Ketto: Exploring a Web3 Native Healthcare Ecosystem
Designing a tokenized community for Asia’s largest crowdfunding platform
When people in India face medical emergencies, they can look to Ketto for help. Ketto’s Web2 crowdfunding platform has raised hundreds of millions of dollars for more than 200,000+ patients in need.
Over time, Ketto has developed a vibrant community of donors, patients, and medical service providers. Excited by the possibilities of Web3, their leadership team expressed interest in tokenizing their community to better align incentives and reward value-creators.
The rest of this report explores the possibilities and advantages of applying the web3 paradigm of product development to the healthcare sector. We explored how Web3 will affect healthcare, who the existing players are, how Ketto can better serve key stakeholders with a tokenized offering, and the basics of the tech stack behind making this platform a reality.
For privacy reasons, elements of this report have been redacted.
The Promise of Web3
Up until a few years ago, software development had largely taken place within closed systems. Which means everything from decisions regarding product features, ownership of consumer data, revenue distribution, etc. had been at the discretion of the ‘platforms’ upon which these softwares had been deployed. Winners of this platform-race created gated ecosystems to leverage their distribution (eg. Play Store). The dynamics of such software-platform relationships though have always been skewed heavily in favour of the platforms - they have complete access to competition and consumer data, and partnerships can quickly turn into competition.
With the evolution of web2 into web3, software development, and developers, can now thrive in open systems. A whole new world built upon public blockchains, using open source code and governed by the community. This is made possible by layer-1 blockchains like Ethereum and Solana that are built as platforms which can store both data and executable code.
It must be said that ‘open source code’ is not a web3 concept. In a recent podcast, Chris Dixon said, “95% of the world’s software is already open source, it just couldn’t run itself… until now”. With their native tokens as rewards, blockchains are able to incentivise anyone to set up an ‘instance’ to validate transactions and maintain the state of the network, which means that you need not depend on any singular entity to operate these underlying platforms on which the next generation of apps are going to be built.
What does this mean for consumers and these applications?
Consumers own their data forever: Everything is permanently stored on public blockchains, secured by a user’s private key - this means data is portable across DApps. If one social media app shuts down, anyone can spin up another one with all your data intact; as long as the underlying blockchain is up and running. Whereas, if you exit Twitter - all your content and followers are locked within that platform.
Censorship resistance: Unlike platforms which can censor or compete with thriving partner apps, apps built on public blockchains cannot be censored. In fact, app developers also take on the role of validators/delegators as they are invested in further decentralising the blockchain.
Composability: Open source code and data means that applications are now creating blocks which anyone can choose to further build upon.
Web3 in Healthcare
With this context in place, let’s consider how web3 could impact and revolutionise healthcare services over the next decade.
Direct to Consumer
In the healthcare sector, the ‘platforms’ are the insurance companies. In theory, their function is to aggregate risk and ensure smooth cash flow during healthcare emergencies. Which means that hospitals and other service providers only get paid when you fall sick, and they are thus incentivised to maximise revenue per illness. This higher revenue translates into insurance companies penalising policy holders with stringent payout clauses, waiting periods and other hassles to ensure they are not being defrauded of the money you so willingly handed over to them. Moreover, you are restricted to the network of hospitals empanelled with the insurance provider. And you are further bound to any changes to premiums they implement. Lastly, switching providers is carefully gated and comes down to the power that national regulators exert on these players.
In the web3 world, much like the function of market-making has been automated by AMMs, the role of risk aggregation can also be automated, making insurance a platform function and passing on a larger share of value to healthcare providers. This is possible because there isn’t a need for a centralised authority to mediate between a patient and a hospital. Smart contracts and public blockchains automate this in a trustless and permissionless way.
Open Standard for Medical Records
Despite multiple efforts from regulators and industry bodies, there is yet to be a widely adopted standard for medical records which are portable across providers. In India, this is largely because a big chunk of data collected is offline; meaning these records need to be meticulously digitised - quite a non-trivial undertaking. There is also little to no incentive for any of the players to actually be the first one to adopt portable data standards.
