#228 Corey Todaro & John Bass: Hashed Health – Rebooting The Healthcare Industry

Transcript

[Music] this episode of epicenter is brought to by kenosis an open platform for businesses to create their own prediction market applications on top of a theorem network they recently launched venosus X a challenge inviting developers to build apps on top of the kenosis platform to learn more go to epicenter of TV slash gnosis X hi welcome to epicenter at the show which talks about the technologies projects that startups driving decentralization and the global blockchain revolution my

name is tuba thank you Joe and today we have an episode where we're gonna focus on healthcare and who better to have on today than two people who are working very hard on solving some of the hardest problems in the healthcare industry specifically you know the US healthcare industry which at least from my standpoint and from all right live you know has a lot of problems that it's looking to solve I think we'll get into that during the episode and so the differences between the US and other countries and when it comes to healthcare but let's introduce our guest today Don bass who is the CEO of hashed health and kori Todaro who is the chief product officer and

also running their labs initiative and so hash health is a an innovation firm a health care innovation firm that is focused on accelerating the use of blockchain and distributed ledger technologies in the healthcare industry and they're located in Nashville which is sort of a hub in the US for for healthcare and specifically hospital companies that are situated there so hi guys thanks for coming on the show today before we get started and before we dive into this topic which is which is a very vast topic as I've learned you in doing this research is let's let's first get a bit of background from each of you so perhaps starting with John please tell us a bit about yourself how you got

involved in the space and your background in your industry sure yeah so I've been in the healthcare industry specifically healthcare technology for around 23 years I've been fortunate to be a part of a few different healthcare technology startups that grew up and starting back in the 90s so I'm a kind of a product of the dot-com days of the 90s where we created a b2b platform one of the first gonna be to be platform specifically here in supply chain called impact health comm and looking back at that you know the tech was not that

difficult what was hard was getting people to collaborate getting people like hospitals and their trading partners to to sit at a table together and work together in new ways using the Internet and so that process we survived the dot-com crash and we were ended up being acquired by coming called global healthcare exchange which is still around today after about 10 to 10 years or so with ghx I helped start another company called in vivo link which was a care management platform for orthopedic and spine episodes of care both if you think about it are kind of these these concepts you're on shared operating systems and

in healthcare so when you talk about shared operating systems you're talking about fundamentally you know trust and transparency and interoperability and studying clinical and financial performance across that a value chain or an episode of care or a revenue cycle and you what you're doing is you're kind of trying to stitch together information from a bunch of siloed relational databases so so through those two startups I did kind of my 10,000 hours trying to get people to collaborate using technology and so that's become kind of the theme of my career and when we sold in vivo link back in 15 to HCA I

really began to study blockchain and earnest and I just kind of let it go and so I started the nashville blockchain meetup which is which has grown a lot over the last few years and eventually started hashed to create a firm that was purely focused on using blockchain to build products that solve you know unmet needs in the healthcare space i have fundamentally believed that we are approaching kind of a financial crisis here in the US and I think that that draw that feeling drives a lot of our work here at hashed you know over the last twenty years or so I've watched

these unmet needs that I was talking about caused us to accelerate towards this crisis where we've got currently three point three trillion dollars being spent on healthcare roughly 18% of GDP it's about ten thousand dollars per person here in the US and by 2016 it's going to be five point seven trillion dollars and at the same time where I have this really uneven kind of quality and access so we're not getting our money's worth so we feel like blockchain has the ability to help us fix some of these value chains that are driving a lot of the cost and trust and transparency issues so so that's that's a little bit about me and hashed I'll

let Corey introduce himself as well I'm Corrie sodaro III lead product design and hash labs within hashed health my career in health care started a little over 10 years ago with a company called Vanguard health systems which is a an example of something unique in the United States which is a corporate run hospital company corporate hospital corporation if you will we owned and operated 26 hospitals in six states we also ran to us ISM two of those states I worked in our strategy innovation right under our chief strategy innovation officer I had a front-row seat to the Affordable Care Act or Obamacare being passed also I was involved in a lot of our efforts around fundamentally new payment models for

healthcare somebody called fee for fee for value or outcomes based payment as opposed to the prevailing payment paradigm in healthcare almost the world over which is fee-for-service a doctor does a procedure they get paid for that procedure but instead should we be paying physicians and health systems based upon the quality of what they're doing yes she did a surgery but was the surgery effective was it efficacious in relieving the overall condition was it was it thrifty or was it wildly spendthrift in the sense of all kinds of measures that we can do I'm a veteran of trying to make data systems inside Hospital companies do things they were never designed to do so our claims medical claims payment systems were

never designed for value-based care they were designed to do the one thing they do really well now which is get paid fee-for-service and we tried to pull data from a variety of existing stacks inside our Hospital company to get it to give us the data that we would need to really build a foundation for a fundamentally new way of paying for health care and I I'm not ashamed to say but we failed it's a really hard battle to get those data systems and the paradigms the way we think about how healthcare is paid for it and delivered to change so I've got the scars of change management as well following our acquisition by a larger hospital company in America which seems to be a trend that's been going on to

the last seven or eight years I became a venture capitalist in health IT space I spent about three years about 15 investments at the seed and early stage gave a really good view into what the healthcare enterprises are ready to do in terms of technical innovation and disruption and how they view new technology and what their appetite for that is largely but it was in that role I started researching blockchain in late 2015 early 2016 I met John bass when the nashville blockchain meetup was for four of us in a bar and when John said he had the idea for a hash to health I said hey I'm ready to quit my job today and get going on it because once you climb that learning curve a blockchain it really is

quite exciting the the kinds of problems we think we can address with this new technical architecture makes us passionate advocates for it because we've lived the problems in health care and now we want to design solutions we think are fundamentally new but uniquely efficacious for for solving these long-standing seemingly intractable problems great thank you so you mentioned one thing that I think perhaps we should should talk about and that has changed management and I'll ask this question to the both of you yeah how how much has changed management played in sort of we both of you have been in the in the in

the innovation space around healthcare for a number of years how much has changed management played in the ability or the non ability of your clients customers to implement you know solutions that might on the face of it solve very important problems but just can't seem to move with the change well I'm John can come in here's my comment on change man in general people will do what they get incentive to do and often the problem with change management is that you're introducing a new workflow you're introducing a new technology that fundamentally conflicts with the existing incentive structure

and I've seen it time and time again and why I think blockchain is somewhat unique and so change management does present a fundamental issue when we talk about some of the disruptive applications of blockchain I can't sell to an enterprise technology that's going to fundamentally disrupt their core revenue generation engine it just makes no sense to them on the flip side though blockchain is really compelling because block chains are somewhat unique systems for generating incentive or behaviors among all sides of a transactional set so that's true of crypto currencies it's true of the most successful blockchain use cases that we've studied in the

