The Era of Trump: How the New Adminstration Will Affect the ACA

Today, we are going to do something we did last week and liked: look at several blogs all on one site.  This seems to give us a pulse of what people are thinking about and several perspectives to consider.  Going under the microscope today is The Healthcare Blog (THCB), where we have several articles about Mr. Trump winning the election and what that means for the Affordable Care Act (ACA), and insurance and healthcare in general.  What we will do is look at the articles individually, sum them up, and then provide commentary on their conclusions, and then our own.  If you are only going to read one paragraph, make it the last one, the conclusion.

The first article is Healthcare’s sky isn’t falling; President-elect Trump’s path forward, penned by Gary Mendoza.  Mr. Medoza is detailing what will and what won't change.  Here are the highlights: Mandated benefits and indirect cross subsidies will go away.  Inclusion of existing conditions and allowing children up to age 26 to stay on his or her parents policy will stay.

The second article, Dear Mr. President-Elect, about that Ryan Plan Thing, by Margalit Gur-Arie is basically a rant against the Ryan plan to reform health insurance and an admonition to avoid buzzwords like "Patient-Centered," "Value-Based," and "Transparency."  If you follow along with us you know that we despise buzzwords as smoke and mirrors that salesmen use to describe things they don't understand.  One great point here, though unsubstantiated, is Gur-Arie's statement that

"When you go to a doctor who runs his or her own small business, you pay half as much as when you go to a doctor that is employed by a large health conglomerate, and you get better care to boot."

It only makes sense that your personal doctor, in private practice, cares more about you as an individual patient, is lower cost due to not having to pay a big corporation for the privilege of a working for them, and make more money personally, for the same reason.  Voltaire has some interesting things to say about common sense, however.

The third article is where things get really interesting.  A Vote For Trumpcare by Niran al-Agba, a Physician in Washington State, states

"Our problems in health care have little to do with the patients or the physicians; rather it has to do with corruption of our administrators and nonessential healthcare players.   Beware of the snake oil salesmen touting their latest “solution” for the health care conundrum; instead, look to physicians with boots on the ground caring for real patients to provide tangible answers."

Strong words, but we agree whole heartedly.  What we do not agree with are some of the individual points in his manifesto, like 'stop penalizing physicians who do not use electronic health records.'  the benefits of EHRs are many and large.  Discussion of that topic is beyond the scope of this article, if you disagree you can go do the research yourself and write your own article.  What we need is a better EHR, one that doesn't interfere with care, or have an outrageous price tag.  Clearly, physicians can't design and develop software to document what they do every day.  If they could, they would have. 

Here is our conclusion based on the three reviewed articles: The ACA isn't going away, except by name.  We are going to continue to cover existing conditions and children who live at home and that is a good thing.  What we need to do is figure out how to take the business out of medicine, mostly, and to streamline processes and free the physician to  take care of patients with no other outside interference.  Sentia Health (the 'we' in this article) proposes an insurance company that provides its own EHR, free of charge, to document patient care in a way that is as fast as a physician can write, is dictation enabled, so the physician doesn't even have to write if she doesn't want to, and feeds directly to the insurance company, where we will electronically adjudicate the claim and pay for it in near real time.  This eliminates several cost centers plus the entirety of the insurance company.  We propose to provide this application as part of the insurance.  Our insurance will be billed at true, dead cost of the actual care, as determined by our actuaries, plus a small subscription fee of $10 per month.  By eliminating the cost of the EHR, the Medical Coder, the Billing Department and the whole insurance industry, we estimate that we can save the consumer about 1/3 of the cost of his or her insurance premiums.  That saves the population of these United States about one trillion dollars per year.  Go tell Trump that this is the way to save healthcare.  Get on the phone with Governor Christie and tell him to get this in front of Mr. Trump today.  This kind of innovation is the key to our future, just like it was 5 years or 5000 years ago. 

The Demise of Obamacare is Due to Health Insurance Carrier Waste and Greed.

I’m doing the daily thing this morning and peruse by a new site, HealthInsurance.org, where six of the first six articles are about Obamacare and the seventh is about health insurance carrier greed.  I wanted to make a couple of observations about what these blogs are saying.

