As we all know, search giant Dr google is trying to enter Medical field and trying to get legal access to medical histories. And we are at the door steps when AI and analytics can help analyze tons of healthcare data and use it for our betterment. This does cause privacy concerns but let us assume that those are taken care of.
Understanding the pain points in Medical and Dental field Insurance companies control the healthcare market. What treatment is covered and its frequency of treatment is all governed by insurance. How much patients pay and how much doctor gets is also controlled by insurances. Similarly how much a procedure costs is also determined by insurance.
Where do dental clinics or a medical clinic spend most of their time and staff resources?
You would not believe but most work, a medical or dental office spends is on the following:
- Checking insurance eligibility
- Checking past treatments to make sure the current treatment can be done and get paid because insurance controls the frequency of the treatment
- Filings claims and supporting documentation such as X-Rays and intro-oral images
- Getting patients to pay for their portion of the payments
Imagine a “Connected Healthcare” world
Lets imagine there is a system in which patients must go and get their preventative services such as physical exams, x-rays, dental-cleanings done when prompted to go. Patients get incentives to get these preventative services done and get penalized for missing these services. This itself will bring down the cost we all spend on fixing our body. The system knows the patient’s history and decisions are based on analytics and not time based.
Medical providers perform exams and this results in notification of any worsening symptoms, to the central system, which in turn results in authorizing the medical provider to perform the treatment in real time. The treatment is performed, details get sent back to the central system and money is transferred to the provider as soon as the patient leaves the office. With the technology today, this can happen with AI and in real time.
This system is similar to a smog test being performed and results getting uploaded in real time to the DMV. All sensors/x-rays/ECGs are sending real time data to central system which is analyzing the results and authorizing payments.
What good does it do
First of all it reduces patients visits to a medical provider. This is a big benefit because the treatment gets started right away. Secondly, there is no front desk calling insurance companies to check the eligibility, no waiting on phones to check whether the doctor can do a treatment or not. There is no billing effort after the patient leaves the clinic. There are no collection headaches. Everything gets done real time.
How can we reach this level of automation?
This needs changing the way we have been working so far. Companies like Google, Apple, Amazon and Warren Buffet announced in 2019 their intentions to make healthcare more efficient. This can be done through collaboration and not dividing the worlds in to Alexa and Google home. A central database of patient’s medical history is a key. Over that the analytics algorithms of today can do magic beyond our imagination. The algorithms can provide useful information to the medical providers. They can inter-link medical history, oral health and vision history to each other thereby providing all necessary details to the medical providers. They can predict an incident and thereby allowing a chance of prevention.
No filling any medical history forms. No waiting for 6 months to get the next dental cleaning done. Doctors free up their time that was spent on insurance claims and collections. They see more patients on a given day and staff dependency reduces. I can see a saving of at least 20-30% compared to today. And if we can prevent a root canal or an implant just by preventing it, that a huge savings.
I did not talk much about medications but that is another place where a connected healthcare can integrate patients, medical providers and pharmacy together.
I hope our our Federal agencies, private companies and insurances can work together to unlock a huge potential to revolutionize the medical field and reduce the costs significantly so that the system can provide an excellent healthcare to all individuals at reasonable cost.