PIM Health | Payment Infrastructure Modernization for Healthcare
The most important stakeholders in American healthcare are unhappy. That’s mainly an architecture failure, not policy…well, maybe some policies.
By Don P. – Founder – Visit my website
#8 (and final) in the series: HOW THE AMERICAN HEALTHCARE SYSTEM BROKE & WHY NOBODY FIXED IT.
The most important stakeholders in American healthcare are unhappy. That’s mainly an architecture failure, not policy…well, maybe some policies.
- Providers spend 15-25% of revenue on billing and collections and see only greater costs on the horizon.
- Independent practices are being consolidated into large hospital systems because independent practices can longer absorb the administrative burden and fiscal uncertainty.
- Physicians are spending more and more time on documentation and less time with patients.
- Patients can’t find out what anything costs until weeks after care is delivered. Surprise bills arrive for services they thought were covered.
- Medical debt is the leading cause of bankruptcy.
- Payers maintain massive claims processing operations: claims adjudication, denial management, prior authorization, utilization review – these exist because the gatekeepers have zero incentive to adjudicate quickly and a profit motive not to pay.
Nobody designed this system. It emerged from a century of reasonable responses to immediate problems – each one moving the patient further from the transaction, each one adding complexity that the next reform had to work around, until only the most financially powerful held the keys to the entire kingdom.
As Lord Acton said, “Power tends to corrupt, and absolute power corrupts absolutely.” Sadly, this is where we are
The question is, “are we stuck with this?”
What would it look like to build a payment infrastructure that:
* Told patients what they’ll owe before they receive care?
* Paid providers in days instead of months?
* Eliminates the administrative complexity that siphons off hundreds of billions a year that might be spent on:
* Improved medical care,
* lower cost and better insurance products,
* less taxpayer burden, and
* targeted innovations.
That’s not a fantasy. The technology exists. The policy frameworks are emerging.
The system we have was built by accident. The system we need is being built…on purpose. Pim.health
If you wish to review the entire series go to my Substack HERE