We believe there are two trends which will change this,
Reduced costs due to increased digitisation: As mobile and internet penetration increases, the monetary cost and friction for capturing health information digitally is going to consistently decrease.
Incentives to participate in open healthcare: The creation of an open healthcare system will create consumer demand for these products and incentives for service providers to start adopting these open standards. It is unclear when this flywheel will kick in, but it is inevitable - possibly fuelled by visionary first movers.
Gamification and Incentives
“The first time we saw websites, we thought they were digitised brochures - eventually they ate up the shop and then some more” (paraphrased from cdixon’s podcast). There is an inherent temptation to take new technology and map existing paradigms to it. But this is just one part of the puzzle. New paradigms also bring along native use cases which just wouldn’t make sense (despite being possible) when applied to other paradigms. You could technically send across a twitter thread via speed post, but you won’t.
The fact that we have programmable money which is global and trustless opens up new possibilities. Few examples of this are token-gated access, staking pools and ownership based governance. Because the default in web3 apps is community ownership, it is easy to construct paradigms which reward members in proportion to their ownership. And ownership doesn’t always have to be bought - it can be earned.
Our imagination is really the limit on how much web3 can transform healthcare. Every principle of behavioural economics can now be tested out to shape behaviour such that people think of healthcare as an investment and not an expense. For instance, we could implement loss aversion by requiring people to stake into pools and earn if they meet certain healthcare outcomes.
The Web3 Healthcare Landscape
We can already see projects incorporating web3 elements in order to improve healthcare outcomes. Below are a few examples -
Incentivising good behaviour
The first step towards building an open digital healthcare ecosystem is to have an on-chain healthcare reputation system for members. This includes digital records, past medical history, and more broadly, any positive action you take to improve your health (i.e. exercise, food, etc).
Apps like Clinicoin, Kultur tokens, Cycle4value , Lympo , Bowhead & Sweatcoin are rewarding members for taking positive health actions. This method builds a foundational reputation (or in-game currency) which can then be plugged into an ecosystem of partner rewards and healthcare services.
Bringing data online & on-chain
As mentioned earlier, high-quality, portable patient data is critical for an open and efficient healthcare system. This gives patients the freedom to choose healthcare providers that drive the best outcomes for them. It also factors in that in this day and age, people are more globally mobile than ever before.
Tokens as a means of payments
This is the most straightforward application. And as adoption of cryptocurrencies grows, they will start being accepted as means of payment. Currently this happens extensively “in-game,” and early adopter countries like El Salvador accept bitcoin as legal tender. But only time will tell how this pans out at a more global scale. Central Banks will play a big role here.
Aveon Health & Progressive care are healthcare service providers that accept Bitcoin as payments. Nicklaus Children’s Hospital Foundation is among the first nonprofits, and believed to be the first healthcare foundation in South Florida, to begin accepting cryptocurrency donations.
Consumer-first healthcare trends
Early signs of paradigm shifts in healthcare (you have already seen this in practice):
Healthcare membership model: Even healthcare is building a membership model to align incentives of healthcare providers and patients by passing on a membership fee directly to providers. This allows them to offer more competitive waiting periods and payout terms. In spirit, this is the same objective web3 can achieve - but more efficiently and at a larger scale.
Accessible healthcare financing: Based on behavioural evaluation, Aarogya Finance is providing healthcare loans (paid out directly to hospitals) to individuals who need it the most.
Our bet is that the above are indicative of how current models can improve. These haven’t taken off yet because they are shackled down by the existing system.
Web3 fixes this.
The Web3 Evolution of Ketto
Let’s start by identifying key stakeholders,
Patients and Relatives
Community and Operations
Health Conscious Members
🎯 The Vision: Ketto can create a self perpetuating healthcare ecosystem which incentivises good healthcare behaviour, helps individuals finance medical expenses and rewards healthcare providers for delivering patient outcomes, powered by a Ketto token.
Let’s look at how each of Ketto’s stakeholders benefit from this ecosystem.
