Blockchain Spotlight on WELL

The healthcare as an industry – and medical records, in particular – is an environment that is ripe for disruption via blockchain technologies. I’ve seen a lot of initiatives started, but I think the WELL project is one of the furthest along. It is beyond just storing medical records, enabling an entire telemedicine platform and payment system.

WELL has had a working platform for almost three years now and is the largest therapist network in California. It has conducted 22,916 consults comprised of Post Acute, Wellness Visits, Clinics and Pilots. WELL is a HIPAA-compliant virtual care platform that combines telemedicine, biometric devices and telemonitoring.

Their integrated secure messaging system, integrates a clinical network comprised of over 1,600 providers in 49 of the US states and a variety of countries around the world. WELL also has their trademark approved in the US and a Medicare license. All of this is to say that they are a real, established company that has their ducks in a row for working in this space.

WELL provides the ability to get access to quality diagnosis from around the world, regardless of where a patient is located, also making second and third opinions easier as travel is not required and all the doctors notes and patient history is on the blockchain. Direct and immediate payment for services rendered at the time of service; in the case of insurance billing, WELL says they will facilitate escrow accounts to managed fund transfers via smart contract conditions being met. This can ensure the right paperwork is processed and customers can't arbitrarily put 'stop payments' on a transaction after the fact.

The platform interfaces with common medical devices that have been adapted for the digital transmission of information for telehealth. Current devices include items such as stethoscopes, thermometer, blood glucose meters, blood coagulation meters, pulse oximeters, weight scales and blood pressure monitors.

As to providers, WELL currently works with many providers including: Medicare, myMatrixx, Optum, Century Pacific Medical Inc, Medi-Cal, Veteran Affairs, Tricare, Medicare Advantage, several HMO/PPO plans, and self-pay/private pay, and dozens of hospitals, elder care/assisted living facilities, hospices and over 200 home healthcare agencies. They say they are in process of adding more providers. When I asked, they said the providers are receptive to using the WELL token.

Patient records stored in the blockchain, are encrypted and immediately available, which makes seeing different doctors faster and simpler as there is no lengthy process to transfer records. The doctors/clinics are freed from keeping their own copies on site, also. The distributed nature of the records makes for better resilience of storage and security. The system also records reputation, rather like Uber/Lyft, with ratings, but those ratings are based on factual instead of subjective data, such as time-stamped compliance and performance to name two.

Something WELL says they can help with, which would be fantastic, is fighting fraud. In 2016 in the US, there was nearly $1 billion in false billing. Anything that can help mitigate that corruption is going to be a relief.

They have a live demo to try out the system – use the email addresses or along with the password: password. I went through the intake system to try it out, and it is pretty thorough and easy to use. It was able to tell I had no camera on my computer for the video chat (it worked on my laptop that had a camera). Their messaging platform is using 256-bit encryption, and the video portion was developed by their partner Digital Noema.

How does the process work?

It seems simple – you login to the site, fill in free form symptoms, use checklists to identify various issues, fill in any relevant information that you might have like your current blood pressure, temperature, etc., and any medications you are on (this should be saved on your profile once you’ve done it the first time), and eventually you get to video chat with a doctor.

You can skip any section that isn’t relevant, but it only took me a few minutes to walk through it. At this stage, you are talking with a human being on video chat just like you would when you go in an office, and they can loop in another person to do a group consult. The idea is that you can eventually get to a rough diagnosis and advice. Prescriptions can be issued in a digital format and used with a WELL partner pharmacy. WELL does claim, however, that because of the reduced costs in the business model, that they can generate an average priced reduction of 30% for patients.

I asked the team at WELL what the full utility of the token was, and it was described to me this way:

The token provides for multiple features within the WELL platform:

  1. Form of payment. Tokens will serve as the main means of payment within the system, although they will accept and use other types of fiat or cryptocurrencies.
  2. Currency exchange. It will also support price determination for WELL services. The system will take a fee in WELL tokens, and some premium features will be available only in WELL tokens.
  3. Gamification of healthcare. The platform will award tokens for behaviors that lead to desirable outcomes. Patients will earn tokens for achieving markers, such as improved blood pressure, cholesterol, and other health measurements, or ratings and timeliness. Clinicians will earn tokens for patient achievements, lower hospital readmission rates, ratings, and timeliness. Corporate partners will receive bigger discounts for higher satisfaction ratings from their patients and clinicians or better adherence to smart-contract governance. Programmers will earn tokens for their contributions to WELL source code based on measurable metrics, such as Github references, library usage in the WELL code base and hackathon wins.
  4. Social and gaming functions. The token also acts as an “in-game” token, and participants in the ecosystem earn tokens for certain actions. Also, network members can use the token to unlock network resources such as wellness resources for patients, clinical education resources for clinicians and data and analytics resources for enterprise clients and partners. 
  5. Encouragement and rewards. WELL patients, doctors and other users earn tokens for being on time to appointments, thus reducing costs associated with schedule disruption.
  6. Partnership access. WELL ownership will give access to advanced platform features, and special partnership programs will help in integrating big companies and institutional players into the network.
  7. Data share. Every time WELL receives a payment for de-identified and anonymous patient and clinician data, the corresponding patient and clinician will earn tokens. WELL respects the personal details of all clients and will never disclose any information to third parties without consent from the client.
  8. Payable access to de-identified health histories. Insurance companies and other enterprises will pay tokens to access de-identified WELL health data.

I spent a number of years designing and writing medical billing software, so I appreciate what WELL is doing here. The current systems in place can be a nightmare of complexity and problems. My concern goes back to my opening paragraph; basically, there are a lot of companies going after this space. If even a moderate number of them succeed, it leaves open the possibility of competing systems that don’t talk to each other, but that will shake itself out as we watch these technologies become available.

WELL’s crowdsale will fund the development of their own blockchain to enable more advanced features and easier global deployment. The token sale begins on April 16, 2018 and will continue until it reaches the hard cap of $28M Ether or Bitcoin or until May 15, 2018. There will be 600 million tokens available during the crowdsale.

Read more from this Blockchain Spotlight series.

Article written by Shawn Gordon
Image credit by WELL
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