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Alright, so our next speaker is CEO and founder of Hashed Health, a healthcare tech

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innovation company focused on accelerating realization of blockchain and distributed

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ledger tech. With 20 years of healthcare tech experiences spanning across many successful

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startups, he is also a proud native of Nashville as well as a Tar Heel. So without further ado,

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let me introduce John Bass. Hey, how's that sound? Can everybody hear me? Cool. This is

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great. Thank you for being here. Thank you for coming. I'm going to move pretty fast. Don't

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worry, I'm not going to do a blockchain 101. I assume if you're here you know what blockchain

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is and how it works. I am a member of the community of co-founders of the blockchain. I am

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going to talk a little bit about healthcare and why blockchain is important and how we hope that

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it can empower consumers and become a tool for us to change the system. You know, everyone

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complains about the healthcare system, and it's certainly a topic of conversation right now, but

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it actually is working as designed. I don't know how many of you have read Homo Deus, a great book

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if you haven't read it. Yuval Harari talks about it pretty well in there, basically says that,

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you know, for the first time in history, more people are dying of overeating, kind of eating

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too much than too little, and more people are dying from old age than from infectious disease.

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We've really been successful at creating a system that keeps people alive, that fixes acute care

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illnesses.

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We are really good at that, and we've built up these massive insurance companies and pharma

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companies and a lot of different middlemen in between, EMR companies that have done very well

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because of that system, and it's been successful in a lot of ways, but the problem is that it

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seems to be going a little bit backwards in terms of quality. We rank number one in cost,

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but number 37 in terms of quality.

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And it is eating away all of our GDP. Right now we're looking at about 18, close to, climbing close to 20% of GDP, and by 2020, the estimate is that it will be around $5 trillion in health care costs.

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It's basically eating our government. Over time, there will be little room for much else other than health care.

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And the waste.

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The waste is pretty substantial.

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The estimate is that 25% of those costs are administrative waste.

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About a third of that $5 trillion is waste.

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It comes in a lot of different forms.

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According to the NIH services, basically needless services are the biggest piece at $210 billion per year.

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Administrative costs is at $190 billion.

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Inefficiency is at $210 billion.

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Pricing transparency, fraud, and the failure to prevent diseases continue in terms of kind of making up that 25%.

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The leading killers in our country are heart disease, cancer, and medical errors.

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Medical errors are the third largest contributor to death, mortality, morbidity in the country, according to CDC last year.

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Medical errors kill more people than respiratory disease.

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And one of the kind of central themes here is that our fee-for-service health care system actually rewards those errors.

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You know, if you treat someone and you fail to treat them correctly in the fee-for-service structure, you actually get paid to treat them again.

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And you keep getting paid despite your success.

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We're working to change that.

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But we're still built on top of fee-for-service infrastructure and fee-for-service relational databases and systems that are a fundamental challenge to us digging our way out of the hole that we're in.

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Fee-for-service creates these perverse incentives.

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And the relational databases create siloed data structures that prohibit us from really moving the ball forward in terms of interoperability.

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And at the same time, most of the people who really need help are, for example, mental health patients, one in five Americans.

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And the really bad ones aren't in the institutions where they should be, but they're in jail, or they're on the streets, or they're in the morgue.

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And we're realizing that, you know, while we've gotten really good at treating acute care illnesses,

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we're really not so good at being, kind of, treating those leading causes of death, like cancer and heart disease and respiratory failure.

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Because we seem to have, over time, institutionalized some of those illnesses.

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Health is not about, it's about more than the absence or lack thereof of disease.

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It's about your environment, and it's about what's going on around you.

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It's about things like how close to mass transit you are, do you live in a food desert, and are you generally happy with your situation.

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An interesting study on rats found that rats will choose opioids over food when they're caged,

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but they'll choose food over opiates when they're not caged.

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A lot of your health has to do, and your tendencies towards escape has to do with your situation in life.

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And we know this, yet we continue to market opiates and other things that are destructive to health, because it feeds that system that we've created.

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Another interesting point is that brain studies have shown that sugar is as addictive as cocaine.

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And sugar is, you know, the leading cause of a lot of these problems that I'm talking about.

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Cancer, for example, feeds off of sugar.

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And the last kind of depressing statistic that I will kind of talk about is the, you know, as we start to look at how we're going to change the system,

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we have to recognize that the, you can't read that, but that's the health and pharma lobby on the left.

