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Wouldn’t heath systems like Kaiser Permanente that are fully integrated (both insurer and provider) have the right incentives to disrupt their own processes in
by divbzero 5y ago
Wouldn’t heath systems like Kaiser Permanente that are fully integrated (both insurer and provider) have the right incentives to disrupt their own processes in favor of something better?
- nradov 5y agoWhat sort of incentive were you thinking of? KP is one of the largest Epic customers. They don't have claims as such, but still have similar internal processes to prevent waste and determine how much to charge their customers.
- dragonwriter 5y ago> KP is one of the largest Epic customers. They don't have claims as such Yes, they do (whether you are talking about KP-as-provider-network submitting claims to non-KP insurers, or KP-as-insurer adjudicating claims from non-KP providers.)
- nradov 5y agoI was addressing the comment from @divbzero about integrated systems. Out of network claims are a separate issue.
- divbzero 5y agoI was thinking about incentives around cost of care. KP could switch from Epic to an alternative if it enables deep learning that reduces costs in the long run. Reducing costs is aligned with KP’s incentives because they are not only the provider but also the payer for medical care. This is different from most medical providers which OP suggests have an incentive to be “cost maximizers” to increase reimbursements from payers.