In the first article, Harold Pollack wonders if the nation can ignore a ’drumbeat of cynicism’ and deliver health reform gains under a new administration.  Another, by Daniel E. Dawes, Dissecting Obamacare and its Impact, is an obvious softball about how Obamacare isn’t failing, it is being mischaracterized by the media.  Finally, Louise Norris tells us how to “Escape the Crush of Premium Increases.”  Basically her take is to use accounting tricks to get the government to pay part of your healthcare, get a non-compliant policy that covers only catastrophic illnesses/injuries or just do without.  I pay for government, you pay for government, why should we be forced to subsidize someone else’s insurance premium?

So once again, here we are wondering how to pay for healthcare.  I think that the first order of business is to take the business out of healthcare.  Either you are a doctor or you are a patient or you don’t need to be involved.  You who have been following along know that Sentia Health proposes to provide a free electronic health records system (EHR) to doctors that will allow them to document the care they provide for their patients.  If that patient insures with us, we will issue payment for procedures performed, in near real time.  This eliminates several systems: medical coding, insurance adjudication, the entire insurance infrastructure with the big buildings, the cast of millions and yes the money they put in their pockets (see the History (of health carrier greed) on the same page we have been talking about) and the entire electronic health records industry.  In lieu of all this wasted motion and greed, we will manage all the data for a low cost subscription of $10/month.
 

Before you comment below and flame me, this is instead of traditional insurance, not in addition to.  In the beginning, at least, we will have the same or similar policies, that work the same way, but be about 1/3 less expensive due to automating the entire process.  We will turn every dollar we collect outside of the subscription fee over to your healthcare provider to keep you healthy, instead of wasting it on real estate, salaries and lining our own pockets.  

Even better, we will provide things like a self-scheduler that will allow you to set up your own appointments with your practitioner.  We will provide a secure email system so you can email your doctor questions.  We will provide a portal for you to fill out questionnaires from home instead of sitting in a waiting room with a pen and a form filling out name, address and phone number over and over.  We will provide patient education that backs up and documents what your doctor instructs you to do and shows you how to do it.  You know can control your cholesterol with diet and exercise and this will show you how, and probably lose some weight at the same time.

Yes, we are a for profit company.  Yes, we have decided that $10 per month is enough, even knowing that your current insurance provider wastes about ten times that much and charges you, dear reader, an average of about $100 per month to manage your data.  We have plans to bring these kinds of efficiencies to every facet of healthcare and eventually to every facet of life.  If you don't like us, that's fine.  This kind of automation is going to happen, we just happen to be the first company to not only propose it, but to write the software to support it.  Use another company.  That's fine, we don't care.  Just don't continue to support the fat cat MBAs who run the current crop of insurance companies.  You deserve better than to be ripped off one more time by companies that  are literally killing people for profit.  

There is a better way.  Automation is the better way.  This is the better way.   

Solved: How to Curb Rising Healthcare Costs in the U. S.

In the United States today, there is one model for healthcare funding and that is fee-for-service. That means that you go to the doctor, get what you need and your insurance company pays for part or all of your visit.  In a perfect world, value based reimbursement would be preferable.  Your doctor keeps you healthy and you don't have to see him or her as often and you get fewer tests and procedures and everyone wins with lower healthcare costs.  In a perfect world.  In this world, doctors and practitioners are highly educated, highly paid professionals who won't see their income go down because they have worked themselves out of a job.  I can't blame them.

How do we move toward this Utopia of healthcare payment?  We create a healthier population consisting of healthier individuals.  How do we create this healthier population?  We do it the same way we do everything else: carrot and stick.  We reward the demonstrably healthy patient with discounts for staying healthy.  We reward the less than healthy patients for evidence of good choices: lower weight, lower BMI, better waist/hip ratios, and better HDL, LDL, Glucose and A1c measurements.  At Sentia Health, we call this compliance.  If a patient simply doesn't get worse they are compliant and eligible for substantial insurance discounts.  If these health measurements get better, the discounts increase.  The more healthy you get, the more discount you receive.

In order to make this work, however, we need something that currently doesn't exist: an insurance company that can adjust your rates based on information contained in your medical records.  In the old fee-for-service model, the doctor/practitioner dispenses care and documents your patient encounter however they like, then they hire a medical coder to translate the procedures performed into codes the insurance company can then pay.  In this new paradigm, the insurance company would have to have access to the entire medical record to qualify the insured patient for discounts.  Even better, we can move more toward a value/performance based system since this new insurance company could then pay doctors more for patients who got healthier, in the same way that patients who got healthier would receive discounts for being healthy.  Everyone wins.  The practitioners get paid more per patient, the patients who are healthy have lower premiums, the unhealthy get healthy and the insurance company has less risk. The costs is even borne by the people who are causing the problems, the ones who refuse to take control of their own health.