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And in terms of contributions to government,

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government lobbying, financial contributions far outweighs other types of lobbying.

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So it's really hard to change the system under these circumstances.

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So, despite successes, and there have been many,

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we're really good at knee replacements and hip replacements and fixing trauma and keeping people alive

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and treating people when they have certain types of cancers and heart disease and things.

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My grandfather turned 107 years old a couple weeks ago.

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So there's a lot of good that we can do for people and there's reasons to do that.

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But we can't afford it and it's starting to become weak in terms of its ability to deliver quality to the patients who need that care.

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And we are clearly headed for a crisis in terms of how much it all costs.

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We have a system that worked well for a while and has become a big ugly baby that we need to now take care of.

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So we're at 20% of GDP and we're starting to go backwards.

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How do we fix it?

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Well certainly there's a lot of noise coming out of Washington on how to do that.

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But we really seem to be struggling with it.

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I am not making any kind of political statement here.

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Obama's tried.

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The new administration is finding that things are a little more complicated than they had realized, maybe.

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And we all seem to be headed towards, both sides of the aisle seem to be pointing towards a single payer system where government runs our health care.

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So what do we need to do?

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What I believe is that we've got two paths.

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One is to do that and the other is to change the conversation.

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And empower the patient.

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Empower the consumer.

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And unfortunately in our country it seems like crises are what's necessary for us to really start to change behavior and open a new door.

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But I think now is the time that we can do that.

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And certainly there's a lot that would be required.

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But I believe that one of the fundamental things is how do we start to reinvent the wheel.

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And that's the vision of foundational architecture for the value chains that exist in health care.

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And the consumer's roles and responsibilities.

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The consumer's position in their own care and in the care of their communities.

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So I'm going to talk about how blockchain can help.

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And when I say blockchain, I'm not sure how many blockchain philosophers we have in the audience.

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But for right or wrong, blockchain has become a term that encompasses what I consider a spectrum.

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A spectrum of trust-based transactional systems.

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There are public and private blockchains.

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There's a lot of different protocols that have been advanced to solve specific issues in blockchain world.

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And I'm going to, for the purposes of this conversation, lump that all underneath the word blockchain.

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As many people do today.

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Blockchain, you know, like bitcoin, it provided a new conversation.

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In terms of moving a currency around.

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We need a new conversation in terms of moving data and moving health-related data assets.

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Between companies and between companies and individuals.

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And the guys who were before me gave you one interesting use case of that.

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If anyone was here to see it.

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Trust is a big problem in health care.

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And the concept of moving trust from intermediaries.

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And centralized third parties to the protocol.

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Is a fundamentally exciting and interesting concept that we are pursuing.

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In addition, the idea of taking what's currently building applications across the value chain on top of existing relational databases.

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And using the blockchain as a market level data structure.

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Upon which we can build new types of applications.

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Is a really exciting concept.

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And it's a new way to innovate in terms of health care delivery.

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A few of the use cases that we're working on at Hashed Health.

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Identity and identity related use cases.

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In our world, there are two different kind of versions of identity that we're working on.

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One is patient identity.

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And we've got some relationships with hospitals around the country.

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Where we're starting to look at first putting a core identity.

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And then building out extensions of that core identity.

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To look at the patient's profile.

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Health related profile for health care relationships.

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And health care transactions.

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Same thing is true on the provider side.

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We're looking at core identity and these extensions.

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That are things that currently need to be maintained.

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In order for physicians to transact business.

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In terms of today's structure.

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Health plans have to maintain about 15 different data fields on every physician.

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That is part of their system.

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That information has to be correct.

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In order for that physician to treat a patient.

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Or get paid for that treatment.

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In order for a claim to be processed correctly.

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So that's something that is really a problem now.

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And in the future.

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Core identity plus these attributes.

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Plus things like patient reported outcomes measures.

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And quality scores will be important.

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Physician identity related concepts.

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As we look to create future blockchain based marketplaces.

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So those are a few examples of identity related projects that we're working on.

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And related to that is also on the IOT side.

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And on quantified self.

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If you think about it.

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Quantified self is kind of an extension of your patient identity.

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Right?

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It's a health related extension of you as a person.

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And the information that needs to be understood.

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In real and virtual marketplaces.

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Going forward.

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In order for us to know how to price treatment.

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And things like that.

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Quantified communities.

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At Hashed Health.

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We talk a lot about not only the individual.

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But the community in which that person exists.

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So allowing patients to form groups.

