Re-posted from @hashedhealth on Medium
Welcome to 2019!
As we think about our community’s 2019 goals and objectives in the healthcare blockchain space, I find it helps to reflect on the important and influential news of 2018. In this list, I have done my best to include projects and announcements that I consider real or indicative of a signal and not just noise. That does not mean there isn’t marketing and spin behind them. These announcements are from notable companies, but often have little detail. Several of them took me by surprise. It can be hard to tell how real they are. 2019 will tell us what kind of results are delivered from the strategies outlined in these events and announcements.
Upon reviewing this list, I noticed a few things:
Here are my top 15 healthcare blockchain new highlights of 2018 (in no particular order).
In December 2018 Jose Arrieta and Oki Mek received the first blockchain ATO (Authority to Operate) in the federal government. This announcement has made them like the Jordan and Pippen of the federal blockchain league.
While many others in the federal government and in the commercial space pilot and experiment, Arrieta’s team, with input from the Acquisition Workforce, has deployed a solution that improves access to a standard set of spend data in real-time and decentralizes the execution of logic from that data.
According to Arrieta, conservative estimates show HHS Accelerate having a measurable return on investment of over 800%. Those waiting for proof of value may have just found it.
This announcement proves that blockchain is being used to solve real problems in the government space. I expect Arrieta’s work to drive increased interest in blockchain solutions in the government space in 2019. This hard work has also created two of the federal government’s newest rockstars.
Change Healthcare is the largest claims processor in the US. At the end of their 2018 fiscal year, they had processed nearly 14 billion transactions and $1.0 trillion in annual healthcare expenditures. They are a middleman with a unique perspective on the strengths and limitations of the current payment infrastructure in healthcare. They are also one of the earliest corporate adopters of blockchain technology in healthcare.
In 2017, they hired Emily Vaughn Bailey from Gem (who, in 2018, pivoted away from healthcare and their blockchain OS to being a crypto-wallet) to lead their blockchain strategy. In 2018, they doubled down on their blockchain position with a series of announcements.
First, in January 2018, Change announced the general availability of “the first enterprise-scale blockchain solution for healthcare.” Their solution, which is built on Fabric processes a daily payload of 50 million claim events and scales up to 550 transactions per second.
Then, in December 2018, Change announced they were acquiring Pokitdok who, under the leadership of Ted Tanner, was an early leader in the blockchain space. From the press release it seems that Change is focused on the Pokitdok assets (API technologies, blockchain use case assets, network assets), rather than its talent. The combination of Pokidok’s API marketplace with Change’s legacy payment infrastructure could open the door to some excellent opportunities for Change.
One signal of the maturation of the blockchain market were the companies on stage and in attendance at this year’s Distributed:Health conference. Distributed:Health is the premier healthcare blockchain conference in the world. What began in 2016 as a relatively obscure conference of early thought-leaders has evolved in to a legit healthcare conference of over 700 people from around the globe.
The day one keynote speaker was former Senate Majority Leader Bill Frist (followed by an excellent panel with Michael Painter of The Robert Wood Johnson Foundation), who summarized his experience at Distributed:Health 18 and his thoughtful view of how the technology has matured in this Forbes article published in October.
2018 was a year when the world discovered which would be the first use cases to prove the value of blockchain-inspired technologies in healthcare. After all the talk of ICOs, cryptocurrencies, and medical records on the blockchain, a series of use cases focusing on provider data management have surface as the low-hanging fruit.
Procredex was announced at HIMSS18 as a new solution to the old problem of physician credentialing. Using a distributed ledger to solve for the authenticity of verified provider credentials enables a new business model that the world has never seen before. In addition, a string of announcements introduced a network of health systems and health plans who are coming together to bring this product to market in 2019. Procredex seems to have found the sweet spot between the technical solution, a new business model, and the governance structure necessary to make the use case stand up in a meaningful way.
Procredex is not the only provider data management use case to show viability. The Synaptic Alliance was announced in April 2018 as an inter-company data-sharing solution aimed at the problem of provider directory data. The Synaptic solution is similar to Procredex in that it deals with physician data, but instead of credentials, the Synaptic Alliance focuses on provider demographic data.
