Break the Revenue Cycle with Direct Universal Care

Get paid in minutes instead of months

Introduction

Normally we talk about healthcare and health insurance in this space and today is no different.  In the labyrinth of U.S. healthcare, the revenue cycle stands as a notorious bottleneck—a sprawling process that turns patient care into a months-long wait for payment. From scheduling to claims submission, adjudication, and reimbursement, this cycle devours time, inflates costs, and frustrates providers and patients alike. Hospitals report $6.4 billion in delayed or unpaid claims over six months old, with administrative burdens consuming up to 25% of total spending.

At Sentia, we've reimagined healthcare finance through our four-plank plan, with Direct Universal Care (DUC) as the cornerstone for breaking this cycle. DUC empowers rural and independent hospitals to deliver comprehensive care directly—bypassing insurers, networks, and endless paperwork. Patients get seamless coverage; providers get paid instantly.

DUC dismantles the revenue cycle, drawing from our proven strategies in Saving Healthcare: Cutting Hospital Costs. We'll show how data-driven tools, automation, and smart pricing deliver care and cash flow in minutes, not months—saving lives, slashing waste, and securing rural America's healthcare future.

The Situation: A Revenue Cycle Crisis

The healthcare revenue cycle is a relic of inefficiency. It begins with patient intake and spirals through coding, billing, verification, denials, and appeals. For hospitals, this means:

• Delays Everywhere: Claims take 30-90 days on average to process, with 20-30% denied initially due to errors or prior authorizations.
• Sky-High Costs: Administrative expenses for billing and collections eat 15-25% of revenue, far above other industries.
• Rural Disadvantage: Small hospitals lack leverage against big payers, subsidizing urban giants while facing closures. Over 130 rural hospitals have shuttered since 2010, leaving millions without access.

Big systems dictate terms, but everyone pays the price. Insurers like BUCAH (Blue Cross, United, Cigna, Aetna, Humana) thrive on complexity, while providers drown in endless calls, resubmissions, and lost revenue.

The result? Providers idle while patients wait. Cash flow stalls. Innovation grinds to a halt. And in rural America, where 20% of the population resides but only 10% of physicians practice, the system teeters on collapse.

The Logical Conclusion: Collapse or Revolution

Sentia streamlines rural and independent hospitals via DUC, a direct-pay model that eliminates the revenue cycle's drag:

• Data-Driven EMR: Discrete, relational documentation for instant insights.
• Embedded Coverage: Policy details in every encounter screen.
• Real-Time Payments: Procedures paid as documented—no denials, no delays.
• Reference-Based Pricing: 150% of Medicare, one fair rate for all.
• Service-Risk Separation: $10/month flat fee + transparent risk costs.
• ERP Management: Profit/loss visibility across every financial aspect of the practice or hospital.
• Dynamic Queueing: Oldest/most urgent tasks are assigned to longest idle staff, slashing wait times.

Hospitals offer DUC to patients, partnering with primaries for full-spectrum care. Result: Payments in minutes. Costs cut by 50% for patients, 25% for providers. No more Epic, Cerner, or insurer skyscrapers.

The Slightly Longer Answer: How DUC Works

Data-Driven EMR: From Vague Notes to Actionable Intelligence

Language fails healthcare documentation. Notes are imprecise, unsearchable, and unread. They spawn code sets that obscure reality.

Sentia's EMR uses discrete values—dropdowns stored in a Relational Database Management System (RDBMS). Symptoms link to diagnoses, labs to outcomes in real time. This isn't just better records; it's the foundation for DUC.

• Universal Nomenclature: One system for all specialties, ditching 130+, specialty, legacy EMRs.
• Revenue Impact: Automates coding, reduces errors by 30%, and feeds instant billing.
• Patient Wins: Providers see full histories instantly, cutting redundant tests by 14%.

This data driven approach also drives payments.  When a practitioner documents a procedure, the practice gets paid, with no intermediary steps.

Integrating Coverage: Transparency at the Point of Care

No more calling insurers. Sentia's EMR houses policies, displaying coverage, rates, and exclusions in the encounter screen.

• Eliminates Middlemen: Brokers, agents, and third-party admins vanish.
• Real-Time Clarity: "Is this covered?" Answered in seconds.
• DUC Power: Rural hospitals self-insure via DUC, offering plans at true cost.

This integration shatters the revenue cycle's verification phase. Claims? Gone. Adjudication? Automated. Pre-Auth?  Non-extistent.  Denials?  Eliminated

Pay for Covered Procedures as Documented: Minutes to Money

Real-time detection pays procedures instantly upon EMR entry. Verification, pre-auths, denials—automated away.

• Automation Savings: AI claims processing cuts costs 35-40%, but imagine no claims at all, with no delays, no denials and no adjudication.  
• No More 90-Day Waits: Cash flows immediately, boosting liquidity.
• Error-Proof: Discrete data ensures acceptance with no medical coding.

