Saving Healthcare: Putting all the Pieces Together

We’ve talked about practice/hospital management, health and wellness, EMR and integrated coverage, now let’s look at the big picture

Introduction

Normally, we discuss healthcare and health insurance in this space and today is no different.  Today we are going to show a holistic way to automate healthcare finance and health and wellness as much as possible and put some dollar values to the solution.  We will talk about three perspectives on each system, and what the benefits and challenges are. We will start with the least monetarily efficacious, but most impactful to clinicians, of our solutions and move toward the most financially impactful of Sentia’s four planks in our healthcare revolution platform.

Practice/Hospital Management (PHM)

To effectively manage a hospital or practice you need some kind of Enterprise Resource Management System (ERP), that brings all financial aspects of the enterprise together facilitating a single Profit and Loss statement (P&L) for any entity or combination of entities.  That means we could generate a P&L on any employee, room, piece of equipment, consumable, procedure, or any combination of these things, or even the enterprise with a single button click, by just swapping out the underlying data source.  This will pinpoint inefficiencies and ‘cash leaks.’

How it Works

We track the financials and work produced for several different practice and hospital systems as detailed in this article:

• Financial Management
  ERP systems are used to manage financial transactions, produce financial statements such as balance sheets, manage companies' tangible and intangible assets, and track money owed by and to the organization.
• Supply Chain Management
  ERP systems help to monitor the stock levels, track inventory movement, manage the movement of goods, and automate the purchasing process.
• Human Resources
  In an organization, ERP systems help to manage employee records, automate payroll processing, and manage recruitment and onboarding.
• Customer Relationship Management (CRM)
  ERP systems help in sales automation, automate marketing campaigns, track customer interactions, and improve customer satisfaction.
• Project Management
  ERP systems support project planning and scheduling, and monitor project time and expenses for accurate cost estimation.
• Manufacturing
  ERP systems help in production planning, list all the raw materials required for product manufacture, and monitor the production process.  While it may appear that a practice or hospital doesn’t need manufacturing, they do provide a service that requires labor, capital, consumable and equipment assets and of course real estate, just like making a widget.

Now that we have a financial record of everything that goes on in the enterprise, we can build the one-click report we discussed above, all we have to do is switch out the data source.  This gives administration a window into every financial aspect of the practice or hospital in order that they might manage it appropriately. Gone are the days of an accountant sitting under fluorescent lights typing numbers into a spreadsheet to figure out why the financials aren’t as expected.

Workflow

The real innovation behind this system is eliminating workflow.  This article details why there is no workflow.  We understand that there is a reason for workflow thinking but it isn’t really valid.  Medical professionals want continuity between themselves and the patient.  This is fairly valid at the General Practitioner (GP) level, but most GPs band together in practices of less than a dozen or so. Continuity isn’t really a thing.  You go see “your” doctor.  Even at the GP level there are dependencies; you have to have a patient and an empty room  before you can have a patient encounter, but that isn't workflow.  

At the hospital level, most medical professionals do not need to be assigned to a patient in a workflow kind of way.  We designed queues for all but the practitioner, doctor, to take care of patient needs.  These services are generic, technicians, nurses (I know you don’t think your care is generic, but it is), staff, food service and in some cases even practitioners.  Work is assigned to queues, like food service or housekeeping, or even the two hour checkup from the nurse in a “most needed action” kind of way.  If a patient hasn’t been checked on in two hours, they will appear at the top of the queue.  The first available nurse will go and check on the patient.  All work performed will be handled with these queues.  Of course there are emergencies that have to be immediately promoted to the top of a queue.  There are “all hands on deck” moments everyone needs to go to the point of the emergency and stay there until it is mitigated.  

By keeping everyone busy all the time, this will eliminate patients in waiting rooms, tasks slipping through cracks, patients on gurneys in the hall, staff standing around talking or “charting” (there is no charting) and increase productivity by orders of magnitude.  The person with the time does the task that is most necessary and then moves on to the next task in the queues that have been assigned to them.  

The key to managing the queues is to mark a task with an outcome.  Complete, room cleaned, test ordered, surgery scheduled, whatever the outcome is, we can only release an employee from a task with an outcome for the task.

