Dr. Samir Damani - MintHealth

Mark Masselli: This is Conversation on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, it is hard to believe that it has been just a few
weeks since the terrible massacre in Las Vegas and we find ourselves waking up
to another similar tragedy. A gunman with an assault weapon fired on a small
congregation of Texans, 26 dead and again we hear another course of calls for
thoughts and prayers.

Margaret Flinter: Well, we add our own thoughts and prayers, but as stewards of
public health, Mark, I think we are seeking more substantive action.

Mark Masselli: There are some 33 thousand gun - related deaths per year in this
country and in the past year alone, over 300 mass shootings. The crisis calls for
decisive policy action.

Margaret Flinter: I understand that many of those, nearly 600 victims who were
wounded and required hospitalization did not have health insurance and their
families have had to kick start campaigns to help pay for their surge ries and their
recovery. So we want to take this opportunity to remind people that this year’s
open enrolment for health coverage is underway right now, please make sure
that you and your family are covered for next year.

Mark Masselli: There are only a few weeks left of open enrolment for those
seeking coverage on the Federal exchange. Simply go to healthcare.gov. Here
in our State of Connecticut, it is Accesshealthct.com. There are specialists
available online or on the phone to answer your question s and help you navigate
the sites.

Margaret Flinter: And in the meantime, we’d like to peer into the future and see
st
what kind of trends will be influencing the healthcare of the 21 Century and in
the case of today’s guest, blockchain for healthcare, a secure way of sharing
data and currency across connected networks.

Mark Masselli: And Dr. Samir Damani is a cardiologist, researcher, and
entrepreneur based at the Scripps Clinic in California and is the found of
MintHealth, a global personalized electro nic health record based on blockchain
technology.

Margaret Flinter: And Lori Robertson will stop by, the Ma n aging Editor of
FactCheck.org. But no matter what the topic, you can hear all of our shows by
going to www. chcradio.com .

Dr. Samir Damani - MintHealth

Mark Masselli: A nd as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter , we love hearing
from you.

Margaret Flinter: W e’ll get you our int erview with Dr. Samir Damani in just a
moment.

Mark Masselli: But first, here is our producer Marianne O’Hare with this week’s
Headline News.

Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines.
Closing in on a deal, health insure Ae tna getting closer reportedly to finalizing a
deal with pharmacy chain giant CBS Health Corp for merger of the two entities
worth about $70 billion, Reuters knew cites a source close to the still secret
negotiations. The deal is set to be announced in Dec ember. The president’s trip
to Asia sparked a testing back and forth over the role China is playing in the
opioid crisis. The administration recently declaring the opioid epidemic a national
emergency with drug overdoses now leading cause of accidental d eath in this
country; some 20 thousand of those more than 50 thousand deaths blamed on
the proliferation of fentanyl into the illicit drug market. Drug enforcement experts
have a long length of flow of fentanyl into this country from sources in China;
Chi na vehemently denying the allegations. Opening moment underway for
insurance coverage for next year under the Affordable Care Act and the
uncertain policies regarding the health law coming out of Washington and the
president’s decision to take away those cost reduction subsidies to insurers to
help keep costs down for consumers, means many consumers, especially those
making too much to qualify for tax breaks are looking at much higher premiums
th
this year. Open enrolment ends December 15 for consumers in the Federal
exchanges while some States with their own marketplaces like Connecticut have
nd
extended open enrolment to December 22 . And some teams Arkansas have
designed a device that would impact the number of children dying by heatstroke
th
when left insid e cars, which kills between 40 to 50 children a year. The 9 grade
robotic students from BB Arkansas have designed a sensor they call Baby Saver
2000, a sensor that could be attached to any baby car seat, which registers the
temperature inside a closed c ar and automatically sets of the panic button on the
key fob and also sets off the car’s alarm systems. The enterprising team’s
invention earn them a $10,000 award. The young entrepreneurs are continuing
to develop their prototype for wider testing and d istribution. I am Marianne
O’Hare with these Healthcare Headlines.

