| Having been on the inside of insurer, facility, and provider insurance systems doing automation work, author is almost right but misses the bespoke entity-entity contracts. In short, "Can F1 send you to F2 to be paid by X?" turns on the following: - Regulations / laws
- Contract with the insured (policy)
- Contract between X and F2
The last is essentially "anything X and F2 strike a deal on."So answering the question definitively requires 3-way parsing of those things. Which is generally a unique 3-tuple for any given patient-provider/facility-insurer combination. The closest you get to standardization is "We work with X a lot, so generally know how they work." And as article notes: regulations / laws change years, policies generally remain somewhat stable (post-ACA standardization), and insurer-provider/facility contracts change whenever they're up for renewal. In short, the system's complexity is what paralyzes it. Which means simplification is the path forward. --- >> It’s obvious how to fix health care. Just make everything run systematically, like FedEx or Amazon. There are no technical or business obstacles to this. Anyone who understands IT and/or business can see how to do it. Also, GOD NO. Healthcare is complex because it's required to be a 1:1 model of reality. All of reality. Shark bite while riding a train that gets hit by a plane reality. The reason healthcare is still largely manually done is that it was originally manually done. It's gotten to where it is by progressive automating... but started at "I start the morning with a stack of paper forms on my desk, and work through them, forwarding them on as needed." We're not looking at a breakdown of the system, but an incomplete automation. (And part of the current bottleneck is the Cambrian explosion of medical specialists in the last 30 years) |