The one thing that concerns me in your health care example is the idea of capturing the 10% of unbilled services. Good god, man, health care costs are already suffocating too many people, and you want to make it worse? We need to get the profit motive out of health care, not optimize it.
I get your point, but nevertheless, the payer is usually an insurance company, which then denies as much as they can, low-balls what’s left, and passes the rest on to the patient. Not to mention deductibles. So we still need to get the profit motive out of healthcare.
Good for them. But insurance companies are in the business of making money, not covering medical costs for patients, and that must change. Sorry you have a blind spot on that. Otherwise, you are doing marvelous work with Fractal.
The one thing that concerns me in your health care example is the idea of capturing the 10% of unbilled services. Good god, man, health care costs are already suffocating too many people, and you want to make it worse? We need to get the profit motive out of health care, not optimize it.
10% or more of un-billed services has NO impact on the patient.
It is the hospital collecting for the work it did but entered the wrong code etc. This is 100% between the hospital and the payer.
Today this is done as a consulting engagement - successful at dozens of major hospitals - and never has a patient had to cough up more dough.
I get your point, but nevertheless, the payer is usually an insurance company, which then denies as much as they can, low-balls what’s left, and passes the rest on to the patient. Not to mention deductibles. So we still need to get the profit motive out of healthcare.
Opinions are most interesting.
Facts, however count.
SRD and other groups have, for 20 years performed these audits and found the un-billed services.
In no case has a single patient be charged another dollar.
Good for them. But insurance companies are in the business of making money, not covering medical costs for patients, and that must change. Sorry you have a blind spot on that. Otherwise, you are doing marvelous work with Fractal.