Navigation Menu+

New business models in healthcare

The Unequal and Unfair Healthcare Business ‘Model’

Healthcare Business Model?In no way do I claim to be an expert on business or even the healthcare system, but the more experience I get with the U.S. healthcare business model the more I realize there simply is no business model. We can all agree the system is broken. There is no shortage of statistics or personal anecdotes supporting that statement. The more you dig though, the more you realize just how crazy it is.

How is it that two hospitals in the same city receive different payments for the same procedure? The difference in cost is in no way tied to quality or convenience like one would expect outside of the healthcare bubble. If one digs long enough, at best you find a jumbled, nonsensical list of criteria that the Centers for Medicare and Medicaid Services (CMS) “take into account” when deciding reimbursement rates.

Healthcare Payments TablePrivate insurance companies develop individual contracts with hospitals. Call me crazy, but I doubt that there is any reason an arthroscopy costs 0 more if the patient is insured by United Healthcare instead of Aetna. Costs for some procedures can vary 10 times or more from hospital to hospital. From a billing and reimbursement standpoint, this sounds like nothing short of a nightmare.

Each hospital easily has hundreds of contracts with different payment schedules, and insurance companies are dealing with an astronomical number of providers and procedures. No wonder administrative healthcare costs are so expensive in the U.S! Data on private insurers is very difficult to find as the contracts are not made public, and hospitals tend to guard their billing data closely. Below is a small sample of data of payments from a single private insurer to various NJ hospitals from the New Jersey Commission for Rationalizing Health Care Resources.

To make matters worse, Medicare/Medicaid payments often do not cover the hospitals cost, so private insurers are over-billed to reconcile the losses. Individuals who are not insured are sometimes given lower rates depending on their financial situation, but at times pay more than the private insurer rates because they do not have bargaining power.

I think they are still sore from the last try

by maestro78

The Apple Pippin was a multimedia platform marketed by Apple Inc. (then Apple Computer Inc.) in the mid 1990s. It was based around a 66-MHz PowerPC 603 processor, a 14.4 kbit/s modem and ran a stripped version of the System 7.5.2. The goal was to create an inexpensive computer aimed mostly at playing CD-based multimedia titles, especially games, but also functioning as a network computer. It featured a 4× CD-ROM drive and a video output that could connect to a standard television monitor. The platform was named for the Newtown Pippin, an apple cultivar, related to the McIntosh apple (which Apple had to spell Macintosh in order to avoid infringement)

You might also like
Is Utah the model for a new, improved
Is Utah the model for a new, improved
Business Case-Studies, Models and Design Principles
Business Case-Studies, Models and Design Principles
New Business Models for Vaccines: Targeting Diseases in
New Business Models for Vaccines: Targeting Diseases in ...

Report: IBM Named #1 Preferred Provider of IaaS Cloud by Enterprises  — Virtual-Strategy Magazine
Ultimately, the report states, players competing in the cloud services market will need to build to the end-state structure of a cloud service provider business model that resembles the automotive factory model of services delivery involving a robust ..

Reframing the fiduciary debate  — BenefitsPro
Rhoades proposes we reframe the argument by shifting the focus from the service provider's business model to the clients' best interests. Furthermore, he suggests we move the venue from the offices of regulators to the kitchen tables of clients.

Wiley Evidence-Based Healthcare Design
Book (Wiley)
Related Posts