As a patient, finding a doctor in-network on your health plan can make a big difference when it comes to out of pocket costs. For insurers and the doctors they contract with, finding a better way to keep provider lists up to date, could make a big difference when it comes to administrative costs.
“From the perspective of the provider organizations … (they) can work with up to dozens of insurance plans, and each of the plans are individually requesting or verifying the provider information,” said Mike Jacobs, senior distinguished engineer with UnitedHealth Group’s Optum division.
The administrative costs of updating and tracking down that information are estimated to be more than $2 billion dollars a year for the health-care industry. Yet, in 2016 federal health officials found that nearly half of provider listings for Medicare Advantage plans were inaccurate, with incorrect provider addresses and phone numbers.
“That’s such a large issue that it’s really affecting access to care for many patients,” Jacobs said.
Now, UnitedHealth Group and its Medicare rival Humana are launching a pilot program together to study whether blockchain technology, with its system of decentralized ledgers, can help fix the problem.
The insurers will launch the new program this summer, along with Quest Diagnostics and health insurance consultants at Multiplan, to see whether they can cut costs by sharing data and reduce the administrative burden of keeping lists accurate.
Beyond the technology, Quest drivers who deliver lab supplies to doctors’ offices will be key to physically verifying provider addresses.
“That information isn’t competitive at all … so why not share any work that you do? It’s for the good of the system to insure that information is up-to-date,” said Jacobs.
But it’s not just a goodwill project. Regulators at CMS, the Centers for Medicare and Medicaid Services, may start fining Medicare insurers up to $25,000 a day for inaccurate provider lists, so it’s a problem the industry is anxious to resolve for their doctors, their patients and their bottom lines.
United and Humana hope to complete their study this fall.
