John Halamka, David Weeks, Carl Camden, Mary Butler Everson, and Meyrick Vaz on the Healthcare Alliances: A New Bottom Line with Blockchain Panel Discussion at Converge2Xcelerate Conference (Boston, MA)
- Blockchain technology in healthcare market expected to reach $42.1 million by 2023
- Telehealth makes up approx. 25% of healthcare related technology market
- Blockchain has ability to solve interopability & data quality issues
INTERVIEW TRANSCRIPTS: Dr. John Halamka, International Healthcare Innovation Professor at Harvard Medical School, David Weeks, Senior VP/CTO at NASCO, Carl Camden, Founder/President of iPSE-U.S., Mary Butler Everson, SVP Healthcare Product Innovations at PNC Healthcare, Meyrick Vaz, Vice President of United Healthcare
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 00:00
Well, good afternoon everybody. A fast paced conference and we’ve got some extraordinary speakers today. And my name is John Halamka and I serve as Harvard’s healthcare innovation lead. I also lead innovation at Beth Israel Lahey health. But why am I here today? And that is, is that I’ve served as editor in chief for the last three years of Blockchain in Healthcare Today and quite a lot of early work with blockchain. And so what we’re going to do is explore where we’re forming alliances to bring together like minded stakeholders in blockchain. I travel the world and you still, in basically every country see a lot of folks believing that blockchain will solve a variety of workflow and engineering problems. And so what we’re going to hear is from our alliances and from a not Alliance but interested party as to how they see the world, the problems to solve and we’ll push them a bit on blockchain. So David, why don’t you go ahead and start.
David Weeks – Senior VP/CTO, NASCO: 00:53
Thanks John. I’m David Weeks. I’m chief technology officer at NASCO. We’re a digital healthcare IT company that supports the blue cross blue shield plans. We’re also the operator of the Coalesce Health Alliance that we’ll be talking about here in a second.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 01:07
And so any other members of that alliance other than the blues stakeholders?
David Weeks – Senior VP/CTO, NASCO: 01:09
So we have a four of the largest blue cross blue shield plans and then we have express groups and prime therapeutics. And that’s focused on the initial use case that we’re looking at, which do with distributed accumulators and sharing cumulate information between on a claims processing and pharmacy processing capabilities.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 01:29
Now, wasn’t Express group just acquired by Cigna?
David Weeks – Senior VP/CTO, NASCO: 01:34
They were yes.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 01:38
And so you’re now including Cigna in your Alliance, I suppose by association?
David Weeks – Senior VP/CTO, NASCO: 01:44
By association yes. So well I don’t know if you want me to spend a few minutes on how we got to where we are or I’ll do that.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 01:48
Well, we’ll go through the introductions and then we’ll get to that. So Carl.
Carl Camden – Founder/President, iPSE-U.S.: 01:54
Carl Camden. I am president and founder iPSE-U.S. I used to be the CEO of Kelly services, which deploys about a million independent workers over the course of a year. The issue that we have seen in the U S was that healthcare access was extremely limited to impossible to get on any type of a basis for independent workers and now represent a third of the American workforce. We’re here joining those hoping two things. One we’re hoping that blockchain enables us to bring down the cost of healthcare generically, but also will make it so that individual rated or association rated pricing is not significantly different than employer rated pricing so that we can deal with healthcare access. Bottom line is 37 million independent workers don’t have healthcare insurance. We have to fix that and I’m looking at every solution we can as to how do we go about fixing that.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 02:54
Very good, Mary.
Mary Butler Everson – SVP Healthcare Product Innovations, PNC Healthcare: 03:00
Good afternoon. I’m Mary Butler Everson. I’m representing The health care utility network Alliance Consortium. We are composed of several payers and providers as well as technology and financial services. We have Aetna, Anthem, Cigna, HCSC, large blue in the middle of the country. Sentara health system, Cleveland clinic, PNC healthcare, PNC bank, which I am an employed by and IBM. We are recruiting and in active conversation with four additional founding members.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 03:47
God, no, wait a minute. Cigna was in both of these, is that a problem? More alliances. That’s all good. Okay, Eric.
