Solving Healthcare’s Provider Directory Challenge

Gigo Joseph, March 10, 2021

Solving Healthcare’s Provider Directory Challenge With a Single Source of Truth

Provider directories are one of the most fundamental parts of the healthcare infrastructure: They list all the physicians in the area broken down by the insurance plans they accept and the medical services they offer, and some might include professionals like nutritionists or physical therapists. Without these essential directories, it would be difficult or even impossible for patients and providers alike to understand the medical resources available in a given area.

Provider directories become better with more data, but they also become more complex to manage. Details such as a provider’s address, contact information, service offerings, equipment availability, insurance affiliations, and more can (and do) change frequently. With this, keeping everything updated for hundreds or thousands of providers — ones with various healthcare networks and ever changing service offerings — proves to be a serious administrative challenge. Without the time, staff, or tools to keep up with the pace of change, we get inaccurate provider directories that only make healthcare less accessible and efficient.

Various mandates require directories to undergo complete updates monthly, quarterly, semiannually, or yearly. This repetitive provider directory management undertaking contributes to the estimated $300 billion the healthcare industry spends every year due to administrative complexity “that could be eliminated without harming consumers or care quality.” Everyone agrees we need a better way to manage provider directories — and emerging technologies could certainly provide that solution.

The Cost of Provider Directory Management

Inefficient provider directory management might sound like a minor problem that creates a small cost. However, the healthcare industry spends $2.1 billion on provider directories annually — and often with underwhelming results. (In fact, a Medicaid audit found that more than half of provider directories contain significant errors.) The scope of this problem should be cause for alarm. When provider directories aren’t accurate and complete, there are implications beyond wasting a few billion dollars.

Those include patients who go to out-of-network providers, providers that struggle to keep their billing and administrative costs down, health information exchanges that cannot share information securely, and health plans that risk regulatory noncompliance. The point is, anything less than a perfect provider directory has negative impacts on both the healthcare industry as a whole and the patients it serves. Unfortunately, the scale and complexity of provider directory management make it highly prone to imperfection. That’s where blockchain in healthcare comes in.

Blockchain Technology in Healthcare: A Revolution in the Making

There’s no shortage of blockchain applications in healthcare, and there will be many more as healthcare-related digital transformation becomes a priority throughout the industry.

When it comes to provider directory management, blockchain could eliminate the need for directory managers to contact each provider directly to inquire about information updates. Instead, those providers could report that information to a blockchain — a distributed ledger with immutable information — whenever something changes (think phone numbers, office addresses, and so on).

At the same time, a smart contract can trigger such changes to all records that are applicable, thus reducing manual efforts. In this way, keeping a provider directory up to date would simply mean having providers update the blockchain directly in one place (rather than forcing insurance companies to make their own lists).

A decentralized repository of provider information — one that’s verified by trusted third parties and acts as a single source of truth — could also eliminate the need for multiple entities to manage common data elements across different directories. Finally, a provider directory based on blockchain could integrate with other technologies and data sources to become a high-value resource by providing additional services on top of such a network. These capabilities might include automated credential checks, real-time notifications on facility status, and the automation of repetitive and mundane tasks that go into managing provider data.

Blockchain and healthcare are natural partners because they have similar priorities: accuracy, security, privacy, efficiency, and accessibility. For the purposes of provider directory management (and countless other aspects of healthcare), a blockchain serves as a single source of truth that integrates all critical information under one umbrella for all participants. In this particular blockchain use case, it integrates up-to-date information from providers so individual entities don’t have to solicit updates themselves or operate with an incomplete, out-of-date directory.

Even in other aspects of healthcare, blockchain’s use cases promise to streamline almost all aspects of administration. Imagine what could happen if countless patient directories — each with its own issues — consolidated into one accurate, authoritative directory that also happens to be simple for the patient to privately control, manage, and share.

The network might provide sufficient privacy protections and protocols using zero-knowledge proof to exchange personal health record information without revealing sensitive information. Because it can safely integrate with systems, blockchain’s applications in this healthcare function promise to upend expectations and elevate results faster and further than we’d ever think possible.

In short, provider directory management is simply the foundation for many future healthcare-focused solutions that can be built on the blockchain. This sets the stage for a shareddigital transformation in the healthcarespherethat benefitsall parties — whether that’s by paving the way for scalable precision medicine, ensuring pharmaceutical provenance, enabling real-time collaboration on healthcare claims, or one of its many other promising capabilities.

Now, the question for leaders in the healthcare sphere is this: How could blockchain-based digital transformation shift your organization’s day-to-day functioning for the better? Learn more about blockchain’s array of use cases in digital transformation here, or reach out to Chainyard to discuss how it could fit in your own strategy.

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