> Patrick Bateman voice: Look at that subtle transparent blue coloring. The tasteful consolidated length of it. Oh, my God. Just two payers over the same time, spanning seven different providers.
"You see, a patient might have multiple healthcare providers, but they usually have just one payer at a given point in time (aside from edge cases like dual eligibles, veterans, or cash pay scenarios)."
It's not just edge cases.
Employers change payers/networks often - and employees are with the same employer for typically less than 5 years. That dual-sided "churning" creates enormous fragmentation - and about 155 million Americans get their coverage through their employer. This is one of the reasons that "administrative complexity" is estimated (2019) to cost our healthcare system ~$266 billion per year.
Fair point - but neither is desirable - and there's still no continuity of care. We just had a payer change (BCBS to Aetna) - and it's a completely reset. Any/all history - poof. Gone.
> Patrick Bateman voice: Look at that subtle transparent blue coloring. The tasteful consolidated length of it. Oh, my God. Just two payers over the same time, spanning seven different providers.
10/10
All good until I hit this line:
"You see, a patient might have multiple healthcare providers, but they usually have just one payer at a given point in time (aside from edge cases like dual eligibles, veterans, or cash pay scenarios)."
It's not just edge cases.
Employers change payers/networks often - and employees are with the same employer for typically less than 5 years. That dual-sided "churning" creates enormous fragmentation - and about 155 million Americans get their coverage through their employer. This is one of the reasons that "administrative complexity" is estimated (2019) to cost our healthcare system ~$266 billion per year.
Time-based fragmentation is a different and simpler problem set than concurrent fragmentation seen on the provider side
Fair point - but neither is desirable - and there's still no continuity of care. We just had a payer change (BCBS to Aetna) - and it's a completely reset. Any/all history - poof. Gone.
Which is why the upcoming payer to payer API is good
... not if it supports the status quo of tiered coverage. Which it will - and tech is the easy part. Liability of data xfer less so.
We need employers out of the healthcare biz. http://hc4.us/esi20