The White House Plan for Efficient, Resilient Healthcare Supply Chains

EO 14017 instructed the US government to comprehensively review critical US supply chains to identify risks, address vulnerabilities, and develop resilience strategies. The report was released in June after an analysis that extended across the FDA, HHS, and a dozen other federal agencies.

Hashed Health Themes for 2021

2021 will see a maturation of many of the novel solutions introduced in 2020. As a result of the pandemic, the ways we communicate, the ways we move and manage data, the ways we transfer money and the ways we invest will ultimately become a lot smarter as we fuse old and new ways of doing business.

HFMA Article – Distributed credentialing: The new provider mobility imperative

Validating the identity and credentials of healthcare practitioners poses significant revenue cycle, recruiting, physician relations and access challenges for all healthcare organizations.

The Shift to Systems of Collaboration

Our healthcare system is at an inflection point. The optimistic perspective is that it now seems more likely that the industry can come together to address many longstanding challenges that have traditionally limited our ability to deliver care in more efficient, effective ways. To succeed, innovators and enterprises need to shift from scaling up systems of record for enterprises to creating systems of shared record for collaborative networks. This transition represents the greatest healthcare opportunity in a generation.

Meetups to Startups: Hashed Health’s Evolution to a Healthcare Venture Studio

At Hashed Health, our mission has always been to produce solutions that solve the most challenging problems in healthcare. We believe that the most impactful solutions over the next ten years are those that promote collaboration and shared value, which is why we have a specific focus on blockchain and distributed ledger technologies.

Remote Work During COVID-19. Successfully Transitioning to a Virtual Office

Before coronavirus, virtualization was trendy. A Global Workplace Analytics survey reports that remote work has grown by 159% over the last 12 years. The early adopters who moved to remote work reported improvements in productivity, employee retention, diversity, talent access, opex, and work-life balance.

Link to Original Post on Medium

DAML Driven Development:

Hashed Health

Guest post by Corey Todaro,

Chief Product Officer, Hashed Health

How do seasoned veterans at one of the world’s top provider of blockchain technology healthcare solutions rate DAML — Digital Asset’s smart contract modeling language for distributed ledger technology (DLT) — for solving core healthcare business problems? In this third of a series of guest blog posts by our partners, customers, and others working with the DAML SDK, Hashed Health’s Corey Todaro discusses how DAML is helping them bring their Signal Stream product to market.

Since 2016, Hashed Health has worked to introduce blockchain and distributed ledger technologies (“DLT”) to healthcare. Founded by and comprised of healthcare industry veterans, Hashed Health engages with enterprises from all corners of this diverse industry, ideating and building innovative distributed solutions to address healthcare’s long-standing issues. Hashed Health believes in the disruptive potential for DLT but knows that change within a highly regulated and complex industry like healthcare is challenging. Hashed Health rises to that challenge with thoughtful and strategic design. Our obsession is DLT use case design, balancing varied constraints and regulatory realities to produce DLT frameworks and platforms that meet the needs of diverse stakeholders — easing inefficiency and generating measurable business value for our clients.

Our design process has always been agnostic as to DLT platform selection. We’ve designed multiple prototypes on a variety of blockchain and DLT platforms in an effort to assess their ease of use for both developers and end-users. We’ve mapped a wide range of DLT options to problem classes commonly faced by our enterprise healthcare clients. The metaphor of a toolbox is apt — blockchain and DLT platforms comprise a toolbox which contains a variety of tools useful for addressing and tackling specific problems.

For every business or administrative challenge, there is a right tool to provide a solution. By early 2017, our design process had identified a missing but essential tool. As we worked to reimagine and redesign various business processes in healthcare, confidentiality and privacy were — and remain — essential requirements in any design. While nearly all enterprise-grade DLT platforms provide features for transactional confidentiality, these features at best resulted in over-complicated designs and at worse failed to meet the stringent privacy requirements of the industry. Put simply, we didn’t have the right tool for the problems before us.

In the spring of 2018, Hashed Health participated in the developer preview program for the DAML SDK and the Digital Asset Platform. The result was more than the simple addition of another platform to our design kit. Rather, DAML — Digital Asset’s modeling language for developing smart contracts — has become an indispensable tool, already serving as the foundation for our healthcare contracting platform, Signal Stream.

In our experience, DAML combines a set of features that make it not only distinct from other DLT platforms but also make it an ideal platform for innovative designs for the healthcare industry. It gives us the ability to do something we’ve not been able to do before with distributed ledger technology.

