What are the realistic prospects for the adoption of blockchain technologies in U.S. healthcare? The opportunities exist, but so do seemingly countless complexities. On June 28 at the Sheraton Nashville Downtown, experts and innovators around blockchain shared their perspectives on the subject, during the Health IT Summit in Nashville, sponsored by Healthcare Informatics.
Giles Ward, COO of Hashed Health, a Nashville-based “healthcare innovation firm focused on accelerating the meaningful development of blockchain and distributed ledger technologies,” led the panel discussion, entitled “Use Cases for Blockchain in Healthcare.” He was joined by David Murtagh, vice president of operations, provider data management, at MultiPlan, a New York City-based company that “helps healthcare payers manage the cost of care, improve their competitiveness and inspire positive change”; he was also joined by Anthony Begando, CEO of the Nashville-based Professional Credentials Exchange, or ProCredEx, which provides systemic professional credentials verification services; and by Jeanine Martin, nurse advocate and clinical information leader at C3 Global Biosciences, Inc., a Las Vegas-based research firm involved in cannbidiol (CBD; medical marijuana) development and distribution.
Ward began by asking Murtagh about his perspectives on the research and development work done on blockchain in healthcare in the past two years. “Two years is actually a long timeframe to look back on,” Murtagh said. “We’re fortunate enough, because of the relationships we have, most of the partners are relatively small. United, United Health Group. Optum, Humana, and Quest Diagnostics, collaborative. There’s a relationship factor. United might have a really good relationship with a set of providers, that we don’t have. It’s not like there are certain provider groups out there that say we’re going to shun certain health plans. I believe that the real trigger for this industry to collaborate and use a technology like B that’s relatively unproven, has been driven by regulations. CMS started auditing provider directories of health plans, and for the commercial health plans, CMS has delegated the requirements to the states for audit requirements. And every state has done something different.”
Further, Murtagh added, “If our data is inaccurate, it gets pushed aside. There’s a huge risk to us. If our data is faulty, our network is going to look inadequate. And all of a sudden, we’ll have the state tell us, you’re suspended for a year for participation in programs. So we’ve collectively accepted that it’s going to be imperfect.”
Defining blockchain’s uses cases in healthcare
Meanwhile, Ward asked, “What’s your definition of blockchain? How do you define blockchain, and then let’s go into how you’re applying it.” “Two principles around blockchain are fundamentally important around its use cases,” Begando said. “The two pillars are, on one side of the coin, you need to answer four simple questions with a ‘yes.’ First, is there an existing network of counter-parties that need to share information, are willing to share it, and do not have a simple way of doing it? Is there a centralized control within this network, or are there silos of redundancy? The second question is trust. Do the transactions themselves need to be trusted by counter-parties, and is there a lack of trust?”
Continuing, Begando said, “Third is transparency. Is there a need for parties to understand a specific life cycle? And finally, alignment of incentives—are there incentives among all parties to share incentives, align incentives? If the technology only helps one party, that won’t work. Everyone who participates has to share some value in some way, shape or form. The other side of the pillar is focused on three things. Technical model: does it make sense and is it achievable, can it be scaled to market? Second, the governance model: how will this be governed. In most cases, blockchain systems need to be governed by those who use them. The nature of blockchain is democratization. So you need a governance function that manages the rules and playing field for this environment. The third element is the management model. How will all this be managed? You need a Venn diagram matching all those elements.”
“What’s most important to us is its use case,” Murtagh said. “The decentralized nature of it is critical: you can’t have a central owner that can change the rules or cost structure tomorrow. And having that audit trail. You have that transparency within the system, but you also have the security to enforce rules, define rules, and maintain confidentiality among the parties. So that when I need it and am authorized by the rules governing by the blockchain, I can see the full audit rail, right? But if I just need to for example buy or sell or use one piece of the blockchain, I don’t need for everyone to see the transaction.”
“It’s open, it’s distributed, it’s secure, it’s an immutable ledger, it’s a peer-to-peer network,” Martin said, speaking of the advantages of adopting blockchain. “Cryptography is how you secure the blocks. Then you’ve got Bitcoin and Ethereum, cryptocurrencies built on blockchain.”
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