Simple and wrong versus complex and right. That is the state of healthcare today and the intersection we face when it comes to care for ourselves or our loved ones. While we have come to expect transparency, ease of access, acceptable quality, and good value in virtually every area of our lives, our choices in healthcare aren’t always that simple.
When it comes to the costs of healthcare, the solution should be straightforward, yet the current system is designed to add layers of friction, hidden fees, and patient confusion. How do you make a decision on something if you don’t know how much it’s going to cost or how that cost will benefit you?
The Cost Conundrum
There are two problems patients face today. First, lack of transparency regarding procedure cost. Second, lack of understanding regarding procedure purpose. For example, somebody comes in for a cough and congestion and a mild fever, but their vital signs are otherwise normal. As a clinician, I know that I’m going to be sending that patient home. There’s no admission criteria. And one can say, “Well, let’s get an X ray to make sure you don’t have pneumonia. Well, here’s how much an X-ray costs. It costs $75, and it’s going to tell you whether you have pneumonia or not”.
As a patient, you have to figure out, “Oh, wow, I want to know whether I have pneumonia or not”, but what they’re missing is from the clinician is it doesn’t matter whether you have pneumonia or not. The treatment is going to be the same. If you have a bad bronchitis or a sinus infection or a mild pneumonia, the answer is Z-Pak. That’s it. That’s going to cover all of that. So what is the X-ray really doing for you? Is it worth spending $75 if it doesn’t change the treatment plan? So the way I would approach that patient is, “Hey, we could get this here’s an option. You get to decide, but let’s just give you the treatment. And if you’re not getting better later, then let’s get the X-ray”. So that’s $75 saved.
We need to make sure patients understand the cost as well as the value that’s derived from any diagnostic test that’s presented. That’s what’s missing here. A lot of times, clinicians don’t have the time to do that education. At FormulaMed we encourage our providers to teach! This gives our patients a better understanding so they can make an informed decision about their healthcare. That’s the sort of streamlined efficiency needed for healthcare professionals and patients alike.
Six Problems With Healthcare Today
In addition to issues around billing transparency, we’ve found several other areas that negatively affect patients today:
- Full of Friction – Needless forms, approvals, artificial treatment gateways, and unnecessary barriers to care exist at every step.
- Expensive – Healthcare costs are spiraling out of control and the people paying for it as well as the patients receiving the care have no control.
- Not Transparent – There is zero pricing transparency and hidden contracts full of unnecessary complexity are the rule.
- No Custody of Records – Patients do not have meaningful control of their health information and cannot easily share their records with those they wish.
- Not Holistic or Coordinated – Care is completely disjointed and not coordinated in any meaningful way. Factors such as sleep, nutrition, fitness, stress, and mental wellness are not managed.
- Not Technology Based – Healthcare is not leveraging today’s technology to deliver care in new ways and is severely limited by revenue cycle constraints.
I had a patient yesterday who came from Methodist Hospital to MD Anderson. A patient had brain cancer, and they wanted to switch hospitals. It was sort of emergently in between their treatment, and they just showed up in the emergency room. All the patient had was one PDF of 613 pages of just computer-generated reports, all designed to make sure that every billing code is covered. So when they submit that to the insurance company, they will get maximum reimbursement. But that, to me, as a clinician on site looking to make emergency decisions on a patient. I had a phone with a 613-page PDF. It was a patient’s phone, by the way, and I had a minute or two to scroll through and try to pull what I could.
If you think about 2022 in the age of information, that scenario is absolutely preposterous. It is just insane. That’s how health care is still conducted in the United States. So what our platform would do is take that 613 pages: simplify it, make sure we’ve got a working diagnosis list, current medication list, and make it in a format where the patient understands what’s going on, the family understands what’s going on, and it’s easily shareable. So another clinician who needs to know what’s going on, can understand what’s going on.
FormulaMed addresses these issues by leveraging technology and a collaborative, patient-centric approach through an innovative delivery model. This means full pricing transparency, aligning costs for all parties involved.
We’ve lost our way in healthcare and those reasonable expectations aren’t the driving factors anymore or at best have become an afterthought. So I think by putting them at the forefront and then building a very complex system, which is what it takes, healthcare is not easy.
