 Hello, everybody. My name is Ray Dogum. I am the co-chair for the health care special interest group for hyper ledger foundation Today is November 23rd. We'll be doing our general meeting and we'll be discussing some of the Updates in the industry. We've seen in the last couple weeks Before we get started there. This is being recorded and shared on YouTube So if anyone wants to share anything just be aware of that You can find the actually let me share my screen here as well. So you can see the agenda Hope you guys can see my screen here. So like I said, this is being recorded. You can find the hyper ledger and I trust Policy here and this is a public page Just to get started are there any announcements that anyone would like to share here from the community about The special interest group health care blockchain any personal news? Okay Just as a reminder There are tons of different communities in the blockchain and health care space. There are other groups you can join here as well and I'm not going to get through talk about all them here right now, but just wanted you to be aware of that and In terms of upcoming events, there's two that I've highlighted here, but I'm sure there's plenty more First one is the blockchain expo global and This is happening This will be on December 1st to the 2nd and it's in London pretty big names supported here And should be interesting for anyone in the blockchain space. I know hyper ledger is involved as well So if you're in London or interested in this event check it out There's also an event on patient experience experience, which I thought was pretty interesting happening in December as well December 5th and 6th in California. It's about You know how to innovate for patient experience some pretty big names from health systems here as well, so Could be an interesting event for some of you all and right. This is Wendy In a bot in I don't know how to say I I typed the acronym incorrectly in the chat It's I and ATBA. They're hosting digital blockchain week this week It's mostly a European organization and I am speaking on a panel on Actually Thanksgiving Day at 2 o'clock in the morning for yeah That's true True dedication I'm speaking on a panel about privacy versus compliance conundrum with blockchains Which I am happy to share that I'm happy to emphasize a voice of reason so But that's it's it's it's free. It's a great organization about advancing blockchain So it for these sessions that would be more tolerable for a US audience. I definitely encourage you to participate Wendy thanks for sharing that I appreciate that and we can put the I'll make sure to put the link in the Either the YouTube or here in the agenda page as well great Yeah, the theme of the conference is the future of blockchain and they are approaching it from many different industries Sounds great. Thanks for sharing that. Oh, right any other news or anything anyone wants to share, okay So as you can see from my background today, there's a lot of chaos in the Blockchain world especially with FTX and all that we'll be talking about that but that article one of the articles about FTX here in the agenda today But before we get to that, I just wanted to you know talk about some other things going on first number one is hyper ledger has approved a new project called hyper ledger cactus and The tech steering committee approved that Recently I think Or sorry, it's been renamed to cacti. That's the announcement Because they're adding basu to they're adding another one to it's cactus plus Yeah, I think they combined this so the community has merged two systems architectures as well as code bases to create a new project hyper ledger cacti And it's a multifaceted interoperability platform that draws on the cutting-edge technical features of Cactus and weaver a hyper ledger lab So that that was interesting. I think I put the incorrect link here So I'm gonna make a quick adjustment to that so people don't get confused There was a workshop on it about a week ago on how to use it with it. I think it was a code along with it Yes, that's probably in the recordings Most likely, yeah Thanks Elizabeth appreciate that so That's one. I wanted to also anyone have any specific information on that merger or any Are they as anyone here working on that? They want to share anything about it I'm just curious. What is it? So apparently it's an interoperability Layer or platform so It's a pluggable framework to link networks built on how to heterogeneous Distributed ledger and blockchain tech and to run transaction spending multiple networks Okay Yeah, so there's a lot more information in this article as well Pretty detailed and I know that there's a you know group that's specifically focused on this They probably have more that they can share and if you need help getting in touch with them Let me know You try to make a connection Moving on to the next article here that I found that was interesting related to health care typically how We as patients get in touch with providers and doctors and There's this trend where messaging or sending an email to provider is starting to cost money for patients and I think Cleveland Clinic here is one of the first health systems To start charging some messages that patients send to the provider So, you know here it's saying it's either a cash grab or a logical business decision to compensate Physicians for their