Patients and Relatives: More Successful Crowdfunds, Faster
Reward donors who donate to Plus & Amplify campaigns: This creates an additional reason for patients to use Plus & Amplify services, knowing that they will attract more donations.
Reward patients who successfully complete a crowdfund: This not only gives patients an additional reward for listing their crowdfund on Ketto, but also ensures they keep their fundraising goals realistic.
Reward patients and donors who refer other users to the platform: Social proof and word-of-mouth referrals are the single most effective form of marketing. Using a token to reward this behavior has the potential to accelerate Ketto's growth dramatically.
Reward donors who share crowdfunds on social media: Using the technique of ‘impression mining’, the token can be automatically delivered to those who share particular crowdfunds on Twitter, Facebook, etc. This turns every donor into a marketing channel for Ketto.
Reward donors who become SIP members: Create an additional incentive beyond altruism for donors to become recurring monthly donors on the platform.
We can also leverage the token to gamify the crowdfunding experience in new ways:
Staking the tokens for Premium Listings. As an additional way to support a campaign, any KETTO token holder can stake (i.e. lock up) tokens on a campaign that resonates with them. The act of staking the token would provide a boost within the listings on the Ketto platform, allowing any donor to create a sort of ‘promoted post’. The more Ketto that gets staked in a particular crowdfund, the higher it appears in the rankings.
Rewarding Early Bets. It's understood that donors prefer to give to campaigns they think are going to succeed. For that reason, the hardest bit of funding is accumulating the first 20%. We could also use the token as a reward for those who donate early. If you're in the first 20% of the donors for a campaign, you can earn extra rewards when it successfully completes the raise.
Community and Operations: Decentralising Ketto Operations for Greater Scale
Fully incorporating a Web3 ethic implies adopting progressive decentralisation. While the entire project does not need to decentralise on day 1, it's useful to imagine what a decentralised community would be able to accomplish. The token would serve as the alignment mechanic for various parties as they build the ecosystem together.
Expand the Patient Engagement Team. The Plus & Amplify program provides excellent margins for Ketto, but is operationally intensive. Currently, team members must sit in hospitals and connect individually with patients. Oversight and management of the Patient Engagement team is preventing this valuable service line from scaling. By introducing token rewards, we could incentivize any competent party to act as a Ketto consultant, paid only when they produce meaningful results. Anyone with an interest in helping patients get their crowdfunds completed successfully - through photography, digital marketing, copywriting, etc. - could be rewarded with tokens.
Community Member Governance. Ketto could, over time, become a DAO (Decentralized Autonomous Organization). The DAO would constitute KETTO token holders (e.g. patients, donors, healthcare providers, etc). This community could work together to improve products, create marketing campaigns, and generally govern the development of the KETTO protocol over time. Community ownership of the protocol through the KETTO token would ensure that all community members have the best interest of Ketto at heart.
Partner Ecosystem: Supercharge Growth of the Health Mall
As we seek to scale Ketto's impact, we need to bring in additional partners. The Health Mall concept will be a foundational piece of structure that enables users to find high-value medical products and services, and will allow providers an avenue to reach a captive audience.
Sell Products and Services: The token could accelerate the adoption of the Health Mall concept. Access to the Health Mall could be gated to KETTO token holders, creating further demand for the token. Providers who sell products or services in the marketplace can price their offerings in INR and earn KETTO rewards for their sales. The token provides an additional layer of incentive to work with Ketto beyond access to the customer pool. It even encourages existing providers to refer new providers to the platform; since the more holistic the Health Mall, the more the Ketto token will be worth.
Telemedicine Services: Thinking broadly, the Ketto token can also expand the types of services offered in the Health Mall beyond standard check-ups. For example, healthcare professionals could offer telemedicine consulting services (with requisite legal disclaimers). They can get paid in INR and be additionally rewarded in KETTO tokens. This would give individual healthcare practitioners an extra incentive to refer their colleagues to the platform.
Content Creation: Finally, the token could enable decentralised content creation within the Health Mall. Professionals could be rewarded in KETTO tokens for writing guides to managing common diseases, and community members could be rewarded for editing/approving the pieces. This would reduce operational overhead while simultaneously incentivizing content creation.
