The Medical Interoperability Miracle You Are Waiting On Will Never Happen

My new LinkedIn friend, Anne Zieger Posted a new article this morning on her site EMR and HIPAA entitled "Are We Waiting For An Interoperability Miracle?"  It is well written and insightful, but for all that misses the entire point.  Anne alludes to the fact that thousands of companies, tens or hundreds of thousands of people, or more, are working on this problem and simply can't come up with a workable solution.  They can't solve the problem because the problem they are solving isn't the problem they think they are solving.

Smart guys, programmers, doctors, marketing people, et al., are simply barking up the wrong tree and eventually will get to the end game that Anne pointed out

"The cold reality is that eventually, the data sharing system we have — such as it is — will fall apart of its own weight, as organizations simply stop paying for their part of it. So while we might not need a miracle as such, being granted one wouldn’t hurt. If this effort fails us, who knows when we’ll have the time and money to try again."

Precisely.

Here is where they are getting it wrong: It isn't about interoperability.  It is about a central data store that everyone reads from and writes to.  You can have all the interoperability in the world, but if nobody knows who you home healthcare provider is, who the custodian of your medical records is, you, or your emergency room doctor or anyone else outside that system, will not be able to find and access your medical records. 

The problem is a little like looking for your keys.  You had them at one time.  You know they have to be somewhere, because you got where ever you are, but good luck tracking them down.  The analogy breaks down when you realize that we are probably going to be looking for a web service, with no graphical user interface, so not only is the entire internet the room your keys are in, but the room is sealed, has no lights, and you have to hire someone (a programmer) to design and construct you a power source, a switch and a bulb to even be able to look for them.

As stated above, the only solution to sharing medical data is to have a central repository.  There are two viable alternatives to who designs, builds and maintains this repository: The government and health insurance companies.  We all know (and had proven to us with Obamacare) that the government can't understand, or even manage people who do understand, the technology.  How late was healthcare.gov and how many times did it crash in the first few weeks?  That leaves insurance companies.  Even if a health insurance company was savvy enough to actually build a working Electronic Medical Records (EMR) system, you still have the fragmentation of not knowing which insurance company to ask for your records.  ...and it is a security nightmare.

Which brings up the point that apparently nobody can build an EMR, much less those hotbeds of technology, insurance.  Pardon my sarcasm.  There are two viable enterprise EMRs in the land, Cerner and Epic.  Cerner is built on an amalgamation of software technologies, like nearly any big company will do in order to get productivity out of programmers they've hired and have no idea what they do.  No one person has an over view of the architecture used for their offerings and it just keeps growing.  Epic's offering is written in an archaic programming language called MUMPS designed in the 60s.  MUMPS was pretty slick then, but that was 50 years ago.  Both of these packages require weeks or months of training, are difficult to use, slow and cause great gnashing of teeth at hospitals all over the country.

If you follow along with our blog, you know that we have only once identified a problem and not offered some kind of solution.   We, at Sentia Health, have designed and developed a solution that not only gives us the central repository we discussed above, but automates the entire insurance process.  That means that the doctor in Switzerland who is attempting to fix the leg you broke on your skiing trip, has instant access to your medical records.  Even better, the cost of your health insurance will go down by about 1/3 because we don't have any big buildings, no people adjudicating claims, give the doctors the EMR, free, and pay in real time based on the procedures they perform and document.  That means they don't have to pay for an EMR, a medical coder, or a billing department.  The savings is in the automation.  that means saving to the consumer.  The consumer him- or herself gets the 20%+ the insurance company wastes (as mandated by the ACA, and why the think they can't make money) replaced with a simple $10/month subscription fee.  If your insurance is $450/month, like mine is that means you immediately save $80 (.2*450 -10). your doctor doesn't have to raise prices for years because he gets to keep the $32,000 per year he currently spends on EMR, the $40,000 he spends on compliance reporting and eliminates the coding and billing departments completely.  Ad the $80 to your part of the $72,000 in savings and you get about 1/3 of the cost of healthcare just going away.  The wasteful part.  The business part.  The part that all the Harvard MBAs waste or put in their own pockets at your current insurance company.  That means that everyone will be doing things this way because it is both better and cheaper and it will organically give you your central data repository.  Go look at SentiaHealth.com and tell us what you think.  follow us on Facebook, LinkedIn and Twitter.  Call the neighbors and wake the kids: real change is coming. 

