By Alexi Alizadeh
When an existing paradigm can no longer withstand external factors, often new and unforeseen, its structure weakens and crumbles. It no longer serves its intended purpose. It’s often these external factors, measured against the internal disintegration, that determine the structure’s fate and the urgency for a radical transformation. In this case, that structure is our healthcare practice.
After suffering a stroke at the age of 22, I personally witnessed the weakening dynamics of the industry. Given my condition at the time it was a challenge to even pick up the phone to schedule an appointment. As I learned firsthand, even when a patient is very sick during a health crisis, scheduling an appointment can be a cumbersome process. So much so that it’s almost easier for some people to suffer through the issue and make do on their own rather than see a healthcare professional.
Because of this, I vowed to do what I could to address the system’s pitfalls and make necessary changes. Equipped with a background in policy and regulation and an expertise in technology, security, and infrastructure, I strived to create a digital healthcare platform with the structural integrity to withstand the elements. Now, with the onslaught of COVID-19 directly attacking our existing healthcare system, the need for a strengthened foundation has become more urgent.
An optimized healthcare system must be accessible to all. And lower costs for healthcare providers and patients are a large part of that. In the digital arena, a fully integrated medical services platform is the solution to achieving this. It’s technically fortified to withstand most all digital healthcare needs, with space for additional features. These include: accountability via reliable physician reviews; security to meet patient privacy needs and HIPAA-compliant communications, as well as to protect digital pre-payments for medical services and medical record transfers; efficiency with online appointment bookings and actual telemedicine sessions; and, lastly, transparency for pricing and cost comparisons.
We can’t simply tear down our current health system to start a revolution and demand better—we need to start with a better foundation that is truly rooted in centricity around patients and providers. To accomplish this, we should consider these key foundational aspects to how healthcare should work.
Increase Capacity with HIPAA-compliant, Impenetrable Security
While COVID-19 caused a temporary suspension of some HIPAA enforcement actions, they will soon be reinstated and enforced. An optimized platform with end-to-end encryption protects patient privacy while ensuring HIPAA-compliance. It not only closes the gaps in security, it provides a permanent solution to these risks.
Current healthcare platforms are not equipped to withstand the sudden and dramatic increases in digital healthcare demand, leaving providers to lean on unsecured teleconferencing software that exposes users to data leaks and security breaches. Secured telemedicine software must be designed specifically for healthcare services. It needs increased capacity to allow space for additional health services that are aligned with emerging patient and provider needs.
Additional essential features should include space for the patient to digitally schedule and pre-pay appointments. Most notably, it must be able to integrate well with electronic health records (EHRs) to securely transfer and manage complete medical records.
Remove Barriers to Care Through a Streamlined, Automated Scheduling Process
To make an appointment, patients still must call the doctor’s office in most cases. Aside from the time involved to do this, it’s becomes inefficient and discouraging when these calls turn into a back and forth of missed calls. This delays care and puts patient health at risk.
Simplicity contributes to efficiency and can overcome barriers to care, many of which can be costly. Avoiding burdensome downloads is key.
By simplifying automated appointment scheduling, patients can see the available schedule and book an appointment quickly and easily. It eliminates the middleman and reduces potential for confusion and errors, saving users in time and cost. It frees up administrative staff to focus on other necessary tasks, reduces employee stress from multi-tasking, and reduces overhead costs. Automated reminder tools, sent via email and text messaging, also save providers costs by helping to prevent no-shows and cancellations.
Promote Price Transparency in Healthcare
We don’t buy cars without knowing the cost, so why is it okay in healthcare? Our current system provides no transparency. There is no way for patients to see pricing and comparison shop for services. Costs are often bloated. And services are often skipped because of current pre-authorization and referral requirements, which add additional copays, time, and delays in necessary medical treatment.
Prior authorization is a tactic that many insurance companies use to avoid paying for treatments, procedures, or medications that would cost them more. In these cases, your doctor must ask your insurance company for approval before he or she can prescribe a certain medication, a diagnostic test, or physical therapy. Your insurance company has mandated their own approval to supersede that of a doctor’s recommendation in order for you to receive coverage. They make those decisions based on policies that have nothing to do with you, your medical needs or history.
Filling out prior authorization forms and waiting for approvals can delay time-sensitive treatment and have devastating effects on your health. Prior authorization creates roadblocks in the healthcare process, preventing your doctor from quickly and efficiently treating your symptoms, condition, or disease.
Insurers maintain that prior authorization prevents doctors from over-prescribing and committing errors, but studies indicate that it has a negative effect on the speed and efficacy of treatment. Studies also show that prior authorization simply increases the cost burden on the medical provider instead of the insurer.
When you purchase health insurance, you do so with the understanding that you will receive the coverage and healthcare that you need. In reality, insurers often refuse to cover particular diagnostic tests or procedures simply because they don’t want to pay for what the doctor recommends. That results in one of two things: (1) Either you don’t receive the care you need, potentially jeopardizing your health or (2) You do receive that care, but your claim gets denied and you’re saddled with huge out-of-pocket costs in addition to your insurance premium.
Money should not determine the care you receive, but it’s often the determining factor behind decisions made by your insurance company. While you may think that paying for insurance coverage will prevent worry over healthcare costs, the unfortunate reality is that money continues to be a determinant when insurance companies are permitted to place profit margins ahead of patient care. An optimized platform equips users with the tools to compare costs of health services, enabling them to make more informed decisions.
Telemedicine today—and tomorrow—requires the structural integrity to withstand the escalating needs for optimized digital interaction between the patient and healthcare provider. An effective platform allows patients to search for healthcare service providers, read trustworthy reviews, compare prices, schedule and prepay appointments, and transfer medical records all in one space with the assurance that all records and communications are confidential, secure, and HIPAA-compliant. It provides the healthcare provider a holistic view of the patient. It improves continuity of care and builds the foundation for improved patient/provider relations and treatment decisioning.
Alexi Alizadeh is CEO of Adviise.
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