When medical and financial regulations meet

The medical and financial fields are two of the most stringently (though not perfectly) regulated sectors in the US. A suite of governing bodies oversee them, from FINRA, to the FDA, to the CFPB, to the CDC, and far beyond. When money and medicine intertwine, compliance becomes notably complicated and demanding. 

But there are opportunities for fintechs where these regulatory obligations meet:

Data protection

While the shift to electronic medical record systems like EPIC has helped catalyze a data-driven move toward personalized products and recommendation engines, it’s also exposed patients’ medical and financial data to bad actors. Ransomware attacks on medical networks have increased dramatically over the past five years, and, though most of these attacks end with a ransom payment, they do interrupt medical provider operations and compromise the integrity of patients’ information as well as their sense of security.

“It’s a really interesting question about what compliance-type opportunities are spawned by that FINRA-meets-HIPAA sort of dimension, and then layering in the other types of credentialing and validation that players are looking for,” Shawn Ellis, Managing Partner at Distributed Ventures, told The Financial Revolutionist. “Sparks fly for me from an investor vantage point.”

Fintech talent can work to both safeguard financial data in medical systems, and also demonstrate best practices for other parts of medical providers’ digital ecosystems.

Data insights

Ellis identifies a convergence in the types of bundles of healthcare and fintech data that may be processed and used to personalize care and other services. Many of the same recommendation engines that help consumers choose insurance plans according to their financial information could, with the right compliance and anonymization frameworks, leverage historical medical data to help consumers select the best plans for them. 

We may expect fintech leaders with experience in generating insights from financial data to expand their purview into medical data, leveraging insights from doctors’ offices as well as bank accounts to optimize the healthcare plans and services offered to patients.

Real-time payments

Though not as apparent as the compliance-related concerns that come from the digitization of data, payments processes can also be a promising site to solve for compliance. In particular, real-time payments can help insurance carriers meet state requirements for claim settlement. California, for instance, requires that carriers settle claims within 85 days of their filing; through real-time payments, carriers can expedite the tail end of that process, mitigating the risk of legal violations and enhancing patient wellbeing.