My mother was in the hospital over Thanksgiving for eight days.  The holdup was the need for an MRI.  She had a bladder control implant, and the MRI department wouldn't do the procedure without disabling the device.  Assigning the task "Research Bladder Control Implant”  to a queue and consequently to a single qualified person would have cut down my mother’s stay from eight days to a couple of hours.  

Benefits

Of course, we can tell how much work an employee is doing.  While that might sound a little corporate-ish, and medical professionals aren’t corporate, they are more like artists, but it is going to get really uncomfortable in the board room when the hospital isn't making money or has small margins or is doing performance reviews, or wants to shrink margins, or make more money, or basically anytime.  Gone are the days of “let’s wait until the end of the month and see how much money we have left over, and call that profit.”  We can definitively answer the question “do we need a new MRI Scanner or a Proton Beam Therapy System  with real, hard data that shows us the utilization and the P&L for the old ones.

Caveats

Everything the enterprise does or has will have to be issued a barcode.  There will have to be a barcode reader for every point of use where a consumable is used, a service rendered or equipment implemented.  Every employee will have to have some sort of queue reading device and/or a communicator.  The easiest to implement would probably be a smart phone with the Sentia PHM application installed on it.  That would allow for the required tracking of supplies, tasks, and equipment usage, and also the communication to coordinate emergency response and direct communication.

Perspectives

The Patient

The patient won't even know this system is in use.  Patients generally don’t know who their staff is in any case, rarely more than the name of a doctor or nurse, and even then the nurse changes two to three times per day.

The Practitioner

The practitioner will have all tasks queued and all notes available on their communicator at all times, easing the burden of figuring out what the best use of their time is and letting important tasks slip through the cracks

The Practice or Hospital

The hospital gains the ability to run a P&L on anything; a room, an employee, a piece of equipment, (a) procedure(s), supplies of any combination of those.  This is the very first time that there will be a complete financial view into the enterprise.  Consequently that will make real performance reviews more than popularity contests, and support decision making at all administrative levels.  It will also make better use of existing employees, existing infrastructure and everything the hospital purchases or uses.

Health and  Wellness

84% of all healthcare expenditures in the US are spent on behavior-based, avoidable, chronic disease; over $4 trillion in 2024.  The Organization for Economic Cooperation and Development (OECD) states that in 2023 the mortality per 100,000 in the US was 336.  The average of the OECD countries was 225 per 100,000.  That is ⅓ higher.  If we can get our mortality to the OECD average mortality, we could save ⅓ or about $1.34 trillion in 2024.  These numbers come from this article.  

Our system automatically prescribes patient education on whatever abnormal results found in the patient’s data.  This patient education is not only an indication of a problem but a proposed solution.  Since our Electronic Medical Records System (EMR) can identify patients by clinical measurement and lab result, patients can be flagged for future follow up and extra care.  This not only generates extra revenue for the practice, it also keeps patients healthier and results in lower costs for us all.

That’s great, but how do you change a patient’s behavior?

We actually pay patients for improving lab results.  For a patient that comes in already doing what they should be doing with normal, acceptable clinical measurements and lab results, we apply a 15% discount to their health insurance (more on that later with the EMR/coverage discussion).  For patients with less than perfect results, we prescribe patient education based on clinical measurements and lab results for them to read, understand and follow.  When the patient complies with the education and improves his or her results, s/he regains the 15% discount.  Notice that the measurement and results don’t have to be perfect, just improving.  For those patients who don’t improve or get worse, their coverage continues with the lack of 15% discount and an additional 15% per year to shift the financial burden of bad behavior to the bad actors as a consequence.  Yes we understand that you can’t legally raise people’s premiums based on behavior and lab results.  We will challenge this legislation in court if and when we are sued or proactively sue the federal government for making such a short sighted statue.  In every other facet of life, behavior good or bad has consequences, intended and unintended.  This is no different.

Eventually, after about four years, the coverage will get so expensive that it will be more economically feasible to find alternative insurance, removing the burden of their future care from our risk calculations.  This saves the better behaving patients the financial burden of caring for those who will not care for themselves.  

Perspectives

The Patient

From the patient’s perspective,they get automatically prescribed education to help keep them healthy and earn a 15% discount.  I am sure that the people who refuse to exercise and eat well and don’t earn the 15% discount will not be best pleased, but every one else will when they alone shoulder the burden for bad behavior.

