Healthcare reform and the end of billing as we know it
At long last it seems that the massive health reform bill is going to pass and, hidden among its many interesting aspects, is a subtle yet significant element. This bill requires that, in a few years time, all insurance companies shall use common paperwork and forms.
By on Mar 25, 2010At long last it seems that the massive health reform bill is going to pass and, hidden among its many interesting aspects, is a subtle yet significant element. This bill requires that, in a few years time, all insurance companies shall use common paperwork and forms.
Pretty inoquous you might think, but I am looking at this from the broader perspective that, during this same time frame, the Government has said that healthcare providers who wish to be reimbursed by Medicare or Medicaid will be penalised with lower rates if they do not use electronic medical record data to file their claims. It seems to me that in this case it may be that 1+1=3. Isn't it highly likely that the insurance companies will follow the Government lead and require the use of EMRs, thus bypassing the entire billing process that requires coding of claims before they are submitted? Should this be the case the entire process of determining reimbursement is automated by business rules applied to EMR data and the game of coding goes away. But what would this mean?
Well, from a patient perspective it would mean that there would, for the first time, be a direct link between their medical record and their coverage - perhaps leading (again for the first time) to some genuine price transparency. Similarly, if this link is clear (as it will be through the personal health record, which is also mandated) then patients could actually start to make reasoned care decisions based at least in part on cost.
From the provider's perspective things are less rosey. No longer will it be possible to have the medical record and billing record differ in any respect - they will be one and the same. No doubt this will prevent some over-billing but it will also mean that the EMR will be both medical record and audit trail - something which it was always intended it would be but was impossible while paper was the medium.
From a data perspective this development will be transformational. For the first time it will be possible to track the money and the medical behavior at the same time. Imagine being able to size a market based on what was actually paid (and by whom) rather than constantly hunting for averages, not knowing the discounts, and not knowing the size of the co-pays?
As this revolution takes hold (as it surely will) so the scope for using ALPD to increase the depth and breadth of understanding available to pharmaceutical companies, providers, insurers, and patients will create a tsunami of knowledge that should lead to substantially improved decision making.