time and I feel like this is a kind of a complex issue and it's interesting to see you know that Even with all this technology and AI and the ability to You know make these systems more efficient, I would think with technology You know, we're still Nickel and diming patients, maybe I would say for messages Even as much as $50 per message, which isn't really nickel and diming. That's a pretty hefty cost for a message And I would just think about how can blockchain or or crypto or distributed ledger technology? You know make a difference with this But you know, what's ridiculous is that the The communication from patients through a patient portal is so much more cost-effective than when patients call Patients have to communicate with their physicians And that's part of the patient relationship and it's considered part of the cost of doing business So it this this makes me think that it's as ridiculous, you know as When banks charge, you know, three dollars for using the ATM But they don't charge when you go in and use the time of a person and it's I just hope that this doesn't become excessive because when we think of patients who Have a lot of financial limitations. We don't want them to stop communicating with their doctors because they would be charged for it Now I agree completely and this they're saying here, you know The range could be 50 to 100 six dollars per message additionally It's a this person from medica said that we don't believe charging for electronic messages or messaging will deter Patients seeking care. I disagree. I think the lot of patients will just kind of avoid the question especially if they have to pay these fees so It's a trend that it's not, you know, Cleveland Clinic isn't the only one. I think this is going to become This is Wendy again, this bothers me too because I regularly use the patient portal to communicate with my doctors I ask for medication refills. I ask for I Ask if they would fill out forms and The doctors have been wonderful. I can't imagine being charged for do Reaching out to them Yeah, I hope it doesn't pick up either. I mean here it says Those who support the clinics by the way, the clinic is just a Reference to the Cleveland Clinic They're moved to bill for some my chart messages said it wasn't realistic to expect healthcare workers to answer complicated questions So there's gonna Be some challenges here, I'm sure from patients Well, it'll be interesting to see what the payers positions might become, you know that the using the banking Example, I mean your airlines is being a better example where they push you to the chatbots and whatnot You know make you wait and forever to talk to a person or Answer your question pretty quickly for free in a chatbot. So if you link this to the telehealth kind of reimbursement model the Like the payers could fix this, you know, they say This is true. I mean, it's it's if it if it hits a cost reduction Avenue they ought to pick it up and they probably would That's an interesting point too, but I think it's reasonable, you know, at some point if you're calling if you're asking Questions looking for, you know diagnosis of sorts. I mean, you're you're really consuming health care So somebody should pay for some of it, you know Renewing a prescription may be a different thing but you know, I'm calling in asking about my Hip pain or something, you know, that's That's there the alternative is actually go in which case there's a billable visit which is hundreds of dollars What's the difference? Agreed. Yeah, there's it's gonna be interesting to see how this unfolds I think the difference though is there's already a baseline cost to that It wasn't given as free to start. This is an added fee on top of if i'm reading correct I think that's the difference. It's kind of like if you go into the Hospital and then like, yeah, we're gonna start charging you 50 50 bucks for parking and 10 dollars an hour to sit in the waiting room It's it's layering costs on rather than consolidating and and putting the costs in a transparent and reasonable way these Anytime you're doing message costs. That's that's an easily hidden tough to weigh costs that they're they're Slipping into right and I think it speaks to the the the larger pathology using that loaded term Is that the providers are really in dire margins squeeze that they've got to generate They've got a lower cost or increased revenues one way or another Just to be solving The providers are the provider orcs Well, both. I mean providers are generally under pretty severe margin squeeze right now. I mean, they're not really returning I mean, they most of them call themselves nonprofits. That's kind of a Silly distinction. They still have to get a return on invested capital And they're not getting it right now, you know that for a variety of reasons You could say that they're just they're bloated and they spend too much money Um, yeah, maybe but you know at normal business in a condition like that is looking for new revenue sources and and will Exact them wherever it can Yeah, um It's a good point. We have to look at the other side and organizations health systems Are tight on cash. So this is like their You know way of trying to increase funding and says here They'll begin billing patients insurance for messages that require five minutes or more of the provider's time to answer. So Well, but but you can look