Like Procredex, Synaptic has an equally impressive consortium of healthcare enterprisese. Synaptic is an excellent example of a group of “competitive” organizations coming together under a common mission to solve an industry problem. Kyle Culver from Humana, Mike Jacobs from Optum, and the other founders of this project have been very thoughtful in their approach, especially in terms of governance objectives. Synaptic is definitely a project to watch in 2019.
In 2018, we saw a pair of brand name medical records announce that they were exploring medical records on the blockchain. What made these announcements even more interesting is that the agreements are with Initial Coin Offerings (ICOs) Medibloc out of South Korea, and MedicalChain which is based in the UK.
In June 2018, UK- based MedicalChain announced an agreement with Minnesota-based Mayo Clinic to explore storing patient data on a blockchain. At the time, blockchain thought-leader, Robert Miller, was at MedicalChain and is rumored to have brought the deal together. Miller has since left the organization to begin his own initiative, Honeycomb Health in New York. It is not clear what, if any, effect this will have on the working relationship with Mayo.
Then, in December, Mass General announced a partnership with Korean ICO MediBloc to explore the storage and sharing of PHI. Under this agreement, Mass General will “explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”
These are two announcements I was not expecting, given a) the relative immaturity of blockchain technology for medical records storage; b) the unclear business model related to the medical records use case; c) questions around regulatory concerns with PHI on the blockchain; and d) the 2018 ICO landscape and the perceived risk around crypto-focused blockchain projects. It will be interesting to see whether these projects gain real momentum and publish results in 2019 or if these announcements fade.
Another big health system announcement came in July 2018 when Mount Sinai announced their Center for Biomedical Blockchain Research, which is being led by Joel Dudley (Executive Vice President of Precision Health at Mount Sinai, Mount Sinai Endowed Chair of Biomedical Data Science, Associate Professor of Genetics and Genomic Sciences, and Director of the Institute for Next Generation Healthcare) and Noah Zimmerman (Assistant Professor of Genetics & Genomic Sciences and Director of the Health Data and Design Innovation Center). Besides having extremely long professional titles, Dudley and Zimmerman will be leading academic evaluations of blockchain solutions, leading partnership and consulting opportunities with various companies, and building their own systems within Mount Sinai.
One of the most popular topics at Distributed:Health in 2018 was specific to the opportunities for blockchain to help with the opioid crisis. In September, IBM and the CDC discussed this use case with Fast Company. The two companies are hopeful the technology can be used to track patient symptoms and treatments.
At times it seemed that Amazon was making healthcare technology news every week. Certainly, it was not all about blockchain, but it all seems to add up to a long-term healthcare strategy that includes blockchain-inspired technology. It is clear that Amazon sees a number of opportunities to capitalize on the chaotic, irrational marketplace that exists today. I think they are right.
Here are a few of the many Amazon headlines that caught my attention:
These a few of the many interesting Amazon initiatives that set the stage for a lot more news in 2019 that will push healthcare to innovate faster.
Distributed:Health has become the premier event where companies announce new products and initiatives. Over the years, healthcare’s leading companies including Change Healthcare, Hyperledger, Gem, Hashed Health, TIBCO, PokitDok and others. 2018 was no exception.
The most significant new product announcement at Distributed:Health 2018 was Signal Stream, a new platform that enables healthcare enterprises to automate multi-party or multi-system workflows and agreements. It solves existing administrative issues related to contract adjudication (ex. outcomes-based contracts and other types of multiparty workflow tools) and creates a new way to innovate on contract design.
It seems that payments and value-transfer seem to be an area where blockchain will be able to solve real problems for real companies in 2019.
On their flight to the moon Consensys encountered some turbulence in 2018. Things seemed to change very quickly in late 2018. One example of how fast things changed was Civil, a seemingly high quality journalism network project. I was surprised when I saw the announcement that Civil failed to raise their floor and would refund investors. That failure provided further validation for the general cooling of the ICO market. It also said a lot about the marketability of projects following the framework of the Brooklyn Project and the general lack of appetite for application token sales. The project approach seemed like a risky strategy from a securities standpoint. It was an unexpected, high profile public failure that seemed an indicator of where the crypto market is in 2018.