If you really want interoperability, this is the way to have it.  We are testing this design all over the world today.  We have beta testing going on in India, the Caribbean and soon in South America.  Hang on America, we are coming.  We will fix this.

The Automation Revolution is Coming, Are You Ready?

I was checking my LinkedIn yesterday and found an article by Vivek Wadhwa titled These 6 new technology rules will govern our future, where he discusses the natural destination given the direction our technology and society is heading.

I have been evangelizing for years the eventual arrival of the Star Trek universe as imagined by Gene Roddenberry where we weren't in competition for scarce resources, eliminating the need for war and conflict and where machines do most of the work, freeing us up to think and innovate and to be smart, instead of sweeping floors and typing into spreadsheets.  Mr. Wadhwa said it better than I could and codified a few particulars that will make us 'free to think and innovate.' he says (with my commentary):

1. Anything that can be digitized will be.
   We are digitizing our social lives ourselves.  Doctors have reduced our very genome to a set of data.  With a little help from an algorithm, we can already predict the likelihood of some diseases from this genome.
2. Your job has a significant chance of being eliminated.As a developer, the main thought in my day is to make my own job easier.  I write tools that help me write software.  Some of these tools write software for me.  Today, I can generate about 80% of any application I am tasked to write, with the bulk of the remaining 20% being aesthetics, or making the user interface visually pleasing and easy to use.  If I can automate what I do, I can automate what you do.  Like in this example, the only thing that can't be automated is creativity and judgment.  There will always be marketing people.  there will always be musicians and artists.  There will always be entrepreneurs.   
3. Life will be so affordable that survival won't necessitate having a JOB.Mr. Wadhwa's example was cell phone minutes.  They want from incredibly expensive to virtually free in a couple of decades.  This is the 'freeing us from sweeping floors' that I have been talking about for years.  My company, Sentia Health, has automated the entire insurance process and distilled it down to data management.  We eliminated the need for a medical coder, billing department, third party Electronic Medical Records (EMR) (we provide the EMR free of charge to practitioners) and the whole health insurance infrastructure, plus patient and population reporting for a $10 per month subscription fee plus the real cost of the actualized financial risk of providing health insurance.  All of that automation should cut about 45% out of the cost of healthcare.  EMR and compliance reporting alone cost the average doctor over $70,000 per year.  With the most important (paid) part of the equation, the practitioner, living for less as well, we can reduce costs even further.  This is the 'think and innovate' part that follows the 'freeing us from typing into spreadsheets.'  It is only a matter of time before we (or someone else) automate(s) every other industry on the globe. 
4. Your fate will be in your own hands as never before.With all this automation, you will have the time to pursue your dreams, just like in Gene Roddenberry's vision.  You can solve interesting problems, if that is your bent.  you cant paint, you can dance, you can do whatever your little heart desires.  We advocate going forth and being fruitful to solve problems.  Your particular problem might be the perfect cupcake, or the fastest paradiddle, or the grand unified field theory, who knows?
5. Abundance will become a far bigger problem than poverty.
   We are already seeing this.  With the proliferation of the dollar menu, et al., we see a rise in obesity, cardiovascular problems associated with obesity, and diabetes.  Efficiency goes up, costs go down, we can all have more, and sometimes too much.  So much for the industrial revolution, robotics, and existing automation putting us all out of work and causing us to starve.  As we have been saying, the impact is just the opposite.  Things get so much cheaper that the net is we can afford more.
6. Distinction between man and machine will become increasingly unclear.With the exception of the extreme right, we can already enhance our minds and bodies with helpful hardware.  We already have pacemakers.  How long is it before your fitbit is internal instead of around your wrist?  How much longer after that will I have to wait to have a connection to my phone and therefore the internet, hardwired into my head, and a retinal implant (that I need anyway, to combat extreme myopia) to get results back from that connection that I can read without any external device?  You can draw your own conclusions about prosthetics going forward but I have read reports about mind controlled prosthetic arms in development.