at their business model and it's it's grown to heavily administrative heavy so cutting costs at the administrative level is probably a Long term viable solution rather than short term picking the pocket of the patients who in this case are just Getting shoved out the door if they don't have that money or shoved out the virtual door It's it's you're right. It's a business model, but it's it's kind of a It's kind of an extension of of a crap Anti-patient business model that healthcare in the u.s. Already has and it's just making it worse rather than moving it in a better direction And those they might be losing money, but they're losing money At large scale where they're spending a lot of money and that that expenditure for administrators has gone up Considerably universities are the same. They're not, you know, and obviously university hospitals have overlap. There's been a growth in support structure rather than execution of what they're doing And that's probably a better place to look for those cost savings from a long-term viability standpoint I I think this is ill advised in the current environment, but it's also It's also pushing people towards the brink of Wanting something work into web 3 which is good for this community. I suppose. Yeah. Yep. Yeah, I wasn't defending it I'm just saying it's entirely rational Yeah, that what they're doing Because the only the only use I can see for a patient portal is correcting your record so If you did get into your patient portal and we're able to see your record and you saw mistakes Then you could go back and and correct it, but They should pay you for doing that and With blockchain they can because that's when you you're curating your own record and you're adding data to it That you believe is important And then what you if you're going to add data to your record including what you ate what you You're exercised your meditation all the things that you do You can really make that record valuable And then it belongs it then it would exist in a patient portal that The doctor can see and then they should pay you for that information. What do you think about that? Well, that's a whole different can of worms the patient generated information or certainly patients modifying their health record is Brings all kinds of other problems As to the integrity of that data, you know, you block chains and cryptography and all that play a really interesting role But we're you know, we're nowhere near that yet So the idea that you can get online and start Mocking around with your own record is probably not a good idea and doctors really Whatever they might say or what are the ads might say aren't that keen to have more information about you really they're they're they're pretty spent on the time that they're able to spend and You know, they they come in they've got eight minutes per patient to look at your official record and that's about all they're gonna look at That's why the standard of care is so low. Yep I don't see why it's a different can of worms as you say I think that even if a patient asks a question that's providing data about what's important to the patient so Yeah I mean It's that the the whole topic of patient generated information wearables, etc. Etc is a whole nother we could spend two hours on that one You know and how How trusted that information can be whether payment decisions whether treatment decisions can be based upon Um information that's coming from wherever introduces other complications Yeah, I'm sure and I can solve this today. I'm gonna move on I know this is a good discussion and if anyone on youtube listening has any ideas on what they think Please share. Please make a comment. Happy to respond. Uh, this is from digital salutem. It's a Blockchain technology a guide for healthcare leaders. It's published fairly recently remember 14th and They do a pretty good job kind of outlining what blockchain could do for healthcare And also what it can't do too I'm not going to get into too much details here, but a lot of these things, you know, how blockchain is changing healthcare talking about um revolutionizing the way healthcare is delivered By using a digital ledger you can track each patient's interactions with healthcare Providers and blockchain could reduce fraudulent practices and help keep track of patient data So things I think that you know, we're pretty familiar with as concepts Um, but maybe healthcare leaders might not understand it totally yet So this is a good guide for anyone who sort of getting to the space pretty new Uh, and you know, I like that they have some drawbacks of using it and talk about how Transaction speed is too too low um But you know, there's a lot more that could be expanded on this article Either way it's useful. It's a good start and um Yeah, I just want to leave it here for anyone's interest uh, the next one here is from scientific american Talking about how crisper for personalized cancer treatment is actually it's becoming really efficient and I don't know if that means affordable, but it means efficient and um You know, there's actually many trials small clinical trials shown researchers can use crisper Gene editing to alter immune cells so that they will recognize Mutated protein specific to a person's tumors. This is a very personalized medicine. We're talking about here I think this is interesting because the future is Of healthcare