sense that there's got to be a win-win-win and block chains I think are uniquely situated to do that unlike some other technical architectures which are more extracting the value from players yeah and I think what Corey's mentioning here is part of the challenge I mean any the healthcare is full of great use cases for blockchain you know where there's trust and transparency and incentive alignment issues that we can solve but you know you have to consider not only the technology but also the business model and the governance structure and the change management process in order to find the right use case that's going to move quickly and be embraced by the by

the industry and so I think that this is part this is one of the key challenges and and we spend a lot of time thinking about which use cases can can be realized and change management is a key element that we think about in terms of which projects we choose to focus on I think this is a some key insights that a lot of people working in space can definitely benefit from so just coming back to to Nashville you mentioned yours you're situated in Nashville use both sort of started in the blockchain space in Nashville of course there's some other watching companies in Nashville

specifically one that we know really well and BTC media you know talk about the talk about the space the area what's the watching space like in Nashville and more specifically to Healthcare wise Nashville such an important city in the u.s. yeah and Nashville is pretty amazing right now and i'm a native so i'm like a unicorn here in nashville because almost everyone else has moved to nashville in the last 15 years or 20 years but you know nashville is kind of blowing up right now it's was number one and job growth i think in 2016 and number two and job growth in 2017 it's becoming you know it's always been kind of a create a very

creative city it's known for musical and entertainment creativity but but there you know this is my third healthcare technology startup to be a part of in nashville and it's just a rich environment a lot of your health care a lot of your customers are here for 18 publicly traded health care companies are based in nashville over 4,000 health care companies generally are based in Nashville and so there's a lot of health care technology healthcare services and especially provider side health care companies that are based here I believe

40 or 50 percent of the for-profit health care companies and in the United States have their headquarters here in Nashville so for being a you know a mid-sized city it's very concentrated in terms of healthcare talent technology talent and creative talent and so that gives us an amazing puts us in an amazing position to introduce technologies like blockchain for healthcare and kind of help lead the way I mean there's there's a real hunger

because of some of the problems I mentioned in the intro around this kind of financial crisis we've created there's a real hunger for new solutions and new business models to fix these healthcare problems I mean just think about the the Amazon announcement recently where they're getting together with Berkshire Hathaway and others to kind of form this is if there's all this kind of new energy around the healthcare marketplace around finding creative solutions and so all of that you know provides a really rich atmosphere for us to use Nashville as a base for for change interesting and I must put you in a very very good position then to to

dialogue with with companies in the health care space absolutely yeah and on top of that we've got BTC media's here and you know very David Bailey and his team are very you know have been very influential and kind of some of the work projects we've been doing and there's a number of different startups in the blockchain space so there's there's also a very good kind of blockchain and crypto community that's emerging here right so let's let's move to the core topic here which is the healthcare industry and let's unpack this first so for our listeners just for context so of course

our guests are in the US I'm located in France where and from Canada where you know all those countries have very different healthcare so structures healthcare service structures and and my opinion of you know the health care in the industry in the US is is IIIi don't want to say it's it's it's negative but it's just it it seems strange to me so please guys help help me unpack the sort of medical industrial complex as it were in the u.s. who are the players and what are the interactions between them and where does the patient sit in all of this and let's

remember let's let's remember the patient is a patient that is not a customer or a consumer right health consumer is not a bathroom well at least not in the United States sure well it is a very complex industry and one of the reasons why we think blockchain is is so appealing is because it's a very very complex industry with lots of different players unlike as financial services in which you have a large range of large entities who essentially do the same thing to each other healthcare you've got pharmaceutical manufacturers you've got wholesale distributors of pharmaceuticals you've got the pharmacy distribution companies the technical and software and payment middlemen in that arena as well you've got health systems physicians

insurance companies the list goes on and on and on and there are some very complex workflows between all these different parties but to simplify it even outside the United States the world over every healthcare economy has hair or payers that maybe the government it maybe private insurance companies it may be employer groups it may be individuals who were responsible for all the cost of health care and there are providers providers who deliver service that service can be in action an office visit or can be a product in the sense of a medical device or a pharmaceutical and so with that basic vocabulary of there's a buyer

there's service providers and product providers and there's the recipient of those who is the patient who sometimes the payer sometimes not with that basic vocabulary we can start to explore problems and complications in the industry not only in the United States but globally or in any any setting whatsoever but fun those are the fundamentals and so when I get into conversations with my European colleagues and who who may not come from healthcare and they turn to me and they say something that I find incredibly naive and they say but healthcare is free isn't it well first of all it's never free you may not be paying out of pocket when you go to the doctor but you certainly have paid otherwise to provide that that service to you so no matter if it's single payer

or commercial insurance or no insurance at all as it is in some parts of the world health care is never free and there's an ecosystem around the movement of money and services just like in any other industry fundamentally the United States is somewhat unique in the sense that we have actually the largest payer of health care service in the United States is the US government in the form of Medicare and Medicaid so Medicare's are our social insurance program primarily for the elderly but not exclusively and of course elderly being a far larger consumer or user of healthcare services than any other age group it stands to reason that the u.s.

government has an outsized source or an outsized voice in in health care policy in the United States we also have commercial insurance which is a somewhat unique artifact and employees employer-sponsored insurance which is a unique artifact going back to World War two in the United States that I'm not going to get into but a lot of Americans either get their insurance subsidized through their employer who pays a portion of the premium and the employee also pays an increasingly significant and portion of that premium for health insurance or individuals will go out and buy insurance on the open market and insurance is somewhat unique in America in that it you pay a premium in order to get access to the system itself but oftentimes you continue to pay over and

above your premium or what's on insurance so there's co-pays and deductibles and and a lot of these trends but globally I would say the health care industry around the world is very concerned with cost containment that might be because of Western lifestyles and the advancement of medical technology leads to longer lifespans we see an increase in chronic disease and in forms of diabetes hypertension Oh be city etc these have turned out to be very very expensive conditions to treat and to control and so no matter who the buyer of the healthcare is if it's the

government in a single-payer form if it's an employer who is is spending on on services for their employees or its individuals our longer lifespans our lifestyles in general are leading to higher and higher health care costs and everyone is concerned for how can we find ways to have better care at a better experience for the patient at a lower cost and I think those three goals something we called the Triple Aim about 10 years ago in healthcare seemed to be the mantra for for everyone around the world and so that that really is what can unite us in terms of the role of the patient I think it's almost universally true that health care is done to you as it's also done for you