Meyrick Vaz – Vice President, United Healthcare: 03:49
Thanks John. Good afternoon everybody. My name is Meyrick Vaz, the CIO where I lead an innovation portfolio including several blockchain initiatives. I’m here wearing my synaptic hat. A synaptic health Alliance was founded in late 2017 and as of today, we have United Healthcare, ETNA..So United healthcare, Aetna, Humana, MultiPlan, quest diagnostics and Optum.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 04:32
Great. Well, why don’t we go ahead and start with you. We’re going to go backwards here. I am a provider. Do you know that every year that I have to submit my data to God only knows how many hundreds of organizations and every one of them has to go through some third party intermediary to verify who I am, where I went to medical school and what I’m board certified in. And talk to us about what the synaptic network Alliance used the future to be in a world where we have provider directories driven by blockchain.
Meyrick Vaz – Vice President, United Healthcare: 05:05
Sure. So we picked a provided directory maintenance as a use case to start with because we wanted to we want to do two things. One, we wanted to test out how blockchain could work to solve an operational use case. And then we wanted to focus on something that was relatively simple in the sense that we were working with noncompetitive data that would, that would encourage healthcare organizations to come and partner with us. So the since late 2017 we’ve been focused on testing out our ability to share, provider directory updates with each other using our synaptic blockchain platform. We’ve tested out our ability to share the data. We have tested out our ability to score each other’s data. So I have a sense of whether I trust Etnas data more than I trust Humana’s for example, using our synaptic scores. And now we’re testing our ability to share provider outreach operations as well. So those are the three different scenarios within the directory use case that we’ve been testing. So for you as a physician we, we want to make sure that we don’t individually keep pinging you for data corrections about where you’re practicing and you have to take that same call six different times and from six different synaptic members, you take it once and everybody else gets access to the, to the correction.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 06:41
And so unless the audience think that this is a assault problem, right? There’s a national provider index, the so called NPI. Well I have one, my emergency department has one, my hospital has one. In fact, my hospital has 27 of them. And so the belief that you could actually have a provider directory that’s operated by CMS in the NPI system, you know, so this is definitely an interesting approach.
Meyrick Vaz – Vice President, United Healthcare: 07:05
Yeah. And the industry is spending over $2 billion trying to keep this data up to date every day, every hour, every week. So we believe what we’re trying to do is bring down that cost to well below $2 billion and make sure that we create space and time on your calendar so that you can focus on your patients.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 07:29
So Mary, now we’ve heard about his use case provider directories and we understand a little bit about why blockchain trusted decentralized ledger that everyone can read. Not very controversial data. Talk about your use cases.
Mary Butler Everson – SVP Healthcare Product Innovations, PNC Healthcare: 07:42
So thank you. We’re looking at it a slightly different fashion. We came together as 8 going to 11 founding members saying we want to solve large problems in healthcare, taking maybe small or narrow slices. Our major focus right now is building the governance and the incentive models and incentive structure, recognizing that there is variability in data so that we don’t have withhold of data so that those with the best data are willing to share it. We intend to be a completely open network. We want folks to join us. Each of the founding members that exist today are all actively involved in working on several use cases. If you were here earlier today, you may have heard Pako Cabera from IBM talk about a use case he’s working on with us and two of our payer clients payer founding members, I shouldn’t say clients are founding members.
Mary Butler Everson – SVP Healthcare Product Innovations, PNC Healthcare: 08:51
Two of our payer founding members as well as provider members looking at alternative payment models is one of our primary use cases. A coordination of benefits is another use case that’s actively being worked on. Again, they’re problems that in the grand scheme of things may be a small, say, five or 10% of revenue touching, but they’re massive in terms of what I call value sucking from our organizations. There’s no solid automated fashion. There’s a tremendous number of hand touches on all of these things. There’s significant back and forth work consignment with massive spreadsheets. So our goal is really looking at how do we tackle the big problems, show them with some narrow use cases to prove it out. But each of those use cases have elements that are fundamental in the larger problems. So you have folks participating. My safe folks, I mean organizations coming in, proving the value and then opening it up for others to join because you’ve proven out the basic standards that what we want to do.