it is more personalized care. Um, and You know, how do we deliver that? Or what's the infrastructure that allows us to deliver that effectively? Really to be determined still but I think you know crisper is definitely one of the Biomedical treatments now that's you know gaining traction in humans uh, so Part of the reason that it's so complicated Is that there's just a really complicated Manufacturing process because once you get your sample from the individual human You need to you know decipher that gene and take it and then Build the therapy based on that individual so It takes a lot of time to to do that in the lab I just think that you know, we're starting to see these really novel medicines take take hold and Now i'm curious what you guys have Any thoughts on this or any opinions on how Maybe blockchain can help You know, um I guess what I want to say is target Individuals better and make the think make the process more efficient Again pretty early. I don't really have any great ideas for this yet, but there's supply chain You know components that could be improved. I'm sure With but three Well, I think you know if you get to the point where this is more mature that seems in the extremely early stage Is this is one small trial with only 16 people? but if if they if they do prove safety and Prove value in this and expand it. There's probably a number of different factors genetic epigenetic Other things that that may contribute to any given tumor type and the more you can have available those details About a wide array of patients The better you can start to zero in on which factors are contributing and so I think you know probably similar to other looks at how a blockchain may be able to Help enable better data access for cancer research this the this fits in there. I don't think it's a A different type of use that has been discussed in a lot of different places and and and is starting to be Tried in different places, but I think this intersects with a lot of the the cancer and overall genetics screening applications that that have been Around for blockchain, but haven't really been matured yet and are still as far as I know largely in pilot I mean you need a large network to make it of value getting that large network connected to a system that hasn't been fully set up and and Matured yet is still something that's that's ongoing and in different places But I think I think this fits into that overall category But more on the treatment end of the diagnosis and perhaps Thanks, Shawn. Appreciate that All right, the next articles from the Atlantic, but I know that there's many different articles and publications on what's going on with ftx which was was one of the largest crypto exchanges in the world now it's bankrupt and there's a lot of scandal and issues with the the founder sam bankman freight um It's pretty interesting to see how connected he was in the political space as well as you know the vc space and how many people and organizations sort of missed Missed all the red flags and I know some people did raise red flags early on You know, I think elan musk said he His uh bullshit meter was on was on fire or something like that when he was talking to sam So there's a lot of controversy around this How do you guys think it's gonna affect? The overall and it's already affected markets, but how is it gonna affect the adoption or the trust? people May or may not have had about web 3 and blockchain in general Yeah, and it looks like you know, you know billions of dollars are basically missing and we still this is still unraveling the story here so there's a lot a lot of speculation going on I don't know we had an interesting dialogue on this yesterday internally Sean that I don't know whether we had a consensus, but if there was one it's the crypto and blockchain and web 3 even for that matter aren't the same issue and Don't have the same challenges and problems though. They're linked particularly investors minds So yeah, it's it's somewhat catastrophic to the You know the risk capital side of the story what's going on here The technology is it's almost irrelevant. You know, what's happened was with crypto and decentralized ledgers, but you know breaking Uncoupling that in people's minds is a new challenge we've got certainly it'll take some time for people to trust the Um The ecosystem once again And and and Doug's right. There's you know, there's there's kind of layers to this I don't think it's a new challenge though I mean in 2016 and 2017 when I was still working for department of defense and then after I left and was was invited even more to to brief uh individuals in dod on on Blockchain and you know crypto is something I mentioned but didn't really focus on There was a Higher than the average public familiarity with cryptocurrency there because they had dealt with it as a means of routing and cleaning terrorist funds and so they viewed they viewed cryptocurrency as like a tool of the enemy And I had to deal with that peeling apart Yes, there were there were money laundering that happens with You know crypto just as it happens with car washes, but it is the case that the technology itself Underlies a number of uses both into the financial realm and and elsewhere and that that's been an ongoing dialogue I think I think that it it resurfaces when stuff like this happens And of course, you know, this isn't the