Health care: blockchain for provider data management

EY Global Blockchain
Summit
San Francisco, CA
April 26, 2017

EY Global Blockchain Summit
Blockchain opportunities in health care

Sentiment and market activity

Adoption of digitization in health care is slow.
Adoption of digitization in health care historically has been slow due to the industry’s
resistance to change.
Digitization in health
care lags behind 10 other
industries with an index
value of 1.7, compared
with the leading industry
cluster (IT) at 2.9.
Digital index – by industry cluster
Source: Top500 Digital Index Germany, Accenture, 2016.
3.1
3.1
2.8
2.8
2.3
2.4
2.7
1.9
2.0
2.1
1.6
1.9
1.6
1.3
1.3
3.3
3.1
3.1
2.8
2.7
1.8
1.8
2.2
2.2
2.2
1.8
2.0
1.7
1.4
1.5
2.5
2.9
2.6
2.7
2.0
2.4
1.9
2.1
1.9
1.9
1.6
1.5
1.5
1.5
1.3
2.8
2.5
2.7
2.2
2.0
2.0
1.8
1.6
1.7
1.6
1.7
1.5
1.4
1.4
1.4
IT
Communication
Electronics and high tech
Retail
Automotive
Services
M&E
Consumer goods
Logistics and transport
Utilities
Pharma and health care
Engineering
Construction
Chemicals
Industry raw materials and resources
Strategy Product Sales Processes
Digital index value
2.9
2.9
2.8
2.6
2.3
2.1
2.1
2.0
1.9
1.9
1.7
1.7
1.5
1.4
1.4

Blockchain in health, relative to other industries
16%
of health care executives
expect to have a
commercial blockchain
solution at scale in 2017.
90%
anticipate investing in
blockchain technology by
2018.
Two-thirds
of business areas will
experience widespread
business model innovation.
Despite a slow start, health may be the first industry
with widespread adoption.
Financial
services
Health
Supply
chain
Life
sciences
Energy and
utilities
Audit
and tax
18 months
behind
M&E
Source: IBM, “Healthcare rallies for blockchains: Keeping patients at the center,” 2016,
https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?

Market activity
Government
support
Early
experimentation
Gem and Capital One
collaborated on a
claims processing
initiative.
Strategic
hiring
The largest payor
in the country
is hiring a
blockchain
director to lead
development and
implementation
projects.
Consortia
However,
experimentation is not
consistent across the
industry.
Office of the National
Coordinator of Health
Information
Technology
Department of
Health and Human
Services
United Health GroupGem Hyperledger
Hashed Health

Opportunities in health

Use case landscape
Personal health
record
Information sharing
Identity
management
Administration
Patients in control of
their health data
Intercompany
interactions on behalf
of patients
Connecting with global
identity
Internet of Trusted
[medical] Things
Chain of custody
Contract-governed
processing
► Personal health
history and
repository
► Fast Healthcare
Interoperability
Resources and
Application
Programming
Interface mandate
► Quantified self
► Health advisory
► Patient consent
► Disintermediated
health information
exchange
► Global Alliance for
Genomics and
Health
► Cancer Gene Trust
► Population Health
► Medical-attributed,
owner-controlled
identity (“patient
matching”)
► Unified patient
identity
► Provider data
management
► Provider
credentialing and
recredentialing
► Time-stamped
proof of existence
► Drug Supply Chain
Security Act
► Trusted things
registry
► Pharmaceutical
supply chain
► Claims processing
► Eligibility checks
(Medicare and
Medicaid)
► Proof of coverage
► Drug formularies
► Fraud reduction

Provider data management

Provider data management
Provider data is the
information about a
provider (i.e., physician)
contained in a provider
directory, referenced
during the claims process
and used to determine
network adequacy.
Payors maintain
their own “source
of truth” systems
internally.
Updates come
from a variety of
sources, including
the providers.
CAQH* acts as an
industry
clearinghouse for
provider data.
Providers Members ClaimsCAQH
CredentialingThird-party
providers
External sources Internal sources
Multichannel updates
Name
Address
Location
Tax ID
New patients?
License status
*Council for Affordable Quality Healthcare, www.caqh.org

Reimagine provider data management with blockchain
A network of
health plans
collectively
maintains a
shared record of
critical provider
data.
Providers can
submit updates
directly to the
network, and
credentialing
authorities can
certify and renew
credentials on the
chain.
Credentialing
authority
Providers
Regulator
Active and
passive network
participants
Medical
school
Source: EY

EY activity
Blockchain in health: how
distributed ledgers can improve
provider data management and
support interoperability
EY
Global Health
Innovation Challenge
winner
Blockchain for Provider
Data Management
DemO: provider
data management

Identity validation

New member onboarding
Health plans validate new
members by passing
basic identity information
(name, address, date of
birth, etc.) to third-party
identity verification
services like Equifax,
Lexis Nexis, Experian,
IDology and others.
The health plan is charged each
time they submit a verification
request to a service provider. The
cost per request can be close to
$1.00.
Health plan
Third-party
verification service

Trusted identity marketplace
Less fraud
More cost
effective
Verification
history
A few
benefits:
A network of trusted
parties collectively
validate the identity of a
new member.
Network participants
can validate all or a
portion of the data
submitted, and receive
a proportional amount
of the validation fee.
Smart contracts can
enforce the policies by
which information is
considered “valid.”
Health plan
+ Bank
+ Government

Electronic medical records

New member onboarding
Medical records are
naturally “episodic,”
meaning they relate to a
specific episode or
occurrence of care.
Longitudinal records
(across providers and
health plans) do not exist
unless the patient is
diligent about maintaining
a personal file.
Electronic medical records (EMR) and
electronic health records (EHR) exist,
but there are hundreds of vendors and
platforms, and interoperability is a
challenge.
Andy visits
Dr. Warsing and has
arthroscopic surgery
on his knee.
Andy visits
Dr. Peters and gets
an MRI on his knee.
In response to his knee
swelling, Andy visits
Dr. Velyvis and gets an
MRI on his knee.
2003 2015 2017
Request via fax
10 days later

Decentralized health information exchange
Episodes of care are
memorialized on the
blockchain, recorded as a
pointer to the actual EHR
kept by the provider.
Provider access to a file
pathway is granted only
after patient authorization
is provided via a private
key signature.
The blockchain serves as a
mapping and permission
system for the patient’s
medical records.
Andy visits
Dr. Warsing and has
arthroscopic surgery
on his knee.
Andy visits
Dr. Peters and gets
an MRI on his
knee.
In response to his knee
swelling, Andy visits
Dr. Velyvis and gets an
MRI on his knee.
2003 2015 2017

Key contacts
Andrew Beal
Manager
Ernst & Young LLP
+1 415 894 4929
andrew.beal@ey.com
Dan Gietl
Principal, Technology Transformation
Ernst & Young LLP
+1 317 681 7483
dan.gietl@ey.com
Paul Brody
Principal, Global Blockchain Leader
Ernst & Young LLP
+1 415 894 8046
paul.brody@ey.com

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© 2017 EYGM Limited.
All Rights Reserved.
EYG no. 04033-173GBL
1705-2288253
ED None
This material has been prepared for general informational purposes
only and is not intended to be relied upon as accounting, tax or other
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Health care: blockchain for provider data management

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