I’ve worked in over 10 different hospitals in my journey as an internal medicine physician, and disappointingly saw the following scenario repeatedly: patients presenting to the ER with out-of-control chronic diseases because they couldn’t arrange transportation. They’d explain that without transport, they couldn’t see their physician and therefore couldn’t get a refill on their prescriptions. The system failed, and the patients and their healthcare providers suffered.

Our current medical system, which aims to bring patients to the healthcare system rather than bring healthcare to patients, is mightily centralized. This can lead to various complications. For example, lack of transportation causes nearly six million people in the U.S. annually to delay medical care. Medical errors are another issue, and could be reduced if patients have more insight and advocacy into their own care. Yet, they remain a leading cause of death in the U.S.

Healthcare costs have ballooned, due in part to the steep price of hospitalization. The healthcare sector has attempted to find solutions to complications, but often ends up causing further issues. For example, trying to control consumer healthcare spending has helped to create complex health insurance policies that the average patient has trouble understanding.

What if we tackle some of these inefficiencies by taking a page from decentralized finance (DeFi) and empower patients?

In finance, starting with Robinhood, commission-free app trading “democratized” finance by giving retail investors control of their finances. DeFi takes the concept further, freeing individuals from having to rely on traditional financial institutions for certain transactions. As of April 2021, DeFi was worth more than $100 billion.

In many ways, decentralized healthcare, or DeHealth, is already happening, and it’s nothing short of a paradigm shift.

Patients now have access to their electronic health records in real time, allowing them to be active participants in their own care. Companies such as PM Pediatrics, CityMD, CVS MinuteClinic and others are making neighborhood urgent care more accessible.

COVID-19 has forced healthcare to decentralize. The Centers for Medicare & Medicaid Services (CMS) has allowed reimbursement for telemedicine visits, and with several states waiving temporary requirements for physicians to hold a license in the state where the patient lives, telehealth visits were up 38-fold between January 2020 and February 2021.

Companies such as Teladoc and Amwell offer their own service or partner with healthcare organizations to provide telehealth capabilities. Others such as SnapMD, Doxy.Me, Bluestream Health, Wheel and Veemed also white label telehealth solutions for hospitals. For example, NYC Health + Hospitals now has a new service called Virtual ExpressCare that is powered by Bluestream Health. It provides New Yorkers with instant on-demand access to emergency medicine physicians. Patients can also add nurses, family members and others to the virtual conversation.

Other companies are enabling the decentralized healthcare model, as well. Avaya facilitates communication between providers and patients. PillPack and its competitors literally deliver healthcare to doorsteps by efficiently mailing prescriptions; LabQ offers lab tests in the home; and Apple can store information from an individual’s wearables, smartphone and electronic health records.

Hospitals have followed suit. Fueled by the CMS initiative for Hospital at Home, they’ve started delivering acute care at home. Mount Sinai, Johns Hopkins, Massachusetts General Hospital and many others including societies such as the AHA have joined this initiative.

The trend is clear. The future is DeHealth.

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virtual care

If We Can Have DeFi, We Can Have DeHealth