We WANT People to go to the Doctor

Limiting care with deductibles, copays and coinsurance are counterproductive and increase costs for everyone

Introduction

Normally, we discuss healthcare and health insurance here, and today is no different.  Today we are going to discuss why insurance companies seemingly introduce impediments to receiving care, what they should be doing and what we can do about this if we determine that these barriers are invalid and counterproductive.

The Situation

Big insurance wants you to pay them and they want you to stop there.  They do not want you to go to the doctor and they put up any number of financial and geographic hurdles to get you to give up and just not go.  Not paying for that visit for that scratchy throat increases their bottom line.

They think.

Let’s posit that going to the doctor regularly either in a scheduled visit or for that scratchy throat decreases costs overall.  Decreasing costs overall is the same thing as making more or spending less money for your insurance company.  Regular doctor visits decrease the cost with clinical measurements and lab tests intended to catch and remediate chronic disease before it becomes critical.  For most chronic disease, behavior change is adequate to completely solve the problem.  Further, the financial burden of behavior based, avoidable, chronic disease is about 90%  of the $4.9 trillion spent on healthcare in the US, or $4.4 trillion.  How do we not spend that $4.4 trillion?

We let people go to the doctor.

The Logical Conclusion

The entire output of the current big insurance industry is aimed at keeping you, bot personally and in the larger sense, from seeing the doctor.  Insurance networks are designed to make it geographically difficult to see your doctor.  They are also designed to squeeze your doctor’s practice until it bleeds, but that is beside the point for this conversation.  Deductibles are implemented to penalize you for needing care, and to  dissuade you from seeking it.  Copays are built to convince you that you don’t really need the prescribed treatment your doctor has told you that you need. Coinsurance means that you are actually doing the insurance company’s job and paying for your own coverage.  You are literally being your own insurance company for some treatments.  If you are the insurance company, what do you need them for?

Where does this all end up?  Eventually these tactics will either bankrupt us personally or as a nation, as government ham-handedly attempts to control costs, introducing more complexity, regulation and expense until the entire system collapses.

The Short Answer

Replace big insurance with a system that understands that an ounce of prevention is worth a pound of cure.  Either replace them or convince them to change the entire way they do business.  

Replace them with what?

The Slightly Longer Answer

To solve the problem of stupid business people making stupid business decisions, we call them bizdiots, we have to start at the lowest, fundamental levels and rethink everything we do.  Everything, that is, but the delivery of medical care.  I am not a doctor and the people that are do a fine job given the constraints they are put under. Let’s look at some of these fundamental changes.

Electronic Medical Records

Wait, what?  That doesn’t sound like insurance reform!

Bear with me, we are getting there.

All current Electronic Medical Records (EMR) systems rely on language to document patient care.  That is dumb and wrong.  To document patient care you must have data.  This is not data you extract from physicians notes, this is native data that the doctor picks out of a database.  It sounds complicated but it really isn’t.  Here is a demonstration of our data-driven, non-language-based EMR, the first and only of its kind, that shows just how easy this can be and in fact faster and easier than typing notes into a system that nobody will ever read, nor reference ever again.

Even if we take the data-driven EMR as the gospel way to get this problem solved, so what? What is the benefit and how does that help us remove barriers to care and get more people to the doctor?

With a data-driven EMR we can automate the entire health insurance industry.  That means replace the big, wrong-thinking, biztard led, behemoth corporations with a whirring box in a cold room.  That also means we eliminate all their associated costs.  Imagine the salaries of hundreds of thousands of employees, the skyscrapers in every major city, the equipment and power required to run the whole system, and all the associated costs, just gone.  That is the benefit of a data driven EMR.

With a data-driven EMR we can search and find cases by complaint, symptom, observation, treatment or outcome, or any combination of those.  If Dr. House had our EMR, that show would have been one five minute episode:  Type the symptoms into the EMR and get several differential diagnoses with positive outcomes to choose from and start treating your patient.

With a data-driven EMR we can start to tease out the long term effects of treatments.  Let’s look at patients who had a particular drug and see if there is an abnormal subsequent incidence disease.  

With a data-driven EMR we can identify at-risk patients and contact them for more intensive follow up, by any criteria.

With a data-driven EMR we can start to produce a population health report that identifies problem areas for us to focus on real areas of concern in a population.

With a data-driven EMR we can identify environmental concerns that are causing disease.  If we find cases of aplastic anemia at more than one standard deviation above the mean for a geographic area, we know there is probably a benzene leak of some kind.

With a data-driven EMR we can automate the production of compliance and efficacy reporting required by state and federal governmental agencies.

All of these things can only be done with data and can’t be done with language.

Other Considerations

We showed you how to get people to the doctor and how that would decrease costs over time. But there are several other things to consider.

• Automating the big insurance companies out of business saves about half the cost of healthcare.
• Freeing doctors and practices and hospitals from dealing with big insurance will further reduce costs by up to 25% with the elimination of medical coding, adjudication, medical networks, brokers/agents/salesmen, denials, delays and all the other myriad things the old, bizdiot, legacy insurance companies can’t figure out a way to get around.

This is not a pitch.  We genuinely want to help and we do not care about the money.  We do care about saving lives and making sure the big, corrupt, murderers that call themselves insurance companies are put out of our misery once and for al, by doing everything that they do better, faster and cheaper than they can possibly do it.  This is the only way to get rid of them and their biztard, murderous schemes.

Conclusions

Encouraging people to go to the doctor is the way to reduce medical costs for us all.  To do this we must get rid of the legacy insurance companies.  To do that, we have to have a data driven EMR with integrated coverage that streamlines and automates everything they do and more and steals their clientele and puts them out of business.

There are many benefits to a data driven EMR, and we simply listed a few.  There is only one data-driven ERM on the market and we have shown you a demonstration of it above.

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.