Friday, March 26, 2010

If I were the CEO of a health insurance company

The passage of the health reform bill ( Patient Protection and Affordable Care Act) in the US has attracted a lot of attention. Lots of this is positive, but some is critical as well.

I feel this bill is actually a big opportunity for health insurance companies to get their act together. At present, they are seen as money-hungry bureaucratic corporates which are out to squeeze doctors and patients by delaying the reimbursement process and making it needlessly complex and opaque. This is a valid criticism , but is actually a great entry point for a clever CEO who is willing to think "out of the box" and grab a large market share.

I feel health insurance companies should offer free PHRs to all their customers and free EMRs to all their doctors. This is a potentially disruptive innovation which will help everyone - doctors; patients and insurance companies as well ! This will enable online processing of claims; make finding a doctor much easier for patients; and cut out a lot of the paperwork and telephone tag doctors and patients need to play at present in order to get reimbursement. Insurance companies can actually encourage online consultations and preventive care; and help their clients to remain healthy, rather than just help them to pay their medical bills when they fall ill. They can be seen to be the “good guys” in healthcare who are using technology to heal a sick healthcare system !

But isn't there a reason why health insurance companies refuse to make their payment processes clear and transparent ? Don't they have a hidden agenda of deliberately complicating the payment due to the doctor, so that they can hang on to the "float"? Will they be willing to turn over a new leaf and help to make processing payments more efficient if this will result in a loss to them ?

My point is that a new company can create a new model which no longer relies upon inefficiencies to earn a profit. Instead, it will use efficient payment collections and processing to gain a larger market share. By making payment for medical care easy and painless, they will earn the loyalty of doctors - and patients !

One of the reasons insurance companies need to charge such huge fees is because a small proportion of doctors ( and patients) will game the system and will try to defraud them. By ensuring that patients store their medical data in EMRs and PHRs, insurance companies can prevent fraud and remain profitable without having to cheat and resort to underhanded techniques.

However, isn't there a danger if this is done that insurance companies will then start acting like Big Brother and refuse to cover patients at risk for serious medical problems ? What about the loss of privacy ? Yes, these are valid concerns, but it's possible to anonymize the data, so that the patient continues to own it, but will not be able to fudge it either !

The new bill encourages the clever use of technology to improve healthcare delivery ! Let’s make the most of it – we may not get another chance again !

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