Health Insurance as a Platform

Like Netflix, Uber and eBay, but cheaper and better.

Introduction

Today we are talking about changing the model for health insurance from a traditional adversarial patient/doctor/payer “Direct interaction” to a platform that connects patients with doctors and health records automatically and pays for procedures performed in near real time.  This would cut about half out of the cost of health insurance by streamlining and introducing efficiencies.

What exactly is a platform?

Digital platforms are business models that use online infrastructure to facilitate interactions between groups. Examples include:

• Social media channels
• Online marketplaces
• Crowdsourcing websites and apps

In our case we would be matching patients with doctors and automating all the financial/payment processing in between them.

Why do we need a platform?

Imagine you want a purple ceramic alligator.  Before eBay, there would be hours of searching.  Even with the internet that would be a daunting task.

eBay connects buyers with sellers and takes care of the money for both.  They charge the seller a small fee and everyone gets what they want.

In this instance we have literally made the impossible not only possible but easy.

Let’s take a look at Uber or Lyft.  You want to go from Point A to Point B with as little expense and as quickly as possible.  Traditionally, you call the cab company and they leave the parking lot to come get you and take you where you want to go.  You have humans, you have a car driving around from wherever it is to where you are, then when you are done with it, it deadheads back to wherever it normally stays.  All this driving around and human interaction is expensive, prone to mistakes and wasteful.  With a ride sharing platform, the company finds you the closest car and automatically routes it to you.  Less deadheading and zero expensive and error prone human interaction.  

How would a platform improve health insurance?

If your health insurance company were run like a platform, you could log in, view your medical records, see what doctors are available and book an appointment all right online with zero human interaction.  For the doctor, they get a free medical records system, with all the bells and whistles including

• Integrated health and wellness
• Integrated Email
• Self-scheduling
• Questionnaires
• Reporting
• Telemedicine

Additional benefits include no medical coding, no records system to buy and automated compliance reporting.

The biggest benefit is that it would reduce costs by at least 50% by eliminating unnecessary work, removing the greedy bankers and streamlining processes.  

How exactly would health insurance as a platform work?

Like Uber, your new insurance company would allow you to log in, find a doctor, schedule an appointment and then pay for procedures performed.  Additionally, it would include all the features listed above.  This would be without adjudication, without claims being denied and without any people at all.  The platform would eliminate insurance networks by offering to pay a reasonable amount for each covered procedure.  This reasonable amount would probably be a few percentage points above the current medical consumer price index.  This would further increase efficiency by not having to send an attorney to negotiate rates with your doctor.

What are the benefits of health insurance as a platform?

As stated above, the main benefits of health insurance as a platform are cost and streamlining.  For the privilege of hosting the patient's medical data, we would charge $10 per month.  Of course, the patient still has to pay for the risk incurred but with the efficiencies introduced by streamlining and automating processes, data and communication, the cost should be less than half the current model. The need to integrate systems would be reduced or eliminated by having everyone on the same platform. The made-up requirement for medical coding would be eliminated by using a 'code' set that speaks English (French, German etc.) instead of some arcane alphanumeric unintelligible THING that only benefits legacy insurance companies. The platform would take the place of all the big buildings in every major city in the world, all the tens of thousands of people for each company, all the infrastructure and power and waste that are only designed to deny your claim. Instead of all that, we would have a cold room with a few whirring machines.  

Further, by exposing the data to the patient, we have a one-stop-shopping place for all things medical.  With scheduling, email and video communications and health and wellness, we can actually coach the patient on things that will help them live longer, better, happier and more productive lives, and consume fewer resources.  On last week's episode we discussed why the entire $4.4 trillion medical industry only raises positive medical outcomes by 20%. By exposing the patient to their own data and interpreting it for them, and by prescribing patient education based on practitioner and lab findings we can start hacking away at the 80% of medical outcomes not addressed by the doctor and can only be rectified by modifying the patient's behaviors.  

Finally, the other part not addressed by medicine is actual cost of health insurance.  By cutting half from the cost, we address this as well.  

Yes, we are quite literally saving lives.

Conclusions

Like Uber replacing the old cab companies of the world, Sentia Health can introduce efficiencies that were previously unattainable. The difference is that your cab company couldn’t promise to pay for your ride and then refuse to.  The cab company also doesn’t have hundreds of massive office towers and tens of thousands of employees whose only job is to deny your claim.  

Today we have shown a way to reduce the cost of health insurance and therefore healthcare by at least half.  To accomplish this, we streamlined and automated processes with our unique health insurance platform.  

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.  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 ours the best healthcare system in the world and also the most efficacious and the most affordable.