but the patient's to say the least is not doesn't have a very active role in this we we we are not active purchasers of health care although it comes out of our pocket none of the decision points along the way in terms of what what services were receiving what will it cost are really up to us at all we're also disintermediated from the data that gets generated about us that are held inside hospitals and physicians offices by regulation of course they need to keep those records to to justify what they're doing and to protect our data etc but often healthcare does seemingly does not work for the patient in all

cases and that has a lot of causes but it's somewhat unique among industries in that the primary buyer and consumer of the service has a very little say a and how that service is delivered or what it costs John I think you're right Cory you know I think if you look at health care spending versus GDP and income the same cost trajectories and concerns are shown across the world and and so at the same time the variation in quality on a variety of different healthcare services

are also shared across the world it's just we feel them more acutely in the United States because we're spending almost 20 percent of our GDP and so but what's happening here seems to be I could be being exported and so we do feel like there's commonality there between the US and in other countries and so a lot of the work that we're doing it hashed is to address some of these kind of cost or cost quality issues that are being felt everywhere this episode of epicenter is brought to you by kenosis canoas this is an open platform for businesses to create their own prediction markets on the theorem network prediction markets are powerful

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I I don't really have access to my medical records not really know where they are they're stored in different places perhaps with different doctors so there there seems to be a lot of inefficiencies and that's sort of just a surface of it can you describe for us what are in your opinion the biggest and efficiencies in in in the healthcare space and you know perhaps what you know if you could give us some order of magnitude of like what those in efficiencies costs in terms of maybe like dollar figures or even human lives well so I mentioned earlier on that we're headed to right now or in the United States we're at three point three trillion 18 around 18 percent of GDP the common kind of analysis that is that one

third of that is waste so there's a lot of administrative burden and a lot of inefficiencies in the healthcare environment so that's kind of the they are the cost savings opportunity that we talk about you know in in addition you know there's a real pricing problem with healthcare services especially here in the US and so the variation in cost for a procedure you know for things like CT scans and colonoscopies and knee replacements a lot of work has been done by someone we're a big fan of Michael Porter at Harvard and and others around

Kennedy's these variations and kind of the price of services and the quality of those services so we've got a value problem in health care we've got a problem with the relationship between cost and quality we've got an opportunity to use blockchain to address this complex relationship between Commerce and care that's that is you know I was a lot of people say it's broken we feel like it's working as designed we've designed a a system based on claims infrastructure and fee-for-service and just a very much a volume based reward system that incentivizes people to over use and over

prescribed and and over tests and you know and with no regard for quality so one of the the key things that we're working on at hashed is and it makes us so excited is is this kind of idea of designing an economy specifically for healthcare for value-based care designing an exchange that we can talk about around the rational and transparent open buying and selling of healthcare services you know these and other concepts or why I started hashed and why I think there's so much excitement around what we're

doing yeah I mean but it is a huge market I mean to think twenty percent of our gross domestic product in the United States is going to what we're talking about in terms of specific inefficient and I think John is right on that the system is working as it's been designed to work we're just realizing that that design is is it's not what we want and so we really need to think hard about how we move some fundamental thing is in order to gender different behaviors healthcare is a very conservative industry in some sense is rightly so because they're dealing with with people's lives people's health and so they should move very cautiously but in terms of

technology Healthcare has always been ironically behind the curve not so much in treatment technology is where we see those those new innovations robots and genomics etc but in terms of administrative technology healthcare has always been behind the curve in the United States cloud technologies just becoming the norm in healthcare whereas the rest of the world the rest of industry you know you really saw that eight ten years ago and so it Ministry of lis we have processes which are fundamentally more on the spectrum of the paper-based side than some some more streamlined technical solutions around administration and additionally because

it's so fractured that you've got a health insurance company you've got multiple providers who have multiple contracts with multiple health insurance companies administrative clearing of payment and service delivery authorization for that service delivery requires a lot of back and forth between multiple parties and so our our technical infrastructure primarily based on something called EDI electronic data interfacing which goes back to the purlins airlift to give you a sense of how old some of that technology is at least in terms of its conception is really brittle infrastructure transactional infrastructure and that creates lots of inefficiencies so I've created the video where I talk about

writing a prescription and getting that's that that that the drug to the patient's hand can involve forty five administrative back in touch points that the patient is completely unaware of and oftentimes they break down and they have to be restarted and no one no one of those 45 points really knows what's happening in any of the other 45 points and so we've got a lot of sort of mindless administrative paper pushing for lack of a better word with no real oversight or overview into the overall process that's taking place and that's where we get a lot of results like the patient feeling disempowered not knowing what's going on why does it cost so much these kinds of reactions

that we have to it are based upon the fundamental dysfunction of administrative back-end systems in the industry or more broadly I think you you'd hit the nail on the head when you say that you know the health care industry is one of the most advanced in terms of truth treatment technologies but in terms of administrative technology is is really behind and you know I have friends of who work in the med tech space and this is exactly the sentiment that they've reflected to me is that it's it's sort of like you know walk into you know the the the hottest startup and they're using all the latest MacBooks or whatever but like still using you know paper-based

mail to communicate or something like that we seem to be stuck in these like with paper and faxes in these 1980s era of pipeline pipeline value chains with people you know who are sitting there extracting value and you know and I think so we've got this opportunity to kind of change a lot of the hell those value chains work and you know and blockchain is really good at exposing who's adding value to a value chain and so we are excited about am i you know promoting systems that return value to the consumer I just heard an anecdote there's a software company provides most of their customers still prefer on Prem servers for their solution and they're having

trouble migrating them up to the cloud and just to document how bad it is they just finally off loaded their final on Prem DOS customers in 2018 that's that took me back and so given the breadth of the industry how many players there's there are the variations and their technical stacks are vast and so it's it's it's not an easy thing to move or to change all at once sure and and if there's one thing that I think maybe the US and France have in common in terms of you know the healthcare industry is just the complexity of the administration I've got a stack that's probably about three inches high of

papers because at some point the the French Medicare organizations of didn't know who my new insurer was and then all this stuff stacked up and now I've got to go back and get all that paperwork to them and figure it out by myself and yeah it'll take me a while it's been saving it it's also been sitting there for a while as these things often do so yeah let's move on to so that's a great that's a great intro into into hashed health so let's let's then dive in deeper into what you guys are doing specifically so you know I mentioned earlier that hash health is in an innovation organization

that is focused on bringing blockchain and distributed logic technologies to the healthcare industry so please describe us to us what fundamentally is hashed health and and what what is your company doing yeah so you know we're a products company but when we started the company when Corey and I kind of got together early on a couple things you know our heads were full of disruptive ideas around a lot of the things we've talked about so far and medical records you know this concept of a patient portal where patients are opening and closing the door to their medical records as they see providers you know shared Ledger's for episodes of care new types of value-based

