Proposal to Microsoft & Google

A core element of healthcare reform in its broadest context is cost. The first step in controlling cost is to gain visibility about what healthcare actually costs at a level where action can be taken. Microsoft Health Vault and Google Health are platforms that can provide that visibility for consumers. That information can then be de-personalized and used to provide visibility from multiple points of view including hospitals, private practices, regions of the country, type of procedure, etc.

The problem

If I receive healthcare services that involve more than a single provider I will be billed for services from the primary provider and a host of other providers and services including labs and pharmacies. These will show up as line items on a statement I receive from the provider if I am a direct pay or on a statement from my insurance company. Some will be prompt; some will show up months later. All of them will be printed on paper.

Any effort on my part to analyze this data will require hours to transcribe it to an electronic form and then to assign it to specific illnesses or injuries and then classify it in meaningful sub-categories for analysis. If I find a potential issue it is difficult to challenge it in a timely manner.

Proposed solution

You could provide an interface to providers to capture the data in its electronic form and post it on my personal health record (PHR) as a standard spreadsheet, e.g., Excel. That format would:

  • Identify the service provider with a link to a database for more information, e.g., what services does XYZ Medical provide and how I can contact them – an Internet link would probably take care of most providers.
  • Provide a generic classification of the services, e.g., hospital, lab, ambulance, etc.
  • The date of service
  • Some description of the service which could be a billing code* and a standard translation
  • Amount billed, allowed, payer paid, I pay

It should include charges that are covered by insurance plus non-covered charges such as non-prescription pharmacy at drugstores and other providers that are subscribers to Health Vault or Google Health. It should allow me to add in costs related to trips for treatment, special clothing or devices not covered by insurance, etc.

It should provide the means for me to assign each line item or set of line items to a particular illness or injury or some general classification of my choosing, e.g., seasonal allergy.

Benefits

  • I could accumulate charges related to an incident to get a better understanding of what it cost
  • I could explore options for less costly solutions, e.g., clinic vs. emergency room
  • I would have more confidence in the accuracy of my charges if I could see them sorted in ways that make sense to me, e.g., see that two charges for the same service or item on the same day were for something that could reasonable occur more than once on the same day
  • I would be able to challenge any apparent issues in a timely manner and with a minimum of effort using the data and information in the report
  • I would be able to get a sense of the charges that have been invoiced and those that have not
  • I would see the value or limitations of my insurance to negotiate for more cost effective insurance in the future.
  • I would be better informed about the cost of healthcare and therefore better able to participate in discussions of options and solutions.

Costs

Participation in this service could be part of a provider or payer’s package of services. A translation from their standard formats to yours would have to be developed but we should be dealing with relatively standard data elements as specified by HIPAA and the current work on electronic medical records. The cost per provider or payer should be relatively small.

I leave the cost and benefits of de-personalizing data for broader analysis to you but I suspect that it is relatively small once the data exists in a standard format.

* Related discussion on problems with billing codes initiated by e-Patient Dave on Twitter

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2 responses to “Proposal to Microsoft & Google

  1. This is a good proposal. Making healthcare transaction data like premium charges, payments, claims and “authorizations” available to customers/members/subscribers/patients in a standardized and understandable fashion should go a long way to improving clinical outcomes and lower costs.
    My experience as a healthcare consumer, father of four and healthcare payer design engineer for a couple decades has made this intuitively obvious to me. At the same time, it’s also clear to me there are significant ‘standardization’ and semantic definition/translation challenges. HIPAA code sets are not all they are cracked up and touted to be. Different program types (Medicare, Medicaid, Commercial, HMO, PPO, etc. – and all their variations) apply different meanings to these pesky data elements that many would have you believe can easily be converted and translated so that others can understand them.
    Indeed, my opinion is that all healthcare constituents – consumers, providers, payers, sponsors/employers and other ‘middlemen’ like brokers and government agencies – would all be way better off if data could be shared between them all in a more standardized and usable representation. About 20 years ago a CIO I worked for always harped on us peons that: “the data doesn’t change or have any real value or competitive advantage; it’s what you do with the data (i.e. how you process it) that matters!”

  2. Hi, nice post. I just found your website and I’m already a fan. =]

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