Value-based care: An interview with Katherine Kuzmeskas, SimplyVital Health

Kat Kuzmeskas

Hi Katherine – Thanks for joining us today on Chain Reaction to talk about blockchain solutions for healthcare and how they are helping to implement value-based care.

What got you interested in Blockchain and, more specifically, how did you get involved in building Blockchain solutions for the healthcare sector?

About 2 years ago I was working in my full-time job as a hospital administrator looking at value-based care and realised that I wanted to launch my own company. As I started conducting my initial research I was inundated with articles and scholarly papers about Blockchain technology. More and more resources on this topic were popping into my inbox and it just wouldn’t stop! As I began to read I understood why these articles were finding me – and I started to see the transformative potential of blockchain for healthcare. My general business proposition was a business based around providing value-based care and data analytics and I realised this technology would be a huge asset in delivering our approach, in particular towards the goal of providing a better audit trail for complying with The Health Insurance Portability and Accountability Act (HIPAA).

What are the types of new innovations you are trying to build at SimplyVital Health and what problems are they solving that couldn’t be solved before?

We are focused on value-based care which is a growing trend in the USA and also globally. What we mean by value-based care is a care system in which payment or reimbursement is based on outcomes. Our platform aggregates a shared view of the patient and we are using blockchain now in a practical and realistic way: by creating an immutable audit trail of activity in the platform.

How will things change for patients and for the medical profession as these new systems you are talking about get put into place?

We need to make a very important distinction between individual patient data and what we do, which is working with providers to create a provider solution. According to current research, we have understood that only between 0.5 – 1% of patients actually want to manage their own care and their own healthcare data. This trend will most likely shift over time but the reality for now is that this level of interest is not likely to shift much. We want to create a sustainable business model for our company and currently that means creating business-to-business solutions.

Many people are sceptical about the prospects of patient medical data on the blockchain. As a heavily regulated sector, do you think the healthcare industry and/or governments are ready to embrace this change?

I have a 2-part answer to this question. The first answer is that we do not store any clinical data on the blockchain. Instead, we are leveraging a key pair system, which has been proven by one of our advisors, Dr John D. Halamka of Beth Israel Medical Center. The 2nd part is that our research shows that customers feel very nervous when we talk about combining healthcare data with public blockchains like the Bitcoin blockchain or Ethereum so instead we are creating a permissioned system using HIPAA compliant validators. They may actually be using blockchain but they are not necessarily aware of it as the technology is hidden ‘under the hood’ of our platform.

Isn’t the creation of a secure identity layer one of the key challenges to public acceptance of using blockchain for something as sensitive as medical data?

Currently I think that patients don’t actually trust themselves to handle their own data and public knowledge about the technology and how it works is very limited. So if you take something like Storj (a decentralised cloud storage service), as just one example, they offer a version that technical experts like our developers can use but they also offer a more user-friendly, front-end interface that requires no technical knowledge. This is where we need to get to in healthcare so that the user feels confident to just log in and use an app with all the same back ups and security they are familiar with already.

What are the things that could go wrong with implementation of blockchain healthcare applications – the things that we need to guard against?

I think we largely need to adjust people’s interpretation of the expectations they have for blockchain technology. People really need to know what the technology can currently do and what it can’t do. We have been working with a major national insurance provider on smart contracts for payment and part of the challenge is getting away from the language of rainbows and unicorns which sees blockchain as a universal panacea to what can this technology actually achieve in a real-world practical implementation. In terms of security, we also need to emphasize that much of the vulnerability lies between the laptop and the chair – in other words, with the user. So we need to continue to encourage and promote safe practices like 2-factor authentication, proper passwords and so on.

What is your predicted landscape for the healthcare sector in 5 years time? How will things look for the start-ups of today as well as for the incumbents who may be challenged by this new wave of innovation?

There are a handful of companies making good strides on patient data and this will become a reality along with simple implementations of smart contracts. I can also see a day when distributed data storage for health is provided by companies like us rather than by Amazon Web Services or Azure. The other key area that is ripe for change is the need for better data provenance and security. If you look at the scandal over the Veterans Affairs data breach, for example, this kind of bad behaviour must and will be stamped out by use of technologies like blockchain. In terms of incumbents, I don’t believe that entire companies or groups of people will be replaced but blockchain solutions will help to augment existing technologies. The only possible exception to that is the Healthcare Information Exchanges, which are both expensive and inefficient. The transformation of healthcare by blockchain is happening but we need to look in specific places – and more at the micro than at the macro level.

You can find Katherine on Twitter or find our more about her work at SimplyVital’s website.

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