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And then look at attributes of the group.

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And allow them to connect to provider and provider groups in new ways.

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New and innovative ways of aggregating.

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And self sovereign medical records.

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The idea for you as a patient to have your mobile device.

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That has your information on it.

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And opening and closing the door to that data.

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Much like you would a bitcoin wallet.

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Is an exciting concept.

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Rather than having as you move through an episode of care.

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Each physician you talk to or see.

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Opening and closing the door to their EMR platform for you.

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That does not make sense.

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It's not sustainable.

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And doesn't scale.

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And doesn't solve the problems we need to solve.

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Today or in the future.

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Broken value chains.

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There's a million concepts here.

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Pharmacy benefits management.

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The pharma value chain.

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The supply chain.

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A lot of blockchain based solutions.

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Are looking at track and trace.

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And serialization solutions.

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I think the larger opportunity in terms of pharma and supply chain.

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Is unmasking the complicated.

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And.

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Obscure a way that we manage these value chains.

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In terms of payments.

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And contracting.

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For a lot of different reasons over the years.

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We've built these admin fees.

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And rebate fees.

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And these big intermediaries.

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That sit between businesses.

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So that now pharma companies.

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Don't even know who takes their drugs.

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Without buying that information from a middle man.

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So the middle of these value chains.

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Has gotten so bloated.

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That no one on either side.

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Knows what's happening anymore.

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And so it's a great opportunity to create.

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More peer to peer relationships.

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Between the entities who really.

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Need to understand that information.

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And allow for.

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Allow for.

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Us to take that value.

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That's currently being extracted.

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And bring it and give it back to the patients.

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The same thing.

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Is true on the value chains.

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For medical records.

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And claims life cycle.

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And a lot of different value chains in healthcare.

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Those are just a few examples.

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And then payments and currency.

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You know currencies payments behavior.

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And benefits.

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The concept of programmable value.

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Or programmable currencies in healthcare.

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Is a very powerful concept.

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The idea of linking.

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Payment.

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To benefits.

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Is a concept that over time.

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I think could revolutionize.

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The insurance industry.

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So when you talk about.

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All of these different use cases.

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That I just kind of blew through.

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Identity diagnostics.

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These different value chains.

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Payments that's healthcare.

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And.

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It's a more peer to peer.

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As you chip away at that.

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It builds a more peer to peer.

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Version of healthcare.

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That puts the consumer at the center.

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Of the way.

243
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That also creates.

244
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This feedback loop.

245
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Kind of around a learning healthcare system.

246
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The leading protocols.

247
00:17:25,220 --> 00:17:25,460
You know.

248
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We've done a lot of different projects now.

249
00:17:28,040 --> 00:17:29,600
We've got a lot of different relationships.

250
00:17:29,860 --> 00:17:32,000
That we've got with a lot of different healthcare.

251
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Enterprise and consumer focused organizations.

252
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In our experience.

253
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The leading.

254
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Protocols are hyper ledger.

255
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Fabric.

256
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And sawtooth lake.

257
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This is.

258
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Got some interesting healthcare.

259
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Activities going on.

260
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Obviously.

261
00:17:53,700 --> 00:17:55,320
Anchoring to the bitcoin block chain.

262
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Where you can use a public.

263
00:17:58,480 --> 00:17:59,500
A block chain.

264
00:17:59,640 --> 00:18:02,360
As something that you would strive to do.

265
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Most use cases.

266
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That we come across.

267
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Use cases that people are asking for.

268
00:18:08,440 --> 00:18:09,900
At least in the short term.

269
00:18:10,000 --> 00:18:11,800
Our private permission block chains.

270
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I hope this is a temporary.

271
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Thing.

272
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We all migrate towards.

273
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Public open chains.

274
00:18:19,860 --> 00:18:21,760
But due to some of the sensitivities.

275
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In healthcare.

276
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Especially depending on the use case.

277
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Private permission chains.

278
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Seem to be kind of the default.

279
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We are starting to.

280
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Look at etherment and tenderment.

281
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Because of some of the things there.

282
00:18:36,340 --> 00:18:37,100
And then we are.

283
00:18:37,260 --> 00:18:39,200
Very interested in things like Tezos.

284
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And EOS.

285
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In terms of some of the newer.

286
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Protocols that are coming along.

287
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So we believe block chain is a good enabler.

288
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For the reasons I mentioned before.

289
00:18:51,720 --> 00:18:52,600
I think there is.

