Physicians, Business, Professional & Information Technology Communities
Networking to Develop the Ideal HealthPlan for the USA
HealthPlanUSA is the network concerned with bringing the best available ideas to a unified HealthPlan concept that will help resolve the health care problems in the United States. (Since we have many readers in the UK, Europe, India, Chile, and Canada, HealthPlanUK.net, HealthPlanEURO.net, HealthPlanINDIA.net, HealthPlanCHILE.net, HealthPlanCANADA.net and others will be launched later in 2009 and 2010.) Once every quarter, we review the progress of the ideal HealthPlan for the USA that will make HealthCare more affordable for all Americans and their employers, if an employee benefit exists. This is the current issue and a link to the archives of the Quarterly HealthPlanUSA.net Newsletters.
If you would like to receive these messages, which currently are quarterly, and follow the development of a patient-centered affordable health plan, you may subscribe at www.HealthPlanUSA.net/Newsletter.asp by clicking on Newsletter and then on HPUSA.
Thank you for joining the Medical/Professional/Business/InfoTech Gatherings on the FirstTuesday of each quarter.
The Major Current Problems in HealthCare
The $2.4 trillion health care industry is the only major segment of the economy that is failing, and there is nothing the employer, insurance carrier or government can do about it.
Health care is the only product or service (outside of public education) that has consistently grown worse over the past 40 years, with decreasing customer (patient) satisfaction. Every other product and service in our economy has improved in quality and grown less expensive over time, with increasing customer satisfaction.
Health care is the only sector of the economy where prices have been steadily increasing since the end of WWII. Every other sector of the economy is reaping the benefits of Moore’s Law, which states that the cost of digital technology decreases by 50 percent every 18 months. In health care, it is the reverse-less efficient and more costly. For instance, although the Length of Stay (LOS) for delivery of a child has decreased from four or five days to one or two days, the hospital cost has more than doubled. The LOS for gallbladder surgery has decreased from five days to one day, but the hospital cost has doubled. The surgeons’ fees have remained level or even decreased during this time.
The HealthPlanUSA Solution
HPUSA is the only true Market-based Health Plan that uses the Internet and Digital Information Technology to bring the Insurance Carrier, Service Providers (Hospitals, Surgi-centers, Physicians, Pharmacies, Diagnostic and Treatment Centers), Patients and Credit Providers together at the same interface, allowing data, information and fund transfers to occur in real time.
The patient takes an interest in making an informed decision at every step of the health care process when he or she has a financial obligation in all decision-making processes-which doctor to see, which hospital to use, which pharmacy to utilize, which laboratory to use for testing, which x-ray facility for diagnostic testing, which therapist to use for physical, occupational or speech therapy. The financial stake is proportional to the cost incurred without limit. Thus, in turn, each service provider will provide the best service for the fee involved in order to assure a continuing customer (patient) base.
- Healthcare costs are reduced making it more affordable and available to all Americans, thus eliminating the uninsured concerns.
- Quality is increased by cutting down delays in patient care, thus decreasing unnecessary patient suffering and premature death.
- Spectrum of a customer market base is increased to insurance and credit providers by the direct digital interface with the patient and service providers.
- Efficiency is increased by cutting the time between providing medical services and payment to service providers: hospitals, surgi-centers, physicians, pharmacies, laboratories for x-ray, CTs, MRIs, and other diagnostic and treatment centers. Secondary and tertiary billing, denial of service and further billing has been relegated to the dustbin of history. This duplicative and triplicate cost is difficult to ascertain because currently this cost is difficult to document or analyze, is not available, is not transparent, or is hidden. Actuaries that are working for large health insurance companies have informally estimated that this will be a 30-50 percent decrease in business office costs for hospitals, physicians and other providers.
- Choice is unlimited as patients make their own choice on the basis of cost, quality and efficiency. Unless they improve, inferior or incompetent providers will be eliminated more efficiently by the simple procedure of changing providers. This will be more effective than any HMO, insurance plan, PEER Review, government program, Medical Board or other overseeing or policing agency can provide, thus saving multiple bureaucratic costs which further decreases health care costs. Patients monitoring their own health care costs is the most effective, and sometimes even ruthless, cost deterrent. Inferior providers are simply eliminated due to lack of patients and are forced to look for other employment. Some insurance actuaries have informally admitted this could eliminate up to 90 percent of current quality assurance costs.
- The cost becomes extensive due to provider panels, provider credentialing, the army of nurses and reviewers looking over every hospital admission – reviewing charts daily, controlling every consultation or diagnostic procedure, controlling outpatient consultations and patient evaluations, reviewing and authorizing or denying every surgical procedure, reviewing every CPT and ICD 9 code, and reviewing patient charts for adequacy. Although accurate data is elusive, some actuaries have informally estimated a profound decrease in administrative and bureaucratic cost approaching 80 percent of current surveillance costs.
- The nation’s $1 trillion privately funded health care costs (of the $2.4 trillion total) will be significantly reduced. Although accurate data is inconclusive, conservative estimates by actuaries suggest the nation’s health care costs should be reduced by at least thirty to forty percent, making health care affordable to all Americans that fall between the Medicaid and Medicare programs. As Medicare goes bankrupt and eliminates 66 and 67 year olds, progressing higher as it follows social security benefit restrictions, HealthPlanUSA will easily be able to absorb these unfortunate Americans who have lost an unrealistic unfunded coverage base.
- With patients involved and monitoring their own health care with direct access to all their lab work, x-rays, procedures and medical reports, liability will plummet. Malpractice insurance will drop at least 50 percent within one year of experience and for medical specialists, it will be on the order of their car liability or house, fire, earthquake and flood insurance. This will be a huge savings for physicians and other service providers.
Welcome to an Exciting Journey
We appreciate your participation as we step back each quarter to reflect on where health care has been and just what the ideal HealthPlan might be for the USA and any country wanting to privatize and personalize their HealthCare. As we discuss various issues in our attempt to understand the health care problems for Americans, we welcome your thoughts and ideas in our efforts to create the ideal HealthPlan for the United States and the world. The subject is huge. Although the email response has been overwhelming, we do look over every email and all of your ideas and suggestions will help formulate the future of our country. We will also have a blog link for your direct participation and dialog located on our header.
If you would like to participate or be an investor in an innovative health plan for our country’s future, please send a personal email with your business and professional qualifications to DelMeyer@HealthPlanUSA.net or SatyamPatel@HealthPlanUSA.net.
© DelMeyer, MD 1/2009