Direct Universal Care: Four Perspectives

The patient, practice or hospital, the employer and of course, the health insurance company

Introduction

Normally we talk about healthcare and health insurance in this space and today is no different.  Today, we are going to look at Direct Universal Care from four perspectives:

• The patient
• The practice or hospital
• The employer
• The big insurance companies

First, a definition. Direct Universal Care (DUC) is a model where your local hospital offers a direct model where you pay them instead of your health insurance carrier.  Direct Primary Care (DPC) has been around for a couple of decades and sports a model where you pay your general practitioner a small monthly subscription fee to manage your primary care completely.  DUC is a lot like that but encompasses ALL your care, including contracting with your primary care physician to take care of most of your primary care needs.

Benefits of Direct Care

The biggest benefit of direct care is cost.  By eliminating the big insurance carriers, you streamline and automate your care, and put the practitioner back in control.  DUC eliminates  medical coding, verification, 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 legacy insurance companies and reduces cost by about half. 

You get the same doctors, the same care, the same level of concern about your health, but cut the middle men that are the insurance companies and their associated costs.

The Practice or Hospital Perspective

Fiduciary Responsibility

For the first time in recent memory, the practice and hospital are responsible for the spend on your care and will be cognizant of how they use that dollar.  No longer will they just rely on insurance to pay whatever the negotiated rate is, they are incentivized to keep you healthy and minimize risk and therefore their own cash outlay by keeping you healthy and out of the hospital.  

Sick Care

“Sick Care” is eliminated completely.  I don’t believe that practitioners participate in “sick care” where they have no incentive to actually make you better; the more treatments you get, the more they make.  Hospitals, however, will absolutely make you drive an hour to get a blood draw instead of the Quest across the street.  DUC eliminates all of that.  Hospitals now have incentives to keep you healthy, thus keeping their costs down.

Insurance Monkey Motion

The big insurance companies don’t just waste about half your premium, and return the other half as benefits, they also make your healthcare more expensive by requiring your doctor to do things that make their job more complicated and time consuming.  These include  medical coding, verification, pre-authorization, adjudication, delays, denials and rate negotiation that all increase costs and contribute to doctor burnout.

Other considerations

Sentia also provides a complete Enterprise Resource Planning (ERP) style management system that is adequate to run a Profit and Loss (P&L) statement on anything, up to and including an employee, a piece of equipment , consumable supplies, a department or the enterprise allowing the hospital to find cash leaks and streamline and automate processes like we have automated insurance.

Conclusion to Practice of Hospital

We have shown that the practice or hospital will gain considerably in decreased labor costs and decreased aggravation from dealing with insurers.  We will talk about total costs in dollars and cents in the conclusions section below

The Patient Perspective

Much like the practice or hospital, the patient benefits by eliminating aggravation, and minimizing cash outlay.  

Minimizing Aggravation:

Finally the hospital will be able to “right size.”  Knowing exactly who their patients are they can add facilities and staff to service the clientele they have.  This helps minimize aggravation by having the appropriate staff when you need care.  Further, never again will you be hit with a surprise bill.  The hospital knows exactly what the procedure costs and will pay themselves out of your direct payment.  You don’t even really need to know what the procedure costs, only that it will be taken care of and you won’t have any surprises or an insurance company that just decides they aren’t going to pay for no discernable reason.

Cost Savings

Having a third party payer, that means your insurance company, more than doubles your costs.  Between the money that they either waste, put in their pocket or lose due to monkey motion, half is a conservative estimate.

Sentia replaces the entire health insurance industry with a quietly whirring box in a cold room.  That means you get to keep the half they waste.  The way it works is that we do all the math to figure out the risk (that is really what insurance is) and then provide you with the service for $10/month.

This divorces the cost of the service from the cost of the risk making our system completely transparent.  The prices for the procedures are all published to the internet and available to you on demand.  The prices also appear in the medical record for complete documentation.  Feel free to compare them to any system, anywhere, anytime

The Self-Insured Employer Perspective

Chances are that your employer purchases your health insurance.  They can either pay one of the big insurers on your behalf, or they can start their own insurance company, a captive, or hire a third party administrator to handle the insurance.  All of these options still involve the big insurance companies since they are the ones that do the (unnecessary) price negotiation, and price the policies.  