It seems clear that, with the decline in the price of Ether, ConsenSys is now digging in for the long haul by doing what needs to be done. I am sure these weren’t easy decisions. I see these moves as healthy signs that ConsenSys has its eye on the future.
It seems that part of their strategy could include healthcare. ConsenSys has tapped one of the top minds in healthcare blockchain, Heather Flannery, as Healthcare Circle Global Lead. They could not have picked a better spokeswoman to represent their interests. If ConsenSys Health is given room to grow, it could be a leading player in the healthcare space in the coming years.
This is not ConsenSys’ first foray in to healthcare. Back in 2017, Diego Espinoza’s Healthcoin project joined ConsenSys as a spoke project. Once absorbed, that project quickly rebranded as “Linnea” and quickly lost its healthcare specificity. Diego is now working on a new fintech blockchain startup and it is not clear what Linnea’s fate will be in the new ConsenSys restructuring where most spokes are being spun out to survive on their own.
As mentioned in #11 above, crypto had a really tough year. There were announcements of ICO layoffs, SEC crackdowns, and horrible results reminding us that most of the $30B invested in crypto have “nothing to show.” The 2017 healthcare ICOs are not immune to these criticisms. They come under fire for their lack of decentralization and massive declines in value.
As more ICOs come under fire for securities violations, the scary truth is that those electing recission must pay back FMV as of the date of the original investment and, I would assume, probably have to pay it back in fiat.
While the crypto market is in question, the B2B market for blockchain and distributed ledger solutions continues to heat up as we enter 2019. Recent research by Markets&Markets and others predicts significant growth over the coming years in areas such as supply chain, interoperability, payments, and other areas.
In 2018 we realized that successful blockchain use case development is harder than it seems. ICO projects are not the only ones struggling to prove themselves. ICO’s catch a lot of flack because they raised so much money and have produced so little, but we are all learning that meaningful work in the space is really hard. It requires a clever piecing together of technical, business, and governance concerns that often feel like a three dimensional chess match. Even as the technology matures, many good projects have failed or will fail for non-technical reasons.
This year we wish Bitcoin a happy 10th birthday. To celebrate, I went back and re-read the Satoshi Whitepaper which I first discovered in 2015. This vision of a totally decentralized digital currency and payment system changed my life. I saw it as an invitation to apply it to what I know about healthcare.
I like how Laura Shin (if you don’t listen to her podcasts you are missing out on a great source of information) recently described Bitcoin as a global, leaderless, user-owned IT department which is now more valuable than Goldman Sachs (over $100b market cap). And despite the value flowing through it, Bitcoin has never been hacked.
Our original summary of the Satoshi whitepaper can be found here. The Bitcoin genesis block was introduced ten years ago on Jan 3, 2009. It is amazing how far we have come and we are just getting started. Thank you Satoshi whoever you are.
So there you have it. The top 15 healthcare blockchain news highlights of 2018. These announcements indicate use cases that I think are real as well as some interesting new hype.
The announcements I’d like to see next year have everything to do with results from the projects announced in 2019 and host of new concepts. In terms of a goal for 2019 for the larger healthcare blockchain community to strive for, I think we can aim for four (4) DLT or blockchain projects that are in production, being used by a network of real companies, and have publicly recorded results of value created by the end of the year. This is a goal for the larger community of which Hashed is a member.
At Hashed, our contribution to this goal comes through our efforts to solve real problems for real companies in today’s world while building bridges to a more rational, value-based, patient-focused future. Using blockchain and DLT, we build products that unlock new solutions to old problems in healthcare. I believe we will look back on 2019 as a banner year for Hashed, our network partners, and the larger healthcare blockchain community.
See the original Medium post here: https://medium.com/@hashedhealth/2018-in-review-6bf92c6d273d
Blockchain and DLT has the potential to change the way music is sold and consumed. Over time, new technical and business models will affect how rights holders (labels, producers, musicians, other artists) interact with each other and with fans. In July we heard from Jesse Grushack, co-founder of UJO Music and their rights management system. We also heard a Nashville innovators perspective from Chris McMurtry head of Head of Music Product at Exactuals and Lee Greer President of NPREX a blockchain backed performing rights exchange.