Mark Masselli: We are speaking today with Dr. Samir Damani , founder and CEO
of MintHealth, a company utilizing blockchain technology to built a portable
secure and soft governing persona l health record. Dr. Damani is also founder
and Chief Medical and Strategy Officer of MD Revolution, which aims to build a
technology enabled platform for clinicians working in chronic care management.
Dr. Damani earned his Doctor of Pharmacy at the Univ ersity of Georgia and his

Dr. Samir Damani - MintHealth

MD at Medical College of Georgia. Dr. Damani, welcome to Conversations on
Healthcare.

Dr. Samir Damani: Thank you .

Mark Masselli: You know are hearing a lot of buzz around the emergence of
blockchain technology and its potent ial game changer, but I think for most people
it is probably still a mystery of what blockchain technology is, but we have many
people who sort of betting on this technology pointing to blockchain potential for
creating safely encrypted financial transacti ons, as well as a secure platform for
storage and sharing personal health data and I am wondering how it w orks both
in theory and practice and what motivates you to be translating this into the
healthcare area.

Dr. Samir Damani: I think it is important t o understand that 40 of the 56 million
annular deaths that occur globally occur from preventable chronic condition and
what is even more important is that modifiable risk factors including obesity,
hypertension, sedentary activities, tobacco use, and poor nutrition represent over
70% of the risk for development of dying conditions and patients today have
taken the path of physician and their health to their provider kind of dominant and
silent clinical and behavioral data. The blockchain enables to help so lve in
patient control health record that is tied to a global unique identifier. It allows for
the seamless and secure transfer of clinical and behavioral data between patient
authorized stakeholders and so blockchains are essentially the centralized ledg er
of all transactions across the peer - to - peer network and using this technology any
participant can confirm the transaction without the need for any kind of central
certifying authority. Let’s say I want to transact with you, this requests a
transaction that you broadcast a peer - to - peer network of computers known as
nodes. These nodes then validate the transactions and the user status through
algorithm, so over a period of 10 minutes f or example the Bitcoin network
processes all these transactions into a block, then these nodes then validate
those transactions every 10 minutes and there’s a hash that represents the block
and there is a mathematical formula that has to be solved and that’s what this
peer - to - peer global network open source is actually doing . It is actually validating
that algorithm and that verified transaction involves financial currency, it involves
contracts, records, other information and then once it is verified, the transaction
is combined with these other transaction added as a new b lock to an existing
chain that is completely orderable, open source and essentially immutable, so if
there is a previous block that gets hacked then the blockchain would get
essentially disrupted. What this allow is you know at least in healthcare, you
wo uld have an EHR, some sort of data repository that would be needed in order
for patients to get data, but what can happen now is blockchain essentially
eliminates the middleman and allows for seamless and secure transfer of data or
information and that giv es patients control.

Dr. Samir Damani - MintHealth

Margaret Flinter: We have heard that the stumbling block was the interoperability
between systems and overcoming the slios of having this kind of technology and
how does blockchain bypass or overcome the issue of interoperability of
records?