290
00:18:52,680 --> 00:18:54,600
Lots of powerful things we can also do.

291
00:18:54,700 --> 00:18:55,700
Around incentivizing.

292
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Patient behavior.

293
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A lot of that could involve.

294
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Using a token.

295
00:19:03,020 --> 00:19:04,160
And we are.

296
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Looking at moving towards a world.

297
00:19:06,420 --> 00:19:08,020
Where patients.

298
00:19:08,140 --> 00:19:10,360
Are at the center of these collaborative networks.

299
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That are designed to organize.

300
00:19:12,380 --> 00:19:13,720
And empower people.

301
00:19:14,040 --> 00:19:15,860
Who both are providing.

302
00:19:16,640 --> 00:19:17,940
And consuming.

303
00:19:18,200 --> 00:19:20,000
Health related services.

304
00:19:20,500 --> 00:19:22,220
The idea of prosumers.

305
00:19:22,240 --> 00:19:24,200
The idea of you as the consumer.

306
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Using your data.

307
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To create value for yourself.

308
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Those are concepts.

309
00:19:30,440 --> 00:19:32,500
That we are very excited about.

310
00:19:32,800 --> 00:19:34,060
Creating new assets.

311
00:19:34,360 --> 00:19:35,340
New types of currencies.

312
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New types of health marketplaces.

313
00:19:38,180 --> 00:19:39,600
Everything we do.

314
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Is built off of mass collaboration.

315
00:19:42,200 --> 00:19:44,700
And we hope that is the strategy of the future.

316
00:19:45,240 --> 00:19:45,880
Certainly.

317
00:19:46,640 --> 00:19:46,760
As we move forward.

318
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To the blockchain space.

319
00:19:49,160 --> 00:19:50,940
And we believe that over time.

320
00:19:51,240 --> 00:19:52,000
It is going to be really interesting.

321
00:19:52,180 --> 00:19:53,280
To watch healthcare companies.

322
00:19:54,340 --> 00:19:56,020
Behave and think of themselves.

323
00:19:56,260 --> 00:19:57,400
More like software companies.

324
00:19:58,000 --> 00:19:59,420
And the same thing could be true.

325
00:19:59,520 --> 00:20:00,640
For clinicians and researchers.

326
00:20:02,840 --> 00:20:04,660
So now is the time that we can.

327
00:20:05,100 --> 00:20:06,200
Because of the crisis.

328
00:20:06,320 --> 00:20:08,060
Because of all this scary stuff.

329
00:20:08,180 --> 00:20:08,780
That is going on.

330
00:20:08,900 --> 00:20:10,000
We hope that now is the time.

331
00:20:10,000 --> 00:20:13,360
To rethink this fundamental relationship.

332
00:20:13,360 --> 00:20:14,000
That exists.

333
00:20:14,220 --> 00:20:15,140
Not only in our country.

334
00:20:15,240 --> 00:20:16,000
But around the world.

335
00:20:16,100 --> 00:20:18,320
In terms of commerce.

336
00:20:18,640 --> 00:20:21,620
And its relationship to healthcare.

337
00:20:22,680 --> 00:20:24,780
I would be happy to stick around for a few minutes.

338
00:20:24,880 --> 00:20:25,520
If you want to learn more.

339
00:20:25,600 --> 00:20:26,400
You can reach out to me.

340
00:20:26,720 --> 00:20:27,220
And thank you.

341
00:20:27,620 --> 00:20:29,540
I think we have time for maybe one or two questions.

342
00:20:29,920 --> 00:20:30,320
Cool.

343
00:20:42,100 --> 00:20:42,620
Hi.

344
00:20:42,940 --> 00:20:43,580
Thank you for your talk.

345
00:20:43,800 --> 00:20:43,920
Yeah.

346
00:20:44,420 --> 00:20:47,080
So there are ways that blockchain.

347
00:20:47,560 --> 00:20:49,580
Could change the incentive structures.

348
00:20:49,740 --> 00:20:50,460
As you described.

349
00:20:50,960 --> 00:20:53,720
For example we could put a bounty on your future health.

350
00:20:53,980 --> 00:20:55,480
And incentivize doctors.

351
00:20:55,640 --> 00:20:57,440
To proactively make you healthier.

352
00:20:57,780 --> 00:20:58,880
As strange as that would be.

353
00:20:59,920 --> 00:21:01,120
But that would require.

