The Change Healthcare clearinghouse experienced a significant outage at the start of 2024, which has emphasized the importance of advanced preparation and risk mitigation to avoid similar outages. The Change Healthcare clearinghouse processes roughly half of medical claims in the United States. A clearinghouse transfers data between payers and providers; in other words, it is how providers get paid.
Outages can have major consequences on the overall healthcare system. For example, outages prevent medical claims from being submitted. This results in the aging of millions of dollars in transactions that can’t be paid or fulfilled.
In the era of cyberattacks, finding ways to avoid outages is key. One way to do this is through payer connection redundancy, which establishes communications with multiple clearinghouses. Decentralization in this form allows for backup systems, as transactions can spread throughout several clearinghouses. Additionally, if one clearinghouse faces an outage, others can step in and provide stability.
Orbit Healthcare is an example of a company that is promoting decentralization and payer connection redundancy. It connects to multiple clearinghouses, which means that payer requests go through even if one clearinghouse experiences an outage.
Being cognizant of redundancy will be critical in the future and can help avoid situations like the recent Change Healthcare outage. This outage provided a good lesson of how to improve the system and ensure greater stability moving forward.
Source: Orbit Healthcare