Mary Butler Everson – SVP Healthcare Product Innovations, PNC Healthcare: 10:03
And our whole goal is really looking at creating some level of standards, not to impede activity, but in fact to accelerate activity because in healthcare, and I spent the majority of my life as both a, the majority on the provider side for a major, major health system. Then on a payer side and now with the bank worrying about me big time. But the problem is we have standard-ish in healthcare. There really isn’t standards in financial services. What I’ve found is that there are standards for things that don’t add value but are create the, the infrastructure or the spine or the neurosystem, whatever you’d like to call it, that allows transactions and activity to occur fairly seamlessly and painlessly, whether you’re a business or an individual, because we’ve agreed on standards for those transactions. I think we need to get there in healthcare. And I think that would help us then create, take a lot of the value sucking activities out like faxes like prior authorizations, those types of things that I think a blockchain has value to support and allow us to redeploy assets and resources to where they belong and that’s caring for citizens.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 11:31
So the great thing about healthcare data standards is there’s so many of them. So what you’ve heard are two use cases that illustrate why alliances are good. So if all the payers come together and agree there’s a provider directory, everyone can share, right? It’s going to reduce administrative burden for everybody here. Remember, sometimes the issue is technology and sometimes it’s policy, but most of the, it’s psychiatry. And so if you have likeminded people who are willing to trust a decentralized ledger because no one owns it and it isn’t your proprietary data being stolen by a competitor, that’s going to cause data to flow. So Carl, you’ve got, a slightly different role here, but tell us about your use case and where block chain might fit in.
Carl Camden – Founder/President, iPSE-U.S.: 12:16
So independent workers intersect with blockchain technology in two ways. One way relevant, very much to healthcare. The first one I’ll start with is a little more developed, which is inside the credentialing space. So if you look at a workforce that doesn’t measure tenure and years, but measures assignments that are often measured in weeks, occasionally months, credentials that have to be obtained from different States, different times, work experience that has to be verified. You see a lot of movement on the blockchain side inside the employment industry, dealing with the independent workers as large companies especially are beginning to look for that certifiable usable way of understanding what the credentials, what the experience are. And so very useful. And how I first encountered blockchain terminology, blockchain philosophy. Inside the healthcare space, which has become the number one social issue for independent workers in the United States.
Carl Camden – Founder/President, iPSE-U.S.: 13:20
Because so many of them go without access to healthcare. And when you look at healthcare insurance and when you look at those who are, especially on the professional side and the accounting, the scientific space and so on, they’re often changing geographies as well as where they’re working as they go. And our scientists case from clinical trial to clinical trial or engineer from one project here to one project, they’re changing providers, changing medical records and so on. And as we’ve looked for solutions as to how we deal with that group, we’ve become increasingly interested with how’s blockchain then going to interface with the lives of these workers who are moving in the space of weeks or months. How do we have medical records that kind of cross multiple States? Not in a question of decades, but in a question a month, years. How do you maintain a common medical record?
Carl Camden – Founder/President, iPSE-U.S.: 14:14
How do you maintain common access to treatment regimens, results and so on. And so very interested in this technology. But I won’t claim to be anywhere near the technical expertise, but in terms of that God, but in terms, but in terms of the people who need to utilize this the two places that we intersect you know, our deep, you know, have deep needs for this to be effective, usable, and the outcomes of how they go about seeking work are how they go about seeking medical care.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 14:48
Carl, I was going to ask you about scalability of a theory versus it’s shucks. So to your point, I mean, it just, I run a large animal sanctuary West of Boston and I have 80 volunteers and employees that come and go and they’re seasonal workers and all the rest try tracking Cory checks, and right as you suggest, you know, it’s like you’ve got people coming and going and tracking this data is very, very difficult. Quickbooks, it’s about the best I can do. So, David, tell us about your use cases and feel free to elaborate how all your people got involved.
David Weeks – Senior VP/CTO, NASCO: 15:21
Yeah, thanks. So first of all it was in terms of alliances and working across healthcare, we had the, the pleasure of a cool a month or so ago with myself, John and Mary and Meyrick. I think that’s just, I think we’ve talked about this a bit in previous sessions. Kind of put the technology to one side. It’s about the solving problems for the patient and enabling the provider to provide better service the patient across all of the healthcare ecosystem. And since then Mary and I have had a call because we both have a common relationship with Anthem. And so we’ve tried to see how we can connect and kind of leverage things there. So I think at a minimum, take the technology one side, how can we build those better trusting relationship business partners to do that? So from a Coalesce Health Alliance, we started about a year ago looking at with a couple of our blue cross blue shield customers at just blockchain technology.
