Half of Your Health Insurance Premium is Wasted; How to Get It Back

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.

Lack of Leadership is What is Wrong with Healthcare

I got up early this morning to attend to some things and noticed the regular email I get from EMR & HIPAA.  Today's installment is "Top 3 Tips for Taking on Digital Health" a guest blog post by Brittany Quemby, Marketing Strategist of Stericycle Communication Solutions as part of the Communication Solutions Series. Follow & engage with them on Twitter: @StericycleComms

Brittany's three tips are these:

1. What does the patient expect?
2. What does the patient want?
3. Where does the patient go?

She states in her article that the patient will gravitate toward "consumer experience when it comes to interacting with their healthcare provider."  I take that to mean that they will do business with a practitioner who has the ability to receive and send them email, offers online scheduling, creates a paperless experience, and reading between the lines, grants them immediate online access to medical records.

This is another classic case of too many cooks in the kitchen.  Every one of the articles and blogs that I read and have read point out some thing or another that the medical industry should be doing but isn't.  They don't offer any solutions.  That is why this blog is different.  Here at Sentia, we don't point out a problem without pointing out and developing the solution.

I know my regular readers are going to know this mantra by heart, but it is true and not being heard: We have that solution that this industry is looking for and can't seem to find, but the noise generated by people like Ms. Quemby, a Marketing Strategist, is drowning out the one real message that will revolutionize and automate this industry.

Sentia's Electronic Health/Medical Records System (EMR/EHR) incorporates the consumer experience called for above, plus automates the entirety of the insurance industry with these consumer features:

• Immediate online access to medical records from anywhere in the world with an internet connection
• Secure email between patients and practitioners
• Integrated, automatic prescription of patient education tailored individually and based on clinical findings
• A practitioner configured Questionnaire generator so the doctor can design and build online questionnaires instead of having you sit in a waiting room (with sick and possibly contagious people) filling out reams of forms

While this sounds like what Ms. Quemby and the rest of the world is making noise about, we went farther and automated the health insurance industry.  We have associated procedures in our EMR/EHR with policies, and policies with patients, so the as the practitioner documents the encounter, payments for procedures performed can be transferred to the practice in real time.  We provide the entire service free to the practitioners and for a $10 monthly subscription fee (plus the true cost of the coverage) to the patient.

Let's contrast the subscription fee with the status quo today.  The Affordable Care Act (ACA) limits the amount of the insurance premium for Exchange policies the insurance company can keep for administration to 20% of the total premium.  That means that if your insurance premium is an average $500 per month, you pay the insurance company $100 for the privilege of managing your health insurance data.  If you have private insurance the percentage is not regulated and probably over 30%, meaning you are paying them $150 per month for something we'll do for $10, and do it better.  $150 is your electricity bill.  $10 is one trip to Starbucks for two. 

Further, as practitioners find Sentia's EMR/EHR they will realize that they won't have to spend that $32,000 per year average that they've been spending on a third party EMR.  Hospital administrators will realize they don't have to spend (literally) hundreds of millions of dollars on their Cerner or Epic installation. With Sentia's built in reporting capability the average doctor won't have to spend over $40,000 each per year  on compliance and efficacy reporting.  This new way of insuring people will further reduce costs by eliminating the medical coder, medical adjudication, and the entire billing department.

Those benefits alone should cut the cost of healthcare by 40-45% without affecting payments to practitioners at all.  Even better, due to reduced cost, this paradigm will become the standard, facilitating the move to a central repository of structured health data.  It will be available to the patient and practitioners anywhere at any time for research and analysis and allow us to calculate a true measure of population health and manage the overall health of that population one patient at a time to further reduce costs.

 As we found out with the failure of the ACA, automation of these mundane tasks, and therefore taking the business out of health insurance, and replacing it with a low cost subscription fee, while giving the patient the consumer experience they crave is the only way to  control costs in healthcare.

As we begin to control these costs we can tackle wasteful administration, big pharmaceutical companies, amazingly expensive medical equipment and everything else that the patient has pay for that isn't healthcare.  As for the title of this article, We believe we are the leaders necessary to solve this problem, the Henry Fords of our time, designing and building a new, better way to get the job done.

Call your senator.  Call your congressman.  Call your president.  Call your personal physician and show him or her this article.  Together, we can do what all the government and greedy insurance companies have been unable to do: cut the cost of quality healthcare.

