Hey everyone. We’re back to our regularly scheduled updates this week. In case you missed it, last week I published predictions for 2020 and the week before that I reviewed what happened in blockchain and healthcare in 2019. Do give them a read if you haven’t already.
Blockchain in healthcare updates
SimplyVital Health announced that they would be the “BPCI-A convener for 32 practices of nearly 200 physicians and 3,000 clinical episodes annually.” The Bundled Payments for Care Improvement Advanced (“BPCI-A”) program is one of the voluntary alternative payment models being run by CMS, each of which is designed to give stakeholders the incentive to provide high quality and cost-efficient care. This particular program combines the payment for physician, hospital, and other healthcare provider services involved in a particular episode of care into a single “bundled payment,” which provides incentives to better coordinate care.
In this arrangement SimplyVital is acting as a “convener,” an entity that brings together others, facilitates coordination among them, and importantly bears financial risk. This is a pivot for a company that was previously focused on creating blockchain and health data infrastructure to doing much more at the “application layer,” being involved in the delivery of care, and adding value by using a range of tools in addition to blockchains. My guess is they are using a blockchain to manage governance of data and provide audit logs of what’s been doing with that data.
There have been an abundance of “infrastructure” companies in the space for the past few years and if these are to survive and thrive I think they need to take an approach like this.
Reflecting on the past few years and drawing on his experience as one of the earliest entrepreneurs in this space, Hashed Health’s John Bass penned a piece on the things people thought would have happened by now. These were
Blockchain would be the great disintermediator
We would have decentralized healthcare organizations
Consumers would use programmable healthcare cryptocurrencies
Consumers will control their medical records from their phones
Enterprise consortia would flourish
It’s a good read but I would like to clarify something however. The article says…
According to recent research by Robert Miller, the healthcare companies who chose this route suffered greatly as a result. Many are dead (examples include Modum which raised $13M, Shivom which raised $35M), having squandered the millions of dollars raised from speculators around the world on dreamy consumer-focused use cases with no hope of scaling.
This gets my analysis wrong in a nuanced but important way. I found that several tokens were dead, although the companies behind them might not be. Here’s the relevant section from my analysis:
Several tokens are, for all practical purposes, dead. The teams behind these tokens may continue shipping updates, but make no mistake, their tokens have bleak futures with little to no volume and no way for consumers to reach them, as they have been delisted from major exchanges.
The nuance here matters because we need to differentiate companies from the tokens they have launched. A company could raise $X million dollars with a token raise and even if their token loses all of its value that company could continue to ship updates and create cool technology. Indeed, the company might even be thriving, perhaps even profitable, but that doesn’t necessarily mean that their token will be adopted or capture any value.
GS1 is a non-profit organization that develops standard which are relied on around the world (the barcodes on products at the store rely on GS1 standards, for example). Their standards are important for pharma supply chains too, and it’s interesting that they created a role specific to blockchain.
What I’m reading this weekend
This was a (relatively) accessible piece on the immense amount of work that has gone into new cryptographic proofs that provide computational integrity, including the mind bending zero-knowledge proofs. Although they are in their infancy now I think these proofs are going to be very important in the long term (and wrote a bit on that in my 2019 review here).
The author does a good job describing the various different families that exist, all of which rely on different assumptions. I thought the above graphic was a cool visualization of that.
Not sure what to make of this but it’s one of the more strange and funny crypto projects I’ve seen in awhile.
But a new study, published Wednesday in the New England Journal of Medicine, showed that the Camden program did not result in fewer hospital readmissions in the six months after a patient left the hospital. While the program appeared to lower readmissions by nearly 40 percent, the same kind of patients who received regular care saw a nearly identical decline in hospital stays.
This will be the “enterprise hub" of Cosmos, it’s public in the sense that there are third party validators, but private in that it brings with it the privacy and control (how exactly is not clear to me). But it’s an interesting design and they mention pharma as an area they could expand to.
If any next-gen blockchain was going to overtake Ethereum in the public domain (or perhaps the Hyperledger family in private) I’d bet on Cosmos with Polkadot as a runnerup. But we’re a long ways away from that.
This does not seem sustainable, to say the least.
Rosenergoatom isn’t planning to mine itself, Nemchenkov said. Rather, it will capitalize on the opportunity to sell additional electricity to heavy users and rent space for their equipment, similar to a data center the firm built near the plant.
"Both data centers and miners are large energy consumers with a stable demand," Nemchenkov said. "For us, it's a way to diversify."
It’s interesting to see nation states doing things with crypto around the margins.
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