Alex W.'s Blog

Healthcare đź©ş

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Of the 100s of articles/podcasts/books I’ve read, these are the best concentrations of healthcare knowledge that I’ve come across:

Salient Observations

  • General physician stats

    • Percent of physicians work in private practices: 54% (Kane, 2019)

      • Percent of physicians who are owners in a private practice: 41%
    • Number of physicians in practices of varying sizes: 35% in <5; 20% in 5-10; 13% in 11-24; 7% in 25-49; 15% in 50+; 9% in hospitals (Kane, 2019)
    • Physicians in USA: ~1m (Wikipedia)
  • Self-insured plan stats

Ridiculous Observations

  • Billed rates are frequently >5x the reimbursed cost (analysis of Medicare PUF CY2018)
  • “There are more than 9,000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.” (pg 150, The Innovator’s Prescription)
  • The average annual turnover for members in health plans is 17%, ie., each patient is a member for roughly 5-years. This disincentivizes preventative care for issues that manifest outside a short (<5 year) timeframe. (pg 206, The Innovator’s Prescription)

Questions

  • What percentage of practices store credit card information for automated billing?

    • What percentage of practices charge coinsurance up-front, before the procedure?
  • How much do claim clearinghouses charge?
  • How are hospitals collecting data in order to accurately price services (for value-based reimbursement)?
  • How are PCPs incentivized to be gatekeepers in HMOs/ACOs?
  • How many self-insured employers directly employ physicians to handle care coordination (or non-physician care coordinators)? Why or why not? Do any TPAs offer this?
  • Who is running Amazon’s healthcare initiatives? What complementary businesses do they need to exist (to create the value network) to provide their services?
  • Review “Competition in Health Care: It’s Evolution over the Past Decade”, Health Affairs (2005) - discusses capitation systems and the problem with it being an approach to value-based care

Written by Alex Wendland, who is currently exploring fintech at Pinwheel. Here's a Twitter handle, a GitHub, some LinkedIn, ol' Facebook, or a hip Instagram if you're interested.