Twitter Livestream Recording:
Nashville Blockchain Meetup – Live from WeWork https://t.co/MTbQxC0q9p
— Hashed Health (@HashedHealth) July 12, 2018
Thank you to our friends at PioPlay Livestream for the seamlessly professional live stream coverage (we loved them, they are awesome – consider us a standing reference for their work)
A blockchain is essentially a database in the form of what’s called a distributed ledger. That is, information is distributed across a network of participants. The participants can see activity on the ledger, but no single party controls it. Once data is in the blockchain, it can’t be changed. New information is timestamped and linked to the previous entries, making the blockchain auditable and secure.
Blockchain is probably best known as the technology that supports bitcoin, but its potential goes well beyond cryptocurrency. Innovators see promise in using a trusted, shared database of transactions for payments and money transfers, records and verification, to reduce risk and fraud.
The technology, while still evolving, is becoming mature enough that some states have announced that blockchain would be treated similarly to existing electronic record systems. This development should encourage broader acceptance of blockchain applications.
Steve Betts, chief information officer for Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas, explains why health care innovators are excited about blockchain.
Some experts also believe blockchain has the potential to revolutionize health care.
“The reason all the hype is there is because if it works, if it’s true — if half of it is true — it has the potential to fundamentally change market structures and the movement of value,” says John Bass, founder and CEO of Hashed Health, a company focused on solving problems in health care with blockchain technology.
“There’s so much potential to improve how care is delivered and paid for, and that’s got everyone very, very excited,” Bass says. “Part of what’s driving all the cost and quality problems is fundamental issues around trust, transparency and sense of alignment.”
That’s because the health care industry has so many different parties — insurers, doctors, hospitals, consumers and more.
These groups have their own data, and it’s often a struggle to share accurate, up-to-date information in a secure way. That’s what blockchain was designed to do.
And innovators are taking notice. More blockchain initiatives are focused on health care than any other sector, according to a report from the Stanford Graduate School of Business.
Bass is particularly excited about blockchain’s potential to shift the health care industry toward true value-based care — paying for care that improves patients’ well being and rewarding physicians for quality instead of the quantity of services they provide.
We are accelerating towards a healthcare financial crisis in the US. For many families, it’s already here. In the last 10 years, US healthcare prices are up 22% (vs 17% for the general economy). US Healthcare expenditures are up 45% (vs 28% for the general economy). We have institutionalized a dangerous marketplace known for a lack of competition, obscure pricing and contracting, high administrative costs, and the consumer’s willingness to pay without asking questions or having answers.
The winners have leveraged the current design to profit in an irrational market. Pricing variation, over-consumption and administrative waste are all someone’s profit margin. These companies are emboldened by the infrastructure-heavy business processes that persist in healthcare. These models rely on centralization of data and business models that aggregate and leverage consumer data for profit.
This will not continue another ten years. The government, employers and patient customers are at a breaking point. There is a crisis of confidence in foundational healthcare systems. There will be a dramatic shift, either forced or voluntary.
In March, Alex Azar of the HHS outlined his policy that focuses on empowering patients with their data, transparent pricing, value-based market structures, and removing government influences that impede value-based health. He told the Federation of American Hospitals, “There is no turning back to an unsustainable system that pays for procedures rather than value. In fact, the only option is to charge forward — for HHS to take bolder action, and for providers and payers to join with us. This administration and this President are not interested in incremental steps. We are unafraid of disrupting existing arrangements simply because they’re backed by powerful special interests.”
In response to these pressures we have discovered a potential answer. Recently entrepreneurs and incumbents in the healthcare industry have embarked on an inviting new conversation that has the potential to, over time, fundamentally change our healthcare delivery model. A growing community sees the chance of a lifetime to improve how healthcare is accessed, delivered and paid for. Work is underway to transform delivery through the convergence of healthcare blockchain, IoT, AI, machine learning, mobile devices, telehealth and precision medicine. This technology cocktail leverages a disruptive combination of trust, transparency, behavioral economics, big data and automation. The hope is that we may enable the restructuring of inefficient, ineffective, corporate-focused value chains in healthcare. Doing so could change the market structure under the feet of healthcare companies around the world.