Dr. Samir Damani: Absolutely, I mean the data silos that existed, they really
preclude our ability to deliver personalized care and you know is the reality is that
you when Mary goes to see her primary care physician, there is data resides in
he r EHR of Dr. Jones, but she may see a specialist that has another EHR,
medical imaging might reside in Dr. Jones’ separate administrative or medical
imaging PACS system server, then Mary , who is a diabetic and hypertensive
patient probably has her blood pr essure written on a sheet or may be it is an App
and all those data is kind of spread everywhere. You wouldn’t even imagine that
patients own this data, because they got to through this really arduous process of
getting all these red tape administrative k ind of bottlenecks to get their own data,
the redundancy of tests that occur, so it is a real mess and so what basically
blockchain would allow is for all these different you know health Apps, variables,
implants, EHRs, imaging, all of that to be secured i n the cloud tied to a unique
identifier that can then be accessed by anyone that the patient deems
appropriate and can be written into the blockchain. So we are not trying to
replace EHRs, in fact I spoke with a CEO of a large EHR company like it is the
d igitization of the electronic health records is very important, we have the
digitized data, but to move into value based care, we have to give ownership of
the data back to the patient and that EHR is a really line management software
and what really can h appen with t he blockchain now is that Mary can go to Dr.
Jones and she will have an application or platform like MintHealth that would
essentially tie her personal record to a cryptographic key, then Dr. Jones would
scan that cryptographic key via an actua l QR Code. Dr. Jones would then have
access to her behavioral information on diet, nutrition, blood pressure, and two to
three weeks later, she goes to her cardiologist Dr. Smith and he can access any
CAT scans or echo’s that might have been done at the o ther site and at the same
time he scans Mary’s cryptographic key, so now Mary now has Dr. Smith’s
information in her file and over years you start building this personal cloud
storage, where medical imaging data, behavioral data, clinical data stays there
and that data can then be moved to anyone and accessed in real time and so
now you basically can then share that data with whoever you like in real time on
the blockchain or through the blockchain and so the interoperability issues really
is solved. You k now EHR companies have really claimed to build these kind of
clunky legacy systems in the name of security, but the reality is that they
benefited from having these old legacy systems, where it makes it difficult for you
to pull and push data to it. You k now, the beauty is that there are visionary
CEOs and that are really excited about blockchain and see themselves as
partnering with the physicians and patients to value based care, but we need
patients that have more access to the data and then you can als o layer a token
mechanisms where payers and providers can start incentivising healthy
behaviors on behalf of the patient, where they can start getting rewarded.

Dr. Samir Damani - MintHealth

Mark Masselli: You certainly are a visionary in patients should own their own
information, bu t you’ve taken it one step further as I understand as an App that
patients can actually use that will allow them to have control of that, is that what
MintHealth is doing right now?

Dr. Samir Damani: Yeah, so MintHealth is basically taking blockchain tec hnology
and we’ve seen you know millions of dollars of savings due to some of the simple
behavior like things we talked about, but one of the basic things we noticed was
that by incentivising patients, you can get even more benefit from the human
interacti on that we do today and you know self monitoring, self tracking,
combined it with human interaction and a clinical that pool that sorts data in a
way that allows us to engage patients on a very personalized level, the
Government has done a great job of inc entivising providers for non face - to - face
care through these new codes, like chronic care management, behavioral health
codes, but they are lacking the incentive for the patient and so what MintHealth is
doing is taking existing technology on the patient e ngagement side, but also
taking technology from a cofounder side where they built an actual medical
imaging platform, where they are able to get medical imaging data from the cloud
and render it and stream it instantaneously to an iPad or an iPhone, which has
been a huge challenge just because of the size of these images and so if we
could put not just medical imaging in the cloud, but patient data in the cloud, and
then form a patient engagement model that is tied together by a token called a
vitamin, that could be a powerful model not only for the storage and in creating a
self sovereign record for the patient, but also creating a model to drive down the
cost of healthcare and will be deploying that to commercial insurance companies,
who then would essenti ally use those tokens to incentivise positive patient
behaviors.

Margaret Flinter: Well, Dr. Damani, it seems that the value would be best
brought to the entire public as a public utility. A unique identifier like our Social
Security Numbers in the U.S. , you as an individual could amass that data,
because otherwise we always seem to be caught at the bridge, where the patient
has now changed from one plan to another, what kind of discussions or thoughts
are you having with public payers or policy makers a bout the potential for this as
a public utility versus siloed somewhat into individual insurance entities?

Dr. Samir Damani: The chronic pain management code was trying to pay
doctors 20 minutes for non face - to - face care management back in 2015, was the
first code ever of its kind to reimburse, it was actually a CMS initiative and was
not an insurance sponsored initiative and this is a major strategy for them to say,
listen people service, medicine is here to stay, but they want to start incentivising
the right kinds of services, which is why this code was so beautiful and so what
we did is we saw in the Mississippi population of 3500 patients that we were able
to do a pretty soph isticated case control matching case study and showed that
we had about 3.5 m illion in actual reduction inpatient hospital plans compared to