So with Mr. Wadhwa's points 1-4 you can see where I was attempting to go with my Star Trek universe example: We won't need to work, we will be freed from the drudgery of sweeping floors and entering data into spreadsheets to go forth and solve interesting problems.  I just wish I had said it as eloquently as he has.  I am going to add a number 7, however:

7. Education will become increasingly important.Precisely as in the Star Trek universe, we have to know not only what problems to solve, but how to solve them.  I'm going to go out on a limb here and advocate a liberal education as it teaches you how to think and to consider opinions outside your own.  While seemingly contradictory, I am also going to advocate a STEM (Science, Technology, Engineering and Mathematics) education.  Once you've identified a problem, you still have to have the skills to envision and enact a solution.  As evidence I present both the current and future administration's lack of ability to solve the problems in healthcare that we have.  Literally none of them have both the vision and the technical skills to see the big picture and to put a solution in place to solve the problem they've identified, that is, healthcare that is too expensive.   

So there is my vision of a Gene Roddenberry future: a life of doing things we want to do with no strife caused by competition for scarce resources.  I would caution you all to look closely at number seven because you don't want to be a 'red shirt' (The Original Series (TOS), in The Next Generation (TNG) the command crew wears red and generally gets picked off early in the episode).  You want to be educated and solve problems, be an officer, not a part of the people who can't identify and solve interesting problems.  Without everyone being well educated, I suspect we will devolve back into the feudal system where the educated produce educated children and the uneducated produce more and worse educated children.  That will result in (and may already have resulted in) divine right of Kings.  By that, I mean the haves make all the decisions and everyone else just obeys.  Looking at the last election, I am unwilling to take that analogy further, lest we end up in 1776, 1789 or maybe 2016.

We can already fully automate financial institutions.  A health insurance company is nothing more than a bank that only lets you spend the cash you've saved on healthcare.  That means we can automate banks.  We can automate the trading floor, but we should not.  If your company builds a product, you are nothing more than a financial company that manufactures something.  Ford, Toyota, and others, already automate the manufacturing of their product and we can automate the financial services.  That pretty much automates everything, if not now then eventually.

So yes, there are the predictions, along with the potential pitfalls.  I suspect that a lot of us will sit on the sofa all day, eat bon-bons and watch 'Real Housewives of Proxima Centauri b.'  Those people will have to go get a job because the automated system will see the damage they are doing to themselves and the eventual resources they will consume to combat the outcomes of these choices and hike up their insurance costs until they have to get a job.  Problem solved.  For the rest of us who decide not to be red shirts, we can expect a long and fulfilling life of doing interesting things that make us happy and of helping our fellow human being do the same.

Healthcare IT Purchasers, You are being duped!

AI (Artificial Intelligence) is not here an may never be.  If your software salesperson, and that is all they are, starts spouting 'AI,' quietly show her out of the building, she is trying to sell you a bill of goods she doesn't understand.  On EMRandHIPAA this morning, Anne Zieger posted "Are Healthcare Data Streams Rich Enough To Support AI?"  This is a little akin to asking if we should have a salary cap for Quidditch teams. 

The thing that Anne is calling AI is actually statistics.  If you want advanced statistics calculated, you call an actuary.  Those are some smart individuals, but they aren't capable of making Lt. Cmdr. Data, or the HAL-9000 a reality.  In fact, this is not a valid application of statistics, even.  Like the fictional study of psychohistory, Asmiov's premise was that 'you can't apply it to the individual meaningfully. '  The same applies with statistics, so the assertion that any amount of health data from an individual will give a system the ability to predict (chronic) illness is spurious.  Acute illness is a different thing.  The more nails you hammer the more likely you are to hit your thumb.  Unless you hammer nails for a living.  ...or you have a nail gun.  I think I just proved that you can't apply statistics to the individual.  So yes, before you yell at me, if you smoke, quit.  Smoking is a scourge on society and causes lung cancer and lots of other problems in populations.  That doesn't mean you are going to get lung cancer if you smoke.

"What about IBM's Watson?" you ask.  IBM won't call it AI even, because it isn't.  It is a 'question and answer engine.'  You could do something very similar at home with Microsoft's Speech Recognition SDK that called out to Bing to get you a list of answers.  Is that really remarkable?  Maybe it is pretty cool, but there are lots of search engines and lots of speech recognition software our there.  Sure, that's not all Watson does, but we didn't spend hundreds of man years and millions of dollars to get similar functionality either.