The Practitioner

Practitioners can rest assured that they don’t have to shame the patient into better diet and exercise.  Since the education is prescribed automatically and we can tell when the education is opened and read, then this removes some of the burden from the practitioner for educating the patient.  As the population health improves, there are fewer cases of behavior-based, avoidable chronic disease, easing the practitioner's workload.

The Practice or Hospital

With ⅓ fewer patients with chronic disease hospitals can repurpose facilities and infrastructure for dealing with accidents and unavoidable disease.  This streamlines operations.  

Electronic Medical Records (EMR) with Coverage

The premise is that Sentia, as either the insurance company, TPA/Capture or Direct Universal Care (DUC) facilitator, put the coverage right into the EMR.  This requires several things that are unique in the EMR space and haven’t been done by any other company as we will discuss below.

As an aside, we do not use the word "insurance" when referring to ourselves.  “Insurance” is legacy, complicated, expensive and just evil on many levels.  We at Sentia say “coverage.”

Let’s discuss what makes us different and what it takes to achieve that difference.

Data Driven

All other medical records systems rely on “notes” to document patient care.  We don’t do things that way.  WE based our EMR upon the existing, standard Unified Medical Language System (UMLS) provided by the National Institutes of Health (NIH).  This unified system combines several nomenclatures including Systematic Nomenclature of Medical and Clinical Terms SNOMED_CT, Value Set Authority Center (VSAC) and RxNorm.

SNOMED_CT

SNOMED CT is one of a suite of designated standards for use in U.S. Federal Government systems for the electronic exchange of clinical health information and is also a required standard in interoperability specifications of the U.S. Healthcare Information Technology Standards Panel. The clinical terminology is owned and maintained by SNOMED International, a not-for-profit association.

SNOMED is adequate to document the entire patient encounter both with top level concepts and related concepts, but also 17 categories of other concepts like modifiers, clinical findings, and procedures.

VSAC

The VSAC is a repository and authoring tool for public value sets created by external programs. Value sets are lists of codes and corresponding terms, from NLM-hosted standard clinical vocabularies (such as SNOMED CT®, RxNorm, LOINC® and others), that define clinical concepts to support effective and interoperable health information exchange. The VSAC does not create value set content. The VSAC also provides downloadable access to all official versions of value sets specified by the Centers for Medicare & Medicaid Services (CMS) electronic Clinical Quality Measures (eCQMs). For information on CMS eCQMs, visit the eCQI Resource Center. The VSAC is provided by the National Library of Medicine (NLM), in collaboration with the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP) and CMS.

The VSAC allows translation between the disparate, proprietary, legacy systems so that Sentia’s EMR can be used with wasteful, inefficient, legacy insurance.  As care is documented in Sentia’s EMR, we can use VSAC crosswalks to downgrade our SNOMED concepts to ICD and CPT codes the manual insurance companies use.

RxNorm

RxNorm provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software, including those of First Databank, Micromedex, Multum, and Gold Standard Drug Database. By providing links between these vocabularies, RxNorm can mediate messages between systems not using the same software and vocabulary.

RxNorm now includes the United States Pharmacopeia (USP) Compendial Nomenclature from the United States Pharmacopeial Convention. USP is a cumulative data set of all Active Pharmaceutical Ingredients (API).

This allows Sentia to implement a fully fledged prescription drug database, with pharmacy management and drug interaction capabilities.

Data Driven Conclusions

The big EMR vendors followed Judy Faulkner’s (Epic’s progenitor) lead in the early 70s of putting the handwritten “note” behind the glass of the computer monitor and calling it ‘documentation.’  This method of documenting care is just as bad as paper notes.  It is just as difficult to search, does not correlate symptoms with treatments or outcomes, takes forever, and simply goes into limbo once care is documented as only one other person will ever read typed in “notes.”  Further, because the “notes” are typed in text, they have to be coded by a human into the nomenclature the insurance company uses to pay claims.  This medical coder is the one other person mentioned above.

Conversely, with data a data driven EMR, we can correlate symptoms to observations, to measurements, to lab results, to diagnoses, to treatments, to outcomes.  We can look at any number of symptoms and have the system suggest diagnoses related to all the symptoms, with a positive outcome.  We can search for patients with markers for chronic disease and make sure they get the treatment they need before they develop complications like heart disease or diabetes.  Take a look at the Patient Lists heading in the EMR Demo article.

