Change Healthcare Case Study

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Defining the requirements for blockchain

“When we bring blockchain into the mix, our hypothesis is that we can simplify claims processing, make it more efficient, enable services to be provided more quickly, and improve the cost points,” says Symanski.

His team determined that for a blockchain to be successful the platform had to be really, really scalable, so it could handle millions of transactions between providers and payers every day. With each claim requiring multiple transactions, the team knew from years of experience the blockchain would need to support rapid throughput to expedite the claim’s lifecycle.

And Change Healthcare could foresee one more big issue: Getting buy-in from thousands of different players, many of them competitors committed to different IT vendors.

“We looked at a bunch of private protocols, but with so many different payers and providers on our network, convincing everyone to buy the same software stack from the same vendor would be very challenging.”

Since open source is by definition vendor-neutral, this pointed straight to Hyperledger.

“Not only does open source leverage the great work of many people,” says Symanski, “it also makes that adoption easier.”

Choosing the best platform

Hyperledger Fabric met all those requirements for a blockchain platform. The only question mark was how scalable they could make it.

“A blockchain that could process two transactions every second would be a nice prototype, but it wouldn’t work for us,” says Symanski. “We wanted to put this into production.”

In late 2017, as his team worked to build the blockchain system and link it to their existing network, they found the open source code efficient to work with.

“It didn’t take years, it took a few months,” says Symanski. “Working with Hyperledger Fabric was really easy and direct. We’re using blockchain for what it was built to do: To store information, store it securely, and store it everywhere.”

The new system makes all claims transparent to authorized users via APIs. This enables a hospital administrator, for example, to view the real-time status and remittance of all the hospital’s claims as they move through the system. Every transaction of the claim’s lifecycle, including any changes to a claim, are all securely recorded on the blockchain along with who made them when. The blockchain network is designed to underpin revenue cycle management software and is currently integrated with the Assurance Reimbursement Management™¹ claims submission solution for healthcare providers.

Such a trusted source shared among participants saves a lot of effort that used to be sunk into submitting, verifying, and reconciling data between companies. And it gives everyone the same view of every claim.

Testing the system in production

Since January 2018, the blockchain-enabled network has been running in parallel with the company’s traditional system in an extensive field test.

Thirty different types of events can be written to the blockchain for any claim. Change Healthcare created an API that network members can use to query the blockchain about any of their claims in process. This provides real-time transparency into any claim, which can potentially lower overhead, reduce duplication and errors, and cut costs.

The blockchain initially ran on six nodes in the company’s data center in King of Prussia, PA and the team is exploring moving it to run in the cloud.

Emily Bailey is the blockchain product development director with Change Healthcare whose team built and tested the system. The key question: Could blockchain and Hyperledger Fabric keep up with the high throughput that the system demanded?

“The answer is yes,” says Bailey, noting that the blockchain has shown the capability to process up to 550 transactions a second. “That proves this technology is real. We’ve built the first enterprise-scale blockchain in healthcare.”

“You don’t often see numbers on that order for blockchains, and that’s one of the exciting things for us,” says Symanski. “And we think we can get this quite a bit higher.”

For example, AWS recently announced Amazon Managed Blockchain, a managed service that supports Hyperledger Fabric to build scalable blockchains in the cloud. Symanski’s team is now working with AWS to find ways to boost the blockchain’s throughput even higher.

Future directions

The blockchain was built in part to give Change Healthcare’s customers a chance to work hands-on with the new technology. An ongoing goal is to migrate business partners from the older network to the blockchain, or as Symanski says, “to move providers slowly out of EDI and API ways of interacting with us.”

As Change Healthcare continues to explore how to modernize healthcare, the company has other blockchain projects underway on various technologies. Their ultimate vision somewhere in the future is a healthcare network open to patients, doctors, payers, and every other stakeholder in the system.

The team realizes that there won’t be “one blockchain technology to rule them all.” Symanski says Hyperledger Sawtooth, a modular platform for building, deploying, and running distributed ledgers, has potential, and they’re working with TIBCO Labs to make sure all their projects can interoperate.

“We look at blockchain as an important technology to have in our toolbox,” says Symanski. “We want to be proficient at using it, better than our competitors are. We believe our market is going to be disrupted by blockchain.”

And he sees a definite role for open source in that future.

“We think that it’s important for blockchain to be open source. All in all, participating in Hyperledger makes a lot of sense for us,” says Symanski. Now he says Change Healthcare is keen to give back to the open source community, in part to showcase the great technology they’re building, and in part just to say thanks.

1. Assurance Reimbursement Management is a trademark of Change Healthcare LLC and/or one of it’s subsidiaries.