Language Matters

At the heart of the platform is DAML itself, a domain-specific modeling language used to create transactional templates that define counterparty and related third-party behavior. The majority of enterprise-focused DLT platforms offer the ability to create application logic that can operate on the ledger (so-called Smart Contracts). Developers usually employ a general-purpose programming language to develop these smart contracts. By contrast, DAML is specifically designed to model business and commercial agreements. The concepts of business are core structures of the language itself.

Built on a functional programming foundation, DAML can feel a little restrictive at first, limiting the approaches a developer can take to define a transaction. Indeed, our developers initially found it off-putting. However, within a few short days, we understood that these seeming limitations actually deliver great advantages. DAML is designed for formal correctness. In other words, contracts and transactions written in DAML operate precisely as expected — essential for business trust and value. On other DLT platforms, we need to decide how to best approximate a business interaction and constantly test to assure that the approximation behaves as required because, when you use a general-purpose language, the behavior of that contract can vary. The same input can potentially give a range of unexpected and undesirable outputs — the contract can behave in strange ways. With DAML there is no need to approximate. This led to more efficient use of our development resources.

Language matters; how you write the smart contract and what language you use to write the smart contract matters for the business performance of that contract.

Confidential by Design

One of the more difficult design problems with DLT is transparency of the ledger. Many DLT platforms bear a resemblance, or even a direct relationship, to the original cryptocurrency blockchain platforms. These early platforms were designed for radical transparency. This transparency is essential to both their operation in open, permissionless environments and their trustless, tamper-resistant nature. For enterprises, this transparency at best complicates and at worst limits the benefits of DLT. DLT platforms such as Hyperledger Fabric and Quorum (as well as other Ethereum derivatives) have introduced confidentiality features like private channels, private data collections, and hidden contracts, while still operating on transparent, yet permissioned, ledger networks. While important, these platform developments are secondary designs, often at odds with the original design intention of the platform itself. As a designer, I find these confidentiality schemes to be inelegant after-thoughts.

By contrast, DAML is confidential by design — transactional confidentiality in DAML is a first-class, first-order feature; it is not a secondary add-on. Transactions are only visible to direct counterparties and/or third parties who have been explicitly granted rights to view. Prior to DAML, Hashed Health’s design work was constrained to either ‘data sharing’ use cases in which privacy is not essential or to overly-complicated transactional data models which attempt to preserve privacy on an otherwise open ledger. DAML’s focus on privacy — an essential regulatory business requirement in the healthcare industry — has given us a powerful tool to extend our design and DLT product development. And because of DAML’s fine-grained control over what can be shared with other parties, we can bring in observers, auditors, regulators, third-party service providers — and control precisely what they see out of the transaction. Even if it’s a single piece of data.

Radically Scalable

In 2014, as the financial services and other industry began to consider DLT technology, the scale limitations of open and even permissioned DLT platforms quickly became apparent. Supporting scales of only a few dozen to at most a few thousand transactions per second, many DLT platforms are incapable of supporting the throughput requirements of enterprise workflows.

In healthcare, the needs don’t often approach those of financial markets. In fact, the old saying is that in healthcare, any process taking less than 30 days is ‘real-time’. But as DLT solution designs move from proof-of-concept to production, the problem of scalability is becoming acute. In 2018, Hashed Health has begun work on a number of solutions which require scales beyond the abilities of many DLT platforms. In the DA Platform and DAML, we have found a reliable DLT platform that can accommodate transactional scales achieving 27,000 financial trades per second (which translates to 81,000 ledger updates per second) — the highest I’ve seen. This radical scalability has allowed us to begin designs to address the core payment infrastructure in healthcare — including fee-for-service claims processing, risk-based payment contracts, and other health plan and pharmaceutical financial workflows.

Our new DAML driven product: Signal Stream

Building on our experience with DAML, Hashed Health has recently announced a new healthcare contracting platform, Signal Stream. Built atop the DA Platform and DAML, Signal Stream enables clients to automate multi-party agreements and create an outcomes-based contract adjudication and management platform. This shared performance view is real-time and synchronized through a distributed ledger contractual engine. Addressable areas of healthcare include value- or risk-based contracts, procurement contracting, pharmaceutical rebates and outcomes-based payments and health plan administration. The platform works to:

  • Reduce administrative burden related to value-based contract automation;
  • Delineate value creation within agreements;
  • Offer real-time tracking of contract performance;
  • Achieve counterparty consensus regarding performance against contract value metrics and benchmarks.

