Brian Thompson’s Assassination was COMPLETELY Avoidable
Fixing healthcare finance makes the best healthcare on the planet also the cheapest.
Introduction
Brian Thompson was the CEO of UnitedHealthcare. We are going to show why his assassination was avoidable. We never condone violence, however, the policies of his company certainly contributed to the motive for murder. Had he followed our plan to save 60% of the cost of health insurance, He would still be alive today and the US would have not only the best medical care in the world, but also the cheapest. We will prove this in our usual problem/solution format.
The Problem
All health insurance companies use armies of people doing thousands of manual processes. UnitedHealthcare employed 440,000 people in 2023 and is growing by double digits every year. All those people have to have places to work, equipment to work on, power, air conditioning, networking computer systems and all the things that go with big business. They had a revenue of $371.6 billion in 2023 and a profit of $22 billion, according to Forbes. The math states that they, therefore spent about $351.6 billion on whatever it is they think they need to be doing. They serviced 122,010,000 people during that period. The math tells us that the insurance costs 3045.65 per year each and they consumed $2881.73 of that doing whatever it is they think they need to do. If this sounds low, it is, they are a third party administrator (TPA) for many of these 122 million people meaning they don’t’ actually pay for the care, they just keep track of the patients, payments and their procedures. The ‘self-insured’ company these people work for actually pay for the healthcare. What this does include is dismissing one of every three claims, 32% artificially and illegally driving down the costs of doing business. If you and everyone else isn’t angry with UnitedHealthcare, you aren’t paying attention. If you aren’t angry with all the current, legacy insurance payers, you aren’t paying attention. You SHOULD be angry. We can’t and wouldn’t shoot a businessman and advocate that nobody does, but maybe we can understand a little.
The Solution
The Short Answer
We here at Sentia are in the business of streamlining and automating processes. We have even automated many of the processes of writing software and no, it isn’t AI, you can’t use AI for this. Similarly, we’ve streamlined and automated the health insurance process. We designed and built a universal Electronic Medical Records system (EMR). We provide this to your doctor free of charge. That allows us to detect procedures performed and pay for them in real time. Your health insurance company becomes, therefore, a (loudly) whirring machine in a cold room. It is completely automated. We don’t have 440,000 people trying to figure out a reason to deny your claim, no big buildings, no $351.6 billion in expenses. If you want to skip the details, go to the “Financials” section below. It details how we can save a full 60% from the cost of healthcare, and those are conservative numbers.
The More Complete Answer
We detailed this new insurance system in our article “Changing Healthcare, a Fifteen Minute Explainer,” but it bears repeating. We mentioned a ‘universal EMR’ earlier, here is why: Epic, Cerner, Athena and hundreds of other vendors produce EMR systems. They are doing it wrong. What we need is a simple, elegant program that captures everything the physician does with a universal ‘code’ set. That way we can document the entire patient encounter without using an archaic method that only details diagnoses and procedures and ignores everything else, like ICD and CPT do. Sure, some practices or specialties do specific things that only they need. To mitigate that we have a tool that allows us to configure a checklist or request for information from the clinician. The practitioner types in a question once and that question then appears in the medical record forever more, along with the appropriate answers. This is fully customizable and can capture any data for recall later. The combination of this universal code set and the configurable questionnaires comprise the entirety of the EMR, making it lightweight, configurable and easy to use.
UMLS
What we need for this EMR is a universal code set. The smart people at the National Institutes of Health have codified dozens of disparate data sources, like SNOMED_CT, ICD9/10, CPT, plus many of the legacy EMR systems code sets into one database called, oddly enough, the Universal Medical Language System (UMLS). There are over 14 million concepts plus VSAC and RxNorm. This is truly a one stop shop and it gets even better: once you understand how this database is put together, you can look for anything using the exact same code and procedures, whether it is Epic codes or drugs or SNOMED. Even better, there are built in programmatic crosswalks that will automatically find related concepts in another nomenclature, giving us the ability to translate back and forth almost automatically.
Patient Education
The other thing that will reduce cost is patient education. If we can get Americans to move around a little and not engage in risky behaviors, they will live longer and consume fewer medical resources. We already know that if you tell an American to get an Xray, MRI or some other test, they will just go get it. That points to the fact that if you make it easy for the patient to comply, they will.
Of course, it is far easier to sit on the sofa and flip channels than get in the gym. Since we have control of the system, through the EMR, we know when the patient reads his or her education and how long it took. If they change their risky behavior, we can measure that with clinical data. The patient will lose weight. The patient’s HDL will go up and the LDL will go down. Measurable changes will happen. When they do, we can offer discounts for good behavior. If you don’t follow the education, your rates will increase. This puts the teeth in the patient education that we need to save American lives and drive down the cost of healthcare.
Other Modules
To really spur adoption, Sentia needs to provide everything the hospital or practitioner needs to get the job done.
