How Does Patient-centered Care Affect The Consumers And Providers Of Care

Why doesn't the US Government just deregulate the healthcare industry and let capitalism in that industry flow and reduce prices? Is there something wrong with this plan?

Because that was tried for decades, and it caused prices to rise, it caused people with pre-existing conditions to die, it caused millions to go without health insurance, and that caused millions to die needlessly, and oh, did I forget to mention the sky rocketing price rising.It failed.The ACA did not start the insanity, it just didn’t help. Why? Because for profit healthcare, as opposed to patient centered care, doesn’t work. It never did, and it never will. The insurance industries, and big Pharma, are still there with insatiable desires to make money. More people have access to healthcare with the ACA though, so there is less needless death, but that isn’t what your question is about.Perhaps it’s time that we looked at why and how the rest of the industrialized nations provide health insurance for their citizens with less cost, and better outcomes. Or, we could just go back to what you suggested, and watch people needlessly die again.Would you like to know why the Republicans couldn’t come up with a solution for healthcare? Because the ACA was already the Republican compromise. There is no other solution besides outright universal healthcare. The ACA is based on RomneyCare from Massachusetts, which was based on a plan from the conservative Heritage Foundation. The Heratige Foundation plan was developed in the early 1990’s, in response to President Clinton’s plan to overhaul healthcare.So, there is no other option to stop rising costs and needless death than to bring about truly universal healthcare. None. The ACA was the conservative compromise.And I spent 34 years in my profession watching needless dying, so please don’t insult my intelligence by claiming no one ever died from lack of health insurance.

What service to healthcare patients need to simplify understanding or affording their medical bills?

Understanding and affording are two widely divergent topics.As for understanding, most bills are deliberately complex by design and a hospital’s chargemaster is often a work of fiction as most reimbursements come from capitated contracts with insurers or the government. A single favored-nations and transparent price system would be helpful. Thus similarly situated people would be paying approximately the same amounts without surcharges to provide for mandated care to indigent patients.As for reducing costs, let us return healthcare insurance to insurance: large interstate risk pools, actuarially-sound premiums, and the ability of the consumer to purchase a diverse range of products meeting their specific needs. For the young, it is catastrophic coverage with few specialty items; for the aging, there would be more comprehensive coverage available. By adjusting risk pools, almost everyone can be accommodated. Of course, people would pay for their own birth control, minor visits, and incidentals.As for a service, perhaps that might be an app where you enter the name of your facility, your preferred physician, and a procedure and you are presented with a simple list of your options sorted by price and potential outcomes.Of course the biggest fix would be to remove politicians and corrupt special interests from the process. No paying ten times the cost of a CPAP machine for a single night’s rental.

Are there any companies working in patient engagement space in India?

Patient Engagement space in India is getting quite a hype in the recent years. Information Technology in the Healthcare is growing leaps and bounds worldwide and India is catching up with the speed of the globe in this space. There have been lots of companies who develop IoT (Internet of Things) products like Fitbit, Cardiac monitor devices and few more home grown companies who does some fantastic job.Now, Patient engagement has become one of the prominent space in India. Lots of companies are trying their best to enter the space because the business is huge and within couple of years we might see companies mushrooming in this space. Although there are few companies tested this ground in other countries and they are trying to enter the Indian market and make the life of Patient and Care team much easier and simpler.Here, I introduce ChARM EHR (A Product of Medicalmine Inc., also a subsidiary company of Zoho Corporation) a complete Out-patient management solution. Let’s not talk about Out-patient management but lets focus majorly on Patient Engagement portal.With ChARM Patient engagement portal and App one can easily book appointments with the doctors, they can also share their historical Medical data, receive prescriptions electronically, receive lab results electronically and also the recommendations from the care team. Most important of all the patients can securely message their doctors for any doubts or questions. They are pioneer in this field and the first company to provide this solution in India.One amazing feature they have is Telemedicine which is the Doctors can video chat with their patients and without visiting the clinic the patients can get diagnosed and get prescriptions for the issue.P.S: I work for Medicalmine Inc and in no way I am promoting this product but sharing the information since the question demanded it.Thanks :)

Why is it so hard for patients to know out of pocket expenses for medical services prior to receiving a bill?

