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Page 698 – Stanford Medicine X

Blockchain, Networks and Health Care: Leveraging a blockchain to create new network behaviors in diabetes prevention.

Diego Espinosa despinosa@healthcoin.com


Networks move from one state to another through a series of common patterns. The most important of these is self-reinforcement: a dynamic that causes a network to "do work" along a certain direction, so that the more work gets done, the more work gets done.

What does that have to do with health care? Diabetes and heart disease prevention is the health care challenge of our time. We are in the midst of a global epidemic that is sickening hundreds of millions. In the U.S. alone, the cost of treating diabetes is roughly $440B. The medical system—a type of network—has failed to prevent the epidemic. From their perspective, however, the $440B is evidence of their success: a measure of the enormous value they provide.

How do we get the network to leave its present state, one marked by apparent success, to a future state in which the system saves much of that $440B?

One answer is to use technology to change the existing network. This is the purpose of much innovation around population health and EHR systems, as well as value-based medicine. The problem is that technological progress has long outstripped the networks own ability to shift behavior.

Networks change behavior through a set of common patterns. The most important of these is self-reinforcement: a dynamic by which the more work gets done, the more work the network does. Clearly, we are not in a self-reinforcing dynamic when it comes to diabetes prevention. How do we spark that pattern?

One answer is by adding new types of nodes to the network, making them just as important as the medical system itself. Something like this happened in the early era of public health, when sanitation engineers were arguably more important in producing health outcomes than doctors. They employed technology to prevent disease in a way that doctors could not.

The modern day equivalent of sewers and water pumps is the blockchain, an enabling technology for bringing multiple new actors into the prevention network.

Blockchain allows us to distribute data in a way that is trusted and secure. The specific data is prevention-related biomarkers, heretofore the exclusive province of doctors. The core idea is to tokenize improvements in biomarkers to produce and disseminate "proof of prevention." Those tokens form the basis for incentives from network stakeholders: insurers, employers, and merchants. These can pay successful users pre-set rewards based on the number of tokens they earn.

At the same time, the underlying biomarker data, plus supporting wearables data, creates a vast longitudinal database for drug research and precision medicine.

The tokenized efficacy proof creates a self-reinforcing dynamic. It is a public signal about what works, and what doesn't, when it comes to prevention. The more the network produces and rewards tokens, the more actors get involved, the more rewards get offered, and the more information we have about what works. 
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