first time and it won't be the last time You know from mount gox to to other things these are these are going to Put a put a mark on you know people's comfort and trust level on another level. This is this is I mean, if you look at the scandal From what you said ray from the political aspect, I mean this dude bought off politicians and media with huge amounts of money This is this is old school manipulation of the legacy banking system that's now being executed by Those who are making money off of crypto and so perhaps this is you know Not not the first person you want at the table, but cryptos arrived at the table with regard to how much it can influence society not just in the Corners where people are paying attention to it, but in you know, moving elections and moving Public opinion behind the scenes the way has always been done by banking and every other legacy industry So I think I think it's uh, it's a it's a minor setback In the short term, but it's it's another broader advance into society in the long term Well, I hope it's minor, but I'm afraid it's not I'm afraid that the ill winds that it blows you added the Political one. I hadn't really thought much about but related to that Is the I would anticipate that we're going to see more regulatory action now You know the last thing anybody really wants right now is more regulatory friction, but Public and the politicians will cry out for it. What I was most concerned about what I mentioned initially was the You know the the investor community is very fickle and very risk averse by their nature and I think it's going to put a he's going to put a real damper on Anything that looks like smells like blockchain Unfortunately, at least to the extent that we can't uncouple those in people's minds Did you say investors are risk averse? Yes Extremely risk averse. It's that that's their business. There's picking out they've got Eight projects, you know If they've got 80 projects they can fund one or two and the the Primary sieve they use is their perception of risk and you can go to you know, lean canvas kind of techniques to assess that but that's By and large, that's what they're about is all of their projects are high risk It's it's a matter of picking the least of the high risk programs to fund Okay, this just adds more just another You know another filter that we're going to have to wade our way through Yeah Go ahead. What I believe is happening is that It's a shift towards asset backed cryptocurrencies So if a cryptocurrency is anything that's hashed or encrypted then It would be the tokens that are asset backed carbon housing, you know real estate or Maybe even medical data And so this shift I think is in the right direction because the whole problem with that btx was that this There was not there. There was no backing There was there was no fdic. There was nothing to back up the currency But when there is you can find people are still trading The carbon market's still hot real estate's gaining ground And I think that they're just going to ignore This the scandal because it's all the scandal was more about You know backing it up with something that's real instead of just the hype That that sam was using over I mean you're right Yeah, I mean one component for sure impressions I get from folks I've talked to is No, it's just it's just another It's another Slide in the deck that's going to have to be compelling You know, it's just another reason to defer to disqualify. I mean investors are it's like beauty contest You're not really looking for the The prettiest thing you're looking for flaws that you can discount disqualify Others and this just gives us, you know another Another pitfall Yeah, two things I want to point out about this as well is one. I think this might also encourage people to Be more suspicious of exchanges like you said Doug and others And then move there any funds that they have into their own personal custody self custody Either a hardware wallet or something like that. And I think that's a educational learning point for the Industry as well, you know for people who still have their coins Or you know ether ether bitcoin on my coin base or something or Gemini they might Think twice and say maybe I should get a ledger wallet or something to to move my funds out of an exchange because You know, that's one thing and the other point is now there's an effort to show proof of reserves as a As a way to prove that you do have the assets that are backing what you say you have Um, so these exchanges are some of them are working on that. I think some of them are Deciding not to share proof of reserves, which is obviously pretty suspicious um And the other thing to mention here is about the political side of this Sam Begman Fried was the second largest donor to the biden campaign. So there's a lot of You know things we still don't know about this whole case. So it'll be interesting to see how Connected or how important, you know, his father and also I know that some of his other co-founders or employees Are also connected to Um, I know mit to some degree and also some other political affiliations I'm sure you can get into a lot of the juice online. I'm not going to get into all of it now, but there's A lot to dig in here. We'll probably talk about it in our next meeting as well to some degree Any new findings? Probably because are we going to need accountants and