Four Perspectives on Healthcare and Healthcare Finance

Examining what the affected parties think about the system and how we can produce better outcomes

Introduction

Normally we talk about healthcare and healthcare finance and today is not really different.  However, we are going to talk about what the big players think about the current system, what they think the problems are and how Sentia can help make the whole thing better.

Patients

First and foremost among the concerned parties is the patient, the one who receives the benefits of the system and pays for the entire thing to spin.  But what do patients want?

What patients want

Patients want to be left alone

I think that says it all.  Patients, people, just want to not be bothered and be left to live their lives the way they best see fit.

Patients want to be healthy

Completely at odds with the first thing that patients want, to be left alone is to be healthy.  Of course, nobody is born with the knowledge of how to take care of themselves, long term, most of us use a combination of ‘make it up as you go along’ and what your friends and relatives say you should be doing.

Patients want inexpensive healthcare

Nobody wants to pay extra for anything.  I believe that we as a population think we are getting fleeced by the big insurance companies and probably the hospitals too, with lots of expensive tests and ‘upcoding.’  Upcoding is the process of switching out one procedure code that the practitioner picks for another that the insurance company will pay more for.  This is one of the things that the Epic billing system is famous for, and it drives up costs for everyone.  

Summary

Patients want to mostly be left alone.  They want to be healthy, and they are mostly willing to do what it takes, but they need access to information and advice to do what is necessary to get there.  What we need then, in the words of Dr. Christopher Vesy is an ‘Easy Button,’ a single place where the patient can go to view his or her medical records, insurance information, patient education and of course contact their practitioner.

Practitioners

Second only to the needs of the patient are the needs of the practitioners.

Practitioners want to be left alone

Medical professionals want to be left alone to practice and not be annoyed with dealing with insurance companies, regulators and hospital administration.

Practitioners want easy, accurate documentation

Practitioners hate EMRs.  Practitioners hate EMRs because there aren’t really any EMRs there are billing systems.  Billing systems aren’t granular enough and simply do not have the language necessary to document a patient encounter.

Practitioners want to automate the automatable things

Nobody wants to do the same thing day after day and just be bothered and annoyed with things that don’t change and can be automated.  Things like giving the patient information about healthy living.  Things like reports that don’t need to be hand calculated.  Things like efficacy and compliance reporting.  

Summary

Practitioners want to be left alone to practice.  They need a one-stop-shopping solution for everything they do including the medical record, the insurance information, telemedicine, secure email to answer and ask questions without being too invasive, and generally just practice medicine without the business of running the practice.  They need to be able to see what is covered and for how much, to avoid excessive cost and maybe avoid doing things that aren’t covered or figure out a better way to do what needs to be done without harming the patient financially.  Isn’t that part of the Hippocratic Oath too?  It should be.  

They also want to be able to automate the advice given to patients that isn’t really part of practicing medicine.  “Eat right and exercise” is fine, but what does that really mean?  How much time would a practitioner waste giving advice that is the same for every patient?  Automating the things that can be automated, like patient education, frees their time for the things only they can do and makes sure that correct knowledge is transferred. They want the same “Easy Button” that patients want.

Hospitals and Practices

We don’t really think about the needs of the hospital or practice, but they are crucial in this process, everything has to have a place to happen.

Hospitals and practices want to be profitable

Profit, or in the case of a non-profit, not losing money, is the name of the game.  Most of these entities are businesses and as such, they only exist to make money.  

Hospitals and practices want to automate manual processes

Let’s face it, work sucks.  If we are sweeping floors, digging ditches or running a hospital, we all wish there was a machine that could make the work effortless and easy, so we can focus on actually improving the way things are done. Imagine having a Ditch Witch® or a Roomba® that would run your practice for you.  

Hospitals and practices want to know where the money goes

This is actually a little different than being profitable but those things are related.  Making more money is exactly the same as spending less money and if you can find the cash leaks, you don’t have to charge your client patient more to keep your enterprise running.

Summary

Hospitals and practices want to be left alone to make people better.  Sure some of them are for profit, and that is fine, even necessary, but they don‘t really want to have to maximize billing to an old, wasteful legacy insurance company, and they don’t want to have armies of accountants, billers and coders to do it.  They want the same “Easy Button” that practitioners and patients want.

The Big Insurance Companies

Nobody cares what they want, everyone that doesn’t work for or depend on them for income just wants them to go away.

Summary

We don’t really need a summary here.  The insurance company should assess your risk, charge you a fee to manage the data and be done with it.  Everything they do that isn’t assess risk and pay for your healthcare is costly, wasted effort, that you get charged for. We have a list in the conclusions of the wasteful things your legacy insurance company does that don’t need to be done, but the big lesson here is that these big, greedy banks need to go away.

Addressing what everyone wants

Let’s take a look at how we can address the points about what everyone wants.  If we distill down what everyone ( except the insurers, they seem to be the problem) wants, we find that everyone wants the same things:

• Healthcare to be as inexpensive as possible
• As easy as possible with automated processes
• To not have policy dictated and work assigned to them by people that don’t help patients.