Blockchain provides the foundation for this change. Most people see blockchain as a new technology, often referred to as the “Internet of Value.” What most people don’t understand is that its power for value-transfer disruption lies in the enablement of new business models and the blockchain’s ability to embed belief systems in to the software itself. This combination of open source technology innovation, business model innovation and governance innovation makes it challenging to get right, yet potentially very rewarding for those who use it effectively.
Most people have not spent the time and energy to fully understand the convergence that is happening. It takes a lot of work to fully understand the opportunities presented when you bring together new business models, new technical models and new governance structures.
With all the hype, it’s healthy to be skeptical. Whether or not you believe in the technology, you have to admit that emergence of blockchain is creating an amazing opportunity to collaborate in new ways. Collaboration begins with communication around ideas. These ideas represent a refreshing new conversation in healthcare. It gives us a chance to imagine a world where we can stop repeating the mistakes of the past and stop repeating the same conversations around the obstacles that stand in the way of empowering patients, transparency, interoperability, value, and irrational market forces in healthcare.
For good reason healthcare is resistant to change. Transformation won’t be easy. In fact, it has never been done before. It will require us to shift our paradigm from a model that rewards the centralized business models that underpin many of the largest healthcare companies today. It will require us to double-down on the shift from volume to value. It will ask us to trust software protocols where we formerly trusted companies and middle-men.
In return, we can expect to see new ecosystems in healthcare arise that are in line with the needs of patients, employers and other communities. These ecosystems will center around new types of market structures that provide more efficient access to health resources. These new markets hold the promise of rationality and transparency. Consumers can make choices based on information, cost, and a seller’s reputation for delivering value. Innovative offerings can be listed on new exchanges by innovative sellers that reflect the needs of innovative buyers like the VA or Amazon, JP Morgan, and Berkshire Hathaway.
To succeed, we will use a variety of new distributed and decentralized protocols that embody the belief systems of their creators who come together around solving the industry-level problems borne of centralization. These parties (new and old) have already begun to collaborate and offer an alternative to healthcare’s current value chains that keep us locked in 1990’s-era pipelined processes where rent-seeking rules the day. We are already building ground-up economies that use programmable value transfer to automatically respond to behavior, quality and outcomes. We will no longer need to depend on infrastructure (ex. claims) that is not designed to support the important relationship between cost and quality.
The winning innovators will differentiate themselves based on trust, value and collaboration. Across the globe, “minimally viable networks” are coming together to test production systems that solve old problems in new ways. The early use cases focus on physician identity, patient identity, claims adjudication, consent, supply chain and payments.
Experts will tell you it’s just a matter of time. It will happen network-by-network over the next ten years or so. The decentralizing forces that have been unleashed cannot be held back. Hiding from these realities is akin to hiding from the internet in 1999, but even more dangerous. In the 90’s we were changing the container of the flow of information. Today we are changing the container of the movement of value and digital assets. That’s a much bigger story that could shift the landscape in dramatic ways. There will be companies who ignore the shifting market structures under their feet, possibly resulting in a new corporate extinction event in a relatively short period of time.
That might be what it takes to right-size a system that has outlived its design. It also just might be our only viable alternative to the next US financial crisis.
John Bass is the Founder & CEO of Hashed Health, a healthcare innovation firm that focuses on using blockchain and distributed ledger technologies to solve unmet needs in healthcare.
By NINA TALLEY, MedSpeaks
When it comes to blockchain in healthcare, Electronic Health Records (EHRs) dominate the conversation. The need to secure and move this highly sensitive data has long been a bottleneck in healthcare. Healthtech futurists are looking hungrily at burgeoning blockchain and related technologies as a part of the solution to this time-consuming problem. But are we truly there yet?