contracting solutions for you know clinical and pharma improving clinical trials improving insurance all of these great use cases that are very disruptive but we also realized a few things pretty quickly you know we knew that you know back then we needed to focus on what could become meaningful in a short period of time and we needed to kind of grab it we were a start-up so we needed to make sure we were building kind of a roadmap towards the these disruptive things by solving real problems for real customers in a short timeframe and knowing that most of those early use

cases were b2b you know what simple use-cases can we define and then build a network around so as Cory mentioned it was that's not like our previous work where it's build a product sell the product in the minimally viable Network concept is as important often as the minimum of minimally viable products that we create so he needed networks and we needed collaboration so we realized that and we also knew it was too risky at that time to kind of go all-in on one one product like a supply chain product or a revenue cycle product claims adjudication those types of things and we needed a way to explore a number of different projects and you know and the good news was our heads were full of

great product ideas and the other thing that we very clearly realized was there was no market we need to spend a lot of our time you can imagine how you know that's a pretty daunting thing to start a company where there's no there's no market no one knows what you're talking about when you walk in and start talking about blockchain so we had to create a way to really educate and organize the market around us and develop a market as we developed products and so we came up with a model for hashed around kind of hacking together a market as we build product you know by being in the space for a long time we did have a good network so we immediately began searching out kind of thought leaders

and collaborators and so that was really we hit the ground running but we formed this model that we that's matured significantly but it's a model where we've got these three areas of our company one's called collective which is community building and wins one's called Enterprise which is basically market development for enterprise customers and then one's called labs which is where we build product and we also innovate around business and governance concepts that model has allowed us to begin you know really accelerating market development and finding collaborators and thought leaders who can help us and organize them around these use cases

that Cory and I have been have been dreaming of over the last several years and so now you see us working on a variety of different use cases that we we kind of prove them out and we take them to market oftentimes with partners and you know we can we can go into a little bit more detail about a few of the initial product and business efforts that are emerging out of out of hash but I'll let Cory comment before we go there no it's just the first company I've been involved in where there wasn't sort of a straight-up product play NIT and that that betos to the uniqueness of blockchain and that it is a network play

it needs transactional counterparties utilizing that shared infrastructure jointly operating that shared infrastructure in order to get the value out of it and thus it's not something that can be sold one-off to a customer it's got to be convened in a way we need joint buy-in from a range of counterparties it's not a situation where I can build it and they will come I think that's a really dangerous strategy one not probably bound for much success and thus working with enterprises we need to be acutely aware of their appetite their interests their their their willingness to expose themselves to change and some technical risk and some business risk and and so

it pays that we have such you know wide-ranging conversations with the industry we've talked to hundreds and hundreds of players across the diverse ecosystem of healthcare and we've done that globally and so when when a use case comes up and we start to think about who who would be interested in participating in such a network whose value or what value does it pose to different types of players we we've got a very long and complex set of debts on everyone in the market who's aware of blockchain what they're willing to do what they're not willing to do what kind of value do they want to see demonstrated first and so I think the real value of hashed health is not only in the use case ideation and the

building of a blockchain solutions but it's also in the network convening it's it's how do we entice enterprises to come together there and start to utilize shared infrastructure which is really alien to them in general we always reach a point in the conversation where where they say oh well we can't own the the infrastructure itself I don't control it and I and that that they have to get over that speed hump before they really start to see the value of what comes from not exclusively controlling that transactional structure this is something that I'm very much familiar with is you know you mentioned it's not one of those industries where if you build it it will come it's more like if you build it or if you build a company and talk to them and educate and for a

very long time then they might want to sit down with you and then want to talk about some applications that aren't very much you know fit for this technology and then maybe you'll build it and maybe then they'll buy it yeah so they importance of you know building these networks is something that I very much agree with and so specifically with regards to the the the applications that you're building and the solutions that you were building we'll come back to those in a few minutes I just want to first maybe talk about the three different parts of hash health so you mentioned hash collective hash hash labs and hashed Enterprise so as I understand it hash collective is sort of a community where you're bringing together different market market actors stakeholders developers people from the industry and talking

about some of the applications for this technology within the healthcare space is that sort of good representation of yeah yeah that's right it's it's a community building organization within hashed and so we think it's important to educate and organize companies and innovators and investors and you know all the different members of kind of this global conversation who really care about healthcare and blockchain and invite them into a forum that's open and a neutral that allows people to engage in the use case as they care about and you know that has value for us as well I

mean we get to meet a lot of developers and a lot of investors and a lot of potential collaborators from around the world through these conferences and meetups and podcasts and different innovative community building events kind of whatever we can do wherever we can do it tends to provide a lot of valuable feedback for hashed and so as we build this ecosystem this community is now kind of wrapping around those different products and businesses that exist within that ecosystem so that's that's collective and you guys are doing great work there so I'll point out that there's actually a hashed

health podcast you can find on soundcloud link to it in the show notes and you guys put out videos quite frequently explaining key concepts but also exploring use cases your blog your arcs actually quite active on your blog posting things regularly there so yeah it's it's a really good wealth of information I think you know perhaps even like the biggest repository of like information about blockchain and how it pertains to to the to the health yeah health industry yeah I think you know what hashed is what differentiates us is deep knowledge about healthcare blockchain and and venture capital I mean that's kind of the our core team

and so we try to express our views and our feelings around use cases and around what's going on in the healthcare space that's appropriate for a blockchain audience as frequently as we can and and I think that has has served us well and it's helped us develop this community in this market in a meaningful way cool Cori could you talk about then the labs and your role there and what what are you doing with laps well Labs is our product dev shop so we have a team of full-time blockchain developers philosophically hashed health is protocol agnostic we were not developing our own protocol we're not a

platform company per se we're a solutions company and so we built on a variety of different protocols in the past year and in our products that we were launching this year are actually on two different protocols we're a member of hyper ledger and we've utilized various hyper ledger incubations fabric 1.1 just came out sawtooth lake 1.0 came out just relatively recently but project burrow project indy project Aroha under hyper ledger all very interesting developments and we were constantly staying up to date on what's happening there we're also a member of the enterprise aetherium alliance a lot of our developers came out of the etherium space as their primary blockchain experience that's especially valuable from a solidity perspective and smart

contract architecture perspective and so we want to bring the the best protocol to the use case and not the other way around and so issues of transactional speed and scale cost of network running and whether it's proof of work or otherwise levels of privacy that are achievable on different protocols either from the ledger perspective or from the transactional perspective can we have individual transactional privacy how we deploy the network all of these considerations have to be folded in to what we think is the best protocol in any given time and we also advise everyone to say hey you know this stuff is evolving rapidly let's let's hang back a little ways and not go all in on a single protocol because you know every

