OSF Healthcare, a U.S. provider that serves more than 900,000 people a year, is researching the use of blockchain and cryptocurrency to incentivize people to stick to medical advice. A 2014 study in the U.S. estimated avoidable health costs from non-adherence are as much as $100 to $300 billion a year. For example, around half of people with heart conditions don’t stick to their programs. However, as we’ll see, incentivizing compliance is a controversial topic.
The OSF blockchain research
OSF is working as part of a research collaboration with the University of Illinois, a Jump Arches program exploring using a mobile app to reward patients with blockchain-based rewards. They might receive an incentive when they do their exercises, take their medicine or perform other health-related activities.
The system will explore using Zero Knowledge Proofs, encrypting data to maintain anonymity, so there’s no data leakage about who is providing the incentive or receiving the reward. For example, without knowing a person’s name, there might be a zero knowledge proof that can verify that a person has a cardiac condition and hence be compensated for the activity.
One of the advantages is that the reward is immediately received instead of accumulating points over time. Hence rather than only focusing on the health condition when there’s an appointment coming up, the aim is to provide incentives in between health visits.
Challenges with incentives
Given the massive costs of non-compliance with health advice, this is not the first time this sort of idea has been explored. There are a few challenges.
Firstly, there’s the need to ensure compliance with privacy policies, which is a key goal of the experiment. Additionally, the United States has strict rules on not providing incentives to patients to encourage them to stick with a certain provider. That’s part of the motivation behind ensuring the reward provider is also anonymous.
Fifteen years ago, the UK’s NHS wrote a paper about whether it’s acceptable to pay people to adhere to medication. While the goal of saving on the costs of non-adherence is a good one, the conclusion was that it’s a bad idea, especially if used in a blanket way.
There’s a concern about the potential for fraud. While Zero Knowledge Proofs might help, it’s only effective if the data added to the blockchain is accurate. There’s still the potential for medical practitioners to falsely mark people as having a health condition to receive incentives.
Another issue is that many people would typically comply with medical advice. If you start paying non-compliant people, the compliant people might change their behavior and expect to be paid, which becomes expensive. The conclusion is it might only be viable if it’s possible to identify intentional non-adherence in specific high cost groups. That’s not easy to do.
The NHS author is also concerned that by paying people you might be signaling that compliance is not inherently in their own interests.
The article concludes, “Convincing people to accept treatment when they are reluctant to do so is a genuine problem, but paying for adherence, however seductive it may appear, will never be the way to solve it.”