Even for patients very knowledgeable in health insurance, it is often difficult to know in advance how much he or she will have to pay ( out-of-pocket expenses). The following factors can affect how much the patient has to pay:1. The patient’s deductible and status in meeting the deductible for that year.2. The patient’s status re: the out of pocket maximum for the year.3. The doctor’s billed amount.4. The insurance company’s allowed amount, based on reasonable and customary charges.5. Whether the doctor is the patient’s primary care doctor or a specialist.6. Whether the doctor is a participating provider.7. Whether the doctor is a preferred provider.8. Whether the cumulative allowed charges exceed any threshold (dollars or visits) for the condition or procedure for the year.9. The patient’s required co-pay (dollars) or co-insurance (%) for the type of charge or doctor, taking into account the status of deductibles for the year.The above is what I can think of right now. It is possible I have missed something, or have not been completely accurate in describing the factors. The insurance experts can review and take a shot at this. Depending on one’s perspective, it may or may not be complicated. The above does indicate why the exact out of pocket amount cannot always be determined by the patient or the provider’s office before or after the visit.The difference between amount billed and amount allowed is that the former represents the dollars billed by the provider. The amount allowed represents the amount (dollars) allowed by the insurance company based on reasonable and customary charges for the type of provider, procedure, and geographic area. Most of the above items are applied to the amount allowed, not to the billed amount. However, if the provider is a non-participating provider, the patient is responsible for the difference between the amount billed and amount allowed, after all of the deductibles, co-pays and co-insurance factors are applied.Differences between what is billed and what is allowed and paid out can be substantial. For example, a doctor’s office may bill $1,200 for a visit and various laboratory tests and other procedures. The amount allowed by the insurance company may be $475. Without considering deductibles and other factors that impact the amounts paid to the provider and required of the patient, one can readily see why there is often a large difference in what the provider bills and ultimately receives.

Is the key to lower health costs eliminating the insurance industry, health care industry / bureaucracy?

The key is finding ways to lower actual health care costs. Insurance is a factor but it’s not the main driver of health care in the U.S. Health care delivery, staffing, liability and medical interventions (drugs, therapies, etc.) are what generate health care charges.The focus should be to reduce things that generate health care bills in the first place.Any reform that does not focus on actual cost generators is foolish. Throwing up strawmen or demonizing insurers will not make drugs less expensive or make it cheaper to maintain an MRI machine.Things that will make the most and lasting impact entail re-thinking how we approach medicine and health care as individuals and as care providers.I believe the best, most realistic and cost effective way to do it is having a health care system and paradigm that is patient-driven, then patient-centered.People are their primary care providers because they supply their own health basics- food, water, exercise, as well as stress/weight management and environmental safety. Health care should place preeminence on personal care and health learning. I would however, discourage invoking penalties for poor personal care for another 40-50 years until the new paradigm is normalized. (People need time to adjust.)When a person manages these well, the need for secondary care outside of family or community can be dramatically reduced. Effective preventative care leads to less need for medical intervention- barring genetic-based incurable disease, accidental injury or assault/homicide.Insurance subsidy should be focused most on primary (personal) care. Good personal care outcomes should be rewarded with increased benefits for more premium personal care benefits or even refunds of paid health insurance premiums.From a wider system perspective, I believe these issues will also lower health costs in the U.S.:better health & lifestyle choices and habits (diet, exercise, seeking out timely and appropriate medical intervention)foster less litigiousness toward care providersappropriate, right-sized legal liability for care providersmore affordable yet safe processes to develop and market drugs, therapies and biotechnologiesright-size and optimally re-configure health teamsre-configure health careers and care providers’ education/training requirements and priceAll of these are really hard to tackle but what must be done to really get a handle on cost itself.

What are some of the primary drivers of health care cost?

My top 4 picks - random order:Lack of pricing transparency.  Lot's of work underway to change this - but Mary Meeker did a financial analysis of USA, Inc earlier this year.  Her chart highlights how consumer "out-of-pocket" healthcare expenses went from 47% in 1960 to 12% in 2009.  Her chart (below) was meant to highlight the growth of Medicare/Medicaid - but I found the out-of-pocket percentages to be noteworthy as well.  When the patient/consumer doesn't know or understand pricing - it has a corrosive effect on the system overall.Obesity epidemic.  The CDC has a great time-lapse version of this chart - which shows how the country (state-by-state) has added weight.  The time lapse version is compelling to watch - online here:  http://1.usa.gov/p1d1LQ  The health effects of this are numerous - well known - and largely preventable.Volume versus value payment model.  The US healthcare system has evolved to one which rewards volume over value.  As a single example - imaging scans per thousand insured patients went from 85 in 1999 to 234 in 2007.  There are more MRI machines in Pittsburgh than Canada ( http://healthcare-economist.com/... ), and doctors are four-times more likely to order a scan if they own the imaging equipment than ones who don't.  Providers will argue that "defensive medicine" (to avoid litigation) is to blame.  Shannon Bronlee's book - Overtreated - also highlights the role of patients in this equation.Inefficient and/or fraudulent administration.  Billing errors, Medicare fraud (estimated at about $50B/yr), paper-claims processing, paper health records, Rx errors - all add up.Much of this was also summarized by PWC in their 2008 landmark study called:  The Price of Excess.  They estimated that $1.2T - or about 50% of all healthcare spending - is wasted.  They had three similar categories:  Behavioral, Clinical and Operational.  That study is downloadable online here:  http://bitly.com/hmFymb