Although applications of blockchain in healthcare are still at entry-level phases, if that, many stakeholders remain bullish on the technology’s potential to decentralize health data without compromising the security of protected health information. For those organizations that are dipping their toes into blockchain, most pilot projects are starting on the administrative side of healthcare.
Last December, for instance, Arizona Care Network (ACN), a Phoenix-based physician-led accountable care organization (ACO) announced plans to pilot a blockchain technology platform developed by Solve.Care with the aim of improving clinical outcomes, relieving healthcare’s administrative burdens, and reducing waste within the system. “There are so many inefficiencies in today’s healthcare system,” David Hanekom, M.D., CEO of Arizona Care Network, said at the time of the announcement. “We want to help patients get the information and care they need more quickly and ease the considerable administrative burden on our providers.”
Arizona Care Network is comprised of more than 5,500 primary care and specialty physicians providing a broad range of clinical and care coordination services to adult and pediatric patients in Maricopa and Pinal counties. ACN has already gone live with the Solve.Care platform, which began by enabling providers to use the Care.Wallet mobile application to receive payments.
ACN officials note that Care.Wallet works by automatically and continuously synchronizing benefits information, including deductibles and co-pays, along with co-insurance and out-of-pocket expenses for the network’s 300,000 member patients. Patients will also be able to use Care Card applications for immediate authorizations, to schedule appointments with physicians and share accurate benefits information.
More recently, ACN launched the next iteration of Care.Wallet, the Diabetes Care Administration Network, produced in collaboration with Solve.Care and Boehringer Ingelheim Pharmaceuticals, Inc., designed to arm patients with information and other resources to help them manage the chronic disease and its associated risks.
As Bill Conati, Arizona Care Network’s senior director of IT, puts it in a recent interview, “We are in the business of trying to keep members healthy, and we [actively] engage with providers, [sharing with them] analytics and statistics about our network and about our members so they can provide the best care possible and work with our at-risk patients.”
And ultimately, Conati adds, if the goal is to manage a population of patients, the idea is “to bring it down to the level of members/patients, give them control of their destiny as far as what their condition is, educate them about their condition, and feed them information so that all the information is coming back to them in a secure wallet that they own and are in control of.”
Trying to enable patients to take an active role in their healthcare is something many providers struggle with due to lack of patient understanding and interest. For example, if a patient goes to his or her doctor and gets a lab test result back, maybe he or she will briefly talk to the physician about it, but beyond that there’s often nothing that happens in between that moment and the patient’s next appointment that aids with self-management.
What ACN is striving for, however, is to “have the member Care Wallet give patients access to that information and hopefully connect them to the ACO’s care coordination team to help them actively manage that process, so they have experts available when they have questions,” explains Conati.
And as the wallet evolves, ACN plans to use it in a number of different ways. Not only can members request information, for instance, but they can also schedule appointments, schedule rides through Lyft or Uber to their appointments, as well as standardizing the administrative forms process so that patients don’t have to fill out new forms with the same information every time they have a visit, Conati says.
Eventually, he adds, a Care Circle application will be added that will allow patients to invite family members or others who they want to share their information with onto the platform. This functionality will also give patients the ability to better communicate with providers who they are seeing for the first time, as oftentimes they will go see a provider who doesn’t have much history on them, but through Care Circle, they can share data that’s available in the wallet with the provider, Conati explains.
This is all made possible via blockchain technology, where indelible “blocks” are added to a distributed ledger each time a healthcare interaction occurs. And with the Solve.Care technology, there are various wallets—a Member Wallet, a Provider Wallet, and a Care Coordinator Wallet—that are unique and specific to the users. “It’s like the wallet in your back pocket; it’s yours and you don’t really share it with anyone unless you want to. Blockchain just presents itself as a unique way of allowing those things to work well together,” says Conati.
Why Diabetes?
ACN leaders chose to focus on diabetes as its first entry into this concept since more than 30 million Americans—about 9.4 percent of the U.S. population—have the condition. And despite medical advances, heart disease remains the No. 1 cause of death of people with diabetes. “Recent changes to treatment recommendations reflect the urgency in driving a fundamental change in how healthcare providers consider how they approach the care of people with type 2 diabetes,” the network’s officials note.
Along with glucose readings and lifestyle recommendations, the Diabetes Care Administration Network will aim to help educate people with diabetes about evidence-based recommendations to achieve a goal of improving their health and coordinate care among physicians. Family members also can use the network to coordinate care for their loved ones, according to ACN executives.
A group of about 5,000 ACN members with diabetes will be part of an initial cohort sample that will use the Care.Wallet application. Over time, ACO leaders will analyze utilization metrics for how many applications have been downloaded and what cards within the wallet—cards can be used for scheduling visits, communicating with care coordinators, and educating yourself about your condition, for example—have been used. “So we will be getting a good understanding of how the [platform] is being used, the frequency of its use, and the effectiveness of it. And you can call a care coordinator directly from inside the wallet and speak to them, so that’s being measured as well,” says Conati.
And eventually, the goal is to measure key clinical metrics for these patients such as blood pressure and A1C levels, to ultimately understand if the program is an effective way of helping members use this information to become healthy, he adds.
A staged rollout for the diabetes cohort is set to begin sometime in the next month, with the Member Wallet and Care Coordinator Wallet being the first two coming out, notes Conati. “Specifically, the interaction between those two wallets are critical and we see it as the magic sauce that allows us to ensure our members our staying healthy. We want to give them every opportunity to work with our team to manage their health, coordinate their care, and understand their health.” Then in December, the Care Circle and Provider Wallets will be rolling out, he adds.
Conati cautions that this project is still very early on in the process, and understanding the application’s effectiveness is the key priority right now. “We are kind of venturing into territory no one has been in before, so we want to market it to this [sample] group that has met these specific conditions, see how it goes, and then see how we can potentially expand it into different areas and different chronic conditions,” he says, adding, “Whenever you decide to stick your head out and do things differently from everyone else, you have to be careful, but it can reap good rewards. So we’re looking forward to ensuring that we can engage our member population in a much better way.”
