Page 26 - Delaware Medical Journal - May/June 2018
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Blockchain and Health Care: Improving Patient Care
Andrew Dahlke, MD
Whenever we discuss a geeky subject like blockchain technology, many people give up and say, “I will never understand
that,” and stop reading. Please persevere, because the blockchain is beautiful in its simplicity. The fact that the blockchain is associated with Bitcoin and virtual money also turns people off, since most people do not use, understand, or trust Bitcoin.
The blockchain is simply a list of data
on a computer network that is linked in chronological order. It is also a fault- tolerant method of sharing data in a network — fault-tolerant because the data is kept intact when a computer fails.1
The blockchain creates an opportunity to securely share information between parties that do not trust one another. In our health care system, the doctors, hospitals, private insurers, and public insurers are examples of parties that do not trust one another. The blockchain provides an opportunity for data to be shared and creates openness and transparency between distrusting organizations.
At the Medical Society of Delaware, our
an effort to make preauthorization easier for the doctor, faster for the patient, and transparent so the insurance companies can be held accountable for their delay in patient care. We are working with a contracting with insurers and working with the Delaware Health Information Network (DHIN) to make this possible.
The insurers spend a lot of money on
the prior authorization process, and
there is no data showing that the prior authorization process lowers total cost of care or improves patient outcomes. There is data to suggest that it delays patient care, harms patients through that delay, and creates a large time/cost burden
for physicians as they attempt to help patients access needed care.
To save money and ease the administrative burden, Medscient
plans to track doctor performance on
prior authorization for Highmark Blue Cross Blue Shield of Delaware. Those physicians who rarely get denied will have a high score and get a free pass. Those who get denied all the time will continue to undergo scrutiny. This is a phase-
one plan that is easy to implement with insurance data and is intended to reduce prior authorization by 50 to 80 percent. The insurers are on board with the concept because the prior authorization center on their balance sheet.
Appropriate ordering of radiology
studies is simply matching CPT codes
and ICD-10 codes. If you are able to
pick an appropriate code, then the study should be approved. Unfortunately, different insurers have different criteria for appropriateness. Even within a single insurance company, there is variation
in what gets approved and denied,
and sometimes it seems random and whimsical. The data generated from the smart preauthorization process should
be able to track what ICD-10 codes are CPT code to be performed. If there is a denial, the reason will be logged. If the doctor calls the insurance company and gets a reversal of a denial, this will also
be logged.
In 2017, the American Medical Association (AMA)’s Prior Authorization Physician Survey
found that 30 percent of the time,
care is delayed for more than three days. This kind of delay will not
keep patients out of emergency departments. Approximately 78 percent of respondents said prior authorization sometimes leads to treatment abandonment. This is denial of care to the insured, and when those patients suffer a catastrophic loss, the insurance company cannot be sued. The survey indicated that approximately 14.6 hours is spent by physicians and staff each week to get an average of 29.1 prior authorizations per physician approved. Repeat pharmacy prior authorization submissions for chronic conditions is a on the physician by the insurer. Per the AMA survey, 79 percent of physicians are asked to do this.2
The AMA, American Hospital Association, Blue Cross Blue Shield, America’s Health Insurance Plans,
and the Medical Group Management Association produced a consensus statement on prior authorization and meaningful reform.3,4
1. SELECTIVE APPLICATION
OF PRIOR AUTHORIZATION. Differentiating the application of
prior authorization based on provider performance on quality measures and adherence to evidence-based medicine or other contractual agreements (i.e., risk-sharing arrangements) can be helpful in targeting prior authorization requirements where they are needed most and reducing the administrative burden on health care providers. Criteria for selective application of prior authorization requirements
may include, for example, ordering/ prescribing patterns that align with evidence-based guidelines and historically high prior authorization approval rates.
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Del Med J | May/June 2018 | Vol. 90 | No. 5