- Integrated health and wellness
As described above, demo on request. - Integrated Email
You can’t send medical information over email, it isn’t secure. We provide an email-like interface that IS secure - Self-scheduling
Patients will be able to schedule a 15-30 minute appointment with a chief complaint, reducing staff. - Questionnaires
This eliminates the reams of paper in the waiting room, can be completed from home, or anywhere, and having staff to type the answers into the system. This is also the same functionality that makes the EMR universal, eliminating the need to design and build 135 different specialties. - Reporting
Once this system is up and running, we can write reports to cover everything. Profit and loss, inventory, room utilization, the answers to individual questionnaires, or the aggregate of all questionnaires. Even a tax return is nothing more than a report that should be a one click process, when all the information is available. - Telemedicine
Let’s get rid of the brick and mortar (almost) completely. Much of what happens in medicine doesn’t require a change of venue, or even a venue at all. - DICOM/Image viewer
The ability to share and image across the internet isn’t new, but seeing the face of your practitioner and sharing an Xray or an MRI and being able to draw on it or show a reticle to highlight structures is. - Practice Management (coming soon)
With all the modules above we have all the information we need to fully manage the practice or hospital. Inventory, personnel, utilization, scheduling the whole ball of wax becomes a few clicks. This is actually a fully-fledged Enterprise Resource Management system (ERP) that will allow the practice to design and maintain their own configurable processes.
How do we get there (What makes us different)?
Yes, Epic, Cerner and others are decades old and have been continually writing code and ‘improving’ their products. Sentia has a few things they don’t.
Architecture
Databases and applications
We have a well thought out and executed architecture that groups functionality. We have a Single Sign On (SSO) system that is the repository of all things security (authentication and authorization) that all our modules use. Second, we have a Master Data Management (MDM) database that holds all shared information. Only the data for the application is stored in the application, everything that could be shared between applications is stored in the MDM.
Back End for Front End (BFF)
Each User Interface has its own back end for front end layer that aggregates all the various database calls into one place. Insure is our product that shows us what a patient’s insurance deductibles, co-pays and co-insurance are. Insure also allows us to produce an accurate estimate of the cost for any procedure based on his or her current, legacy insurance and the practice’s negotiated rates. The Insure BFF combines the Single Sign On, Master Data Management, Eligibility, Integration and of course the Insure APIs. This gives us a single point to program against and makes code reuse as easy as possible.
Automation
We wrote a program that generates the architecture described previously. The application API and its BFF are generated automatically. The developer can then paste the SSO and MDM models (that were generated previously) into it from source control to have about 60-70% of the coding done on the first day of development, based on the database design. This is how we replicate the work of literally thousands of people, like legacy insurance, with fewer than ten in the same amount of time.
Benefits of this Process
First and foremost, this is a comprehensive rethinking of healthcare finance. Second, with the additional modules we can solve the problems to save 60% of the cost of health insurance. There are four financial benefits to this process:
- Your old, legacy insurance company only returns 53% of your premium as benefits. With Sentia’s new system that uses its own EMR to detect and pay for procedures we can give the patient back that 47% in lieu of a $10 per month health insurance subscription on our platform.
- With this EMR comes the elimination of medical coding, compliance reporting through automation and insurance adjudication, cutting the financial burden on the practitioner by over $70,000 per year per practitioner.
- Decreasing costs by providing built in, science based patient education with incentives to live a healthier lifestyle in the form of discounts for demonstrated healthy behavior through clinical data, we further reduced the cost of health insurance through increased population health and reduced payments for behavior based chronic disease.
- By mitigating the risk of extremely high-cost care individuals through reinsurance we have further reduced costs by an average of 12.5%
There are four benefits to patients and practitioners.
- Reduced costs for all
- Increased wellness due to reduced cost and patient education
- Increased profits for all practitioners on the system
- Reduced complexity for each practice on the system, further reducing costs.
The Financials
The average monthly premium for health insurance in the US is $477 per month for a 40-year-old individual. If we could cut this by half, and we can, that monthly premium would turn into $239. The drop in price does not include the $70,000 each practitioner spends on EMR, compliance and efficacy reporting and billing, coding and collections. Much of this savings would be passed on to the consumer in the form of decreased costs. This also does not include the education windfall. As Americans are fully informed of the consequences of their health behaviors, we have shown that they will change these behaviors, resulting in decreased risk and therefore decreased costs. 84% of healthcare expenditures in the US are on behavior based chronic disease. If our patient education system could reduce this by just 25%, we would see a 21% overall decrease in expenditures and save lives. That would reduce the 239 down to about $190.80 over time.
We already know that we have the best healthcare on the planet and cutting the costs down under $200 Per month would make it among the most affordable. As the population gets healthier, and Sentia takes over some of the more wasteful practices, we could see this dramatically drop to the most affordable while maintaining the best quality of care. Eventually, we will move to a pay-for-health or value-based care instead of a pay-for-procedure model. This would give the practitioner incentive to keep his or her patients healthy instead of rewarding performance of procedures.
Conclusion
We called Brian Thompson. We didn't get hold of him, but we did try. We extolled the virtues of this plan from the rooftops to anyone at UHC that would listen. This plan will save the American insurance buyer 60+% and put almost $300 per month back in your individual pockets on average. That puts us on an even footing with South Korea, some of the cheapest health insurance the developed world, while giving us US levels of care. Had we been able to convince Brian Thompson to adopt our plan, he would still be alive today.
Call to Action
We addressed all the issues that got Brian Thompson killed. We have shown a way to reduce the cost of healthcare and health insurance by far more than 60%. Then, we will be not only the cheapest medicine in the world, but also the best. We already have the best doctors and the best equipment; we just need to implement the above detailed framework to give them all the tools necessary for success.
We have this system in prototype now, fully functioning.
Contact us here or on our site and we will be happy to provide a demonstration of the fully functional prototype.
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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 the best healthcare system in the world also the most efficacious and the most affordable, and a way to move toward value-based care. See the video version of this article at Sentia Health - YouTube or click the video below.
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