The Change Healthcare clearinghouse outage had steep consequences, and there are many lessons to learn from this situation. For background, a clearinghouse is a platform that supports data transfer between providers and payers. This allows healthcare providers to get paid. The Change Healthcare clearinghouse is a large entity, processing 50% of medical claims in the United States. A cyber attack in February of 2024 led to a significant outage, hindering the clearinghouse’s ability to transfer payments.
This attack impacted the largest processor of prescription medication, which handles billing for more than 67,000 pharmacies across the US healthcare system. Outages cripple a clearinghouse’s ability to submit medical claims, which results in the aging of millions of dollars in transactions that can’t be paid and fulfilled. Until systems are stabilized, this creates a financial gap.
Luckily, the Change Healthcare clearinghouse outage reveals important lessons in how to avoid such incidents in the future. A key takeaway is the importance of redundancy. Payer gateway connection redundancy establishes connections between multiple clearinghouses. This leads to decentralization, which creates backup systems in case of outages. No single clearinghouse is immune to attacks, but a network of clearinghouses can continue to function, even if one faces an outage.
What specific steps should we take to establish decentralization? Choosing the right system to help with the process is important. This system should be able to communicate with multiple clearinghouses and should be built on modern architecture. It should also be highly scalable and remain functional during outages.
Orbit Healthcare is an example of one such system. It connects to multiple clearinghouses so that payer requests go through, even if any single clearinghouse has an outage. Supported clearinghouses include Change Healthcare, Availity, Waystar, and Experian Health.
As the Change Healthcare clearinghouse outage shows, outages can pose significant risk. However, there are ways to prepare for cyber attacks and outages. Building redundant and decentralized payer systems is key to success in an era of cyber attacks and ransomware, and should be a focus of clearinghouses moving forward.