Data driven also means we can use SNOMED concepts, along with a price for procedures to fully automate the health insurance industry.  More on that later.    

No Specialties

If you took your 911 into the Porsche Service Department and found that they have a separate documentation system for the engine, the transmission, the suspension, the electronics, the body, ad nauseum, you would run, not walk, to the nearest Ferrari dealership and trade it in.  This is the correct response.  Why would you need separate systems for each of the major (and minor) systems on your car?  We have specialists, sure, for all those things, but a separate documentation system is just less than bright.

Why then do we need specialties in medical documentation?  Hint: you do not.  In fact, not only do you not need them, you can’t have them in your patient care documentation system.  Epic and Oracle/Cerner have over 130 different programs, one for each specialty that all do the same thing.  This is another example of Judy Faulkner’s lunacy, and everyone else just followed right along.  Think of the armies of expensive humans necessary to maintain and update these legacy, badly written, trainwrecks.  This is why there are Epic installations that are charged at  over a billion dollars

Since Sentia uses the UMLS, we have a nomenclature adequate to document any patient encounter.  There are no armies of expensive programmers, managers to herd the programmers, managers to herd the managers, buildings and lights and infrastructure to house the tens of thousands of programmers.  We have about 30 highly skilled developers who build the system and just a few architects to read and vet the code they turn in.  This is all that is necessary to build and maintain everything that we do.  The upshot is that not only is what we do actually viable, but is it fairly easy and certainly orders of magnitude better, faster and cheaper than anything Judy Faulkner and company ever dreamed of.

The EMR Itself

We published a demonstration of our system in action and referred to it earlier by sending you, dear reader, to the Patient Lists heading.  If a picture is worth a thousand words then a video must be worth ten thousand.  Sentia Health’s Electronic Medical Record Demonstration shows our system working in real time.  I personally shot these videos from my own machine as I was documenting a sample patient encounter.

The EMR has these additional features

• Individual Health Risk Assessments Report
• Population Health Risk Assessment Report, suitable for proving Value Based Care (VBC)
• Automatically prescribed patient education, as detailed above
• Complete, single page encounter documentation
• One click documentation based on previous encounters
• Imaging and Documents (DICOMs, and all imaging formats, plus any other document or file you want to attach to a patient encounter
• Secure “eMail”
• Patient Self Scheduling for GPs
• Patient Lists as described above
• Telemedicine

Go take a look at the demo in the link above, I think you will be pleasantly surprised by the ease of use, obviating the need to spend six weeks in Vegas for “training.”  I have yet to spend more than 15 minutes training anyone to use the system.  You know how medicine works, this supports that; you are already trained by your education to use the EMR.

Perspectives

The Patient

The patient gets a streamlined, insurance free, delay free, denial free, seamless experience that costs about half of traditional insurance.  We have been researching plans with no copays, coinsurance or deductibles as well.  This is just a risk proposition, of course, as usage increases the cost of the risk increases, so we will see that the patient’s appetite for higher risk v. copays and deductibles

The Practitioner

Practitioners get the peace of mind of knowing that they won’t be second guessed by some bizdiot at the insurance company.  There is no delay in care, no worry of denials of a procedure.  If the patient needs it, the patient gets it.

The Practice or Hospital

The practice or hospital gets to completely do away with medical coding, delays, denials and all the associated insurance roadblocks and monkey motion along with the costs they entail.  Our system will work with legacy insurance, but all the things they make you do will still need to be done.

Integrated Coverage

Since Sentia has the only data driven EMR on the market, based on the UMLS, we can simply assign dollar values to covered procedures, assign procedures to plans, and provide the plans as policies to assign to patients.  It is just that simple.

Once I had the idea to integrate coverage with EMR, the actual coding only took a few days, because we used the data driven discrete values discussed above to associate procedures with payments.  This is exactly why we can’t have language to document patient care and the reason we make disparaging remarks about Judy Faulkner.