Dr. Samir Damani - MintHealth

that to about 800 thousand that they spent during the eight - month period on the
program. So we shared that with CMS and they really loved it. You know, we’ve
seen an intense amount of intere st for anything that is going to get patients to
engage and if you look at the recent MACRA legislation, which came out in 2015,
it was bipartisan. You can actually see that now MIPS, which is the Merit Based
Incentive Payment System is a system by which anybody who is taking care of
Medicare patients, you get penalized if you don’t have certain metrics and
improvements or benefit care information of quality and part of those metrics are
engaging patients for preventative and encouraging them to have healt hier
behaviors and in fact we have already started to engage and as we show fairly
success over the next 12 to 18 months, we definitely have in mind that this would
be platform that the Government, not only of the U.S., but other countries that are
sufferi ng from chronic disease would want to use.

Mark Masselli: You know, Dr. Damani, I notice the Forbes magazine had eight
reasons to be skeptical of blockchain technology and because of the inherently
distributed peer - to - peer nature of blockchain based tran sactions can only
complete when all parties update their respective ledgers, what are your thoughts
about the nay - sayers about the technology?

Dr. Samir Damani: There is no question that this technology is going to
transform every business that requir e d eclaring this now, just from things like
identifying voters to property ownership and so many things where bottlenecks
exist right now because of that. Yes, there are some bottleneck issues, you are
right. Right now, you know they can only do a certain a mount of transactions per
second, but there are new blockchains that are emerging right now like ELS,
which actually is claiming to be able to do 100 thousand transactions per second.
So there is definitely, there is different ways, there is concepts in t erms of how
you actually verify transactions and there are very innovative models coming out
to help verify the transactions in a much more rapid pace. I think right now there
is that combine 20 or 30 transactions or somewhere in that second, but you are
going to see that scale by you know in an exponential fashion. We will be doing
token offering for MintHealth and we’ve got a pretty strong crypto - based group
billed out of token mechanisms that are working on the App currently.

Margaret Flinter: Well, I liked something that I read where you called it a quiet
revolution in healthcare being led not just by the big institutions, but by people
themselves, certainly with their smart phones and their wearables , it has been
just astonishing watching the rise o f the use of fit - bit, so sort of gives us a
tremendous amount of data, there is kind of alter our step and ready to go some
place, but I am really curious are you also laying out research agenda for really
trying to identify what does work best and with wh om in this patient engagement
space, can we look forward to big contributions to those state of knowledge
around what we can do to help patients?

Dr. Samir Damani - MintHealth

Dr. Samir Damani: So out of my medical degree, I got a Doctor in Pharmacy and
then after doing cardiology, I actually spent almost four years doing research, ran
multimillion dollar grants, so I am very much, I got into the MD Revolution
business around patient engagement with the idea that bringing data together at
one place would allow machine learning to real ly reach the promise that we’ve
been kind of pushing for so long. We haven’t because the data has been so
scattered and siloed and I think the reality in this situation where you have this
personal cloud story that’s protected by the blockchain that has m edical imaging
has the clinical behavioral information and also the EHR information in one place
that the patient can share now. You have a way that not only are yo u enabling a
central repository, but if you are allowing patients to then decide and we hav e a
very unique mechanism where we are going to allow a lot of patients to board on
the way they able to use the data. So if pharma wants to know all the diabetics
who are on a certain drug and what their response is then, patients can now
volunteer to sh are that data using the MintHealth application, so research and
academic institutions, genetic companies would be very interested because one
of the problems with data that is brought in is very disheveled. What we really
need is deep data and broad data and you can no longer in the spirit or name of
security, we can’t give you your data and that’s the beauty of the blockchain, the
atmosphere is immutable, it is an open source, so you can see everyone that has
accessed anything ever. So the answer to that is absolutely, the ability to gather
the data allows for machine learning to really reach its full potential.

Margaret Flinter: We’ve been speaking today with Dr. Samir Damani, practicing
cardiologist at Scripps Clinic and Scripps Research Institute and founder and
CEO of MintHealth, a company that utilized blockchain technology to build a
portable, secure, and self - governed personal health record. You can learn more
about his work by going to minthealth.io. Dr. Damani, thank you so much for
joining us on Conversations on Healthcare.

