Distributed Ledgers, Meet Revenue Cycle

Distributed ledger technology and healthcare revenue cycle management are like chocolate and peanut butter — a perfect match.

Photo by Aaron Burden

First, semantics. Blockchain is a type of distributed ledger technology (DLT) most commonly associated with bitcoin. Not all distributed ledgers are blockchains, though, and distributed ledgers have broader applications for the healthcare ecosystem. That said, here’s why we think DLTs matter.

Working Together, Better

Healthcare in an inherently collaborate service, with many different providers, payers, and 3rd parties working together to provide care. The term “co-opetition”, meaning competing organizations collaborating for a common goal, is an apt description of how these partnerships work in many cases. Competing organizations with a common goal of patient care have incentive to do only what is necessary for the patient; in this context, being ‘hard to work with’ can be a competitive advantage if it results in higher administrative costs for everyone else.

Distributed ledgers (DLTs) are collaborative databases which allow multiple parties to share data with each other securely, privately, and efficiently. They also provide for networks of trust to be created, even amongst (assumed) antagonistic parties using things like distributed IDs, zero knowledge proofs, consensus algorithms, and the like. In practice, two competing organizations with nodes on the network can trust each other to do exactly what is programmed into the smart contract, which runs automatically whenever the conditions are met. And, since they are running the same smart contract, neither will benefit from the ‘hard to work with’ strategy. Furthermore, the contract is automated, requiring no human interaction, which removes risks of inaccurate data, obviates the need for a number of manual validation checks, and reduces the cost of administration.

Privacy & Security, Made to Order

Healthcare data is highly sensitive and needs to be protected at all costs. However, because of the nature of collaborative care, healthcare organizations are required to share the three most important categories of personal information with each other: identity, clinical, and financial. And with attacks on data becoming more common and more sophisticated, there are valid reasons to be concerned with how and when we share data.

As opposed to traditional databases, DLTs are purpose built to share data. As a result, things like security and privacy are inherent to the underlying architecture. Data distribution and consensus algorithms help ensure provenance and traceability while cryptography provides data security. Privacy can be addressed through self-sovereign identity as well as permissioned networks that, while they may be public, offer connections only to validated counter-parties. In summary, DLT’s are, in many ways, a security technology as much as a data technology, providing an important tool to improve our current information security infrastructure.

Smarter Automation, Less Administration

Healthcare administration (i.e. revenue cycle management) is a complex set of functions, each with a lengthy and cumbersome workflow, that is expensive to maintain. Antiquated systems, built over many years, still form the basis for much of the communication between functions and parties, with each organization building their own utilities and processes to meet their goals. Third party vendors build tools that aggregate common tasks, which provide a welcome simplification of workflow, while adding to the proliferation of IT systems that need to be funded and maintained. The end result is a healthcare system that is untenable, with IT costs growing at almost 18%/year.

DLTs simplify and automate workflow through smart contracts that are defined and agreed upon by all parties before a care episode begins. As opposed to other automation technologies like robotic process automation (RPA) which automate existing manual workflows, DLTs allow us to simplify the workflow before we automate it. In addition, in highly collaborative scenarios like healthcare, this technology can be especially valuable when changes to contract terms become necessary. Rather than cascading the change throughout the organization and ecosystem over time and with communication risk, a smart contract change on the network will be both visible and actionable immediately by all connected parties.

The Path to Patient-Centric Experiences

Healthcare is confusing for patients. Patients don’t always understand where to go, what services are covered by insurance, what care will cost them until it’s been provided, and are often surprised with the final bill. The complexity of the healthcare system itself is largely to blame for a patient experience so different, and so much worse, than every other consumer experience in our lives. To date, the answer has been either 3rd party vendors trying to ‘put lipstick on a pig’ or providers and payers creating their own portals and mobile applications with lipstick of their own. In either case, the uptake has been slow, and incremental improvement, gained largely through new UI/UX, is essentially all that’s on offer.

The current experience will only be improved in a material way when the information from each organization involved in care is made available to the patient in real-time. DLTs do precisely that. They provide an always current, transparent, accurate, and secure single reference point for patients which encompasses the information from all parties. The patient, having rights to their data and real-time access to a network of organizations involved in their care, is empowered to make informed, proactive decisions about their care. With DLT at the core of healthcare administration, the patient experience can be reimagined. Searching for approved providers, scheduling appointments, populating registration forms, understanding coverage, evaluating out of pocket estimates, and paying at the point of care — DLT promises a change to the way we disseminate and share the underlying data necessary to transform healthcare experiences into ones we expect.

Now is the Time

For the first time in many years, technological innovation has delivered a tool that has the potential to make a transformational impact on an industry in desperate need for a change. In the same way that artificial intelligence (AI), machine learning (ML), and natural language understanding (NLU) are changing the way humans interact with machines, distributed ledgers are recreating the fabric of secure, autonomous collaboration and systems of trust. Even in their infancy, the platforms offer significant improvements to existing systems, and will give rise to a modern healthcare ecosystem where the patient experience is as informative and supportive as it is intuitive. The industry is already starting to wake up to the potential. Now is the time to deliver.