Latest Healthcare Trainwreck: IBM Watson Partners with FDA on Blockchain Driven Health Sharing

In the latest installment of "that's now how it works, that not how any of this works" by Anne Zeiger on EMR & HIPAA  The FDA picked a privately held company to partner with.  First, The FDA can't 'partner' with anyone, they are a government agency.  they can hire IBM to solve a problem, but they should not.  Second, IBM's Watson is a Natural Language Processor.  It doesn't have anything to do with health or databases.  Further, you can do the about 95% of what Watson does with any speech recognition software and a Google/Bing search.  Third, Blockchain is nothing new.  Blockchain is just a database.  That means that it is a central repository kind of like we have been advocating for over a decade.  

So what we have here is IBM using its brand recognition to even further muddy the waters of healthcare interoperability.  As stated above, Watson has nothing to do with healthcare, at least until we start needing natural language processing.  We might want it, but I doubt we will ever need it and it will be completely useless until we have that central repository database we here at Sentia Health have been advocating for years.  We have been advocating it for years, because we went ahead and built it years ago.  

Blockchain is the power behind bitcoin.  Any time you make a bitcoin transaction, the transaction details are added to the database.  We have had several articles about this over the years that you can look up and read.  The 'added' portion is important because it is like a ledger system.  All our databases use this 'added' notion because it gives us the ability to see all the transactions, in case something gets sideways, you can manually correct it.  We stated that the financial industry model (a clearinghouse) wouldn't work  because we need to see all the history for any given patient.  While the central repository is similar to the Blockchain concept, it isn't the same.  Blockchain was designed and built to manage financial transactions.  Person 1 pays Person 2 X amount of bitcoins.  In medicine, a patient could present with a headache in the left dorsal region.  They could present with his of her heart on the wrong side.  He or she could present any of several hundred thousand ways, with any of several hundred thousand concepts applying to several hundred thousand situations or body structures.

The abundantly clear single point of failure is that all the practitioners in all the world are going to have to hire software developers to scrape data out of an existing Electronic Health Records Management System (EHR), hook up to the Blockchain's web service and transfer said data in the correct format (ICD codes won't work because that only documents procedures performed, not documenting patient encounters).  There is a database for this called SNOMED_CT.   Here are two problems with using SNOMED_CT: first, the Blockchain people don't know about it, probably, and second, the existing EHRs don't use it anyway, so have no ability to translate what is in their EHR database into SNOMED_CT codes. 

Clearly, the FDA has no idea what they are doing.  Clearly IBM has no idea what they are doing, unless this is a publicity stunt.  If it is a publicity stunt, shame on them for creating noise that obscures real work done on real solutions.  Clearly, Blockchain isn't capable of handling this kind of data, currently.  ...and maybe ever.

Speaking of real solutions, those of you who follow along know that we here at Sentia Health never point out demonstrable idiocy without offering an alternative, better solution.  Here it is: our insurance company vends its own EHR based, of course, on SNOMED_CT.  Use of that EHR is free for medical practitioners.  we have designed and built a way to pay practitioners and practices in real time for procedures performed.  Our insurance costs $10/month plus the actual calculated cost of the care spread out over the insured population.  This is going to equate to about 20% less than ACA Exchange policies, and anywhere from 30% to 50% over private policies.  We will save even more as adoption increases and doctors start using our free system (with integrated reporting) instead of paying $30,000 average per year on buying an EHR and another $42,000 per year on efficacy and compliance reporting.  Even better, the practice won't have to have a medical coder or a billing department as payments happen in real time.

This new kind of insurance will be wildly popular because it doesn't cut payments to practitioners and is easier and cheaper for patients.  As they flock to our EHR, we build that central repository that the FDA is bumbling around looking for.  This isn't a pipe dream or vaporware.  We are planning releases in India, Central America and the Caribbean this year.  Yes, we will have to build some web services so the die hard, old school users can integrate their (literally) several hundred million dollar hospital EMR installation with our free system (that doesn't make much sense does it?) but that won't take more than a couple of weeks (again literally,  Our sister company Sentia Systems generates most of the software) to build.

So yes, the FDA is fumbling around showing us they don't really understand the problem, IBM is spinning, posing and posturing.  In the meantime, we have the real solution.  Maybe you should call the FDA (or your senator/congressman/president) and have him or her read this.  If you are going to partner with someone, partner with someone who can really solve has already solved the problem.