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Why Out-of-Hospital Blockchains Matter


By Cyrus Maaghul for Coindesk

Cyrus Maaghul is a blockchain innovation advisor and the head of product at healthcare platform startup PointNurse.

I bought my first bitcoin in May 2013 while on a vegan retreat in Asheville, North Carolina. Going through the purchase process reminded me of when I first downloaded Mosaic and surfed the net. I thought to myself, “this is going to be a game changer”. It was.

Bitcoin and blockchain technology will be game changers, too.

Bitcoin, its underlying blockchain and evolving peer-to-peer networks with Turing-complete smart contracts such as Ethereum will have a disruptive impact on many industries for years to come. Financial services, payments, supply chain logistics, insurance, and healthcare are just a few that will be disrupted with these new technologies.

Out-of-hospital blockchains

Healthcare will be a primary beneficiary of these new technologies, especially outside of the walls of hospitals.

As more and more health and preventive care is provisioned in virtual environments, at home, in cars, at work, etc, the need for open and accessible tracking, verifying and provisioning of care will become extremely critical for patients, payors, providers, scientists and regulators.

These new out-of-hospital (OOH) blockchains developed in the non-clinical community will set the pace for how patient behavioral and inter-clinic visit vital data is tracked in the future for provider reimbursement, regulatory compliance, safety monitoring and patient adherence.

The blockchain is a near-perfect technology (not necessarily the current implementations) to securely and safely make OOH data easily accessible with relatively minimal privacy and hack risk to all patient stakeholders, including the patient themselves, family, caregivers, clinics, providers, insurance companies and all those with a stake in their patients’ health.

Each and every one of these stakeholders or network peers approved by the patient can easily join OOH blockchains as either nodes or buyer or seller of tokens or payments to gain access to patient data, utilizing a variety of open access methods and smart contracts that store and monitor real-time contractual conditions agreed to by and between various stakeholders.

There will be many OOH blockchains developed to address the myriad of use cases in healthcare, including tracking the development of drugs, doctor and nurses credentialing, real-time population health data analysis and alerts, insurance peer-to-peer risk pooling, telemedicine and home health visit data sharing, decentralized autonomous organizations, verification and audits, and remote device monitoring commonly addressed today under the Internet of Things category.

These open and viable peer-to-peer healthcare blockchains will open the door to new business models in healthcare, including analytics-for-healthcare products and services, flash malpractice insurance and friction-less claims processing hence shorter revenue cycles.

Healthcare insurance claims processing

It is no secret that healthcare claims processing is a nightmare for all parties involved. Reimbursement is opaque, fraud is prevalent, and transactions frequently difficult to reconcile.

For example, home health, a great OOH blockchain example, is possibly one of the greatest sources of fraud in the US healthcare industry today. Smart contracts powered by a blockchain could provide consumers and payors with the means to manage claims in a transparent, immutable and responsive fashion.

Insurance contracts, premium payments and their respective claims could be recorded onto a blockchain and validated by node consensus, preventing fraudulent claims from being processed. Smart contracts could enforce claims triggering payments when due or dispatching specialists, nurses or doctors to follow up with patients when anticipated claims are not recorded by presumptive dates.

Managing “super-utilizers”

The term super-utilizer describes individuals whose complex physical, behavioral and social needs are not well met through the current fragmented health care system.

These individuals go from emergency room to emergency room, to admission and re-admission, in a chaotic and costly manner. Mental health, substance abuse, poverty and education are frequently cited as common characteristics of many but not all in this group. Many researchers and experts postulate how more “community support” and “real-time engagement” is needed to manage this socially isolated population of healthcare super-utilizing consumers.

Smart contracts powered by an OOH blockchain utilizing the bitcoin payment system could be used to create a rewards and incentive system to manage super utilizer behavior.

Behavioral contracts could be developed between payor and patient to trigger rewards denominated in BTC for attending support groups, regularly engaging a telehealth professional, reporting health conditions (possibly at kiosks with bitcoin point-of-care devices), and meeting agreed upon health goals.

Payors would fund reward payouts via efficient BTC accounts established at commercial digital currency exchanges. A smart contract would trigger a reward payment (or loss) when goals are met near real-time to the patient’s public bitcoin address which in turn could be tendered at local participating outlets equipped with BTC point-of-contact devices including community centers, supermarkets and apartment complexes to pay bills, purchase healthy foods and meet rent obligations.

Medical malpractice insurance DAOs

In theory, decentralized autonomous organizations (DAOs) are entities that are self-governing. DAOs on a OOH blockchain could enable trust and provide an immutable record and audit trail of an agreement without a single controlling body.

Doctors and nurse practitioners could collaborate to establish a peer-to-peer malpractice DAO and record each peer’s premium payments and claims on the blockchain. All premiums paid in would create a pool of capital to pay claims.

By combining the blockchain with the peer-to-peer business model, this creates the potential for a near-autonomous self-regulated insurance business model for managing policy and claims. No single entity would control the network. Policyholders could “equally” control the network on a pro-rata basis.

But, these are just a few examples of how bitcoin and blockchain technology will change the face of healthcare in the future.

The blockchain is a new and exciting technology, and we are now just beginning to see both small and large players dip their toes into the water. I personally would discourage any entrepreneur from pursuing the use of blockchain technology inside the walls of clinics and hospitals today, as the those lanes are laden with painful obstacles – the OOH blockchain is your winning lane today.

This article originally appeared on LinkedIn and has been republished with the author’s permission.

Future doctor image via Shutterstock

Disclaimer: The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, CoinDesk.

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