In 2016 in the people of the United States spent $550 billion on health insurance. Of that, we collectively received $290 billion back in benefits. That means that for every dollar your family spent on health insurance, they only got back about 53 cents on the dollar. That means that on average your health insurance company either kept or wasted about 47% of the money you paid them.
So what do health insurance companies really do? On a macro scale, they accept claims and pay benefits. It seems pretty simple: request and response. Netflix has the same kind of system. You request a movie and if they have it, they play it for you immediately. Netflix buys the product of movie makers; insurance companies buy the product of healthcare providers. Sure there are a couple of differences. Your insurance company doesn’t have a handy dandy little list of things that they cover on your policy, and even if they did, they work on ICD codes, currently in version 10. So that means the in our Netflix example, you would have to have a three inch thick book to translate the name of your movie into this arcane code that Netflix would then understand. There are several other problems such as the fact that your insurance company doesn’t provide every movie to every consumer, but we’ll get to that in a minute. The entire point is, that exactly like Netflix, your insurance company simply handles data.
How do we make health insurance more like Netflix, then? First, we provide a web (or smart device) interface for our movie watchers, er, doctors, to look up procedures, see if they are covered and for how much. Then, if they are, we deliver the payment in real time, directly after the procedure is performed. We’ve eliminated the back and forth, the calling, the verifying, the adjudication, the monkey motion that is the difference between the 47% they waste and the 3% on average, they claim as profit yearly.
If Netflix can manage your data for about $10 per month, your insurance company should be able to manage your data for about $10 per month.
We here at Sentia Health aren’t like your bloggers and pundits, they speak and write far better than we can, but we actually solve the problems we identify. Having identified this problem a couple of decades ago and marveling at the arrogance of the insurance companies for mandating who does what work and how much it all costs, we solved the problem.
Sentia Health provides an Electronic Medical Records Management System (EMR) free of charge to doctors. There are no hooks or catches, it’s really free. We make our money by managing the health insurance data for our patients. We charge, as mentioned above, $10 per month for the privilege of managing the patient’s data, plus the true cost of the health insurance risk, clearly about 53% of traditional insurance. If the patient doesn’t have our health insurance, the doctors can still use our system, they just have to jump through the hoops of medical coders, adjudication, billing, ad nauseum, as outlined above.
There will be additional savings too. First the average practitioner in private practice spends about $30,000 per year on some kind of EMR. The average practitioner also spends about $42,000 per year on compliance an efficacy reporting. All our reporting is done in real time and automatically. They won’t have to hire some accounting firm to count the beans, just click button, get report. The billing department will shrink, if not go away. The doctors will know what is covered and for how much, and since we publish all this information to the internet and make it available to the patient, he or she has the ability to know the cost of a procedure before it’s performed.
Instead of having one huge insurance company, we are currently in negotiations with Capstone Associated to allow practices to provide their own insurance via a captive insurance agency. This would allow the practice to set its own pricing and completely obviate the need for these wasteful, greedy bankers and their insurance companies. Ideally, with reference pricing, maybe 125-150% of what Medicare will pay, we can even curb the rising cost of the care itself, causing practices and hospitals to streamline their own processes like we have for big insurance.
Just as important, are some the other facets of Sentia’s EMR:
- Integrated health and wellness – We provide patients with a portal that scientifically analyzes the annual (semiannual, quarterly) checkup and prescribes patient education on how to live healthier, better, and longer.
- Integrated Email – We give the patient the ability to contact the doctor via SECURE email.
- Self-scheduling – log in and see when your favorite practitioner is available and schedule a time to meet.
- Questionnaires – Practices have the ability to design, assign and read questionnaires online. This means you as the patient don’t sit in the waiting room with sick people filling out reams of paperwork.
- Reporting – Individual and Population Health Analysis: the individual gets a printable report of his or her health as it was recorded on the date of the health assessment. Population Health reporting gives the practice the ability to see how they are doing.
- Compliance – as this product matures, we will be able to differentiate between people who live a healthier lifestyle and those do not by comparing the individual’s metrics against themselves over time. Those who make demonstrably better decisions will pay lower premiums than those who do not, based on personal metrics. No longer will you be asked to pay for the risk of a “Bunny” who sits on the sofa and eats bon bons and watches soap operas all day and weighs 600 pounds.
- Telemedicine – Coming soon, you will be able to meet with your doctor via web conference.
We have demonstrated a way to cut about half from the cost of health insurance. This is accomplished by streamlining processes and cutting out waste. We believe this is the only way to accomplish this lofty goal without completely revamping the way care is delivered in this country and we hope you share our vision.