Is blockchain in healthcare for real? 6 questions with Hashed Health CEO John Bass

Hashed Health Founder and CEO John Bass brought more than 20 years of healthcare technology experience to his new project: a healthcare technology innovation company focused on accelerating the commercialization of blockchain and distributed ledger technologies in healthcare.

He was previously on the startup team at InVivoLink, a surgical registry and managed care application sold to HCA in 2015, and he has experience with patient engagement, supply chain and value-based payments. Here, Mr. Bass discusses the potential for blockchain in healthcare and explains the pathway for achieving real disruption in the future.

Question: What is the buzz around blockchain in healthcare now and where is it headed?

John Bass: Most of the messaging going around today is focused on big concepts that are exciting because a lot of people are hungry for something that will fix interoperability and revenue cycle complexity. We are also looking for ways to give patients responsibility for their own information and fix the supply chain. The question now is how do we get from here to there? We need to build the foundational components of blockchain in healthcare and then work our way to a larger vision that will solve more problems. The small, bite-sized pieces of blockchain we're working on now won't change the world, but they do show blockchain can deliver real value, building infrastructure to a decentralized future.

Q: What role does Hashed Health plan in advancing blockchain in the healthcare space?

JB: Hashed is a collaborative innovation; some people refer to it as a consortium because without a network of participants, these blockchain solutions are expensive academic exercises. The blockchain enterprise is only valuable if you are solving market-level data or asset movement issues. We focus as much of our energy on building networks as we do on products because that's what drives real value for commercialized healthcare systems.

Change Healthcare recently joined Hashed Health and we're working on exciting concepts around payments; that's a big goal. When you break it down, you're talking about providing identity for the patient, provider and claims payment channels between them. We are also breaking down the larger projects like physician identity into smaller projects that will help with the claims process in the future.

Q: How do you envision blockchain helping providers with physician identity capabilities?

JB: We are working in Illinois to provide a decentralized version of state licensing for physicians. Today, the state licensing process is cumbersome and unmanageable. If you're a telemedicine physician and practicing in many states, obtaining licensure is a challenge. Right now Illinois and other states are obtaining permissions through emails phone calls and faxes. It's all manual.

If they build a centralized database, it becomes a honey pot for hackers and could suffer the traditional issues around centralized data structures. We all agree we have a need for interstate medical licensing; why don't we share a distributed ledger that no one controls? We can all look to it as a primary source for medical license information. It's a better, faster, cheaper way of working the system.

Everyone is creating an ecosystem of shared value because the licensure requirements are a meaningful and expensive problem for states.

The same process could also be used for graduate medical education attestation. The blockchain could serve as a provider directory and you could add patient reported outcomes measures and other quality and volume information so patients can look at physician information and see who the best surgeons in the country are. It all adds up to a decentralized identity and reputation concept. Now you have a vision of how to take what we started with and build it into something disruptive.

Q: How long will it take for blockchain to reach a place where this disruption could happen?

JB: There are a lot of people talking about disruption today without a foundation or pathway to solve their issues. However, we are obtaining revenue to do our first projects for provider and patient identity and supply chain solutions to take the collaborative stepwise approach to the future of blockchain in healthcare.

We think we might be the first company to have a valuable production-level blockchain system in healthcare in 2018. The early adopters are the thought leaders — those who have seen the blockchain, gone down that rabbit hole and believe in distributed ledger. A lot of people want to be attached to the buzz.

Right now we are climbing our way up the hype cycle; at some point it will come back down and a lot of the bad ideas will be casualties. Out of the ruins will come the real ideas and companies. Then you'll start to see the word “blockchain” fade into the background, and it will serve as an underpinning for IoT, artificial intelligence, machine learning and value-based care solutions.

Q: What role could blockchain play in the revenue cycle as healthcare transitions to value-based care?

JB: I have a bundled payment and value-based care background, so a lot of my thoughts are around programmable value and being able to make healthcare payments smarter. How do you program transfer of value so what you pay is dependent on your behavior as a patient or adherence to a protocol — or as a physician, your quality scores or adherence to best practices and protocols? We are trying some of this today, but it does not work largely because of trust and administrative challenges. There is a huge separation between benefits and payments right now, but the concept around programmable value can make healthcare payments smarter while reducing administrative complexities for the prospective bundle.

Q: Where do you see blockchain headed over the next 10 to 20 years?

JB: The hope is we take all the complexity we have built up over time and a fundamentally new infrastructure will exist underneath it that takes the value currently extracted by companies and returns that value to consumers. For the system to really change we need consumer empowerment. That's what I see happening over time: Blockchain will enable new, exciting solutions that truly put patients at the center.

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