every two months it seems over the past two years seems like a whole new world of in terms of blockchain development so last year in 2017 we did a lot of protocol proof-of-concept public demonstration work we built out some some early prototypes around provider identity and credentialing utilizing fabric and aetherium we did some work with the state of Illinois last summer on the Illinois blockchain initiative on reciprocal medical licensure between states and for that we use the tender mint platform got some real experience with their a BCI or application blockchain interface architecture it's really good learning there and of course we're always working on a theory and some of our latest work is looking at

some of the the newer aetherium token standards specifically 7 to 7 21 and non fungible tokens so Labs is where we build we've also we like to build in partnership with with enterprises and in terms of deployment of that product into the marketplace there's a variety of ways that can be deployed we can do it we can do it in form of joint ventures of course we've been paying attention to the ico market and and the feasibility or desirability of that funding path it's getting increasingly complicated but it's still there and so we have to pay attention to it in terms of how these products ultimately get launched out into the marketplace interesting so it seems to me like yours may because

you sort of described hashed health sometimes in on your website as a consortium and in fact you're more like a facilitator of consortiums providing solutions for consortiums that's right I mean we were really our network conveners of networks of enterprises of networks of enterprises who want to participate in a in a use case in that transactional infrastructure but we're also a party to that transactional infrastructure to that network so we don't just do it on the behalf of others that's true for both network participation as well as development you know we don't build and and then sell it to somebody else to go run we like to participate in everything we continue to build in and we do have some higher level visions of ecosystems emerging but

that can't be too tightly planned so we do have notions of how these solutions start to interconnect but we're happy to wait and let some of that become more apparent before trying to hard-code it into the ecosystems itself so I mean we're worried a products company but you know the the work we do you know the blockchain spaces you can't just build a product and put the product out there there's there's a lot more to it you know it's this combination of the product and the business model that around that product and the governance structure and I think that's what Cori is is better than anyone I've ever met at which is putting

together these different pieces of what creates a meaningful blockchain innovation especially in healthcare with his healthcare background and so I think in you know if we talk about a couple of the initial products coming out of hash I think you know some of that could become more clear so that I guess takes us to our next topic which is more on the hash Enterprise side so before the show we were talking about two products that you have built so one is a provider credential exchange and the other is a decentralized platform for healthcare service purchasing so let's perhaps start with the the provider credential

exchange which at a high level is is sort of an identity management system or a reputation system for for doctors health care service providers I think it sort of is kyc for a doctor so could we please go into detail about this platform and why did you build it and what what problem is it's solving fundamentally sure well I think kyc is a useful metaphor the the validation of the experience education and competence of a healthcare provider whether that's a physician a nurse there's a lots of different professions that require this kind of verification is is very important and it's it's true the world

over so hospitals have to properly credential a physician understand their competencies and their license structures before they are allowed to practice in that hospital health insurance companies do the same thing and in fact the regulations dictate that you have to do this over and over again every two years for a hospital every three years for Outland so you're constantly reviewing the credentials of a physician over and over and over just to be sure that they're that they're allowed to practice and that that you want to accept the risk of having them practice in your facility in your clinic what-have-you it's primarily still a paper-based process in the US healthcare industry where we're faxing copies of

licenses completions of graduate medical school education all kinds of artifacts if you will about that physician their education their experience in their performance back and forth between hospitals there's also the requirements you quote primary source verify this data so if there is an authoritative source I have a medical license from Illinois the hospital will call Illinois and ask them or go on to a website Illinois's website and verify that the license really exists that they really did graduate from that medical school etc etc and so it's a multiparty friction filled workflow and those two

keywords sort of raised our block chain in tenon we've got multiple parties we've got a lack of trust fundamentally in the artifacts themselves and we've got a lot of friction transactional friction in the acquisition and the verification of these artifacts that sort of starts to get the ball rolling on what we think is a blockchain use case the reason we built it as an exchange platform is to answer the question of what's the business case for doing this on the blockchain whose interest does it serve to start to move these artifacts and to verify them utilizing a blockchain and we think we can articulate value for all sides of the equation which is absolutely vital for making a blockchain idea into a real blockchain product that that enterprise will be attracted to

they have to understand the value of doing it in this way versus doing it in any other way and so the provider credentialing exchange really is an exchange very much akin to financial exchanges or other kinds of data marketplaces or exchanges but we have producers or primary sources of these artifacts and we have consumers of them and of course in the middle sits the physician themselves about who all this data pertains to and so we want to provide a streamlined auditable method or primary source entities to make this data available to the consumers and we want to also attach trust data that we can monitor on the blockchain for the consumer to understand that the

artifacts they're receiving really did come from the primary source we can do that what there is key signature technologies and we can also demonstrate via hashing that the artefact has not been altered in any way and so we start to build up a history of trust of verification around individual artifacts and the goal of this is to streamline the process of getting the physician into the room to actually treat the patient and being paid for doing so currently in the United States that process takes about 30 to 45 days to properly credential a physician outliers look at 120 or even longer number of days nine months sometimes to properly assemble all the credentials and to review them and verify them and and so

doing this with a block chain with a trust layer and that's really what the blockchain does there we think we can significantly reduce the cycle time in the in this multi-party workflow to enable physicians to be able to practice faster and to be able to start generating reimbursement or getting paid for what they're doing which is the core of the healthcare business we think we can bring it down substantially and in fact we can we think we can price it down to the day of how much is being lost per day that this process takes to complete and so what's attractive about the exchange infrastructure is I'm not disintermediating necessarily anybody I'm providing a forum a marketplace if you will or producers and consumers the data to meet to discover value to

discover price etc and I'll let the market decide what's valuable in terms of how much that artifact costs what's it going to cost me to get that verification signature digital or otherwise on that artifact etc but that's the most efficient way to move forward and and to have the the marketplace to set itself discover value and so provider credentialing exchange is the first example of our product that really is a market level solution it's not a customer-focused solution it's meant to address all players in the market and it's open for all players in the market to participate in interesting where we're bringing that to market is to convene that minimally viable network that phrase we bandied about first in a

pilot sense you know what's the smallest transactional set of entities that we will need in order to prove value on the platform and then articulate means for the network to grow so who can come on to the network who can go off the network what's involved in those decision points and that all involves the governance agreements that we'll have to build up around so this solution is is it's being built by hashed health but I suppose your facilitating so the the initial conception of a network in in which different stakeholders right the the hospitals the universities you know the healthcare partitioner practitioners etc