With DUC, your employer just calls the hospital and enjoys the same 50+% savings and lack of aggravation.  Sentias can also produce a report with details of each procedure (no names)   and another that gives the practice/hospital names and the amount owed at the end of the month for your employer.  This makes the system completely transparent and bives the employer a chance to question the practice or the hospital about potential accounting mistakes.

Once again, no muss, no fuss and cheap and easy.

The Health Insurance Company Perspective

If by the health insurance company, you mean Sentia Health, then we love it.  We have all the systems built and in place to revolutionize the way healthcare is delivered and paid for.

If you mean the old, legacy, evil, health insurance companies, I suspect they won’t hurt for long before they simply go bankrupt and remove their presence from this plane of existence.  We, you and Sentia, are going to collapse that superposition and find out that the cat is dead.  I am not going to lose any sleep over a bankrupt insurance company that quite literally kills people to protect profit, but I may do a quick scan of the neighbor’s roofs before I go outside to look for UHG snipers.

The Collective Perspective

The collective outcome of this plan impacts everyone, patients, practices, hospitals and society in general.  84% of healthcare spending in the US is on behavior-based, avoidable, chronic disease.  The mortality rate of this disease in the US is 336 per 100,000.  The average in the OECD is 225 or about ⅔ of ours.  If we could get our mortality down to their rate of incidence, we could save ⅓ of the 84% or about $1.35 trillion.  Here is our plan to do that.

Because the software we provide has a built in patient portal, we can prescribe patient education based on clinical measurement and lab results. There are examples of this education in the link above.  When the patient reads this education, they get a tiny discount on his or her health coverage from Sentia.  When they follow the education, as demonstrated by improving lab results and clinical measurements, they get a double digit discount.  This shifts the financial burden of bad health behavior to the people who are behaving badly.  

This literally pays patients to be or get healthy.  If they don’t, that is fine too, though we suspect the lack of discounts should become cumulative, rising every year, until the unhealthy patient either gets healthy or has to opt for traditional, expensive, monkey motion insurance.  Of course this won’t apply to people who can’t exercise, we have to be fair.

Since this technology saves about half from the cost of healthcare, we expect this to be quickly adopted by nearly everyone.  That means that the interoperability problem is solved, we are al using the same, universal software, and everyone has access to the same data.  Making coordinating healthcare possible for the first time.

Moreover, with the ability to produce patient lists according to any criteria, due to the use of discrete values instead of language, we can now prescreen patients for disease before it occurs.  Here is a discussion about how all of that works.

Conclusions

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, eliminating more than half the costs by direct payments to doctors and practices.  

Here are promised points detailing the costs incurred by the legacy insurance companies that you pay currently, according to Grand View Research and current as of 2023 and that Sentia would eliminate completely:

Medical Records:

• The average practitioner spends $35,925 annually on electronic medical records
• The average patient spends $106 annually on electronic medical records
• The average patient encounter or visit cost for electronic medical records alone is $32

Medical Coding:

• The average practitioner spends $20,286 annually on medical coding
• The average patient spends $60 annually on medical coding
• The average patient encounter or visit cost for medical coding alone is $18

Compliance and Efficacy Reporting:

• The average practitioner spends $17,165 annually on compliance and efficacy reporting
• The average patient spends $51 annually on compliance and efficacy reporting
• The average patient encounter or visit cost for compliance and efficacy reporting alone is $15

Totals:

• The average practitioner spends $73,376 annually on completely avoidable costs
• The average patient spends $217 annually on completely avoidable costs
• The average patient encounter or visit cost for completely avoidable costs alone is $66

Yes, you read that correctly $66 per visit.  There must be a better way.  Remember also that these costs are over and above the 50%+ your insurance company wastes or shoves into the pockets.

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 delivered and 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.