attorneys in the future? I you know, just how heavily regulated is blockchain going to become that's the Where I got to keep an eye on Yeah, I mean it also points to the fact that the system Can be Gamed, I mean, you know, they game the system really Obviously it was fraud and um, you know, it's not going to work out well for them, but They got away with it for a while. Obviously not forever, but Still there's a lot of improvement to to do in the regulatory side going back to my earlier point That's where I'm saying this is a huge advance for the crypto world because if you think about it They're playing in the big leagues now. I mean this guy was being looked at He was hanging out with the sec and being looked at as being an advisor to the sec So they were always going to regulate and the question is who was going to be the regulator And this this guy was going to be the regulator because he, you know, put a A pittance of what that company was worth in the in the right pockets. And so he they didn't expect Crypto to come in and play at that level and yet he got on to the main stage without much Trouble at all. Now it all blew up and that's usually the way these things go but what kind of damage is done in the in the short term from a Ethical integrity of the of the regulatory environment Everything's going to get regulated if it's if it gets big enough The question is is it regulated in a transparent way and can the can the blockchain technology underlying some of these things provide More transparency and regulation well self self policing from Regulatory standpoint providing transparency could be one thing this industry does as it matures That other industries aren't able to do and that might be able to set the standards. So, you know, obviously we're not Able to point the direction of everybody and there's always going to be people and probably still are people who are trying to pull Huge scams, but at the same time the more Transparency that can be brought to bear and I think it was Elizabeth who said really looking at focusing on those tokens that have An asset backing and I like the the the thought of of medical and health data and health related data being one of those that's where steady advance and in the proper direction, I think can be made so there's there's There's a lot of drama here, but it's It's it's another step in the maturation of the whole entire industry Yeah, I agree. We shouldn't look at regulation as a enemy from in blockchain. It's actually a Something that we can benefit from if we do it in a transparent way and So for example, if somebody's healthcare data turns out to be an error And then there should be some kind of a consequence for that such as well that person's wallet is no longer You know You know the the data so the reputation so there's got to be some stake in it. So a person has A stake in their own data Being correct their healthcare data being correct, whatever they've put on the blockchain Then you could pull that stake and then they lose and they're no longer in the game and that's one way to Make sure that we have integrity on the blockchain Yeah, and I feel like there's a lot of experiments out there now trying to figure out what is that What is the crypto economics or incentives behind that staking mechanism for for health data, for example And then there's plenty of other types of data carbon credits. There's so many Ways that data is becoming It's self valuable. So We'll see. We'll see how this goes. Thanks for sharing all your thoughts guys. Appreciate that The next article I have here thought it was interesting worth mentioning It's an exclusive from Reuters A week ago. Yeah Russian software disguised as American files pain to US Army and CT pretty concerning. I thought And Specifically, there's thousands of smartphone applications and Apple and Google That contain computer code developed by a technology called push-wush That presents itself as based in the US, but it's actually Russian The CDC Has said it has been deceived had been deceived into believing push-wush was based in the US Capitol After learning about its Russian roots from Reuters, it removed push-wush software from seven public-facing apps So there were at least seven public-facing apps um from the CDC That potentially contained code from Russian I don't want to say hackers, but some sort of Russian um software That's concerning um And according to company documents publicly filed in Russia push-wush is headquartered in in the Siberian town of Novosibirsk Where it's registered as a software company That carries out data processing has 40 employees And about 2.4 million dollars in revenue last year um So it's registered in Russia And I think I read that the push-wush Organization says it does not yet. It does not collect sensitive information And Reuters found no evidence push-wush mishandled users data um However So Russian authorities however have compelled local companies to hand over user data to domestic security agencies So the Russian government still has I think it sounds like they have the right to request data from these companies which in result is um You know, they deliver data of u.s citizens in that way so Thought it was interesting. I don't know if anyone's heard of this or has been affected by this in any way if they're involved with the cdc um You know, it's not just the cdc in u.s. Army. There's