I’ve had the conversation many times about “is it better to have best-of-breed point solutions and the unintegrated burden or an integrated platform and pay the user experience burden?” With AI, feels like we will disintegrate first, reintegrate the BOB winners.
Open source adjudication rule sets targeting different actuarial value and medical models and/or conditions. Blockchain based GAO for voting for changes to adjudication rules. Plans could be built around these rule sets, driving transparency, and predictability.
I had this experience this year, and to make it worse the payer adjudicated the so called “surgery” performed in the office visit as falling under the major medical deductible. Only the 99203 carried the copay.
We would love to talk with anyone working on an ASO platform that either is publishing adjudication rules or providing a full pre-service adjudication simulation API. #healthcare #transparency #adjudication
What would change if all adjudication rules were public and transparent?
Misaligned incentive #1 — Payers that own provider networks: “we can profit by paying our providers more since we are capped by MLR” … and since the Anti-Kickback/CPOM/Sherman/etc statutes are not “strict liability”, proving “intent” is just a complicated shell game played between lawyers.
I think it’s overdue! The AT Protocol it is built on allows someone to maintain the same account name across every social platform that implements the protocol. Using domain addresses … smart. No more variation of account names across platforms. Hope the major platforms find a bridge to it.
Love to see “Patient notification of record exchange” with hopes it goes further into consent. Blockchain with on-chain, revocable permissions to least-privilege decryption keys that expire.
If anyone is working on this, I’d love to interview them on the Platform Health Podcast.