David Weeks – Senior VP/CTO, NASCO: 16:15
But we also said we understood the operating blockchain is about a consulting team and business networks. So we set about defining how you’d actually run a consulting IOM and what the governance structures would be. And we focused on that as much as the technology platform. So we establish kind of the concepts of steering committees and work groups and how they need to work together. How do you get information flowing in there? How do you make decisions around technology? How do you make decisions around business value? And kind of we’ve learned and grown over the last year around that as well as doing a pilot around the concept of distributed accumulators. Now, if you’re a patient or a healthcare user, you would have experienced it, probably ever filled a prescription somewhere. So often when you go fill a prescription, you ought to pay a copay or certain amount of money and often than not, maybe 50% of the time that amount is changed at some point in the process.
David Weeks – Senior VP/CTO, NASCO: 17:08
So later on you’re asked to pay more or less or we’ve taken too much. That’s because there’s a whole data sharing that goes on behind the scenes, behind from the pharmacies to the pharmacy benefit managers and the medical and medical claims processes and they are looking at you on your accumulators, where are you and your deductibles, etc. and how do we balance that information because that happens on a batch cycle perspective. You get all this dissatisfaction from the patient and you have been folks at the, at the health payer organizations and the PBMs who are working to reconcile that. So a lot of inefficiency in the process. We picked that use case because it was core to our business model. We did, we looked at some of the other ones. We also knew the synaptic health Alliance was looking at the provider so it doesn’t make sense to have another consultant looking at that.
David Weeks – Senior VP/CTO, NASCO: 17:53
They have some great progress made there. So then through blue cross blue shield of Massachusetts is one of our customers. We’re going to the express scripts cause that’s the their primary PBM. They were interested in participating in this and then through another of our customers, which is brew copper shield, New Jersey horizon prime therapeutics is their PBM. So they became involved. So we kind of expanded the network based on our relationship and the and the business case where we are right now we’re right in the middle of a beta pilot, which in essence is a pre-production phase. So we hope that by next year we’ll actually have our first production implementation of this for at least a couple of the blues and the PBMs where we’ll be sharing blockchain, sorry, accumulate the valleys through a blockchain network in a distributed manner.
David Weeks – Senior VP/CTO, NASCO: 18:41
Now that the technology, the Hyperledger technology around it is probably the easiest bit of this. I think we’ve talked about this in other sessions. So the hard are getting organizations to work together just in terms of simply just the contracting to join a consulting. I think Mary and I talked about that, the time it gets organizations that haven’t worked together before. Just getting down to the legal teams to agree how to work together, who owns what IP, what are you actually working on? That takes a long time. And then actually integrating to the legacy systems. I think the IBM gentleman had that on his full stage of a slide. So you pick the use case, you do some kind of business blueprint, you do the technology and now you have to integrate it into your existing processes. That’s also a tremendous lift. If you think about all the existing work that providers systems have or in our case insurers, and now you’re asking them to communicate to a different method, maybe in real time. That’s a big lift. So there’s been a lot of learnings and we hope that we’ll be able to share those with the other alliances so we can both work together in terms of improving health care.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 19:41
So I’m going to push David to a use case I really want solved. So a part of my farm is a million bees. So I thought it’d probably be a good idea to have two EpiPens because what if a drunk teenager falls into a million bees in the middle of the night? It could be bad. So what did I do? I went on my e-prescribing system, which is connected to all the networks you’ve just mentioned and look for tier one covered by all PBMs, absolutely formulary and perfect coverage. And I wrote for two EpiPens. I then went to Walgreens and they said, your copay will be $600 and of course you ask the question, doesn’t the doctor at the point of prescribing understand what your out of pocket expense will be? The answer is nope. So if to his points, you can create a distributed ledger that an EHR could query and say, Oh, you have a choice drug A, drug B drug, C, three different packages. This one five, this one 500 I’ll go with a five. Thank you. And it ties in and there’s obviously more to it than just the ledger.