"I hear about Machine Learning!  That has to be AI!" you cry.  Well, not so much.  Here at Sentia Health, we created a little algorithm that told a doctor what his or her top 25 diagnoses were for the past six weeks.  This is just a database query, but the machine 'learned' what the doctors were doing at any given time.  This allowed the influenza diagnosis to rise to the top of the list during flu season so the doctors could document all flu patients the same, allowing one click documentation in the Electronic Medical Records system (EMR).  It appears that the machine learns, and if you only take the top answer, you will get a different one at different times.  We've been doing that for decades and Larry Ellison gave the masses that ability in 1979.  So no, again, nothing new here.  Nothing to see.  These are not the 'droids we are looking for.  Move along. 

So the software salesmen and saleswomen of the world are trying to sell us a bill of goods.  They have co-opted terms they don't understand for the purpose of parting you, dear reader, from your money.  This is not fairly harmless marketing like calling blue 'cerulean', red 'scarlet' or yellow 'sunshine.'  This is misleading you into thinking your IT provider has done something amazing, something akin to GPS, something you can't get anywhere else,  something they haven't done.

Always remember: Beware of Greeks bearing gifts, don't take any wooden nickels, buy low and sell high, and above all follow the money.  In this case, the money will lead you back to a salesperson who does not have your best interests at heart. 

Eliminate the Cost of Medical Reporting: $40,000+ Per Physician Per Year

This morning on EMR and HIPAA I found an article entitled "Quality Reporting: A Drain on Practice Resources, New Study Shows" by Steven Marco the President of HIPAAOne.  His article cites a study that appears in the March issue of Health Affairs titled "US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures." 

The study finds a staggering amount of resources, 785 hours per physician and $15.4 billion per year,  are being squandered on reporting:

"Practices reported spending on average 15.1 hours per week per physician on quality measures. Of that 15.1 hours per week, physicians account for 2.6 hours with the rest of the administrative work divided between nurses and medical assistants. About 12 of those 15.1 hours are spent logging data into medical records solely for quality reporting purposes. Additionally, despite a wealth of software tools on the market today, about 80 percent of practices spend more time managing quality measures than they did three years ago and half call it a 'significant burden.'"

This duplicate manual entry, shipping of spreadsheets over email, copying of files around a network, and general wasted effort (my grandfather would have said monkey motion) is not only wasting these resources, but is insecure.  Anything sent over email is sent in clear text, there is no encryption.  Even worse, Any manual system, whether it is typing in duplicate information into the reporting engine, or importing it in from a text file or spreadsheet, is going to have errors.  People just aren't designed to expend the level of attention it takes to do these repetitive tasks.

Mr. Marco, of course, makes the point that the answer is "greater reporting automation in the healthcare industry." 

Well, of course it is.  If you've been reading my posts, you know that only once have we pointed out a problem without providing a solution.  Mr. Marco apparently doesn't have the capability to actually solve the problem.  Without sounding too much like an advertisement, and I've been accused of that before, Sentia Health's EMR/EHR offering includes a reporting engine.  Once again, we've already solved the problems that others are just now noticing.  Mr. Marco states that "practices spend an average of $40,069 per physician" on reporting.  Add that to the $32,000+ per year the average physician spends on EMR/EHR and you are talking about some real money, and you see why the cost of healthcare is skyrocketing.  We won't even bring up the point that our EMR/EHR has a built in reporting engine and is free for the physician to use.  Well, I guess I just did.  Here let me stroke you a check for $72,000 every year to say "I'm sorry."

Our mantra at Sentia Health always has been and always will be to simplify, streamline, combine and automate systems.  To that end, we have developed a system that not only completely eliminates the traditional insurance company, but addresses the problems presented by HealthAffairs.org and Mr. Marco.  It's true that we have only deployed three reports so far, but these reports are done, for once and for all.  If you need a particular report, you click the button and it appears on your screen in under two seconds.  You can then save it as a Word, Excel or PDF document.  You can print it out.  It is available anywhere you have an internet connection.

Pardon me, I think I sprained my shoulder patting myself on the back, but I'm sure you, dear reader, see why.  If you see the Doom-and-Gloom naysayers shouting about problems without presenting real, ready-for-market solutions, pooh-pooh them and point them to us.  We'll show them how things can, should, will be and ARE being done.

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.