Here at Sentia Health, we actually have the system that would be the basis for this Utopian insurance company.  We already have the systems in place to allow the doctor/practitioner to document patient encounters in a free Electronic Health Record (EHR) that we provide and to see what is covered, what is not, and for how much, in real time, for the patient they have in front of them.  When a covered procedure is performed, the payment can be sent in near real time to the practice, avoiding all the current insurance monkey motion that goes on with medical coding, adjudication, and everything else that the insurance company does that doesn't need to be done.  Further, we have a patient portal so the patient can log in and get his or her medical records, secure email to the practitioner, a secure scheduling system, the ability to see images (like x-rays) that the practitioner uploads, and of course the patient education that we prescribe automatically that instructs the patient on how to get healthier and get those discounts.  This patient education is aimed at engaging the patient, showing them what is wrong, how much it is wrong and how his or her lifestyle decisions affect the tested values and there for his or her wallet.  Then we show the patient what better choices he or she can make to get that discount back, or increase it.

Sentia can provide this system to the patient (it's free for doctors, remember) for a small subscription fee comparable to Netflix: $10 per month.  The insured will pay the total actual cost of the coverage on top of that, and we will handle all those calculations as well.  This is the actual cost of the coverage this is not $10 plus what your insurance company charges you now,  on average the insured sees a decrease of 1/3 in the total insurance cost and the $10 is about 10% of what the  current insurance industry charges for the same service.  The average medical specialist in the United States spends about $32,000 per year on his or her EHR.  Since we would be providing this, that money can go back into his or her pocket immediately.  Hospitals spend sometimes hundreds of millions of dollars implementing an EHR.  That money could be better spent on improving care as well.

While the processes we automate as detailed above will save about 1/3 from the total cost of healthcare, that isn't enough.  To truly contain costs, we have to have a healthier population.  The only way to have a healthier population is to base health insurance premiums on maintaining health.  That way, the doctors who service a healthier population can be rewarded with higher payments and by being able to see more patients.  The patient who is measurably compliant will also see a decrease in the overall cost of healthcare.  For those others, they will have to carry the cost of their own decisions and their doctors will now have some 'skin in the game' as my grandmother says, to persuade patients making questionable decisions to rethink their choices.

The practitioner isn't alone in this quest for healthier patients.  As described above, Sentia automatically prescribes patient education, based on lifestyle and measured tests.  This education shows the patient how to get healthier and therefore how to get discounted health insurance.

This is the only solution that I see to the skyrocketing cost of healthcare.  I think this could be the ONLY solution.  I welcome any input, so discuss with me and among yourselves, and maybe we can fix this problem TOGETHER.

Why Obamacare is a Failure from a Doctor's Perspective, and How to Fix It.

I got an email from a fan this morning with a link to an article "Dr. Marc Siegel: What doctors know about the ObamaCare crisis (and you should, too)" by (of course) Dr. Marc Siegel.  His premise is one I haven't considered.  The plans on the healthcare exchanges don't have large diverse networks.  When you go to the doctor demanding service, you may need lab work, x-rays, specialists, and all manner of things that the general practitioner doesn't or even can't provide.  This means they can't send you to their preferred partner, down the prebuilt channel, they have to farm your referral out to some practitioner they have never heard of and then re-integrate your data from several disparate sources, back into your medical records, wasting everyone's time and money, and ultimately increasing the cost and complexity of healthcare.

Just as bad, practitioners are forced to sit in front of a computer  (a 2009 federal law mandates electronic medical records (EMR)) with his or her back to you documenting your care.  To add insult to injury, private practices spend about $32,000 per year to implement and maintain an EMR.  With the average number of patients a practitioner maintains around 2800, that means that you personally spend over $100 per year for your doctor's EMR.  Even worse than that is the fact that your hospital probably spent over one hundred million dollars on its EMR system.

You who follow along with my meanderings, here, on Sentia Health, and on LinkedIn, you know we never identify a problem with out pointing out a solution.  The solution is a have a health insurance company run by technology.  The health insurance company provides an EMR to the practitioner that is capable of documenting the patient encounter quickly and easily, showing the practitioner what is covered, what is not, and for how much for that particular patient, then pays the claim, in near real time, automatically.  This new insurance company would only charge the insured a small subscription fee of $10 per month.  That's what we, Sentia Health Services, do.