companies like unilever the union for european football association nufa The nra as well. So there's If this is truly a You know Backdoor code Russian situation hacking situation. It's going to be affecting a lot of different organizations It's been embedded in almost 8 000 apps like I mentioned so another another case of data security and privacy Any any thoughts or Has anyone heard about this? Okay, well Now you're aware of this i'll move on and the best company in the world according to a16z is Will be a tele a consumer health tech company I thought this was interesting to talk about why it would be a health tech company and I think we've Already accepted that or acknowledged that this century or this decade will be the year of health tech and biotech and We're really seeing that and I think you know, it's interesting to Get that validation here as well by a16z saying that you know health tech is a big deal, especially for the consumer side So yeah, I just wanted to point this one out. I thought it was an interesting report short report Yeah, so the most exciting thing about consumer health care is the amount of white space We'd go so far as to say there is infinite room to improve consumer experience in health care And build massive companies as a result. I agree. I feel like With all that's out there now and we're still kind of early in the In the patient experience improvement Strategies We've outlined two paths to building consumer health care A consumer health care giant one that's vertically integrated and one that's a horizontal play That said numerous health care companies will be built in both models As mentioned the american health care industry is five times the size of the global Advertising industry which makes up most of gaffa's revenue so Yeah, it'll be interesting to see how How right they are. I think they're right but any any thoughts Okay, well, it's a small world. I mean, there's we're having the same conversations in a number of places We chewed this one up pretty good yesterday as well and it's it's it's got some really interesting points in it um I think the overall thesis though is not that the you know the Antitrust fair trade practice laws just will not allow the vertical it even be considered Even the horizontal will have lots of problems just by their conclusion, you know that It's five times as big as advertising and it doesn't and advertising doesn't as directly effect Health I mean human lives It affects, you know, the antitrust laws are there to protect market You protect markets against abusive or inordinate market power So the idea You just look at real time the epic is being hectored by Our uhg rather i'm sorry uhg is being hectored by doj to just acquire one more company So the idea that uhg could get much bigger than it already is is already under question so the the idea that the that somebody is going to Get anywhere near oligopolistic let alone monopolistic power in the sectors just not gonna happen um, I think the what I took away from the article though was that the The opportunities for horizontal It's in solidation and expansion Are very interesting You know someone like I don't know it's probably not like a microsoft or an ibm But somebody that that plays within a particular strata and does a very good job at it could Could really get bigger faster But the vertical power of let's you know say epic or apple or somebody Subsuming big chunks of health care isn't gonna happen Yeah, no I agreed good points Thanks, Doug Yeah, I mean they know they talk a lot about here Um What they would have to do to be successful These companies would have the ability to you know Plug into the complex health care industry sure And work equally well if the consumer health or employer health plan commercial plan or government is covering the bill So that's a really complicated part of this too, right the whole payments idea Issue they're saying visa is the go-to choice because all merchants accept it consumers choose amazon Because they sell about just about everything. So I just think it's interesting to compare You know the visa of health care What is the visa of health care now? We don't really have one, right? It's You know what they didn't say which I thought would might be in a different Hypothesis is that cms itself or we could move toward a more national health plan and the government could get bigger itself Which is the age old argument, you know that The left versus the right, you know is is health care business or is it a you know something else? um But they didn't really they didn't take that one Well, you know to your point and also back to Sean's point originally is if they did do that Let's say cms and we had a national payer Will it be a transparent system, right? We'll be be able to see all the transactions that are going on and if so, that's that's great I think that's what you know, we'd want to to have So people can be held accountable We'll see Any other thoughts on this article? Well, I The idea of what's the visa for health care? I think what's interesting is you know the distinction you hear Frequently from a lot of different folks is you know health care and health. We we don't have a A unified market for health in the u.s. We have we have a health care market and as fractured as it is It's you know making lots of money and a lot of money goes through it, but that's