Mark Masselli: At Conversations on Healthcare, we want our audience to be
truly in the know when it comes to the facts about healthcare reform and policy,
Lori Robertson is an award - winning journalist and Managing Editor of
FactCheck.org, a non - partisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in U.S. politics. Lori, what have you got for us
this week?

Lori Robertson: Senator Rand Paul claimed that the National Institute of Healt h
provided $2 million for a study on whether “kids don’t like food that has been
sneezed on” that misrepresents the research. The $2 million went to a six - year
project composed of multiple studies on children’s reasoning about food. One
study a video of an actor sneezing on food as a means of understanding if young
children can pick up on subtle cues about contamination. Paul also ignored the
ultimate aim of the NIH research to contribute to developing ways to nudge kids
to make safer and more healthy fo od choices by understanding why they make
certain choices to begin with. The Senator made the claim while advocating

Dr. Samir Damani - MintHealth

legislation he introduced to change the Federal Grant funding process, but the
NIH didn’t spend the money to figure out if people don’t li ke food that has been
sneezed on. Among the studies in the overall project was one to understand
whether kids of various ages can pick upon subtle cues about contamination.
The study didn’t find that people are less likely to choose food that has been
sn eezed on as Paul said, that might be the case for adults, but the picture is
more complicated with children. The kids were shown a video that led them to
believe a blue bowl would contain clean apple sauce and a red bowl would
contain sneezed on or contam inated apple sauce. The researchers found that
57% of the 3 - to - 8 year old ate from both bowls and 28% only ate from the clean
bowl. 3 - to - 4 year olds also ate significantly more contaminated food and rated it
tastier. The researchers concluded that subtl e cues can effectively impact
children’s choice, consumption, and evaluation of otherwise identical food, but
that influence differs by age. Future researchers needed they said “to
understand the scope of context” that might either decrease or heighten
ch ildren’s sensitivity to contamination. And that’s FactCheck for this week. I am
Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck .org is committed to factual accuracy from the
country’s major political players and is a proje ct of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com , we will have FactCheck.org ’s , Lori
Robertson, check it out fo r you, here on Conversations on Healthcare.

Mark Masselli : Ea ch week conversations highlights a bright idea about how to
make wellness a part of our communities into everyday lives. Soaring
prescription drug prices have been taking a toll on American he alth consumers,
but until now most didn’t understand that they might actually have some say in
what their prescription drugs cost them. Many Americans have resorted to
purchasing prescriptions online, often illegally or overseas. While cheaper, these
sol utions come with their own risk. So an enterprising pair of brothers have
created their own solution. Matthew and Geoffrey Chaiken founded Blink Health,
a free online destination that links patients with prescription sources that can be
up to 90% cheaper than what’s found on the traditional market.

Matthew Chaiken : The way it works is you go to B linkhealth.com, you look up
the name of your medication. The price you see there is the price you get it over
60,000 pharmacies nationwide, that price is less than what you normally pay for
your prescription. You pay for it online and we provide you with what we call a
digital blink pharmacy card and you show that card to the pharmacist and then
your medication rings up to $0.

Mark Masselli : Cofounder Geoffre y Chaiken to CBS News recently, they
negotiated prices directly with drug manufacturers.

Dr. Samir Damani - MintHealth

Geoffrey Chaiken : We actually have contracts with every single pharmacy in
United States. What is important for consumers is that when they go to Blink,
there is on e price that they are going to see. They will get that price no matter
which pharmacy they go to.

Mark Masselli : The Chaiken brothers say that customers can purchase the drugs
online, but still pick them up at their trusted local pharmacy. Since Blink last
year, users have saved millions of dollars on prescriptions and a majority of
those prescriptions are filled for $10 or less. Blink, an online site for purchasing
prescription drugs, offering consumers an option to safely fill prescriptions at a far
more competitive price. Now, that’s a bright idea.

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
University , streaming live at wesufm.org and brought to you by the community
health center.