David Weeks – Senior VP/CTO, NASCO: 20:57
There’s all the other process in terms of your benefits, you know, and that’s, that’s the complexity of all the insurance systems is how your benefits are held or how planes process against that.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 21:08
Well here David, so here, this is my health insurance card. So take a look at that. So this is four point type and it includes the copays on every possible variation, care at every place I could be. And there’s not a person on this planet who understands it. It’s a solve that for me will definitely that I met John before because I know this was going to go. Okay, so we have a couple of minutes left and maybe open it up for the audience in a second, but I just do want to push on if each of you could say why blockchain, you know, that is in 2018 it seemed like the obvious choice. It was the technology buzzword of the moment in 2019 or are there folks who are saying, Hey, I know it’s lost its luster. Why blockchain?
Meyrick Vaz – Vice President, United Healthcare: 21:50
Actually, I don’t believe that it needs to be blockchain. Right? And I’m not a technologist, so I don’t, I don’t swear by blockchain. We just happen to pick blockchain because three or four architects from our companies kept meeting each other at blockchain conferences. And I think over drinks, they said, you know, it’d be cool if we convince our executives to invest some money so that we can find some blockchain work. And that is literally how Synaptic came about. But as we were talking about the use case that we wanted to pursue, we decided to pick the provider directory use case because we felt that that would be a use case that could benefit from some of the capabilities of blockchain. So the idea being you bring competitors together to collaborate on a platform on a noncompetitive use case.
Meyrick Vaz – Vice President, United Healthcare: 22:44
So there’s this trust issue that we’ve been talking about all day, right? But you use the technology to break down some of those trust barriers. We’re using blockchain to enable our data crowdsourcing approach for sharing directory updates and finding those directory updates. We’re using the security elements, the encryption that blockchain brings about the fact that the data cannot be changed. And I’m kind of using generic terms. I’m not the technologist here, but we decided as we would trying to figure out the use case, we decided that blockchain seemed ideal for this use case. As we’ve talked about other use cases, we clearly believe that there are use cases that blockchain doesn’t really need to be the underlying technology.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 23:36
Great. So what’s your heard is choose the technology that solves your problem in the case of blockchain? It’s not just a technology, it’s a platform and an approach. Yep. Okay. Mary, how about you?
Mary Butler Everson – SVP Healthcare Product Innovations, PNC Healthcare: 23:46
Simple what he said! So we looked at it for all the reasons that Eric said. But I think really what it came down to is smart contracts the ability to enable smart contracts to auto execute and create the deterministic payment. And by the way, I’m not a technologist at all. I’m a strategy business person. I actually, when we were working on this started maybe three and a half years ago, PNC, for those of you who don’t know, we’ve been in healthcare for almost 30 years. We have a clearing house. We do electronic data transaction, blah, blah, blah. I can remember vividly sitting in the airport in LaGuardia and saying we should be out of the business clearing houses would be disintermediated. All these, a lot of these connectors that exist should be out of the business.
Mary Butler Everson – SVP Healthcare Product Innovations, PNC Healthcare: 24:45
You know, blockchain can create new business models. It’s really to create real time, transparent, secure deterministic execution of things that are very paper driven delayed require consistent and ongoing reconcilement of somebody said earlier this morning nine months for bundled payments to be reconciled with Medicare. Really? How are we going to move to a value based payment system under that? And blockchain also enables a more mutualized infrastructure. If we’re sharing the cost of infrastructure, again, you don’t have to keep each of us putting in millions and billions of dollars in our infrastructure to auto adjudicate a claim that could be adjudicated through a different fashion. That’s why blockchain for us.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 25:42
Got it. So it’s a utility and it’s a shared utility and it basically takes the focus off having to build yet another bit of infrastructure and support. Why blockchain Carl?
Carl Camden – Founder/President, iPSE-U.S.: 25:54
I actually wasn’t found that question to be interesting because what happens as the CEO, multibillion dollar company, they never come to me to actually get an opinion as to if the blockchains is the right answer.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 26:04
Correct. It must be your Bitcoin investors.
Carl Camden – Founder/President, iPSE-U.S.: 26:10
They walk in and say we need to do blockchain, man, you’ve hired the seat, you hired the CIO. The CIO has been blessed by whichever board member you’ve assigned to pay attention to the CIO’s meanderings. And the CIO and the and the board number both say we need to do it. And that is down to how much do we need to spend, how do we get there? And it ended up moves on. So by the time it leaves the CIO level, it’s no longer a decision by the management team to do blockchain or alternative a, B or C.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 26:41
Got it. I need to work for him. I’ve been a CIO for 25 years. I have no authority of any kind. You worked for different companies. So David, why blockchain?
