STREETCOIN: HEALTHCARE'S BLOCKCHAIN
In Brownsville, Brooklyn, 2015, a group of formerly gang affiliated youth and Harvard graduates started working together to assess and improve urban value through design and technology. What has emerged by 2018 is "Streetcoin," a blockchain for health insurance based in embodied health risk on the street.
Neighborhood ledger: population geography, measurable by electronic health records
Blockchain has been gaining steam as an innovative model for health insurance (1,2,3,4,5) particularly stressing the importance of buy-in from high risk participants. Cumbersome paperwork and slow data feedback are left behind when individuals are given blockchain value through an insurance company. This value is then exchanged in different healthcare settings in an anonymous way. The blockchain ledger is updated to represent adapted risk based on social network data, geography, consumer choices etc - in a word, behavior. As behavior changes by a large enough group of involved individuals, so does collective risk, which means savings for insurance companies, savings represented in blockchain value.
Various companies have begun to speculate on ways to innovate this space, particularly Google and their Cityblock(6) program, which aims to use urban design and construction to accomodate the risk of patient participants. The resulting urban design, landscape and housing not only addresses health care issues; it raises neighborhood real estate value over all, becoming an asset that improves over time.
Cipher: data mining for streetcoin
Cityblock was launched in Brooklyn's Crown Heights/ Brownsville/ Bed-Stuy area last month, June 2018, with the help of neighborhood team members, some of the very same folks who helped create "Streetcoin."
But long before Cityblock and its $21 million in venture capital(7), the neighborhood team began innovating their "Streetcoin" strategy. Young men from the streets of Brownsville, Tameel Marshall, Alonzo Jones, Sean Turner, and others teamed up with Harvard graduates Alan Waxman (the author), Quardean Lewis Allen (of Made in Brownsville), and Brownsville Community Justice Center leaders Deron Johnston and Erica Mateo to begin addressing the prevention of violence and chronic disease through design and technological innovation. The first few collaborations were mainly focused on user interface design, social media design, and changing the atmosphere around violence in the population. These "studios," as they were called, were funded by groups like the Center For Court Innovation and the Police Foundation and found partners in design firms like BBDO and Wolff Olins. They mostly focused on the North side of the famous gang beef between the Brownsville Houses (to the North) and the Marcus Garvey Village (to the South).
When Alan Waxman and Ionna Jimenez were given the opportunity to start a studio in the Marcus Garvey Village side (the South side of the beef), they jumped into action, involving a team of youth to create the first "Urban Rhythms" studio(8,9,10). The group came up with a methodology(11) to "turn up" or "turn down" collective risk through architectural intervention, inspired by Kenneth Frampton, who had designed their housing project over 40 years before(12). In a dramatic design review at Columbia University they presented their work to Frampton in Columbia with the help of professors Kaja Kuhl and Tricia Martin. Waxman and Jimenez continued to be funded by the Brownsville Community Justice Center to innovate. A follow up study was recently published by the Urban Institute on their work.
In 2016 Alan Waxman and Tameel Marshall won a grant from Storefront For Art and Architecture to follow up with the Brownsville Houses (North side of the gang beef) and develop an innovative healthcare strategy. What resulted was a methodology for adapting risk from the inside(13). Marshall analyzed the history of the neighborhood, particularly the murderous 80s and 90s in Brownsville, as drug kingpins dominated and terrorized the streets. Over time, the "traphouse" typology began to form as a way for youths to find family-like bonds and safety in the wilderness of the streets and also to work together to manage collective risk through the social network. Participation and also reluctance and withdrawal to participate in what was sometimes called the block's "chain gang," would result in violence prevention in particularly high risk zones of gang territory. As Marshall and others described, the more time an individual spends on the street, the more time he or she comes to embody the collective risk there, and the more power they have to address that risk through behavior.
The research team, which in 2017 included Tameel Marshall, Dee Banga, John Wick, Adam Bush, and Alan Waxman, developed a spatial data integration technique to evaluate changes in the block's potential to affect collective health(14). They call their technique of data mining a "cipher.” The group gathers in a confidential HIPAA protected space to cipher, or mine, their “Streetcoin:” high risk areas in the gang territory are assessed in terms of the intensity of risk felt by the participants that day, even in that particular moment. This is discussed in terms of emotion, usually through the metaphor of music, and recorded in terms of perspective paired with biorhythms, heart and breath rate matched with geographic location. The result is a block by block framework of collective sensitivity. Then the real data integration begins as the team weaves in layers of socio-economics, real estate value, crime data, etc, to create a background beat for the particular block framework in question. For the most sensitive spot, the group adds lyrics, wrapping personal social network information into the data set. HIPAA protection offered by the legitimizing hospital or clinic means that these personal records mint the “coin” with the biorhythms of the participants as well as the records that “chain” the community as a whole.
Each session or "cipher," as it is called, renders a data set (“streetcoin”) valued in terms of its ability to translate into insurance savings. The group has continued the process for over a year, under the auspices of Brookdale Hospital, producing “streetcoin” for this high risk series of blocks in Brooklyn.
The streetcoin: actionable insights for savings in health insurance
Now that programs like Cityblock have set up shop in the neighborhood, the hope is that they will buy neighborhood "Streetcoin" and likewise buy-into existing neighborhood social infrastructure.
But it’s not just Cityblock, any organization with a standing ledger of neighborhood health - electronic health records, for example - stands to gain from improved care at lower cost through the participation and insights of high risk members of their population. ACOs (accountable care organizations like Kaiser Permanente), government agencies, Medicare, and even local government hospitals have interest in making and buying “streetcoin.”
These organizations have a stake in buying “Streetcoin” from participants and funding action in their area of jurisdiction to translate insights into real savings. Over time, the shared, living, ledger – the electronic health records – come to represent these changes in improved health at reduced cost.
How to make “streetcoin:”
Living (Blockchain) Ledger: the geography of high risk zone tied to a population set and social network, the neighborhood
Data Mining Cipher: HIPAA protected data integration cipher with high risk individuals who have a personal stake in health insights
Streetcoin: resulting integrated unique data set from the cipher mining process, with valuable health insights for prevention and cost savings for health insurance
Coin Marketplace: City Block, Accountable Care Organizations, Medicare, and other insurance agencies