For health care providers, credentialing is an important step in establishing a clinical practice and is critical to secure reimbursement from insurance companies and other third-party payers. Professional credentialing is complicated, expensive and tedious. Blockchain credentialing is a new technology-based approach that could save time and decrease cost. What exactly is blockchain credentialing? First let’s take a look at the current method for credentialing, then I’ll describe how blockchain technology could streamline this process.
Current Method of Professional Credentialing
Healthcare institutions are responsible for keeping patients safe while delivering high standards of care. To accomplish this, facilities must confirm the competency of their staff. Credentialing is a process that ensures healthcare providers have the proper qualifications, training, licensure, and ability to provide direct patient care (Patel & Sharma, 2019). Documentation verification may include state license, drug enforcement agency (DEA) license, board certification, education, on-going training, hospital affiliation, and malpractice insurance. This process entails contacting a multitude of organizations to authenticate the information. All healthcare professionals regulated by a licensing body to provide care, without supervision or direction within the scope of the individual’s license, must be credentialed (Patel & Sharma, 2019). Many practitioners work in dozens of healthcare settings and are required to maintain credentials with each one resulting in great redundancy.
Through their Credentials Verification Organization (CVO)
the National Committee for Quality Assurance (NCQA)
will verify credentials such as diplomas and degrees with the primary source. The National Practitioner Data Bank (NPDB)
, a program of the U.S. Department of Health & Human Services, is a web-based warehouse of reports containing information on medical malpractice payments and adverse actions related to health care practitioners, providers, and suppliers. The American Board of Medical Specialties (ABMS)
certifies 150 medical specialties while the American Association of Nurse Practitioners (AANP)
and the American Nurses Credentialing Center (ANCC)
will verify nurse board certification.
Blockchain is a technology that stores data on thousands of servers (not a central server), allowing anyone on the network to see entries in real-time. This supports the creation of communication networks that could facilitate healthcare data sharing. Mearian (2019) describes blockchain as a “public electronic ledger… that can be openly shared among disparate users to create an unchangeable record of transactions,” each time-stamped and linked to the prior transaction. Every set of transactions becomes another “block in the chain” tied to the next block by a unique secure code. Individuals would be granted access and once data is entered it cannot be erased. While not impossible, the blockchain is extremely difficult to hack. To manipulate this type of data system, one would need to access every single computer on the network.
Blockchain credentialing is being piloted by several healthcare organizations. The traditional method is costly and time-consuming, often taking between four and six months, resulting in lost income and reimbursement. Using blockchain technology would allow organizations to efficiently access the most current health care provider data. The Council for Affordable Quality Healthcare
estimates that payers spend close to $2 billion per year maintaining provider databases (American Hospital Association, 2019). This cost could be reduced significantly utilizing one secure, verified source such as blockchain.
How would it work?
Gaffney (2018), a senior manager with the Health Research Institute of consulting firm PricewaterhouseCoopers (PwC) succinctly outlines how blockchain could expedite the credentialing process:
- Provider/health professional uploads background information such as educational history, certifications, licenses, malpractice insurance, and other documents to the blockchain.
- Primary sources access the blockchain and verify the provider information.
- Health facilities check provider data on the blockchain using primary source verification and either accepts or rejects the provider, then uploads the decision/result to the blockchain.
- If the provider is accepted, the enrollment application is sent to the payers.
- Payers verify data in the blockchain using primary source verification and either accepts or rejects the application, then uploads the result to the blockchain.
- Patient may verify the provider credentials and if he/she is in-network using blockchain.
- Government regulators audit provider credentialing processes.
Could blockchain technology be the newest pathway to credentialing? Theoretically it might, however this innovative approach requires large scale implementation, strict testing, re-testing, and evaluation before it can be fully adopted by the healthcare industry. It will be interesting to see how this unfolds.
Do you have any experience with blockchain technology? Please share in the comments below!