Making healthcare cheap and easy

This is probably the biggest problem in healthcare today, and not only in the US.  At Sentia, this is our main reason for being.  We have a three pronged approach to control costs.  You can read the details of this plan here.

Enterprise Resource Planning (ERP) style Practice/Hospital Management (PM) System

Every medical conference there has ever been has a breakout session on figuring out where the money is going.  Usually the conclusion of these breakout sessions is ‘put an accountant in a room with a spreadsheet until he or she figures it out.”  

This is the wrong solution.  We are working on a Practice management system that documents and tracks every penny that comes into and goes out of the practice or hospital.  It includes these modules:

• Accounting
• Asset Management
• Purchasing and Acquisition
• Human Resources
• Inventory
• Project Management
• Customer Relationship Management (CRM)
• Reporting

Together with reporting, these things control every penny the enterprise earns and spends.  This means that we can generate a full, detailed Profit and Loss (P&L) on demand and/or for a project or set of projects, like a surgery or a department.  That will immediately find your ‘cash leak.’

For publicly traded facilities that means that you can no longer hide the money, it will become painfully apparent where the money goes when the shareholders or board of directors asks for a P&L in real time.

To read more about the PM system and how it works, click here.

Health and Wellness

The OECD average mortality for behavior-based, avoidable chronic disease is 225 deaths per 100,000 in population.  In the US it is 336, about a third higher.  If we account for the fact that this behavior-based, avoidable, chronic disease consumes about 84% of all healthcare spending in the US and we spent $4.9 trillion in 2024, then we can say we spent over $4 trillion just on avoidable, behavior-based disease.

If we can use the health and wellness module discussed above to just get us down to the OECD average, we could save $1.34 trillion dollars as a population.  This won’t be immediate but will happen over time.

To encourage people to read and comply with our patient education, we will offer a small discount for simply reading it.  If they comply with it, as evidenced by better, or at least not worse clinical measurements and lab results, then we can offer a double digit discount on health insurance.  This gives the teachable a big discount for saving us all money, and the risk is shifted to the people who are costing us money by making them pay more.  …I mean not giving them the discount.  For a detailed discussion of the health and wellness program click here.

Automating Health Insurance

We stated above that we “are working on” the ERP style PM system.  We have a solution in place, built and deployed, that automates the entire health insurance system.  To accomplish this task we provide the Electronic Medical Records System (EMR) to the hospital or practice.  As the practitioner documents the patient encounter, we detect procedures performed and pay for them in real time.  

This eliminates medical coding, pre-authorization, insurance networks, adjudication, delays, denials, rate negotiation, sales/brokers/agents, the cost of a third party EMR, skyscrapers in every major city in the US, and the hundreds of thousands of employees that work at the insurance company that you, as the insured, pay for.  

For the privilege of managing your data we charge $10 per month.  Of course you have to pay for the risk incurred, but you are already doing that.  For a detailed discussion of risk, what it is and how it is calculated, click here.  The $10 per month replaces the list above with automation.  We do it all and save you about half, which is what your legacy insurance company simply wastes or steals.  

That bears repeating: we will save you about half.

To see a demonstration of this system in action, click here.

Conclusions

Take a few minutes and click the links and read the details about how this plan actually works.

If we transfer all hospital savings to doctors either as cash payments or less work, that is, time off to avoid burnout, and the health and wellness process is successful, and we save 50% by automating health insurance, we are looking at a 75% savings; 50% immediately from automating of health insurance and another 25% over time as the incentives kick in.  The least expensive country in terms of per capita expenditures on healthcare is South Korea, the insurance automation alone should put us on an even footing with them.  Cutting out another 25% of the whole or 50% of the remainder makes healthcare in the US about half the cost of the cheapest in the OECD, while not affecting how medicine is practiced, nor reducing care and decreasing doctor burnout.  

This is also the only plan that actually works and doesn’t cost twice as much as everyone else, in fact, half of the cheapest over time.

We have the health and wellness and the EMR built and deployed for use right now.  The ERP style PM system has been designed and is in the process of development.

Contact us here or on our site and we will be happy to provide a demonstration of the fully functional prototype.

If you liked what you read, please like and subscribe, click on the notification icon, subscribe to our newsletter, and follow us on all our social media and blog sites.

We have built a comprehensive health information system to keep the patient healthy and on the right track with the ability to incentivize healthy living. This system includes the automation of the health insurance industry completely.  We have designed and are currently building the ERP style PM system.  Implementing this system should be fairly simple and will completely revolutionize the way healthcare is paid for, saving countless lives. We have shown a way to use this system to make the best healthcare system in the world also the most efficacious and the most affordable.

If you liked what you read contact us here, on our site, SentiaHealth.com, our parent company SentiaSystems.com, or send us an email to info@sentiasystems.com or info@sentiahealth.com.