The Future of Medical Information Technology: steamlining from doctor to patient

Cost Estimates of Private Practice Standalones vs. Consolicare

I will try to provide an estimated cost comparison for the average cost of a stand-alone private practice start-up versus start-up costs per "entity" as a member of the Consolicare community. This is a rough copy and reductions in expenses from a one-entity private practice to Consolicare will be based on shared resources and integrated infosystems.

A Trend of Consolidation

The trend of outpatient healthcare consolidation has been occurring silently throughout the past 8 or so years. The following article in the New York Times has done an excellent job in summarizing the trend: 


http://www.nytimes.com/2010/03/26/health/policy/26docs.html.

Expert analysts claim that doctors are "facing rising costs and fearing they will not be able to recruit junior partners — are selling their practices and moving into salaried jobs, too."

The main benefit and concern, as iterated in the article, are that "bigger health care organizations can provide better, more coordinated care. But the intimacy of longstanding doctor-patient relationships may be going the way of the house call." So it seems that there would be some kind of trade-off between efficiency and being personable. I find this to be a paradox, however, as efficiency would free up time to better talk to your patients. When a patient enters a Consolicare, I want that patient to feel like a part of the family. Each appointment should, in time, feel like a visit with a distant relative. Because of high switching costs (very time-intensive), it is much more likely that a new patient stays with us for many years. In addition, the patient will, by nature of the business model, schedule multiple appointments each visit. For these two reasons it is vitally important that that patient feel comfortable throughout the visit. 

What I'm Offering

What is the service that I am suggesting? I am suggesting a service that all but eliminates risk of out-of-networks costs. It is a service that saves time associated with insurance expenses, reduces doctor billing costs and therefore insurance claim costs. Consolicare is a service that collects and streamlines existing specialty and primary care practices into one facility and database, acting as one entity that will save patients time, money, and hassle with insurance companies. The entity will apply collectively to insurance networks and will be accepted collectively, or deny entry.

What value does this have specifically for the patient?

- Lowered billing by the doctors' offices: Through reduction of administrative and overhead expenses, as well as doctors' time collaborating with each other. All of these costs constitute a significant portion of the final bill.

- Saved time and gas money: Appointments for general matters will be scheduled in such that they can all be handled on the same day, if possible. For example a patient with allergies requires an annual allergist "check-up." Likewise, she requires a 6 month dental cleaning and general check-up. Consolicare will schedule her for consecutive appointments that will allow her to receive treatment in all of these areas at one time, in one place.

- Less insurance confusion and hassle: Insurance claims will detail each appointment and outline each service provided, and questions regarding these claims will be directed to only one person in Consolicare's medical billing office. Like doctors, medical billing professionals will take on clients in order to have more familiarity with the situations and billing history of patients.

A solution

Health care is subject to a game. How can we play this game better?

Realizing the problem

I can remember sitting around the kitchen table a little over a year ago, rambling with my father (Tony) about the trap of health insurance companies: the restrictions, the hassles, the money, the necessity. It was my winter break, and I had come home to Chicago from the college lifestyle that Madison, Wisconsin so generously offered. Tony was half-engaged in the conversation as he flipped through bill after bill, health insurance company after health insurance company. In a family of five he was responsible for 3 insurance companies and countless statements.

"But the real problem is the legislation," I argued. "Health insurance is not universally accepted at hospitals and clinics. It provides minimal incentives for consumers to better their health, and it rates on pre-disposed, largely unavoidable circumstances. The larger the claim, the larger the "red X" on your record, and the higher the premium. The "X" is written with permanent ink. Companies need to find a way to profit through universal file claims and incentive-based ratings."

My dad shook his head as I drifted further into the clouds. Judging his skepticism, I pressed on.

"I am serious though! The current system is killing people - physically and financially." I had recently met Dr. Nijhawan, a leader in health care reform, at a poker game. After visiting his website, http://www.mmkills.com/index.php/, I had some idea of the reality of the problem.

My dad wanted a conversation, not a monologue. He placed his envelope on the counter and opened up.

"Listen Ben. I am a small business owner. I have had a heart attack. Thankfully the rest of our family is healthy. Do you know what we pay for our health insurance premiums?"

I started to add up some ill-conceived numbers...

"Over $15,000. That's the bottom line. We have good coverage of benefits and a decent co-pay; our network is lacking in accessibility. I don't care how companies rate or how they expand their network, but there has to be a way of profitably doing both, at a lower cost."

Little did I know, this was a grim reality for many Americans.