will participate well we're launching it as a joint venture into its own company called provider credentialing exchange with a partner who brought significant off chain tech stack to the solution set so alongside the blockchain there is a unstructured database product which stores and can move the artifacts themselves some of them can be large some of them can be highly sensitive and so we're very acutely attuned to what we're putting on the chain and so the blockchain itself sits alongside this this exchange platform if you will to actually move the data and the blockchain provides a role hashed Health's role is to build a blockchain component of that overall solution and to jointly work with our partner on

articulating the business case in the use case and to help convene the network okay so as is often the case with these types of sort of consortium networks but my question is what what does the blockchain bring here that a like you know it seems to me like someone could have just started a company built a SAS platform with a traditional sort you know SAS business model and and even potentially integrated some sort of a market where an identity provider could be paid for artifacts that they provide what what does your solution offer that you know a such a SAS product or with a

trusted third party that presumably healthcare service providers and companies in the healthcare industry would trust what is the advantage well first off with with provider credentialing there's a whole range of primary source entities who are unique sources of data some some of those entities already monetize their data in the status quo by their own proprietary portals or or verification services etc so that that presents the consumer with a bewildering array of sources that I have to assemble in order to get all the data and so the exchange platform provides the consumer a unified place to try to get that data no single entity could spring up and

provide that data without the consent and participation of a wide variety of parties who provide those artifacts and who are the legal primary source of those artifacts and so what the blockchain does for those producers of the data is it provides a guarantee that although I'm making my data available on a platform that is not my own out of my control the blockchain guarantees visibility and transparency into who's utilizing my data and on what turns so that I can trust making my data available on the common exchange platform because the blockchain guarantees that I'm getting paid when I'm owed and I'm getting full transparency into who's utilizing my

data but the consumers the blockchain provides a unique role that a third party cannot do in that the artifact is signed by the primary source entity and that it's fundamentally been unaltered and such there can be no third party who can provide that level of trust both for the primary source entities and the consumers of the data without a ledger an immutable ledger to sit alongside any exchange platform to provide that level of transparency and the cryptographic trust we need around the individual artifacts the fundamental problem in provider credentialing exchange is that you can't take another person's word necessarily and so we have to find a

means of mediating the movement of data while also providing that trust layer back to the primary source density ultimately and we think that blockchain is the unique technology that enables that the fundamental problem around all technology and provider credentialing has been trusts and blockchain provides that trust layer in a I think unique way so who who are the first partners that are onboarding with this with this platform well I can't name names yet but we've been in conversations for about five months with a variety of different entities some of who are stepping up and really want to participate in the launch and the pilot and you know this is the the the fundamental problem of all blog

will not blog them it's the challenge of all blockchain solutions is how do you grow hack the network so what incentives are there for the early participants versus someone who comes on later and how do you balance those early incentives with a fair governance structure for the future operation of the network itself and these are some of the hard problems hard challenges that we're currently working on and solving but will will be coming out in probably q2 q3 with a list of the initial participants but you know we've been talking to health plans we've been talking to very large health systems hospital companies hospital systems etc we're talking to a range of primary source entities all who are very interested in the solution set they just want to know the details what does this

mean for us what do we get out of it what's going to be demanded of us and so that's where the rubber really meets the road and sort of deploying these networks is figuring out all those details and how do we start to encode the our sense of working together into a governance agreement sure I totally get that I mean that and the instruct the incentive model is is very important however for a platform such as this one where I mean I presume there's no monetary unit or monetary token in sort of the the payment and the purchasing of credentials that is that handled off chain or is that handled by a token value on the system on chain it is

handled off chain and it's it's you know priced and transacted in in Fiat and and USD okay it could write the model could easily accept the token it's more so our judgment that the market is not ready to to transact and and and you know at a token that who's acquisition introduced new friction in addition we've been doing a lot of research into medium of exchange tokens so tokens used for payment for buying and selling and those kinds of economies are extremely difficult to balance and so we you know it's great on the whiteboard it's a whole different matter when you're

actually trying to get an oppressor to sign on to such a platform yeah absolutely I mean III I sort of feel that that that pain point of onboarding enterprise clients onto it onto a platform you mentioned you know so the incentive structure that that to me that that's one of the major challenges is converting a proof of concept with an initial group of sort of eager and interested companies and clients to a network that will you know grow and scale and become ubiquitous and perhaps even replace the existing systems how do you think you'll get over that hump of going from the POC to the production

system yeah well it will be a production system even in pilot stage so we've got the fundamental technical proof of concept already accomplished we think in our the goal of our pilot is to carefully document the ROI you know we've got our research and numbers on the front end but we want to bear out that value in actual transactional counterparties and we think once we do that the costs and the burden of this business process and the status quo is such that if we can prove value in operation with a pilot group expansion of the network will be relatively easy in addition you know due to our experience in healthcare you know we

know how to or we know who to look for for quote aggregating participants on the network so selling it one by one is never going to get you very far but you know can we approach a health system that will bring on multiple hospitals in a marketplace or in a geographical region can we go to an association to provide us access to a number of health plans etc and so these aggregation strategies are important and you just have to know to know how to navigate the different sort of silos within healthcare on the provider side on the health plan side on the primary source side etc and so those conversations have been ongoing and so just real quick you know we've been working on this use case for around

two years so we've built multiple versions of the product and a couple different platforms we've kind of had some different iterations around the business model for it and so and we've over that period of time we've received a lot of feedback on kind of these different these different go to market strategies and so we at this that's part of why at this point we feel pretty confident that we've kind of landed on the right the right model so this will unfold pretty quickly over the next six months or so and it'll be fun to watch it get to market fascinating well I certainly hope to see

more about this and and and looking forward to seeing what what what this production platform would look like and who will be the initial partners and I wish you a lot of success with that the the other use case you mentioned and this is this is one that I find really fascinating although I I can't really conceive it from from my sort of European perspective is a decentralized platform for healthcare service purchasing so you described it earlier as a platform where non fungible tokens could be issued by an minted right by by health care service practitioners and

sold to purchasers of medical services so can you can you unpack this use case for us and wise by Orlan why are you building it right before I talk about the technology let me just talk about the set up in the US healthcare market it's primarily addressed at the US market although it has applicability I think the world over and that's a couple of facts price in healthcare is a negotiation between payer and provider except that in the vast majority of cases globally the payer is mediated from the consumer it's not the same entity so in the United States a health insurance company reaches a pricing contract with a physician a group of physicians a hospital that price list is

under non-disclosure agreement they can never disclose the price to me the consumer me the health plan beneficiary and so there's great anecdotes you could just google it you go into a physician's office and the first thing they make you sign as a patient is a financial responsibility form saying I will agree to be financially responsible for all the costs associated with the service I'm about to receive if you were to turn around ask the obvious question of what is this gonna cost no one can answer that question for you no one and so the world over no one knows what health care costs on the front end now in some cases that's completely understandable you know if I'm in an accident if I have a