David Weeks – Senior VP/CTO, NASCO: 26:48
Yeah. And maybe just to give it a slightly different perspectives. I agree with very much with the other panelists who say it is, there’s just within the organization you need to be looking at what’s the what technologies or business paradigms can change and innovate and, and help you grow as a company and help you to solve the problems for your customers. So the, the concepts kind of incubation of different ideas. I think blockchain certainly fitted in that with a lot of companies in the last company is they have, so you’d work through different areas of, of technology. I think a lot of people now are looking at different forms of artificial intelligence, whether some proof of concepts around that three or four years ago. And that’s become more a stance created. It’s, it’s there in the way we work with Amazon and Siri and all those things.
David Weeks – Senior VP/CTO, NASCO: 27:36
So blockchain kind of was the next one there. And so organizations said is I want to be disrupting out. It’ll be part of the disruption. What can we do to help me grow? So I think some companies did it in their innovation arms and I think that’s how it came out of a lot of our organizations. So I think that’s part of it. Just to say can this help drive and solve problems? And then is it shifts out of there? It’s about the what we talked about. So in our particular use case it’s about the distributed nature of real time information that you have consensus on. So therefore it develops that trust. So those kind of facets of it, a key. And then security, cause we have a whole, we have talked about this much here, but you have, we have a whole legal security and privacy and compliance work stream around us solution. And so you have to work through around does blockchain enable that? Does it make it more risky? Is it less risk, but potentially has the ability to help me security. Nothing has ever, ever 100% secure, as a technologist, but it might help with some of the capabilities around that.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 28:33
Sure. And so when he said it’s quite important in baking security into the infrastructure at the foundation level, I was in Amsterdam two days ago and we were talking about GDPR and of course everyone’s at, Oh, we can’t share data for any purpose. GDPR prevents that. Well, no, it tells us how, and blockchain is an instantiation of a set of security and privacy principles that may simplify some of those work. Well, Hey, I think we have probably a minute or two for an audience question. So anything out there in the world? Best blockchain platform. Etherium, Hyperledger. Yeah, go ahead.
Speaker 1: 29:10
Hi. Robert Miller. I’m in the blockchain space, open and permissionless networks. Right. And that stands in contrast to the closing fragments and systems that we have in health care paths. And I’m wondering if you all could talk about the second consortia, how you’re thinking about adding members and perhaps the governance functions and where do you might fall along that spectrum of closer, fragmented versus open in the future?
David Weeks – Senior VP/CTO, NASCO: 29:37
I give a real quick short answer. Yeah, we’d certainly view us as a private network. I think it would be hard in our industry to not almost impossible to not operate it in that manner given the controls you need to have in place in terms of security, identity and privacy. So that, and that’s one of the things where you talk about when you differentiate yourself from like a Bitcoin type solution in terms of the business model. It’s an instantiation of a technology and a different business model. So that’s the short answer.
Meyrick Vaz – Vice President, United Healthcare: 30:07
Yeah, I would agree. And that’s how we’ve got our blockchain set up as well. And we’re actually actively recruiting health systems now because we’re trying to pivot towards the second use case and we want that second use case to be patient facing. So as we recruit new members we, we actually have created instructions and we’ve got a lot of help type information that we’ve made available to these new members to help them stand up their node and connected to us and optic blockchain network and tested back and forth, etc. But yeah, it has to be permissioned. It has to be a secure closed network.
Dr. John Halamka – International Healthcare Innovation Professor, Harvard Medical School: 30:50
And just to amplify their points in the state of Massachusetts. Lauren Peters, who is here as one of our undersecretaries working in the office of the UHS is working on regulations which will help us understand who from a data perspective can participate in a data exchange and what are the objective criteria by which they should be enabled to join. We don’t want to exclude anybody if they’re a trusted party who will drive value from the network, but if it’s two folks in a garage who are mining data in an inappropriate way, that’s not right. Well, I think we are at time, Brian. And so we will thank these folks so much and I think next we have a telemedicine Titans group. So thanks again.