DAML represents an essential innovative platform design, enabling enterprises to harness DLT within the business frameworks and realities of enterprises today. Hashed Health is excited to partner with DA to realize the promise of DLT for the healthcare industry.

Follow Digital Asset on Medium or Twitter, or join the community and register to download the DAML SDK Developer Preview at

About the author

Corey Todaro, Chief Product Officer, Hashed Health

Corey Todaro is CPO of Hashed Health. Hashed Health is a healthcare innovation firm focused on accelerating the meaningful development of blockchain and distributed ledger technologies. Corey is at the forefront of blockchain and distributed ledger designs for the healthcare industry. He brings to Hashed Health experience in venture capital investing in the health IT space as well as a wealth of operational experience in large national health systems with a focus on the challenges of healthcare payment innovation.

About Hashed Health

Hashed Health delivers to payers, providers, and suppliers real technical blockchain product solutions focused on decreasing the cost of care and reducing the administrative inefficiencies. We offer strategic services to accelerate blockchain adoption and product development across the healthcare industry by providing subject matter expertise and strategic advisory services to innovative organizations looking to create new networks and redefine business models leveraging blockchain/distributed ledger technology.

Allscripts Podcast

allscripts podcast blockchain hashed health

Blockchain 101

Blockchain begins with the basics.  In this episode, recorded at by Allscripts (@allscripts )at HIMSS 2018, COO of  Hashed Health (@hashedhealth)COO Corey Todaro (@hashed_corey ) gives a brief primer on exactly what blockchain is and how organizations are already using it in healthcare. For more discussion on current uses and future ideas, visit and join the Hashed Collective community.

On March 26th Richard Close and Brian Hoffman of Canaccord Genuity  hosted a call to discuss blockchain in healthcare with John Bass, CEO of Hashed Health.  We can connect you if you would like to read the full report.  Canaccord Genuity Industry Update Report blockchain healthcare

Reference: Canaccord GenuityRichard Close , Brian Hoffman, John Bass

Hashed Health Resource Brief: Michael Porter Research on Value-Based Healthcare

The following is part of Hashed Health’s ongoing Resource Briefs explanation series. We have aggregated blockchain healthcare resources on our site that we believe are instrumental to understanding and designing the new future of health and wellness. Our past resource briefs have focused on the revolutionary Bitcoin and Ethereum white papers. Today’s brief explains why we look to Michael Porter for inspiration in redesigning our healthcare system. For more on Michael Porter’s background, click here.

The healthcare system in the United States has produced many miracles and scientific advancements in treating acute care injuries and sustaining life. Despite these advancements, we are not getting our money’s worth. Patients are faced with high and rising costs, restricted services, care that trails leading benchmarks, patient and quality cost discrepancies across the system, access issues, socioeconomic distress and many more concerning trends. How can this be possible in a country that spends $3.2 trillion on healthcare annually ([1]), more than any other country in the world?

Michael Porter, the renowned Harvard Business School Professor, has done extensive research in the healthcare field and has pioneered the “Value Based Healthcare Delivery” framework. Porter’s framework focuses on the idea that healthcare systems should strive to deliver maximum value for patients. To the uninitiated, this value-based assertion may seem obvious, but in fact, our current healthcare system is not designed to promote value. Today, the fundamental health infrastructure we have in the United States is designed around fee-for-service transaction-focused healthcare. This infrastructure is not aligned with what most would agree is the core purpose of healthcare, which Porter defines as “Value for Patients.” When you accept this basic principle, it becomes clear that healthcare must shift from volume to value. The following guide will brief you on the current state of the healthcare system, Porter’s framework for creating a value-based system and Hashed Health’s vision for a new infrastructure for healthcare.

Instead of approaching care as an individual site, specialty or intervention, Porter espouses an approach that considers the patient’s medical condition over the full episode of care. From both a clinical and a financial perspective, the focus is on addressing the full set of results that matter to the patient, instead of the more narrow interests of each participating entity. In this model, outcomes become the driver of reducing costs.