Create Communities of Members Invested in Each Other's Health
Most of us consider healthcare an expense. But by focusing on building communities among members and rewarding those who act in healthy ways, we can begin to change this web2 mindset.
The Ketto token can be leveraged in two ways:
Mutual Aid Members: Groups of Mutual Aid Members can pool their INR into an insurance pool that supports any member who falls ill. And then, with the Ketto token, we can incentivize members to remain healthier. Token rewards could be allocated in proportion to the size of the pool based on the pool’s usage. In other words, the longer the pool is untapped (i.e. the longer that no one in the pool needs to remove funds), the more Ketto rewards are released. We could create pre-programmed conditions that deliver rewards at particular tiers (e.g. a 1 lakh INR pool gives 2% APY, a 5 lakh pool gives 3% APY, etc). Since the rewards are paid out in Ketto tokens, the ‘cost’ to the Ketto organization is extremely low. This will create an incentive for Mutual Aid Members to form a healthcare support group, as they would be financially invested in the health of other members in their pool. Since the APY would be proportional to the size of the pool itself, Mutual Aid Members would also be incentivized to refer their friends and family to the pool to maximize the rewards earned.
Rewards for Healthy Living. To further align community actions with the mission of Ketto to create a healthier world, rewards could be provided to users who lead a healthy lifestyle. This could include integrations with fitness trackers, rewards for attending Ketto affiliated fitness sessions and rewards for getting regular healthcare checkups.
Token Value Proposition
In order to have sustainable value, the Ketto token must generate demand. This requires creating a use case for the token (i.e. utility).
Broadly speaking, the token will generate utility in three ways:
Token as Access Pass
Everyone wants to be part of an exclusive club. The most straightforward way to generate demand for the token is to ensure only token-holders are able to access particular products and services. Note that this does not require them to spend their tokens. Rather, by hodling their tokens, individuals are investing in the success of the network. And for doing this, the network rewards them back.
The following services can be made available only for token holders:
Members Mutual Aid Program: In order to get the benefits of the insurance pools, people must first buy and hold the token.
Users of the Health Mall: Different tiers of token-holding can grant access to different levels of services, or even priority services. For example, holding 10 Ketto may provide access to normal checkups, while holding 20 Ketto is required for telemedicine.
Sellers at the Health Mall: In order to list their products and services to the highly engaged Ketto user base, service providers could be asked to stake Ketto tokens to demonstrate their commitment to the platform.
Token as In-Game Currency
Short Term: The Ketto token can provide payment discounts for certain small scale actions within the ecosystem. These may include,
Payments: For services which are free for Ketto to provide, the Ketto token can become the means of payment. For example, the ability to boost a particular crowdfunding campaign by staking tokens can be accomplished only with the Ketto token.
Discounts: Ketto can offer a discount on platform fees when the payment is made in Ketto tokens. For example, if a Plus & Amplify campaign costs 1000 INR, it may cost only 800 when paid in the equivalent amount of Ketto tokens.
Long Term: The most ambitious vision for token utility is for it to be the sole unit of exchange within a particular ecosystem. It entails denominating all ‘in-network’ services in the Ketto token. This would first require that products and services offered are so valuable that service providers are willing to accept it as payment.
We believe there are several difficulties with implementing this in the short term.
Token as Citizenship
People naturally want to belong to communities that are making a meaningful difference. If/when the DAO is created, the Ketto token will be required for anyone to have a say in the governance of the network. Using the token as the basis for voting rights gives stakeholders a sense of community ownership, which will only further increase their desire to help the Ketto ecosystem grow in the long run.
Token Distribution Strategy
Principles of Token Allocation
In this section, we’ll explore a high-level implementation approach. The guiding principle is to build iteratively, get real feedback from the community, and repeat.
For initial applications, we must prioritise data and use cases already within the Ketto ecosystem. This ensures we have complete control over the quality, availability and structure of data. It further minimises moving parts and allows us to focus on getting the product right.