How does this solve the problem?  We estimate the we can save the consumer 45% on his or her health insurance.  We actually publish that we can save 1/3 for the same coverage by eliminating all the waste and greed that is imposed by big insurance on the practitioners and the public, medical coding, insurance adjudication, EMR, and of course excessive profit, with that $10 subscription fee. This drives insured people to us, because we are at least 1/3 less expensive, and drives doctors and practices to us for the free, easy to use EMR giving us incredible leverage to put every practitioner in the United States in our network.

I don't know what you all call that, but where i come from we say 'cat skinned.'  That means 'problem solved' to the rest of us.  As we grow, we can apply this expertise in automation to every aspect of the medical industry, further driving down administrative costs, until there is nobody left but the you, the patient, and your team of caregivers.  Even better, Sentia Health is a division of Sentia Systems where we do this kind of automation for every industry.

Share this with every person in your network.  Call ME.  Call your senators, call your congressmen.  Call Hillary and The Donald and shout to them that this is the solution they've been looking for.

Healthcare: Disruption v. Change

My routine has changed, but the search for what's going on in health IT remains.  This morning I was searching around trying to get caught up and found Brian Eastwood's musings on "A Shift From Disruption to Change" on Chilimark Research.

His basic point is one of semantics, with statements like 'Disruption is a hodgepodge of effective but disconnected point solutions' and 'Change is full-scale implementation' and 'Disruption is talk. Change is action.'

If you read my 'buzzwords' article you know how I feel about them.  In fact when I hear 'disruption'  All I can think of is Klingons (the old Klingons without the bony ridges who are apparently an embarrassment to ones with the bony ridges.  Interstellar racism at its best.) shooting at old James Tiberius Kirk (with disruptors).  On the other hand When I hear Change all I think of is Obama and the ACA debacle, but I digress.

Mr. Eastwood's underlying principle is sound.  Disruption is a path to a good thing, but not the end, in and of itself.  Change with systemic provable results is what we are after.  We here at Sentia Health have always taken a holistic view in the solutions we provide.  You've read in this very blog how we provide the entire solution, not simply another widget to hang on your tool belt.  We've likened ourselves to the various industrial revolutions in that when our model is adopted, business as we know it will be as fundamentally changed as it was from 1760 to 1820.  We propose to have ONE system per industry that does everything that industry is interested in doing.  In this case we are talking about healthcare and we have a system that will do everything that we don't actually need a doctor or practitioner to do.  All of the patient encounter documentation is easily generated with Bing/Google style searches of the SNOMED_CT database, and is rendered in a plain, easily read SOAP note with no visible codes shown or needed.  With this documentation, We can pay for a patient's claim, in near real time and cut about 1/3 of the cost out of healthcare with this increased, non-human efficiency.  Actually we calculate the savings to be about 45% with the demise of the external EMR, the billing department, the medical coder and all the internal waste and greed of the traditional insurance company.  

So yes, Mr. Eastwood is absolutely correct.  Take out all the people and all the systems and all the monkey motion except the doctor and the patient and replace it all with one automated solution that is easy to use and where everything just works and happens automatically.  In fact, I submit that this monolithic solution is the only way to actually accomplish our goals.  Otherwise we will continue to be stuck in this disparate integration nightmare of trying to have a scheduling system, an EMR, an Insurance company, and all the literally thousands of other systems that go into making healthcare 'go' today.  In fact, the medical coder and insurance adjudicator is just a slow, error prone, expensive stab at integration.  We've solved that particular problem with no people and do it instantly.

So yes, Mr. Eastwood, what we need is change, not disruption.  No, Mr. Obama, we don't need more and more government layered on top of a fundamentally flawed system.  We need efficiency.

Speaking of Klingons what we are really trying to accomplish is to live in Gene Roddenberry's Star Trek Universe where people are freed to think and innovate instead of compete for scarce resources so we can all just get along.  Like the First Industrial  Revolution, we are using our brains to increase average income and standard of living for every person on the planet and free them of the drudgery of punching a clock.  Like the First Industrial Revolution, we are creating systems that automate tedious tasks.  This is the only path forward.  This is the only way we can continue to increase growth without working harder and harder.

