no need to go hunting for the dispered un-insureds, many of who are the "uninsurables" in our uniquely american health care caste system (i.e., worship of the almighty dollar, with actuarial high priests).
instead, just start with one large self-insured employer. [wr] - - - - - - - - On Jan 16, 2007, at 5:16 PM, beancycler wrote: > You have two very valid points. Un-insureds could really use this as > a means of straight forward financial relief. Your second point is > basically how would one make an entrance into the market? The > software product as a whole would need to have a brand name. This > brand name would now in theory bring varied savings between many > patient using these open methods. This brand name could then be > marketed to Third Party Administrators(TPAs aka the companies that > actually pay the claims), as a 'pilot' cost management tool. TPAs > taking part in this pilot would be exposed to a truly innovative piece > of the software being that the discount would be applied immediately > at the doctors office thus reporting immediately to the TPAs; giving a > significant edge in marketing the product because TPAs would receive > immediate turn around and have access to report & evaluate the pilot's > cost savings effectiveness. Ultimately by first exposing this > software to un-insureds a certain amount of cost saving confidence > could be understood before actually entering the market place. There > are many different strategies that can be used to bring this product > into the market. To really get TPAs interested, it would be ideal to > have a way of communicating the required discount amounts with them. > Let's say a TPA will have to raise premiums 5% because of rising > healthcare provider costs for certain CPT codes in a certain region or > a certain provider group. This could be entered into the open system > to counteract that trend yet not cause everyone to suffer. If that > certain provider system refuses then perhaps it would be better to go > to a provider who will negotiate this cost. > > --- In openhealth@yahoogroups.com, "mspohr" <[EMAIL PROTECTED]> wrote: >> >> Interesting idea. I can see how people without health insurance >> would >> use this "marketplace" but I don't understand how existing clients >> who >> are locked into a plan would use it. >> >> --- In openhealth@yahoogroups.com, "beancycler" <mmiller@> wrote: >>> >>> Hello, I am new to this group. I have worked in the health care >>> sector of IT now for 7 years. I know the 'in and out' of the PPO >>> Network business. If you don't know what a PPO Network is you can >>> find a brief description at >>> http://healthinsurance.about.com/od/jobbasedcoverage/a/hmovsppo.htm; >>> the PPO paragraph of course. >>> >>> The basic principle of the PPO business is to 'steer' patients to >>> certain clinics whom then in turn willingly accept a decrease in >>> health care charges. I do not want to go into detail on this page >>> about the practices used by my present employer. I am interested in >>> creating a version of this business model by developing and >>> utilizing >>> Open Source Software. >>> >>> Ultimately the goal of this new software would be to give the >>> organizations & individuals who pay for healthcare premiums and >>> health care providers a more intimate relationship with health care >>> cost management unlike today's seemingly complex cost management >>> businesses. My opinion is that medical networks are taking the >>> negotiating away from patient/doctor and making it impersonal, >>> inefficient and ultimately more compatible with there business >>> model. >>> Envision a network of people and phyisicans capable of negotiating >>> there own health care costs rather than medical health plans having >>> the only say. Phyisicans could choose to be in or out of your >>> particular plan all within a personal negotation process >>> coordinated & >>> organized by this software. Do you think this would be beneficial? >>> What potential issues would be encountered? >>> >>> Over the course of the last three years I have established a >>> completely open source development environment. This includes a GNU >>> coding repository containing Sun Java source code, Linux development >>> server, MySQL database, and Apache/Tomcat web server. I find >>> today's >>> Open Source technologies extremely powerful and would like to employ >>> this power in a business sector I have a passion to improve for the >>> betterment of mankind. >>> >>> If you have certain knowledge or particular interest please send >>> me an >>> e-mail. Thank you. >>> >> > > > > > > Yahoo! Groups Links > > > > [wr] - - - - - - - - will ross project manager mendocino informatics 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.minformatics.com - - - - - - - - "Getting people to adopt common standards is impeded by patents." Sir Tim Berners-Lee, BCS, 2006 - - - - - - - -
