her office. This can lead to “surprise” medical bills when care isn’t covered. Only a handful of states have laws protecting patients from balance billing for out-of-network care delivered in emergency rooms or in-network hospitals, and even those have ambiguities and gaps.
A recent CMS report found 52% of Medicare Advantage online provider directories are inaccurate. An earlier CMS review found a 45% inaccuracy rate. CMS has requested more oversight in light of the problem.
It’s not just patients who pay for network inaccuracies. Plans that fail to keep directories current face stiff fines — up to $25,000 per error per physician and up to $100 per physician for errors in plans sold on HealthCare.gov.
The AMA and LexisNexis are partnering on a project that centralizes provider data to meet federal and state directory standards. VerifyHCP allows physician practices to update information for all participating health plans in a single site.