Plan Pricing

There are two things Sentia will charge for: access to the system/data management and risk.  To be perfectly transparent, we separate the cost of the service (access and management) from the risk.  The cost of the service is a flat $10/month.  We don’t care if you are a practitioner, or a patient, young, old or middle aged, the price of the service is $10.  The only thing we will add to that is the cost of the risk (plus the 15% for non discounted patients for the, you know, increased risk).

Risk

In this context health insurance risk refers to the potential financial burden that an insurer may face due to the occurrence of events such as illness or injury that are covered under a policy.  Here is how we calculate risk

Let’s use that in a little example.  A laparoscopic appendectomy is about $15,000.00; an open appendectomy is about $5000.00 if we average those we get $10,000.00 to use and as example.  The incidence of appendectomies in a population is 228 per 100,000 patients per year.  That means that a population of 100,000 will spend (on average) (228 * $10,000) $2,280,000.00.  If we break that down per patient, that is ($2,280,000/100,000) = $22.80 per year, or monthly ($22.80/12) = $1.90 per month in risk.  That is all.  A $10,000 procedure with a 228/100,000 incidence incurs a measly $1.90 in risk.

Like this:

Sentia can do this calculation for each covered procedure and come up with a premium for our insurance.  We will also publish the reimbursement price and the monthly risk for every procedure.  We break up the population into 10 year tranches, since we don’t want the 20 year old paying for the 80 year old’s care.  In the case of Direct Universal Care (DUC, more in the Coverage Delivery Methods section) we can calculate the risk based on actual usage of their particular constituency.

Associating Payments with Procedures

As mentioned, since we use a data driven system with the UMLS, it is trivial to associate procedures to payments. We added tables for plans, policies (instantiations of plans), and linking tables for UMLS concepts (procedures) to plans and plans to patients (policies).  That sounds a little technical but that is really all the legacy insurance company does, except of course deny your healthcare.

Procedure Pricing

We, as a nation, need to agree on one price for a procedure.  The appendectomy costs above are an average and that is probably a good place to start.  We don’t want to gouge either patients or practices/hospitals, but we need to get doctors out of the board room negotiating rates, wasting hundreds of thousands of man hours on thighs that just do not need to be done.  Sentia is going to recommend 150% of Medicare as a hard and fast reimbursement rate.  This can be adjusted as we collectively gain experience, but there will only ever be one  price for a procedure.

Perspectives

The Patient

From the patient’s perspective, integrating coverage into the EMR streamlines, eliminates unnecessary work and reduces costs across the board and provides complete transparency.

The Practitioner

From the practitioner’s perspective, integrating coverage into the EMR means no interaction with some remote, second guessing insurance company and ensures they are practicing medicine instead of worrying about payments.

The Practice or Hospital

From the practice or hospital perspective, the payment amounts are set in stone, non-negotiable and therefore planning can be done around revenue.  The payments occur in real time as procedures are documented.  It also obviates the need for entire departments in the enterprise.  Medical coding goes away, and billing becomes “cash and carry” meaning that the patient pays his or her part and billing is less necessary.

Coverage Delivery Methods

There are three delivery methods for Sentia’s coverage

Sentia as the Coverage Company

Sentia can supply all the services the traditional legacy insurance company has.  We simply streamline and automate everything they do so it is better, faster and less expensive by about half, since we only charge $10/month for the coverage service plus the actual cost of the risk.

Sentia as the TPA/Captive

Sentia can be the Third Party Administrator (TPA) or captive insurance company for self-insured employers.  This means that we do all the same things that we normally would, we just submit a bill to the self insured employer for the procedures performed on their employees. Saving them money.  We only charge the same $10/month per employee for our service and the employer pays for procedures, eliminating the risk.

Sentia as the Direct Universal Care Facilitator

We also offer our software for the same $10/user/month to run a hospital and let them offer their own Direct Universal Care.  The hospital partners with its admitting general practitioners and specialists to offer a complete healthcare package.  Here is an article about that.

Basically, Sentia “installs” all the software necessary to run the hospital and manage the patient’s data.  The hospital then manages all the funds necessary to finance care.  This eliminates all the extra work the legacy health insurance company requires to be done, and eliminates associated staff, streamlining and automating the entire coverage process.

Perspectives

The Patient

The patient loves this new system.  They get more of their doctor’s time and the doctor has more time to think about their care, not getting their care financed.

