1 / 19

Allen Okie MD Perspectives

Allen Okie MD Perspectives. Provider – Private Practice-Board Certified-Allergy/Immunology;Pediatrics Medical Administrator – CEO/Medical Director Vantage Health Plan; Medical Director Peoples Health Choice –Medicare HMO; Consumer Advocate.

drake
Download Presentation

Allen Okie MD Perspectives

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Allen Okie MDPerspectives • Provider – Private Practice-Board Certified-Allergy/Immunology;Pediatrics • Medical Administrator – CEO/Medical Director Vantage Health Plan; Medical Director Peoples Health Choice –Medicare HMO; • Consumer Advocate

  2. Dr. Paul Ellwood who coined the term “HMO” has acknowledged that “Managed Care as we know it is dead.” Double digit premium inflation 5 Million people without health care insurance in the last two years Dissatisfaction by patients, employers, Drs. HMO Enrollment is falling

  3. What do we need? • Consumer Driven (Centric) • Open Access • Market Driven • Quality Drivers • Financial Viability for all parties • Medical Management – Rational Rationing – Educate Consumer • State of the Art Information Technology

  4. SIMPLIFY • Simple solutions Captain Underpants and the Perilous Plot of Professor Poopy-pants • Separate Insurance From Finance • Managed Care has merged and blurred the differences between Insurance and Finance • We (providers and insurors) have made the system too complex

  5. Eliminate Intermediation that does not provide value to the system • Develop a Value-Based health care delivery system through Providers and Patients • Focus on the Patient-Physician relationship • Reward quality and value

  6. Give power back to the patient • Change the patient status from user to consumer – Purchase Power • Educate and inform the patient • Universal participation – Product Offering – “Adverse Selection”

  7. What Will Achieve These Goals? CONSUMER DRIVEN HEALTH CARE Discount Fee For Service Plans

  8. Provider Perspectives • More Patients – More Revenue – Less Overhead • NO HASSLE FACTOR • NO CLAIMS (or Adjustors) • NO MEDICAL INTERFERENCE • NO ACCOUNTS RECEIVABLE • PAYMENT AT THE TIME OF CARE –ELECTRONIC TRANSFER OF PAYMENTs

  9. The New Medicine • No More “Mommy May I” • No More Pended Claims • No More Costly Billing and Claims Submission • No More Accounts Receivable

  10. The New Medicine • Reduce Overhead • Increase Revenues from More Patients and efficient operations

  11. The New Medicine • This system will allow the physician to pass savings directly to the Patient instead of to the Intermediary

  12. Can We Get There From Here? • Yes! • HOW? • Discount Fee For Service Plans - clearly separate Finance from Insurance

  13. Discount Fee For Service Plans aligned with • Low cost limited benefit insurance products • Financial institution to provide finance options to allow access to care • Higher deductible HSA Product (Serves as the front end to assure cost effectiveness)

  14. Shift to Consumer Driven Model • Shift from medical management to health care education • Develop Value and Quality Patterns for Provider Services • Provide Financial Services for Health Care Access • Sales and Marketing of Provider Networks – “Carve Outs” Medical E-Bay

  15. Discount Fee For Service Plan • Provider Network – Proprietary Contracted • Vehicle for Service Selection • Providers are rated based on satisfaction results and Professional Certification and training • Swift Payment with out Hassle • Payment Authorized by Patient • Market the Professional services of network to patients and employers • Financial Resources for the patient to access services of the network

  16. IDEAL • Explanation of Payment goes to Patient • Diagnosis and procedures are priced • Diagnosis is matched to evidence based practice notices which the patient checks if they were offered by the Provider – • Based on the score the physician would be paid or not paid or reduced • This is the quality criteria attached to Discount Fee for Service Plans

  17. Statutory Oversite • Discount Fee for Service is NOT INSURANCE – Keep it Simple • Minimal Credentialing – no need for primary source verification • Marketing and sales over-site • Patient Education over-site • Audits of performance and satisfaction • Monitor complaints • Economic Credentialing

  18. POTENTIAL • Discount Fee for Service Plans can provide reductions in operational costs which can be passed off to the patients and not absorbed by intermediaries • Can be attached to an indemnity insurance product • Can be the front end of a Health Savings Account • Provides the economies of group contracting

  19. Allen Okie MD • Thank you for listening

More Related