Creating A Decentralized Clearinghouse Network

Clearinghouses are an extremely vital part of the healthcare system, as they facilitate essential data transfers between payers and providers. They are responsible for ensuring proper payment is given to the providers who rendered the services. Change Healthcare stands out as one of the most prominent clearinghouses in the nation, processing approximately half of all US medical claims. They serve around 900,000 providers and handle a massive 15 billion healthcare transactions annually, which is a third of the nation’s total.

However, in February 2024, Change Healthcare suffered a cyberattack that resulted in a disruptive outage that lasted several weeks. This disruption delayed millions of dollars’ worth of medical transactions, which can cause severe disruptions to the entire healthcare system. These financial challenges can’t be solved until the entire system is stabilized. Change Healthcare’s recent cyberattack highlighted serious flaws in the current clearinghouse structure that must be addressed to avoid further disruptions. 

The clearinghouse system must adopt a decentralized approach to diversify transaction channels. By spreading transaction information and utilizing redundant payer systems, payment continuity can be maintained even during a cyberattack. Change Healthcare, Availity, Waystar, and Experian Health are all supported by this decentralized clearinghouse approach and must continue this adoption to ensure uninterrupted transaction processing and upholding of system stability.

Lessons Learned from the Change Healthcare Cyberattack
Source: Orbit Healthcare