With this in mind, let’s break down the solution space in the following sections -
An important distinction while prioritising use cases:
Owned and Structured Data: This is information defined and generated within the Ketto systems. This includes current use cases like donating to and promoting a campaign, and also future web3 implementations like staking to INR pools operated by Ketto. This data will originate outside the blockchain and will be sent on-chain through an oracle.
External and Unstructured Data: This is data originating outside the Ketto system, mostly from partners, social media platforms and medical service platforms. The access and quality of this information is not under our control; we recommend not putting these on the critical path for the initial launch.
Building Blocks for the Ketto Ecosystem
Ketto Token: This will be issued on-chain. It can be earned by performing ‘good’ actions or can be bought/sold on an exchange.
Token gated access: within the Ketto platform (including discord) you get access to a community of members, content and support.
Custodial wallet, with support to withdraw funds into self-custody
Staking: lock your tokens and put them to work for the network, or gain access to some premium features (the best insurance pool)
Spending: pay for products and services with Ketto tokens
Healthcare Data: Patient data is currently fragmented across multiple sources
Medical records: Diagnostic tests, hospital reports, etc. do not have a standardised format and are mostly offline or are scanned copies (i.e. hard to process). There are emerging digital claims products - Ketto should keep an eye out and ride the wave, not try to be a leader here. If these are in the critical path for anything on the network, they will need to be manually translated into a digital format - not advisable or scalable.
Health Data: One thing everyone unanimously agrees on is "walking is good for you, 10k steps a day". A simple starting point can be linking wearables and similar tracking devices to Ketto, and eventually scaling to more devices like ultrahuman. A lot of these currently operate within closed ecosystems.
Insurance liquidity pools (mutual aid): These could either be stablecoin denominated or maintained off-chain.
Keeping it on-chain brings in the benefit of decentralisation but puts the funds at more risk than necessary
Keeping it off-chain requires oracle-based governance and rewards payout
We recommend starting with the following applications of the token:
Earn rewards for donating to a campaign
The easiest and most intuitive place to start, and could apply retrospectively as well, is to enable anyone donating to a campaign to earn on-chain Ketto tokens. It is worth noting that Ketto is the centralised authority that verifies the donation - this is an acceptable trade off towards progressive decentralisation. Over time donations can take place on-chain too.
Token Gated Donors Community
The next step is providing immediate utility to the token. A great way to bootstrap utility is to create a community that receives and generates content, camaraderie, rewards, etc.
Mutual Aid Staking Pool
This one is a bit further down the road, but really gives a glimpse into the potential of web3 in healthcare financing.
We start by creating a traditional mutual aid deposit pool but combine it with staking rewards and incentives offered by DeFi. Keeping the deposits in INR ensures minimum financial and compliance risk.
Fast and Efficient: By leveraging proof of history, Solana is able to process transactions in parallel and is thus an order of magnitude faster than other L1 blockchains. This makes it possible to build applications that are just as fast and intuitive as the ones we’re used to (in web2) but with all the underlying benefits of web3. Companies like Audius and Render are migrating to Solana for exactly these benefits.
Growing community: Web3 is about building products bottom up with your community at the heart of things. The Solana ecosystem is seeing rapid growth, as many developers and investors are building their products and services on it. Ketto will massively benefit from the compounding benefits of this growing ecosystem which is organically onboarding more users and building more products and tools than currently any other L1.
Suggestions and Implications for Ketto
Ketto has the unique opportunity to lead India into a healthcare future that is more patient-centric and outcome-driven. By leveraging it's existing brand awareness and userbase, Ketto can launch a token that creates a self-sustaining healthcare ecosystem. Transitioning to a Web3 model offers the possibility of more aligned incentives, more engaged users, and ultimately more healthy people across the country.
This research report was a collaborative effort by Kash Dhanda, Aditya Shetty, and Abbas Shaikh. Special thanks to Akhil Pradeep for designing the graphics, Anirudh More for editing this final draft, and Shek.dev + Mohit Chawdry for contributing their expertise.
If your organization is considering moving into Web3, we’d love to collaborate. Reach out here to set up an introductory call.