354
00:21:01,340 --> 00:21:03,240
A change of that level would probably require.

355
00:21:03,440 --> 00:21:04,560
A long regulatory process.

356
00:21:05,160 --> 00:21:07,900
So what do you see as the potential entry points.

357
00:21:08,380 --> 00:21:09,620
For researchers.

358
00:21:10,000 --> 00:21:10,580
Startups.

359
00:21:10,600 --> 00:21:12,480
And probably most people in this room.

360
00:21:13,000 --> 00:21:14,880
To start acting.

361
00:21:15,040 --> 00:21:16,640
And changing the incentives now.

362
00:21:16,800 --> 00:21:19,960
Without requiring a long government approval process.

363
00:21:20,380 --> 00:21:20,900
Yeah.

364
00:21:20,900 --> 00:21:23,560
So this was exactly.

365
00:21:23,560 --> 00:21:25,620
The question I had for myself.

366
00:21:26,580 --> 00:21:28,200
About a year and a half ago.

367
00:21:28,260 --> 00:21:29,260
When I left HCA.

368
00:21:29,460 --> 00:21:31,020
To start Hashed Health.

369
00:21:31,240 --> 00:21:33,320
How do you create a company.

370
00:21:33,360 --> 00:21:34,240
In the healthcare space.

371
00:21:35,320 --> 00:21:37,480
You know with that in mind.

372
00:21:37,600 --> 00:21:39,500
And so what I decided.

373
00:21:40,000 --> 00:21:42,800
Was simple demonstrations of value.

374
00:21:42,860 --> 00:21:44,160
In the B2B relationships.

375
00:21:44,160 --> 00:21:45,520
Were a good place to start.

376
00:21:46,620 --> 00:21:47,700
How do we.

377
00:21:48,240 --> 00:21:49,960
Create new ways.

378
00:21:50,040 --> 00:21:52,000
To manage things like provider directories.

379
00:21:52,820 --> 00:21:54,000
For insurance companies.

380
00:21:54,700 --> 00:21:55,760
And now granted.

381
00:21:55,780 --> 00:21:57,460
That those types of use cases.

382
00:21:57,640 --> 00:21:59,220
Are kind of nibbling around the edges.

383
00:21:59,280 --> 00:22:00,240
Of existing systems.

384
00:22:00,880 --> 00:22:02,640
But I think in the short term.

385
00:22:02,760 --> 00:22:04,900
Those are important demonstrations of value.

386
00:22:05,000 --> 00:22:06,140
To prove that the blockchain.

387
00:22:06,640 --> 00:22:09,200
Is capable of solving real problems.

388
00:22:10,000 --> 00:22:10,260
In this world.

389
00:22:10,400 --> 00:22:11,980
As we build a foundation.

390
00:22:12,500 --> 00:22:13,980
For these longer term.

391
00:22:14,220 --> 00:22:15,720
More disruptive solutions.

392
00:22:16,500 --> 00:22:18,000
So when you think about.

393
00:22:18,420 --> 00:22:20,300
You know there are real problems in identity.

394
00:22:20,700 --> 00:22:21,680
Both on the patient side.

395
00:22:21,900 --> 00:22:22,840
And on the provider side.

396
00:22:22,980 --> 00:22:25,860
That we can solve in the next year or two.

397
00:22:26,220 --> 00:22:27,160
Using the blockchain.

398
00:22:27,600 --> 00:22:29,340
There are real opportunities.

399
00:22:29,660 --> 00:22:31,800
In things like reward systems.

400
00:22:32,140 --> 00:22:33,500
For health behaviors.

401
00:22:33,660 --> 00:22:34,560
I think that we can solve.

402
00:22:34,720 --> 00:22:36,560
In a fairly short period of time.

403
00:22:40,000 --> 00:22:40,480
That identity.

404
00:22:41,060 --> 00:22:41,680
Payments.

405
00:22:41,980 --> 00:22:42,600
Incentives.

406
00:22:43,480 --> 00:22:45,480
Start to form the foundation.

407
00:22:45,480 --> 00:22:46,540
For a marketplace.

408
00:22:47,640 --> 00:22:50,280
That becomes more and more real.

409
00:22:50,860 --> 00:22:53,020
Over the five to ten year horizon.

410
00:22:55,730 --> 00:22:56,580
Thanks for your question.

411
00:22:57,340 --> 00:22:58,480
Thank you very much.

412
00:22:58,640 --> 00:22:59,000
Thank you.