Speedy bill diagnosis
19 05 08 - 18:11
BY SANDRA GUY Sun-Times Columnist
Imagine no more bills from insurance companies, hospitals and offices months after you've been to the doctor.
Scott Kornhauser, CEO of Healthation (healthation.com), and Daniel T. Knies, chief technology officer, have developed software to let people pay their doctor's bill instantly at the doctor's office or their hospital bill at the hospital, just like people pay for their prescriptions at the drugstore.
The architects of the largest pharmacy-transaction software systems in the United States have set up headquarters for Healthnation in west suburban Darien to start what they hope will become a software revolution in health care.
"It's a model much like any other retail marketplace. Today, shoppers know who the retailer is and how it performs, and they pay for their purchase at the counter," said Kornhauser in an exclusive interview with the Sun-Times.
Making this possible within today's complex health care system will require new business models and radical software innovation, he said.
It's no small challenge. Annual health care spending in the United States tops $2 trillion now and is expected to grow to $4.1 trillion by 2016, according to the National Health Statistics Group.
Healthation is promoting its enterprise health care administration software, called AcceleHealth, and a business infrastructure it calls the Information Currency Exchange as the underpinnings of the health care retail revolution. Twenty-four companies are using the software.
The exchange will process and route a person's medical and health insurance information to the many parties involved, such as the employer, the insurance companies and the doctor's office, and decide who owes what.
The outcome would look much like a bank's ATM system: Make a quick transaction and see the results instantly. The exchange works much like a stock exchange in that it will employ a common technology platform to process health care transactions and route information.
Consumers decide who pays for their health care and who can see their health care records.
Brokers, such as a bank, an insurance company or a financial adviser, would sponsor consumers into the exchange for a fee.
Kornhauser said the value of the system is in the information that is passing through the exchange in real time.
The flip side to this health care payment nirvana is that everyone would have to take responsibility for their own health care.
The Information Currency Exchange will generate scores, much like FICO credit scores that determine how high an interest rate a person pays, which will benefit or punish people based on their health care behavior.
So if a consumer usually chooses a "Mercedes" prescription when a cheaper generic version is available, he or she will pay more out of pocket.
For example, patients who share their information with pharmacy companies may be offered drug rebates, much like a grocery shopper gets rewarded for using his or her loyalty card.
The idea is that everyone will have access to the Information Currency Exchange, including the self-employed, unemployed and others with no health insurance. The idea is that everyone will be insured, and that people will change their bad health care behaviors to reward themselves.
A cottage industry of health management "coaches" is expected to spring up to guide people in making better health care decisions.
The health care industry is headed in the direction of Healthation's vision. Already, the federal government is requiring that personal medical records be digitized as electronic records, that the electronic records operate with health care's many computer systems and that employees be rewarded for maintaining their own tax-free health savings accounts.
There have also been resulting controversies: concern about a lack of privacy and security lapses in medical records, and a Government Accountability Office study that shows that health savings accounts benefit the wealthy.
"We're focused on the business transactions of health care," Kornhauser said. "As we evolve the infrastructure ... we are looking to transform health care from a $1.4 trillion 'cottage industry' into the world of 21st century computing."
There's a long way to go. Only 10 percent of doctors use electronic medical records, and today's medical payment clearinghouses are expected to set up their own "exchanges" to process medical transactions, rather than operate within a single exchange.
The effort could take 3 to 10 years, and the federal government may end up sponsoring the exchange that processes the payments.