that's not It's it's more from from uh just transactional what i'm buying and selling and being marketed That's more Like a disaster relief than it is a day-to-day transactions I you know I do my shopping at the store or on amazon or this but the the health part of health is Largely uncaptured there. It's the health care part when someone gets sick a little bit of maintenance has worked into that but because we only have An economy set up around the the the endpoint when there's a problem It's a very it's a very big and very dynamic and very messy But very skewed and only partial economy I think I think the the health economy is potentially Much much much bigger even than they're realizing and maybe they maybe they kind of sense it and just haven't articulated it here and I think being able to motivate incentivize capture guide help people towards health Separate or you know pre that health care portion is where the the biggest gold mine is and I think that from You know blockchain standpoint. There's a lot of value the technology brings to fractionalizing costs incentivizing things and also being a distributed and immutable ledger for What has happened and you know we talked earlier about self-recorded data from patients. Well, if it's not me reading off of some sort of device, but instead that device feeding information or making available information that can be validated through Some sort of blockchain mechanism that that brings a huge level of value to social determinants data to non health but health related data and I think that's where a lot of a lot of this this huge um Future market if you will is I I think it's barely been barely been tapped into from the health aspect But the health care aspect obviously can have a lot of improvement as well That was a little bit rambling, but I'm just sort of seeing this as really just the tip of the iceberg I think it's a great point the flipping back though the what you're suggesting would take a huge paradigm shift at least in america and in other places That the focus isn't just upon health care It's it's even more on payments, you know who's good in other words What care is provided is somewhat less of a concern to the system as a whole as to who pays for it how it gets paid for and the you know the issue of Shifting that further away from consumers or or not moving back toward patients themselves is you know, it's not Unfortunately, not the trend line we're on so as if you're if you're trying to move them the Center gravity toward health versus health care that means patients themselves have to be a lot more involved Not a lot less involved. So right now they're not very involved. You know, they're they're care providers Sort of decide what they're going to get and then the payers decide on top of that Whether they agree with the providers or not and then they argue, you know, policy argues back and forth. So We're not moving in the right direction um for what you're suggesting, but I think It's it's a it's a matter of framing and incentivization. I mean the the nfl is uh Is a five, you know, the all the nfl teams are worth five billion dollars or somewhere in that neighborhood It's a series of groups that have been playing a game for entertainment for close to a century now Fantasy football, which only is really off paper, you know in the past 20 years Become something has has four times that value So we went from having a very popular sport that has a huge amount of value what they've created But then people found a different way of incentivizing and becoming interested in a very statistically heavy and And weird minutiae if you if you did this back in the 90s people used to make fun of me And then all of a sudden now it's it's it's four times the value The the market for fantasy football is nearly four times the value of of nfl combined So you can take a populist and make them more interested in a weird minutiae that they have Control over I think I think gamifying health has a has a huge role to play in in this not just a straight incentivization but a gamification could become Big and you're seeing that in some of the things like peloton and some of these these connected Exercise and health efforts that now have people competing in their health I think that that's probably gonna play a role in it too. I know we're getting close to time So we'll stop there. Yeah. No, I appreciate that both shone and dug I think, you know, just last point I want to mention is If you think about retail investing now, it's a huge thing that maybe 20 30 40 years ago people were Kind of relied on their financial advisor or whatever to invest for them. So now it's been gamified with like, you know different apps and things So How can we do that for health care, right? But in a way that's productive and not sort of You know bad for humanity Well, thank you all for being here today and participating in this conversation One last thing there's an educational nugget here. I published an article or sorry a podcast with Shinya Yamamoto from Japan and we talk about web three innovation in Japan. He runs an accelerator in tokyo Did you guys know tokyo was the most populated city in the world? I found that out Um, so yeah, I just wanted to let you guys know about that and again to all the Americans on the call and everybody else Thanks again. Happy Thanksgiving. Hope to see you guys next time