Here is your call to action: Call your senator.  Call your congressperson.  Call the neighbors and wake the kids.  Demand that we embrace change and growth and eschew disruption.  Heck, call me and tell me I have rocks in my head, but if you do, you better tell me why, and it can't be 'inertia.'

Automating Insurance: Pipe Dream or Inescapable Progress?

Reading along this morning I run across Steven Findlay's "Open Enrollment 2016… Can the Exchanges Be Saved? And Other Trending Questions" on The Healthcare Blog.  I don't know and don't care (neither should you) about the healthcare exchanges, It was a bad idea then and it's a bad idea now, but he shares some interesting statistics.

1. Premiums rose on average a modest 3% in 2016—to just over $18,000 for family coverage.
2. Workers paid 29% of that.
3. Employers continue to shift out-of-pocket (OOP) costs to consumers (That's how they keep the premiums down).
4. The average deductible is almost $1,500.

So while premiums are slowly rising, deductibles are skyrocketing, making using your insurance prohibitively expensive.  Basically people with high deductible plans are just giving money to insurance companies because they can't afford healthcare now any more than they could before they had health insurance.

Then I came across another article on LinkedIn by the New Economy Editor Caroline Fairchild titled "These startup founders think they can replace 5.1 million jobs. Do you believe them?" talking to people like Airbnb Co-Founder Brian Chesky, Uber Regional Manager Rachel Holt, Thumbtack Founder Marco Zappacosta.  That got me to thinking about replacing jobs at the insurance company.

The startup founders have it wrong though.  They aren't really automating much of anything but the access to information: they give you a list of people doing what you need to have done in the area you want to have it done in.  The actual making of beds, washing of towels and driving of cars or hammering of nails still needs to be done.  This isn't true automation.  If we automate those processes all those things just happen, without needing humans.

So i did a search for insurance automation trying to find an article I glanced at this morning in my feed.  I didn't find it but the search returned 448,617 results including "4 Ways Robotic Process Automation is Disrupting the Insurance Market" and "Replacing insurance staff with automation."  Lots of somebodies are thinking about this. the general consensus is that by 2025-2035 we will have semi-automated insurance.  

Since you can see the conclusion we are driving toward let's look at how much of the healthcare dollar goes toward simply paying for medical care:

1. Medical coding: 5% 
2. Transmission to the insurance company and adjudication: 5% 
3. Billing department at the practice: 10% 
4. Insurance overhead and profit (ACA mandated): 20%

That doesn't include installing and configuring an electronic medical records management system (EMR) to get the practitioners notes to the medical coder efficiently.  That costs hundreds of millions of dollars per hospital and the average private practice specialist spends a little over $32,000 per year per doctor.  Let's say that is worth another 5%. If we add that all up we get a whopping 45% of every dollar spent on medicine goes to some non-medical related number crunching company.

We don't necessarily believe that 45% of your hard earned healthcare dollars are completely wasted, but let's face facts, at least 1/3 of them are just flushed down the toilet and don't contribute to making you more healthy at all.  

So in 2025-2035 we can automate this whole process and reduce the costs by 35-45%?  Let's start a plan to do it today.  If we had an insurance company who produced an EMR free for doctors to use that was capable of documenting the patient encounter, that insurance company would already have everything it needs to pay the claim.  If that insurance company gave the doctor the information on what procedures were covered and for how much for the patient in front of him or her, there would never be denied claims, and therefore no need for a billing department.  If that insurance company charged a flat subscription fee for managing the data (that is all they really do) like, say, a Netflix does, and for a similar fee maybe $10 per month, we have just come up with an idea that cuts the cost of healthcare by 35-45%.  If your family is average you could save $8,100 on your insurance bill in 2017.  This ins't an advertisement, we don't (yet) sell insurance.  

If you follow my chicken scratchings and ramblings on my blogs, you know where I'm going next.  Sentia Health has written this application and it comes with a built in health and wellness program, patient self scheduling, secure email with your doctor, automated questionnaires that you can take at home, and a ton of other features.  Click the link and download the demonstration slide deck.  All we need to get started is a little funding to pay claims.  Get the word out, repost this.  Share it with your entire network.  There is a better way.

I don't think we need to wait on 2025-2035.  I think the future is here now.  

