Picture of a block and chain representing "blockchain."

By now you’ve probably heard of blockchain, a new buzz word for healthcare, an older one in other industries. Now it’s being shopped as a solution for credentialing—a process still without a universal, secure, and less-painless way to manage providers’ qualification data. There is no master database for credentialing, enrollment, and privileging, as you well know.

In simple terms, a blockchain is a growing list of records (i.e., “blocks”) linked using cryptography. Cryptography is a way to protect data/communication using codes, so only those for whom the info is intended can access it. Each block in a blockchain contains a cryptographic hash of the previous block (i.e., the “chain”), a timestamp (chronological order), and the transaction data. Blockchains can be permission-based.

People use Wikipedia as an example to help explain blockchain. In both blockchain and Wikipedia, users can enter records, a community makes updates, and no one person controls the information. However, with Wikipedia, administrators/owners actually control access by keeping the master copy on a server, so all users see that latest official version. Think of the Wiki admins as the trusted, independent third-party referees.

But in blockchain there’s no referee or third party. Each user in the blockchain updates the record independently, with the most popular version of the record becoming the official one. Each user has a public key and a private key that aids in sending and decoding messages. Since everyone in the blockchain knows that transfer took place, the security in the system is inherent. Once the data or communication is recorded in a blockchain, it can’t be disputed, eliminated, or changed, because every other participant in that network would see. The cryptography eliminates the need for traditional authentication and authorization, because of the keys used to encrypt and decrypt the correspondence. It reportedly works best when there are a multitude of users.

With blockchain in credentialing, the providers presumably would maintain control of their own data by keeping the private key, giving access to their credentials as they see fit to hospitals, insurers, etc., via the public key.

You’ve definitely heard of CAQH’s CORE efforts and its centralized provider directory called DirectAssure, where providers can update their information so payers can use the data to enroll them. DirectAssure is not a blockchain technology. But DirectAssure and some blockchain efforts already underway have the same goal to save money and time/effort by eliminating the middleman and repetitious processes.

So will blockchain be groundbreaking for credentialing?

Maybe; maybe not. Some healthcare and tech execs interviewed by Becker’s view blockchain as a “solution looking for a problem,” or say it’s being over-hyped. Other companies say blockchain is the answer for credentialing because it allows transparent sharing of provider data and makes it more secure.

While it appears that no one is looking to blockchain for patient data sharing, initiatives are underway to use it to share provider data. A pilot program to share physician directory data via blockchain that included insurers UnitedHealthcare, Optum, Quest Diagnostics, Humana, and Multiplan was launched in June 2018. Their mutual goal in sharing data: Avoid the CMS penalties that occur when an insurer doesn’t have accurate directories, and to save money and cut down on the admin work of upkeep.

Regarding CAQH’s database that aims to centralize and standardize data, critics say there’s still an issue of data duplication and repetition. CAQH, by the way, is a non-profit formed by a consortium of mainly insurance companies (sound familiar?). It charges healthcare entitles for its role as keeper of the provider data it collects.

At least one private company is also ready to monetize credentialing blockchain functionality. Hashed Health announced plans to launch its exchange in mid-2019, where members contribute already-verified credentials information for other members to acquire. True to blockchain form, members will create the rules for the data/communication exchanged.

Some of the other benefits of blockchain being touted:

  • Universality of data: With blockchain, data can’t differ across databases because there’s only one single record.
  • Transparency/accuracy: With blockchain, all data/communication can be traced and audited.
  • Control: With blockchain, a person can own their own data and choose who to share it with, and when.
  • Decentralization: No third-party administrator or single server is needed to be the keeper of the data.

Worth watching

Will all of the diverse healthcare organizations that need provider data gravitate to a third-party-hosted repository like CAQH? Or will blockchain become more attractive due to its ability to eliminate the middleman and its tolerance for only one master data record? We’ll be watching. But this is healthcare after all, so don’t anticipate any quick moves to blockchain.