The Practitioner

The practitioner loves this new system.  S/he is freed from fighting with insurance and constantly typing notes that nobody will ever read into some dumb digitized paper system like Epic or Cerner.  This frees them to do the thing they are trained to do: make people healthier.

The Hospital  

The hospital loves this new system.  They get a shiny new EMR for a single digit fraction of the cost of their old one, that works better, and faster and allows one-click documentation in many cases.  They get to get away from medical coding and all the other dumb processes the legacy insurers force them to do.  They get to streamline and automate most processes in the enterprise causing decreasing costs and rising efficiencies.  

Fraud Detection

The legacy insurance companies use fraud as the reason they adjudicate every claim. We at Sentia believe that your doctor knows what is best for you and took an oath to “first do no harm.”  Sweden, Finland, the Netherlands and Denmark agree with us.  We, and they, use advanced mathematics and analysis called Data Science to detect fraud.  The general practitioner is the arbiter of ‘necessary.’  The result is lower costs for everyone.  We don’t have to employee thousands of doctors to mark claims as “medically unnecessary;”  you already have a doctor who said your procedure is necessary.

Perspectives

The Patient

From the patient perspective, this simplifies, streamlines and makes care better, faster and cheaper

The Practitioner

From the practitioner perspective, s/he will never have to defend a procedure to some bizdiot who is paid by your insurance company to deny as many claims as possible, meaning better, faster and cheaper service for them as well

The Practice or Hospital

From the practice and hospital perspective, payments are expedited and streamlined to a real time payment process.  This automates and streamlines the entire system and eliminates pre-authorization, negotiations, delays, denials and everything else the old legacy companies force the practice or hospital  to do.

Challenges

Adoption

Practices and hospitals are married to their EMR.  the legacy EMRs are eye-wateringly expensive, require a maintenance plan of an average of 20% of the installation costs, require months of training per module (there can be up to 130 modules) and require armies of people to install and maintain.  It is a lot.  We can certainly understand why practices get married to their EMR.

Counterpoint

With eliminating all the old legacy EMR and insurance, the practice or hospital will be cutting expenses by double digits and also boosting productivity by double digits.  I had a colleague say to me that he could prove a 50% reduction in costs or 50% increase in production and nobody would even listen to him.  Think about the real outcome here though: healthier patients.  Less work for practitioners and staff and more of what you went to medical school for.  Finally, This is the only viable solution extant.  This also is a lot, and a big change, but it is the only way.  Unless you like the way things are going in healthcare of course.

All or Nothing

This is not a point solution, this is a complete revolution in the way medical care is delivered and paid for.  As such it has to be installed all together or not at all.  Sure we could get Epic to send us an HL7 feed and have your coders send us ICD or CPT codes to translate into real information, but then we are just as bad as everyone else writing custom code for each client.  This is one of the things that makes legacy systems unsustainable.  Epic writes a new system for every client.  No wonder there are Epic installations over a billion dollars.

Counterpoint

Epic, and everyone else, are doing it wrong.  You don’t need custom code.  You don't need specialties.  You don’t need notes and language.   You do need a system that “codes” your procedures for you.  You do need a system that eliminates everything you do to get paid.  You do need a system that incentivizes healthy living.  You do  need a system that prescribes patient education automatically, not only for health and wellness, but for pre- and post-surgery instructions.

Regulation

If Sentia is to offer real coverage, outside of the DUC scenario, we have to be certified in all 50 states to provide it.  The cost to pass all the regulations is about $1 million per state.  

Counterpoint

$1 million isn’t that much money in the grand scheme.  We will star in less regulated states like Florida and Texas, and when successful, we will tackle highly regulated states like California and New York.  With adoption in highly regulated states we can probably get waivers to provide low cost coverage and save lives in your state.       

Conclusion

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.

We have shown three viable adoption plans to move toward lower cost healthcare in the United States. These plans cut more than half from the cost of health coverage and eliminate the big payers and the legacy EMR vendors in one fell swoop.  Over time we will eliminate about half the remaining costs as patient get healthier.  That means a 75% reduction in costs overall.

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 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.

We have designed and are building an ERP style practice/hospital management system that will pinpoint and eliminate cash leaks and inefficiencies in enterprise medical facilities. 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.