In 2015, Porter introduced his value-based strategic agenda, which includes detailed analysis of the following concepts:

1. Re-organize Care Around Patient Conditions Using the Concept of Integrated Practice Units

2. Measure Outcomes and Costs for Every Patient

3. Move to Bundled Payments for Care Cycles

4. Integrate Multi-Site Care Delivery Systems

5. Expand Geographic Reach To Drive Excellence

6. Build an Enabling Information Technology Platform ([2])

In earlier research, Porter offered the concept of “zero-sum competition” ― a specific type of competition between parties that results in no net benefit ― as the explanation for our healthcare system’s contradictions ([3]). In fact, according to Porter, zero-sum competition between healthcare system participants actually “divides value instead of increasing it.”

Healthcare companies and organizations are competing on vectors not aligned with the best interests of consumers; this drives the system away from fulfilling a patients’ actual needs. Instead of focusing on patient outcomes, healthcare competition revolves around shifting costs, creating bargaining power, attracting and retaining patients and restricting choices and services. This type of competition only leads to gains at the expense of another entity: or zero-sum competition.

When we talk about value-based care, we tend to focus on the U.S. system. However, in more recent research, Porter adds a global perspective to the conversation. The data shows that value-based conversations should not be limited to the U.S. ([4]).

Similarly, variability in outcomes is also a shared concern.

Around the globe, we share a common interest to ensure advances of the value-based agenda in healthcare.

Hashed Commentary

At Hashed Health, we are committed to building solutions that focus on patient outcomes throughout the entire cycle, and thus improve patient care and drive value-based care delivery. We believe that blockchain and distributed ledger solutions offer a once-in-a-generation opportunity to redesign the fundamental infrastructure in healthcare by embedding rational economics into health processes. This is a unique chance to align incentives and change behaviors that are central to the policies Porter describes.

Value is all about the relationship between cost and quality. The very concept of value-based care suggests a need to reconsider the technical infrastructure that has been created to support fee-for-service care. The merging of clinical and financial paradigms is challenging, especially to traditional for-profit health system CFOs who have built careers around the concept of “heads in beds” and systemic business incentives that pay more when patients return.

To make the shift from volume to value, we must consider the basic infrastructure that we are dealing with. One of a blockchain’s core concepts is that of programmed value exchange. Using the blockchain, we can design and embed economic systems in the patient’s full cycle of care. This will allow us to program value exchange based on behaviors, compliance to protocols and attestations from both sides of the “marketplace.” These mechanisms are not possible using fiat currency in today’s claims-based systems.

For example, today’s bundled payment programs have shown promise, but they are hamstrung by trust and administrative complexities that are a result of trying to force a value-based system on top of fee-for-service infrastructures. We believe there is an opportunity to demonstrate that with a new blockchain-based information-technology platform, we can advance Porter’s Strategic Value Agenda.

Several members of the Hashed Health team have a background in bundled payments: John at InVivoLink, Corey at Vanguard Health System, Les at Martin Ventures and Philip at Humm. We have had many productive discussions regarding these efforts; we now feel that while these ventures successfully innovated and improved how bundles are managed, they were intrinsically limited because they were developed or implemented on top of systems that were not designed for value-based care. Building applications on top of (or offering minor improvements to) traditional relational databases simply can’t address that core issue. Other examples of solutions that suffer from these limitations, as described by Porter himself, include:

● Prior authorization for expensive services

● Patient copayments and deductions

● Electronic medical records

● Evidence-based medicine

● Safety/eliminating errors

● Introducing “lean” process improvements

● Care coordinators

● Retail and urgent care clinics

● Programs to address generic high cost areas (e.g. readmissions, post-acute care)

● Mergers and consolidation

Restructuring health care delivery is necessary, not incremental improvements.We believe blockchain technology is the answer. We can now design our own economies and trust systems that support the value-based agenda. We can engage employers whose perspective on value is sorely needed. We can work to harness the power of outcomes and embed outcomes data directly in payment and incentive processes. We can use new IoT devices on the blockchain to understand what’s happening outside the clinic and between surveys (a current shortcoming for Porter’s Tier 2 and Tier 3 measures hierarchy). We can directly link payments and benefits. The possibilities are enormous, and great work is starting to bring about positive changes.

Hashed supports the work that leaders such as the Altarum Institute, the International Consortium for Health Outcomes Measurement (ICHOM), the Organization for Economic Co-operation and Development (OECD) and others are conducting to accelerate the value-based agenda. At Hashed, we are engaging in productive discussions with surgeons, providers, manufacturers, payers and other constituents around the world about how we can begin using the blockchain to advance the value agenda. This is truly a collaborative effort,t and we are immensely proud to be a part of it