Smart Health Profile: A Solution to Medicaid Churning

Recently the Office of the National Coordinator for Health Information Technology (ONC) and the National Institute of Standards and Technology (NIST) embarked upon their “Blockchain Challenge,” which solicited proposals on blockchain as a tool with which to improve healthcare IT.

The smart health profile

Fifteen proposals were selected as finalists, including a whitepaper by the Blockchain Futures Lab titled “A Blockchain Profile for Medicaid Applicants and Recipients.” The paper introduces a blockchain-based innovation, the smart health profile, which would use tools such as tokens, wallets, smart contracts and oracle services “as a foundation for rethinking the way that individual health and financial information is accessed and used.”

The whitepaper applies the principles behind the smart health profile specifically to the problem of “churning” within Medicaid, whereby complex means-tested programs of eligibility, repetitive re-qualifications, and lengthy waiting periods yield a “constant exit and reentry of beneficiaries.” As a result of this turnover, the average adult within the Medicaid system is covered for only four-fifths of the year. Further, access to care is lost, poor health outcomes are more likely, and care providers must dedicate time to constantly checking recipient eligibility.

The proposal argues that a blockchain-based smart health profile and streamlined infrastructure would provide solutions to the obstacles responsible for churning, including:

  • distributed data sources
  • a high need for simultaneous privacy and transparency
  • verification requirements
  • a need for intelligent assistance throughout the process

Indeed, as a distributed ledger technology blockchains’ dynamic record would provide a truly distributed identity in enabling on-demand access to specific information, regardless of where the information may reside. The aggregation and verification of data from an array of sources, in combination with a smart query system, would then enable the profile to “act as a broker that can answer questions…as the need arises.” And when combined with artificial intelligence, that information may allow the smart profile to remind a user and/or health professional regarding medication refills, contraindications, high-risk behaviors and Medicaid eligibility changes. All the while, the profile would present a pseudonymous profile, meaning that only those provided with a private key would be able to unlock the identity of its subject.

Essentially, the smart pseudonymous profile would utilize zero-knowledge proofs and “diverse data streams that are verified through consensus oracle networks,” to build a more efficient, effective Health IT system.

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