trauma some sort of emergency condition if I had diagnosed with a long term debilitating disease the cost of that care is unknown because the timeframe is unknown but there are a range somewhere in the range of forty five percent of all healthcare services or what we call shoppable in that there are there's quite a price variation in a market there's quality variation in a market and I have the luxury of being able to shop for that service and in those situations there is no way for me to shop because there's no understanding of price on the part of the buyer but that's true of me as a consumer it's also true of other kinds of institutional buyers of healthcare services and in the United States the

prime example of that is the self-insured employer who is a large enterprise usually around 500 employees or more does it make sense to become a self-insured entity who's paying all medical claims out-of-pocket so it's really helpful to think of the self-insured employer as a single payer entity who is then trying to buy services on behalf of their employees and the covered lives the the family members loved ones children dependents etc of their employees and they don't have any tools by which to rationally buy health care the way they do it now is they make a they actually make an agreement with a health insurance company to quote rent their physician Network and inherit the

prices that the insurance company negotiated with the physician but I'm paying out of pocket but I can't enter into the negotiations around price now we have seen some some innovations among self-insured employers of last five years or so actually self-insured employer is attempting to directly buy services for their employees there's a great example of Lowe's large healthcare a large company in the United States it's a hardware home-improvement corporation they made an agreement with the Cleveland Clinic to provide back surgeries for all their employees and so what they told their employees is if you need back surgery which is not an uncommon procedure for for a hardware store for people lifting lumber etc if

you need a back surgery we will fly you to Cleveland with a loved one and we'll put the loved one up on a hotel and we'll have all our surgeries done by Cleveland Clinic because by centralizing it by negotiating price and quality with one provider they not only had predictability in their cost but they actually reduced their overall spend on back surgeries because the alternative is to tell the employees just go to whatever hospital near you and get the surgery wherever you'd like that introduced such an intense price variation in that service that it ended up costing Lowe's more than to go out and try to buy the services directly now the problem with that is that it's

really hard to do those kinds of deals something called reference pricing scheme in healthcare it's very cumbersome there are no tools for it and so bramble which is the platform we're talking about that we're building is designed to allow buyers buyers can be institutional governmental consumer buyers of health care services to act in an economically rational way around the purchase of services and to do that we've created a platform that allows the providers of the service to represent their service in a non fungible token structure in the ERC 7:21 compliance asset token which represents a specific position a specific service under

specific terms and conditions and then of the ability to make that service available on an exchange market place for buyers to to meet and simply by creating a service asset that has a time bound to it it's redeemable in a certain amount of time we introduced a whole new variety of purchasing strategies around buying health care services instead of me just going to get an MRI because that's what I'm told I need with no understanding of the quality of the MRI I'm receiving or the cost and if you look at procedures like MRIs or colonoscopies etc price variation even in a single city in the United States can be extreme as much as 10x between providers so and I need those kinds of services I now have the

ability to go out and need a prepay for them or do a future option to buy that service or a whole variety of outcomes based payment models where I say I'll pay you some now I'll hole some in in escrow based upon some quality outcome from the procedure I'm buying from you we've got a whole new vocabulary for buying but the fundamental philosophical premise is to allow the buyers and sellers to discover value through marketplace dynamics which is something new Under the Sun for healthcare services but is very common in almost every other aspect of our lives in terms of purchasing even services whose cost may not be well known at the outset and so this is done elsewhere it's just

simply not done in healthcare and we want to fundamentally change that through the bramble platform okay so there's a lot here now so the first thing I'd like to do maybe address is the the pricing I mean of course here in in France you you go to the doctor and the price is set by the government right so the price is set by the state you pay twenty three years for a doctor's visit usually pay that upfront or you know some doctors you don't pay it up front you simply simply get reimbursed by social they by the Medicare organization and other doctors or perhaps a higher quality a doctor or maybe a doctor that you know provides

additional services has the ability to charge more and certain insurance companies will pay that premium right sort of I guess higher-end doctors or specialists right expanded services and so there's predictability in the price so and even for a non conventional doctor that charges more there's still some predictability because there's sort of tiers in the service offering so you can't really go any any higher than that and every type of medical procedure or service offering I presume I believe as a has the same sort of structure so

insurance companies are you know I sorta have a pricing structure that they can adhere to and if you know if you want to buy it so the basic insurance you can buy that or if you want to buy the insurance that get you the premium doctor you can go you can buy that insurance and some employers will offer that so it's a very different model worse and and so we're talking about price fluctuations or sort of hedging for the future price of a procedure or a service offering that idea that sort of market idea and healthcare to me is it slightly foreign sure well I mean don't think in terms of hedging future price variation because prices don't necessarily fluctuate that

much especially on an annual basis but it does introduce predictability for the buyer in the sense of I know I can buy all the surgeries of a certain type for I need for my employees right now and maybe I can get a discount by buying it in bulk and paying upfront or as a buyer myself I can put out an ask on the market I need five surgeries I'm willing to pay up to X if these quality metrics can be met who wants my surgeries who wants my business in essence and so we're starting to create a sort of an asset marketplace around these services but fundamentally price is always contextual value and thus when it is set by a single entity now in your case

there is a single payer so payer has the right to sort of you know have that outsized opinion about what things ought to cost right if you don't like it you can go elsewhere is fundamentally the premise there but price being negotiated on someone else's behalf does not take into account what they value and and so know for instance what I want in a primary care doctor may not be the lowest cost doctor it may be a doctor who can who can meet me after work hours it may be a doctor who agrees with me religiously or philosophically or has opinions about diet that are important to me certainly my wife and you know we were selecting an OB for the birth of our

children that's a very specific list of what kind of doctor I want to work with to bring my children into the world so I want a female doctor I want a doctor under the age of 35 who understands fundamentally my experience I want a doctor from my ethnic group or who speaks my language and so value and price is a very contextual and personal thing especially in healthcare and we don't have market dynamics now that allow anyone to discover price much less value for the services that we that we pay for but ultimately a lot of that payment comes from me the consumer so I mean this might be particularly the United States but the majority of US workers have insurance that's sponsored

by their employer and the majority of those workers also have something called a high deductible health plan so in addition to paying fifteen thousand dollars of my money for my premium for health insurance I'm also responsible for now an average $7,500 deductible before my insurance kicks in which and the majority of Americans never hit their deductible because thank god they're well and they don't need to use the system a lot but what fundamentally means is that for the entire year I'm paying all my healthcare out-of-pocket coming out of my pocket directly and yet I have no say in understanding price options quality options service variation offerings etc I show up and they do something for me / to me and I

