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Could This Be a Beacon of Hope for Healthcare Finance?

Updated: Apr 26, 2020

How I found a new perspective in healthcare with an introduction to Blockchain

What is your Blockchain Birthday?

There is a term being used lately to mark the start of one's exposure to or acceptance of Blockchain and related technologies, that includes cryptocurrencies like Bitcoin, Ethereum, and others. My Blockchain BIrthday was March 17th, 2016. A friend of mine, who I met when we were both in the same MBA class, suggested we catch up over a couple beers, on what was St. Patrick’s Day 2016. With Irish heritage, I couldn't decline, I didn't realize it would be a lucky day for another unforeseen reason.

Nothing to see here, Just a few friends discussing Healthcare over a couple of beers on St. Patrick's Day

A couple of his colleagues joined my friend and I in what became a very thought-provoking conversation primarily delving into healthcare. All three of them had curiosities about healthcare, and with so much talk of it lately around the country I couldn't blame them. They were interested to learn in more detail some of the reasons why #Healthcare is always described as such a complex, if not broken industry in the United States. They were perplexed as to why there have been so many years of discussion and debate about how to fix the industry yet after all this talk and with so much time passing why truly effective solutions haven't come to fruition.

As the only person at the table who has worked his entire career in the healthcare space, #revenuecycle in particular, either at a provider organization or in a consulting capacity, they were interested in discussing this with me. Through my career, I've accumulated quite a list of observations, if not frustrations about the #inefficiencies in healthcare. Many of which I believe not only make great prospects for case studies as to how broken it really is, but may uncover entry points for innovative solutions to begin repairing the industry.

Working in healthcare is a matter of choice, in more ways than one

As my list of observations, from first-hand experiences as a #Finance Director at a nationally recognized health system, increased in length, so did my frustrations with the healthcare industry.

Now don't get me wrong, I am not naïve, no perfect industry exists. And the industry I have chosen to focus my career, healthcare, is one I would choose again each time given the chance. As many challenges I have seen, I have seen many times more successes and benefits the industry has provided to people of all walks of life.

I had a choice with each frustration I experienced. Admittedly, early in I let the frustrations get the best of me. Though in my defense, I felt frustrated for good reason. Many days what I was observing was simply a game between the providers and the payors with what appeared to be a lopsided balance of power, uneven expectation of accountability, and an endless array of tactics deployed to preserve what I like to refer to as the "piggy bank". By delaying payments, or what's referred to as "adjudication of claims", a few more days would presumably allow that money to accumulate more interest in a payor's bank account or remain on a publicly traded payor's balance sheet one reporting period longer to boost shareholder value.

By the way, publicly traded payors and all the shareholders that have invested in them is one important consideration in the pathway towards a single-payor system that I don't hear a lot of people talking about. How do we unwind all those imbedded parties? But I digress.

Putting it simply, what I was witnessing was broken #trust between business partners. And wouldn't you know distributed ledger technologies, otherwise known as Blockchain, in some ways aim to apply their attributes to industries where trust has been broken. Where there is broken trust one usually finds intermediaries in place. Where there are intermediaries there are additional transaction steps along with duplicative databases or ledgers of information. This combination is a recipe for #inefficiency.

With each passing day, I often added yet another frustrating observation to my growing list of case studies. Together this list paints a colorful portrait of a broken industry, one I had chosen to participate. I also chose to keep fighting the good fight going in each day to try to improve the financial processes of submitting claims to payors and ensuring those claims were paid timely and accurately. When those many days where the process never worked out as I had hoped, I could continue coming home each evening letting the frustrations get the best of me and change my outlook and demeanor. Or I could continue documenting these shortcomings, challenges and failure points, but instead look at them as patterns and opportunities to see the industry from a new angle. Most importantly, I could convert the frustration into energy coupled with an open mind to work on fixing these problems in an innovative way. I may not solve all the healthcare world's problems, or even just one. But it would be a far better use of my time, energy, and talents along with my list of case studies to strive in new ways to make it a little bit better.

This realization came to me several months before my #BlockchainBirthday, thankfully or I might not have had a Blockchain Birthday at all.

I wish my friends and I had met up several St. Patrick's Days earlier

While visiting with my friends over those beers that particular St. Patrick's Day, what would be my Blockchain Birthday, I was able to share a few pertinent cases of how the healthcare system is broken. These points crisply demonstrated how healthcare is in my opinion the most complex industry with many more stakeholders than any other industry. The points I brought up especially painted a picture of the industry's problems are also complex while proving that the real solutions are still out of reach based on the current prospective solutions being considered.

With each case example I brought up, my friends shared a particular motivation, technique, or attribute of Blockchain technology. The broken trust could be addressed by a #DistributedLedger #technology (#DLT) where all involved parties each have their own exact copy of the ledgers being used to conduct business. Additionally, the delays of claims adjudication in healthcare, which often take several months on average, or as accountants measure in "Days in Accounts Receivable", could potentially transition through the successful implementation of this same distributed ledger technology to become "Minutes in Accounts Receivable". Those are just a couple of the examples they shared with me.

What I soon realized in this conversation was that this #Blockchain technology they introduced me to was not necessarily a new concept. But rather, it was a little-known technology that was gaining increasing attention. There were folks focusing on exploring its attributes and thinking through how they could be applied to challenges in supply chain, financial services, even identity management environments, and of course healthcare. I just wish we had this conversation several years earlier, but then again, my mind may not have been open to listening to a description of Blockchain and what it could potentially do for so many industries.

I am sure glad I had the realization a few months earlier to begin looking at my list of shortcomings in healthcare instead as opportunities. So, I was lucky to have the right frame of mind when a few folks who were further down the path of understanding Blockchain were able to enlighten me.