Real Solutions

2016 Presidential Town Hall: Enlarge the ACA v. Repeal the ACA. You're Both Wrong.

I'm watching the debate last night and Anderson Cooper lobs out the baseball that we all want to see knocked out of the park:

"Affordable Care Act, known as Obamacare, it is not affordable. Premiums have gone up. Deductibles have gone up. Copays have gone up. Prescriptions have gone up. And the coverage has gone down. What will you do to bring the cost down and make coverage better?"

We all knew what Secretary Clinton was going to say because she already said it in her open response to the New England Journal of Medicine in her article titled "My Vision for Universal, Quality, Affordable Health Care."  Basically, she wants more of the same thing that Mr. Cooper was complaining about: More ACA giving us higher premiums, higher deductibles, higher copays higher drug costs more regulation, more oversight, more government and decreased coverage.

What we didn't know was how Mr Trump would change healthcare.  He gave us the same old saw about increasing competition by selling insurance across state lines that has become the Republican mantra.  Margot Sanger-Katz wrote about that in the New York Times last year in response to Mr. Trump making similar comments during the republican debates.

“The barriers to entry are not truly regulatory, they are financial and they are network,” said Sabrina Corlette, the director of the Georgetown University Health Policy Institute.

In 2012, Ms. Corlette and co-authors completed a study of a number of states that passed laws to allow out-of-state insurance sales. Not a single out-of-state insurer had taken them up on the offer. As Ms. Corlette’s paper highlighted, there is no federal impediment to across-state-lines arrangements. The main difficulty is that most states want to regulate local products themselves. The Affordable Care Act actually has a few provisions to encourage more regional and national sales of insurance, but they have not proved popular.

My analysis of this situation is that we can't go forward with the Affordable Care Act, and we don't have anything viable to replace it.  I know it sounds pedagogic, anyone who follows this blog has heard it, but we here at Sentia Health have the answer: Health Insurance as a subscription.  Health insurance is nothing more than data management.  Insurance companies take data in, in the form of claims, and send data out, in the form of payments or denials.  The rules are well known and well understood and can be completely automated.  Where everyone misses the boat is first that the patient encounter has to be coded in ICD-10 codes before being sent to the insurance company  for payment and the fact that nobody knows what is going to get paid for in advance.  

At Sentia, we have a better way to run that insurance company.  First, WE provide an Electronic Medical Records Management System (EMR) for doctors and practitioners to use free of charge.  This EMR is sufficient to document the patient encounter completely, and in English (or any of several other languages) without needing a medical coder and shows what procedures are covered and for how much at the time of care delivery and encounter documentation.  This eliminates several processes and their associated costs: medical coding, third party EMRs, and the billing department.  The average practitioner spends about $32,000 per year on the EMR part alone.  Additionally the traditional health insurance company is allowed by the ACA to wad up 20% of your insurance premiums and do whatever they want with it.  As long as the claims are paid they can stick the whole thing in their pockets.  With the average policy running about $300/month for the individual, that equates to about $60 per month per policy.  In rough numbers 270,000,000 insured people in the United States paying traditional insurance companies $60 each per month to be completely wasted equates to $16,200,000,000 per month or $194,400,000,000 per year.  Let's reiterate that $194 BILLION wasted.  A billion here, a billion there and pretty soon you are talking about real money.  That doesn't count all the ancillary costs we outlined above.

We estimate the total waste associated with paying for healthcare to be about 1/3 (conservatively) of the amount paid.  We as a nation spend about $3,000,000,000,000 (yes, trillion with a 'T') on healthcare so that means that one trillion dollars of that goes to waste.  We at Sentia propose to replace that whole system with our EMR-as-a-Service (EaaS) that pays claims automatically as the patient encounter is begin documented in near real time.  For the privilege of managing the insurance data, we will charge a $10 per month to the insured.

Yes, we can do that.  We've already done it.  That $10 per month would eliminate over 95% of the waste and the monkey motion that goes on with healthcare finance and payment.  More of the same and unviable political solutions aren't gong to get the job done.  This isn't a shameless plug for our company either.  The plan is laid out right here.  If big insurance wants to do this, go ahead.  The Cerners and Epics of the world can't build and install a working EMR (for hundreds of millions per installation, no less), and the insurance sompanies can't automate their own processes, so I'm positive that nobody can do both, like we have.  

We need leadership, we need innovation and we need what Sentia Health provides:

Real Solutions