Hospitals reclaim $25 billion industry-wide in lost efficiency. Providers focus on care, not collections.

Pay a Reference-Based Price: Fair, Fixed, Transparent

We anchor at 150% of Medicare—one price, no negotiations.

• Proven Savings: Reference pricing reduces spending 17-21%, shifting to efficient providers.
• Equity for All: Big and small get the same deal.
• DUC Fit: Hospitals set rates, patients pay directly—predictable, affordable.

Separate the Cost of Coverage from the Risk

Coverage ≠ insurance. We calculate risk transparently (e.g., procedure probabilities) and charge $10/month for data services.

• Simplicity: Replaces insurer bloat with a near no cost subscription.
• Trust Built: Patients see exact math—no surprises.
• Revenue Stability: Flat fees + risk pools ensure solvency.

This decouples admin from actuarial, cutting overhead 50%.

ERP-Style Hospital Management: Visibility into Every Dollar

Our ERP tracks everything—staff, rooms, supplies—for granular Profit & Loss statements.

• Leak Detection: Spot inefficiencies in real time.
• Cost Control: Automates inventory, forecasting—saving 10-20% on supplies.
• Data Synergy: Ties to all other systems for holistic views.

Hospitals gain what industries have: precise margins, agile ops.

Queueing System: End Linear Workflows, Start Smart Flow

Fixed assignments (one nurse, four rooms) breed idleness and backups. Queueing assigns urgent tasks to the longest-idle staff.

• Efficiency Gains: Reduces ED waits by 5-6 minutes, no-shows 50%.
• Productivity Proof: Evidence-based reports on tasks completed.
• Patient Flow: Urgent care first; no more gurneys in halls.

Queue theory in hospitals cuts length-of-stay dramatically.

DUC in Action: Rural Hospitals Lead the Way

Imagine a 50-bed rural hospital in Texas. Pre-DUC: 40% revenue cycle costs, 60-day payments. Post-DUC:

• Week 1: EMR rollout, coverage embedded.
• Month 1: Real-time payments; queues optimized.
• Year 1: 25% cost cut, 40% more patients via direct plans.

Self-insured locals flock in for ~$350 universal care. Employers strike group deals. Big systems feel the pinch forcing them to consider offering DUC themselves.

Broader Impacts: A Healthier, Wealthier System

• Patients: Affordable, accessible care. No debt traps.
• Providers: Focus on healing, not haggling. Burnout drops.
• Nation: Halves admin bloat, saves trillions long-term.
• Wellness Incentives: Rewarding wellness with double digit DUC discounts keeps people healthy.

Sentia's system, built, and deployed, not theorized and includes risk prediction and outcomes tracking.

Conclusions: The Time is Now

Direct Universal Care breaks the revenue cycle by design. It automates the automatable, prices fairly, and operates like modern businesses—efficient, transparent, customerpatient-first.

Rural hospitals become DUC hubs, partnering for full care. Self-insured patients and firms follow on price. Big systems adapt and adopt or are forced out of business.

We have shown a way to offer Direct Universal Care, eliminating the big insurers and all the things they force hospitals and patients to endure, by offering direct payments  as a subscription service to the hospital and associated practices.

We have shown a way to regulate every financial transaction a practice or a hospital enters into, the Practice/Hospital Management System (PHM).  Included with the PHM is a workflow elimination tool that extracts more and better work from employees and streamlines and automates every facet of patient care.  All that increases revenue and decreases costs.

We have shown a way to incentivize healthy living in a population and decrease chronic disease and therefore decrease costs for us all in a streamlined and automated manner.  This alone has the potential to save $1.34 trillion or about 25% of healthcare spending in the US

We have shown a way to revolutionize the way medical records are thought of, executed, used and searched.  This eliminates Epic, all the legacy EMR vendors and makes research a simple pick and click operation, saving millions of lives.

We have shown a way to integrate health coverage into the EMR.  The practice or hospital gets paid as the practitioner documents patient care.  That eliminates medical coding, verification, adjudication, pre-authorization, denials, delays, insurance networks, rate negotiations, sales/brokers/agents, money for a third-party EMR, skyscrapers in every major city, hundreds of thousands of employees, all the insurance monkey business and reduces cost by about half. 

It also eliminates Epic/Cerner AND the legacy insurers.

It also makes your facility leaner faster, more efficient and more profitable.

This system includes the automation of the health insurance industry completely, eliminating more than half the costs by Sentia as the coverage company, employer based captive or TPA or by direct payments to doctors and practices.

Here are additional points detailing the costs incurred by the legacy insurance companies that you pay currently, in addition to wasting about half your premium, 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. That is probably more than the practice makes on the average encounter.  There must be a better way. There is a better way and Sentia has it.

Remember also that these costs are over and above the 50%+ your insurance company wastes or shoves into their pockets.

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.

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