Why healthcare payers should consider re-thinking how they manage patient consent

When it comes to consent management, healthcare payers can potentially use this period of disruption to go beyond compliance with the goal of modernizing the member experience and creating competitive advantage.

By and Jia Chen | 3 minute read | August 10, 2020

Masked female patient looking down at her smartphone.

IBM director, Anita Nair-Hartman, identifies consent management as one of six core capabilities that can help healthcare payers make progress toward interoperability. But it’s not just about the regulations. Data sharing has become increasingly important as rising consumer demands are putting more choice and more control in the hands of members. For example, healthcare payers are turning to blockchain, which has been used in other healthcare use cases, such as with clinical trials or public health initiatives.

Think beyond compliance

Two rules from the U.S. Department of Health and Human Services (HHS) aim to help improve patients’ access to their data, prevent information blocking and increase secure healthcare data exchange.1Healthcare payers must support standard Application Programming Interfaces (APIs) to enable members to access their own data and an online provider directory by January 1, 2021 (with a 6-month enforcement discretion period announced by CMS). By January 1, 2022 they must enable payer-to-payer data exchange.2

To comply with these rules and meet expectations from various stakeholders, health plans need to address consent and ensure that data is made available only to entities authorized by the member. However, we would characterize a focus on compliance as a relatively short-term view. We believe if health plans implement a basic consent management solution just to satisfy these terms, they may miss out on an opportunity to revamp consent management that could potentially help provide a better member experience and business advantage.

Consider how to potentially deliver a positive member experience

Members want to exercise control over their data to effectively manage their health and care. This has become even more apparent during the pandemic. In addition, we believe patients need their healthcare history readily available when they access new modes of care delivery, such as telehealth.

This period of disruption affords healthcare payers the opportunity to fundamentally change the experience for members. We hear from healthcare payers that today’s consent mechanisms – signing a piece of paper or clicking a box on an online form – have their weaknesses; these processes can lead to:

  • Duplicate or conflicting member consent responses
  • Members may find it difficult to withdraw or update consent
  • Members likely will not have visibility to who has access to their health records.

We believe blockchain-based solutions may have the potential to help provide that single source of truth that can help simplify and potentially improve the member experience. We have seen a player in the healthcare industry leverage blockchain technology in a clinical trial setting with the potential of providing a decentralized framework that enables data integrity, provenance, transparency and patient empowerment as well as automation of processes.3

Position for business advantage

Many healthcare payers tell us they are grappling with antiquated, sometimes manual, consent management systems and disconnected databases that hinder health information exchange among payers, providers and members. We’ve heard from them that this deficit can have a significant impact on health plan financials. And while blockchain may be new to many health plans, it is a technology that they can potentially explore as other industries have as a possible managed service.4

It may not seem like a business advantage at first, to invest in a payer solution that shares clinical data for members who have left or are leaving, or to accommodate claims and clinical data exchange with third-party app vendors. But we believe that the healthcare payers that invest in consent management may have an advantage, because seamless, secure exchange of health information – clinical and financial – can potentially enable more complete information about each person. We believe these plans may be the ones that could be more likely to receive new members, as well as retaining existing ones.

Emerging from this period of disruption, health plans should re-imagine consent management as a completely different system. Consent is a core component of the healthcare payer relationship with its members – past, present and future. Finding the right way to manage this process is not only important for compliance, but we believe it may also help to improve the member experience and create business advantage for the long term.

  1. https://www.hhs.gov/about/news/2020/03/09/hhs-finalizes-historic-rules-to-provide-patients-more-control-of-their-health-data.html
  2. https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index
  3. Organizations in other industries have used blockchain to manage consent, including life sciences ( https://newsroom.ibm.com/2019-02-12-Boehringer-Ingelheim-Canada-Ltd-and-IBM-Canada-Announce-First-of-its-Kind-Collaboration-to-Integrate-Blockchain-Technology-into-Clinical-Trials) and public health (https://www.prnewswire.com/news-releases/ibm-watson-health-announces-collaboration-to-study-the-use-of-blockchain-technology-for-secure-exchange-of-healthcare-data-300389160.html)
  4. Ibid.