Reduce medical payment friction


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Translation: pencil leadn

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nMay 10, 2017 The New York Times reported that Mary Williams Walsh, reporter of the “Whistle-Blower Tells of Health Insurers Bilking Medicare”, reported on the recent case of insurance companies. The article shows that UnitedHealth makes the patient’s condition look more serious than the actual, in the patient’s electronic medical records to find a way to control the diagnostic code.n
n”The more serious the patient is,” the report says, “the more serious compensation for Medicare Advantage,” says Benjamin Poehling, who broke the news. Shortly after, the UnitedHealth spokesman denied Poehling’s allegations.n
nThis is a recent case of the US complex medical payment system.n
nMedicare Advantage is the need to revise the traditional Medicare program, Medicare plans to provide medical subsidies directly to the doctor, making the cost higher, stimulating over-treatment. In accordance with Medicare Advantage, the government contracts with insurance companies to manage health insurance for the elderly and pay an annual fee for each participant. So the patient’s medical costs have increased recently. This well-known method of stimulating medical providers to diagnose, and sometimes even without any disease.n
nWashington has not yet determined how health insurance reform will solve the payment problem. But industry practitioners will be affected, more and more evidence that the impact will be great. Suzanne Delbanco and Andrea ElizabethCaballero posted the blog “Health Affairs”, pointing out that the success of payment innovation lies in the private sector. The 2015 Health Insurance Census shows that insurance coverage by the employer covers about 56% of the US population. According to this estimate, the private sector can (and should) play a role in health insurance reform, especially to pay for innovation.n
nFrancois de Brantes, vice president and director of the Center for Payment Innovation at the Altarum Institute, a nonprofit organization, said:n
nn”At any time you use a payment method and make it public, are in the opportunity to provide optimization. In the case of recent transition diagnosis, handling of the payment system, the Medicare program encourages payments in accordance with the severity of the diagnosis. The more diagnostic codes you add, the more payments they get. ” As a health insurance specialist working with his insured employee, he argues that future payments for the health insurance industry will be far from the single medical payment model and the “more extensive model”.n
nnde Brantes said that “extensive” means bundling payment patterns. “The patient pays the entire cycle of medical care, rather than a single pay, known as bundling payments.” It is between the single medical payment model and the amount of medical expenses paid by the person (regardless of the number of patients receiving treatment, each person a one-time payment of a fee) between the method. However, bundling payments are still flawed, especially in terms of data. “The problem of bundling payments is to determine the medical point throughout the medical cycle of the price mechanism is complex.” To develop a legal price mechanism, you must collect data for each medical phase. The challenge of collecting these data is the need for complex, costly administrative resources.n
nSome domestic medical programs use technology analysis algorithms to support bundled payment systems. The principle is that the algorithm calculates the actual costs of the budgets, payers, and medical providers of each treatment phase in the bundled payment model, and then calculates the actual costs based on the budget. The correct way to deal with bundling is to adjust the severity of the disease according to the patient and the medical provider. This process is not perfect, because the data between the patient and the provider are isolated from each other and can not be unified.n
nFortunately, de Brantes saw a replacement for this data infrastructure: to centralize books.n
nn”If the patient and the doctor share the same account, in the treatment phase of the record medical data, you can verify the payment mechanism from multiple sources.City chain chain technology changes the status quo is very likely, the current management of medical services, high administrative costs” Then
nnDe Brantes’ interest in the block chain is very practical, “the block chain is a good way to reduce friction, and the friction in the economy is wasting.” It should be prudent to think that reducing waste can significantly reduce medical expenses.n
nWith other health care companies already, Altarum believes that the network functionality of block-chain technology can create a seamless data reporting system that covers the entire medical phase. This may be the reason why de Brantes and Altarum join the Hashed Health chain chain concept project, which will explore new payment solutions based on block chains and distributed book technology.n
nIn addition, these innovators are exploring how to combine payment and incentive mechanisms and preferential design to further improve the alternative payment model.n

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