“Dreams of interoperability and self-sovereign medical records are nothing new,” said John Bass, CEO of Hashed Health, a healthcare innovation firm focused on developing meaningful utilization of blockchain technologies and networks. “It’s understandable that the big, disruptive blockchain use cases have captured the world’s imagination. The blockchain certainly provides an exciting new framework for these solutions. But we have to figure out how to get from here to there.”
Read the full article here: Health Innovators: Let’s Get Practical, Blockchain in Healthcare
Innovation Rising, presented by Healthbox, examines the intersection of innovation and healthcare from a variety of viewpoints featuring interviews with the leaders who are moving our industry forward. The podcast is arranged in 3-episode series around a specific topic in healthcare or innovation. In each of the 3 episodes, we interview a hospital or health system using this innovation, an investor who has invested in this sector and their thoughts on why and the future of the sector, and finally an interview with a founder of a solution in this space, respectively.
Our guest today, John Bass, joins the podcast to talk about the use of the blockchain in healthcare and how it will drive innovation, now, and in the future. John is the Founder and CEO of Hashed Health, a healthcare blockchain innovation firm focused on building the new digital infrastructure for healthcare. John has over 20 years of experience in healthcare technology with expertise in shared operating systems that build trust, transparency, and incentives across health networks.
Prior to Hashed Health, John was CEO at InVivoLink, a care management start-up which sold to HCA in 2015. Since then, John has been a leading voice in the development of the global healthcare blockchain market and is focused on community development, enterprise services, and blockchain solutions development.
Topics we cover in this episode:
John’s background and focus on improving patient outcomes
When the blockchain actually came to be and when and why it piqued John’s interest
What the blockchain is
The types of problems using the blockchain in healthcare aims to solve and how Hashed Health aims to accelerate this process
How the blockchain will truly be disruptive in healthcare
HLTH’s mission is to bring together senior leaders from across the health ecosystem to solve the most pressing problems and actualize the most promising opportunities to improve health. Throughout the event, you’ll learn from and interact with others in small and large groups, at public and private sessions, around topic-driven roundtables, and through one-on-one meetings.
Our curated networking programs maximize your time by connecting you with peers who share your interests, who are prepared to explore partnerships, and who are seeking to create personalized collaborations to help both you and your organization grow.
HLTH is the largest and most important conference for health innovation and is the destination for senior leaders from across the health ecosystem. Over four days at HLTH, we’ve created curated networking programs to maximize your time by connecting you with peers who share your interests, who are prepared to explore partnerships, and who are seeking to create personalized collaborations to help both you and your organization grow.
Presentation time to be announced, but be sure to catch John’s presentation.
John Bass will be presenting “Beyond the Blockchain Hype: Will 2019 be the year it proves its value in healthcare?”
Stay tuned for times and panel bios
Official Conference Information:
Join us at AHRMM19 – the leading education event and the central meeting place for providers, academics, affiliates, and vendors working in all facets of health care supply chain. Together, we will be expanding our collective understanding of how to advance supply chain strategy and effectively manage the quality and affordability of care. You can expect four days of insightful and inspiring keynotes, practical and relevant Learning Labs, and an energized exhibit hall showcase with product presentations that can help support the needs of the patient.
John Bass and the Hashed team will be speaking and attending Consensus and Blockchain Week. Stay tuned for presentation times, but schedule a meeting today.
Consensus is the annual gathering of the cryptocurrency and blockchain technology world. Since 2015, Consensus has attracted every major company, developer, founder and investor in the cryptocurrency and blockchain world to engage in an annual discussion about the future of the industry. Consensus is designed to be a big tent for the industry: it convenes industry participants ranging from enterprise consortia to cypher punks. This convening power breaks down the barriers that separate companies in the industry and allows everyone working on the technology to spend three days learning from their peers. Previous speakers reflect the richness and diversity of the Consensus crowd, ranging from titans of Wall Street and rulers of the Fortune 500, to pioneering cryptographers and the core developers who power the world’s most valuable cryptocurrencies.
These include names like: • FedEx’s Fred Smith • Fidelity’s Abigail Johnson • Square’s Jack Dorsey • Chairman of the US Securities Exchange Commission, Jay Clayton • Whitfiled Diffie, co-creator of public-key cryptography • David Chaum, investor of the first digital cash …And many more