Dear Mr. Bezos

My name is s, I am a physician, who started off as a front-line healthcare provider, who rose to the ranks of physician and hospital leader over the course of 15 years in what appeared to be a very successful career.

Unfortunately my career was interrupted by the impending financial failure of the 110 year old hospital system I worked in and in which I was a physician leader. I left this system, and relinquished my leadership role 2-3 years before its ultimate collapse into bankruptcy.

I left because I couldn’t stop it’s decline. I was a clinician, elevated to leadership positions due to my excellence as a physician and my ability to see multiple points of view and achieve working consensus.

But my lack of understanding for healthcare financing, hospital financing, insurance and electronic medical records meant I was ill equipped to help my 110 year old healthcare system. I then returned to being a frontline healthcare provider for 15 years, before embarking on the next stage of my career, understanding healthcare systems, financing, insurance and electronic medical records.

It is now that I wish to use what I have learned to solve problems, fix issues and make this healthcare system work better, save money, improve interconnectivity and interoperability of electronic medical records systems.

The deficiencies of the system play out everyday to frontline providers, but our voice is limited by our knowledge gaps. I went back to school to learn quality improvement, utilization management and to study Medicare, the largest insurer in the world, along with Medicaid and Commercial insurance. I also went to work in the hospital studying costs of hospital admissions, emergency room care and ways of reducing costs and primary care.

It is my hope that you are interested in reducing healthcare expenses to your business as well as improving the healthcare system by considering The Hawai’i Project.

The Hawai’i Project.

Hawaii is a small state, isolated and 5000 miles from the North American Continent. It is an ideal place to institute reform and measure the success or failure of reforms due to its isolation and relatively limited confounding variables.

Four Parts

Part A: Transform Multiplayer System to a Single Payer and Multiple administrator system.
Part B: Realign Profit Incentives of healthcare system.
Part C: Eliminate the disconnected status of patient healthcare information repositories to reduce wasteful and harmful replication of tests.
Part D: Realignment of Focus from reactive medical care and treatment to education and preventative care. Let’s pay for health not for care of sickness.

Part A Transform Multiplayer System to a Single Payer and Multiple administrator system.

Goals:
Eliminate System inefficiencies to reduce costs and improve care, by reducing provider focus on the multiple Insurance systems and refocusing it on providing care.

Methods
-Standardization of forms
-Standardization of claims and payment processes
-Standardization of criterion for claim denial and appeal
-Increase concurrent review of potential admissions and increase utilization of alternatives to hospitalization

Philosophy of Single payer system in multiple entity administrative Environment
The goal is not to create another governmental entity, the goal is to makes changes to the current system, while preserving the current companies, their infrastructure and their jobs. But change their forms, policies and procedures to standardize them across the industry. Additionally the goal is to eliminate the current profit incentive to eliminate the appearance or reality of a conflict of interest when insurance company profitability is dependent on the difference between insurance policy premiums received and insurance claims paid.
The Hawaii Project is an experiment into implementing the basic traits of a single payer system on a multiplayer system, by standardizing processes, paperwork and preserving the existing medical insurance companies but support a non-governmental approach to a single payer system with existing insurers becoming multi-entity administrators of a single payer system. The systems success must determine the continued profitability and preservation of these companies.

What I am describing is system where we take the advantages of a single payer system and implementing it in a multi-administrator environment. Instead of creating a new government entity. The existing insurance companies become the administrators of a single payer system. The inefficiencies of the multi-insurer system such as multiple types of forms, multiple diagnosis coding systems, multiple types of approval systems should and could be eliminated by creating a standard for all processes.

Part B Realign Profit Incentives of healthcare system

I believe the current profit incentive system creates a conflict between insurance companies desire to earn a profit and the fair and rapid payment of legitimate medical claims for payment. The current system where insurance companies receive premiums, pay claims and derive their profits from the difference between premiums paid in and claims paid out creates a conflict of interest.

Instead I propose a system of payment per claim processed quickly and correctly, according to predetermined criterion. These criterion would be uniform across payers who participate in the single insurer multiple administrator model. The premiums would no longer represent a pot of gold they preserve by denying payment for healthcare services. It would become a reward pool for both healthcare providers who provide care and insurance claim processors who process claims correctly and rapidly. Part of their function will be education of providers on standard medical criterion for payment and education on claims preparation. This relationship could evolve to the point of having them provide claims processors to large providers, to provide education and claims processing expertise in the offices and clinics to make the process of claims submission and reimbursement more efficient. This would improve the cash flow of healthcare providers and insurance claim processors. The submissions for payment by both could be electronic. Providers submit to insurance claims reviewers and processors. Then insurance claim processors submit approved claims to the rewards pool entity and both the healthcare providers and insurance reimbursement providers are paid for approved claims. Any excess funds in the reward pool would roll over yo the next year.

Healthcare insurance providers would continue to calculate recommended premium adjustments each year and would receive bonuses for accurate estimates of Projected yearly costs, but penalties for both overages and underages in premium funding of the reward pool. This allows the new system to benefit from these companies expertise in predicting healthcare costs and provides bonus payments for accurate forecasts.

Part C: Eliminate Information Silos of clustered and fragmented patient information.

Current system partitions the diagnostic, therapeutic and historical patient information in electronic data stockpiles which don’t communicate.

Information requests are submitted by fax and processed manually, which can result in delays of hours to days.

This processes results in therapeutic inefficiency and errors, which are costly and degrade quality of care.

This process results in unnecessary diagnostic redundancy or replication, which is painful, costly and in terms of unnecessary diagnostic X-rays potentially harmful.

Part D: Realignment of Focus from reactive medical care and treatment to education and preventative care. Let’s pay for health not for care of sickness.

Our system is very good at repairing injuries from accidents.
But our system of dealing with chronic disease is filled with areas of potential improvement.

Our current insurance system disincentives primary care through lower salaries and lower reimbursements for Primary Care provided in a clinic or doctors office.

These economic disincentives create a shortage of primary care providers, which results in primary care being provided in more expensive settings like Urgent Care Clinics and Emergency Rooms, where the cost of care is multiple times higher.

Several studies also show that primary care provided in non-primary care settings like Urgent Care or Emergency Rooms is less effective at preventing disease complications like stroke or hospitalizations.

Final Words

This project outline is a draft of incremental changes to our healthcare system in a small closed population. It will need additional work by experts, but it’s success will be dependent on strict adherence to a patient focused and properly incentivized approach.
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