Humana is working with competitors to use blockchain, the technology underlying cryptocurrencies, in a pilot program to improve frequently faulty data that older consumers use to find medical providers.
Federal regulators had found in a new report that more than half the information the insurers submitted for 15,000 providers, such as doctors, had at least one inaccuracy. That meant either the doctor was not at the location that was listed, the phone number was incorrect, or the doctors were not accepting new patients even though the directory said they were.
The Centers for Medicare & Medicaid Services said that the inaccurate date “could pose a significant access-to-care barrier” because Medicare members and their families often rely on the directories to determine which medical providers are in their network.
“Beneficiaries and their caregivers rely on provider directories to make informed decisions regarding their health care choices,” the agency said. “Inaccurate provider directories can create a barrier to care and raise questions regarding the adequacy and validity of the network as a whole,” regarding the Medicare Advantage Organization.
CMS had begun its review of the data based on a customer complaint. Following its review, the agency had sent warning letters to some insurance companies, including Humana, with the three worst offenders — not Humana — being asked to also provide improvement plans.
Now Humana is joining forces with companies including Optum and a rival, the UnitedHealth Group, to address the “critical complex and difficult issue” by using blockchain technology to improve data accuracy.
Medicare Advantage customers represent an important revenue source for the Louisville-based insurer. As of Dec. 31, Humana had nearly nine million customers enrolled in various MA plans. Medicare is the traditional health care program for older Americans managed by the federal government. With Medicare Advantage, the benefits are provided via a private health insurer.
Kyle Culver, an enterprise architect with Humana, told Insider that half the medical care provider records the insurers collect have a change every 18 months. That can include a physician moving to a different location, changing phone providers or no longer accepting Medicare patients.
“Everybody’s trying to keep up with those changes to provide accurate information to the members,” he said.
And it’s a lot of data to track: A search on the CMS website for providers in Louisville alone returns 358 pages of results with nearly 3,600 names, from diagnostic radiologist Aly Abayazeed to obstetrician/gynecologist Robert Zoller.
Many providers also pop up in multiple networks: One physician, for example, may work with 20 health plans, and each of those plans has to provide to CMS data about that physician.
Given the overlap, the frequent changes and the data complexity, Culver said the insurers and their partners decided to address some of the challenges through collaboration.
Culver said that he and tech leaders from other companies considered crowdsourcing and other ways to streamline the process and improve data accuracy and determined that blockchain, which is essentially an encrypted, decentralized digital ledger, would allow for easier cooperation and assure data fidelity.
Culver has worked with the technology and won a third-place award in a national competition sponsored by the U.S. Department of Health and Human Services.
UnitedHealth Group told Insider via email that blockchain technology “is most useful when loosely coupled or independent organizations want to confidently share and audit information and automate mutually beneficial processes.”
The pilot program’s goal, UHG said, “is to uniformly measure the quality and cost implications of sharing provider demographic changes across a permissioned blockchain.”
Culver and UHG said the partners would start small, perhaps by focusing on a limited geographic area, and determine the best approach to ensuring accurate data. The blockchain will retain information about where data originated, so that frequent sources of inaccurate information can be identified and avoided.
The companies hope the more accurate data will enable patients to find doctors and other medical providers within their network more easily, which can save them costs and prevent unexpected surprises, such as a higher bill from an out-of-network provider who erroneously is listed as being part of the insurer’s network.
UHG also said that the improved data also would help physicians and clinics, which may receive fewer calls and emails from insurers trying to verify and update the information.
The insurance companies also hope the collaboration will cut their costs: The industry estimates that to track down and maintain the data costs them $2.1 billion a year.