get a bill 45 60 days later outlining my responsibilities to that but I can't know ahead of time and that encourages a lot of perverse economic incentives on the part of payers and the part of service providers to not give you that information to make decisions with you out of the loop and I think that is fundamentally wrong but I think we can get a lot more value by bringing and activating buyers of health care and putting them in communication with the service providers I think the service providers will get a lot of value out of the set up as well I mean in the United States see aqh has shown that health care providers spend 14% of every dollar simply to recoup

that dollar so the AR cycle is about 60 days with about a 14% overhead you know if you compare that to retail in the United States whose whose payment overhead is 2% the physicians are giving up a significant amount of money simply to get paid in six to 60 to 120 days our system can allow the physician to name their price and if the market likes their price they can get paid up front with very little overhead compared to the traditional medical claims system and so fundamentally bramble is a new payment rail for for healthcare services that puts the buyer of the service in into a closer proximity to the service provider

in order to negotiate and discover value and the you know it's creating a transparent competitive playing field where value is rewarded and people are able to shop based off of reputation or cost or their definition of value and I think what it also does is it creates a platform upon which we can get very innovative in terms of the types of services that are offered on the platform so it goes way beyond our current kind of you know just MRIs and colonoscopies and shoppable healthcare services you can start to bundle together very innovative packages of healthcare services and telemedicine and

travel medicine and surgical episodes and you know things that are designed specifically for certain populations of people and you can also start to organize the the market on the buy and sell side in interesting new ways as well so it really kind of changes the container around how health services are transacted today interesting one of the things that we've talked about a little bit before the show and I'd like to address is perhaps the the risk that speculators try to take advantage of arbitrage opportunities so by up large swathes of types of services or by up

you know the entire service offering of a specific practitioner or group or hospital company and then sell those on the secondary market at a higher price can you address those know this and perhaps other risks of attributing too much sort of market freedom to something as important to society as healthcare sure well it's important to point out at the outset that that's already what happens so what you described now perfectly describes what health insurance companies do with with networks of providers so they negotiate a price they relist that price in the form of premium payments and they take a margin off the top of that and so

your ability to access a network of physicians is controlled by what insurance company and premium you pay and they've already bought up all the services from those providers and are relisting them for you in the form of your premium payment so that that's pretty descriptive of what's happening in the status quo our system addresses it in two fundamental ways the first applies only to our platform and the second of course applies both to our platform and and more broadly even in the status quo now so the first is that these non fungible tokens have an expiration date this is essentially a service backed asset that entitles you to the service within a given time frame that time frame might be 90 days it might be a year but eventually it

evaporates or it gets burned because it's not been fundamentally redeemed that's important for the provider not to have a an open-ended liability on their books to provide a service at some future date if that future date is not bound by a window but that it has an important function on price in that our system connotes a premium price dependent upon the size at that time window and so the longer the time window the higher the premium price because it gives you more flexibility and how you want to use that service and so what that means is these non fungible tokens are constantly depreciating in value they never appreciate in value and so it doesn't make sense to buy up and resell unless you radically alter the price of

that because these are always depreciating they're the second defense against speculative arbitrage is that we're talking about a very flexible supply of services there is a hard limit on the number of providers that exist in the given market and the number services that can be physically delivered within a certain time frame but ultimately it's up to the provider to dictate supply and so if someone were to rebuy up my services and relist them at a higher price than out what I was offering on the market I would simply MITM or NFT tokens and offer met that lower price knowing that the market respond to my price point and not that arbitrage one so we really enable or empower the the

provider that the service provider to be in control of supply as a means of controlling third-party speculative arbitrage they can do that today so I mean when I go into a physician if I don't have insurance or the premium is too high or my deductible is too high I physicians are willing to negotiate with me to bring down that cost for me with payment plans and other kinds of options right now so we see that there already is that sort of supply and price flexibility on the part of providers we just want to provide them with an easier platform in which to to effectuate that one other comment here is that part of the information that's embedded into the

NFT is kind of these terms and conditions and that's an area where we can start to innovate over time in terms of the types of contracts that exist on top of the marketplace that buyers and sellers can enter into and so I think there's a lot of different things that we can do to spur innovation and make sure that the the producers the mentors of these tokens are seeing the right level of value and participation through through those processes so we've got some ideas about how this kind of unfolds over time and we're gonna learn a lot over the first you know a few

years of this product and and continue to mature it but we feel like we're at a point now where it's it's time to get this thing out into the wild and see how it's being used and we're under no illusions that this is not a very forward-looking idea it comes out of left field for a lot of people I think it resonates a lot with the experience in the United States of being a consumer of health care a buyer of health care services but we've already started to talk about the or engage with parties who could perform the form the minimally viable Network where I think bramble gets very interested and that's the name of the platform itself bramble is that it meets where a lot of very forward-thinking

value-based purchasing strategies that Medicare has piloted and commercial insurances piloting and self-insured employers and employer purchasing groups are interested in utilizing as a means of controlling cost they just don't have tools to to pursue those strategies and so I think bramble meets the the sort of leading edge of innovative payment design for healthcare and in a unique way and we draw in our own experience in those kinds of movements over the past 10 years in the design of ramble cool and so bramble will be you mentioned an a theorem a splat form will be on the public key theorem networker

is this going to be a consortium network deployment the movement of the NFT is an ownership of it is tracked on them actually the public aetherium chain that's our design at the moment it utilizes that public utility that aetherium is a really robust very secure chain the data about the tokens themselves is held off chain and so there is a a central a semi centralized component to the overall platform that utilizes aetherium as transactional settlement and an ownership provenance of those service tokens themselves but given privacy regulations in healthcare etc there is a component that that we need to run off chain in order to ensure transit privacy for medical reasons and

what is the timeline here for deployment or release we hope to have the the v1 pilot in and in q4 of 20 2018 so we've already done some significant work our team of developers showed off a very early build of it at the etherium waterloo hackathon last fall it was that project was entitled convergence but it fundamentally showed how to create a basic service asset token and move that around on the etherion blockchain we've been really had a lot of lift from the ongoing development of the 7:21 non fungible token standard on the theorem which has brought a lot of good thinking about how these NF T's are not only

different from e rc 20 but how they interact with smart contracts and what kind of smart contract functions do you need in order to effectuate a real economy around NF T's cool this is uh this is all really fascinating stuff I mean there's lots more we could talk about I really wanted to touch on on identity systems and how they pertain to the medical space and but unfortunately we are running a bit long so we'll have to keep that for another another conversation thank you very much for coming on guys it was fascinating speaking with you and learning all about how you guys are disrupting the health care space yeah thank you for having us hey thank you so much been a pleasure and thank you to our listeners for once again

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