Coping with a Patient-Crushing Healthcare Bureaucracy

Peter C. Raich, MD, FACP
Chief Medical Officer, Prosocial Applications, Inc.
Professor Emeritus, U. of Colorado

Elaine Blechman, PhD
Founder & CEO, Prosocial Applications and Professor Emerita U. of Colorado

Most of us have heard the saying “Penny wise and pound foolish” and have a fairly good idea what it means. It is a criticism that can be applied to the inefficient, fragmented and expensive healthcare system in the United States. Although US scientific and medical accomplishments lead the world, patients, caregivers and providers are being beaten down and frustrated by the never-ending administrative burdens of our healthcare bureaucracy.

Coping with a Patient-Crushing Healthcare Bureaucracy

Overlooked Burdens to Timely Healthcare

In a New York Times opinion piece, Dr. Chavi Karkowsky describes a patient who had to take “a precious morning off from work to ferry documents between a Medicaid office and her pharmacy to prove that she did not, in fact, have alternative insurance, and therefore her diabetic supplies should be covered. A pack of glucose test strips had cost her a small co-pay—and likely most of a day’s lost wages.” Penny wise and pound foolish.

We all know what these uncompensated administrative tasks are: calling doctor’s offices, checking on prescriptions, confirming referrals, clarifying insurance coverage, sorting out bills from multiple medical providers, requesting and copying medical records and bringing hard copies to medical appointments. It is not unexpected that these burdens fall most heavily on those that can least afford it: those with complex medical illnesses, such as cancer, diabetes and multiple sclerosis, those with a chronically ill child, and those with limited job flexibility. Lack of access to computers and the Internet, along with low reading skills, further stack the deck against receiving timely and effective care.

Insurance Obstacles

There is a sense that these administrative burdens are increasing as a strategy by the healthcare system to find ways to reduce costs. A new survey by the Kaiser Family Foundation, a non-profit health research group, found that a majority of Americans with health insurance stated that they had encountered barriers to their coverage, such as denial of care, unexpectedly higher bills, and inability to make timely appointments. Close to half of those who had insurance problems said that they could not resolve them satisfactorily. Those most in need of medical care, including those in fair to poor health, had more difficulty in obtaining timely care. Seventy-five percent of patients needing mental health treatment encountered problems.

Another recent survey conducted by Morning Consult for the American Hospital Association found that 60 percent of patients reported that their medical care was delayed by their insurance provider. Forty-three percent of these patients noted that their health has since gotten worse.

Denials of health insurance claims are also rising. Part of this may be due to the rapidly increasing use of computer algorithms generated by Artificial Intelligence systems with low or inaccurate data bases. The Kaiser Family Foundation survey found that even when patients received treatment from in-network doctors approved by these same insurers an average of 17 percent of claims were denied. Of course, challenging such a denial can take hours of both patient’s and doctor’s time. Curiously, only one of every 500 denials is appealed. A major reason pointed out in the Kaiser survey is that most people did not know that they had the legal right to appeal a denial and did not know how to go about doing it.

A Way to Streamline Your Healthcare

We created the RK360® Cloud Health Record App as a consumer tool to address and simplify many of the uncompensated administrative tasks that perplex patients and family caregivers in our current complex and often confusing health care system and health insurance industry. It is a valuable tool that aggregates scattered health information into the RK360® Cloud Health Record, which consumers exclusively own, control and share across the RK360® Digital Health Privacy Platform.

The RK360® Cloud Health Record gives patients and family caregivers a more complete picture of their health status than the fragmented patient portals attached to clinic and hospital health record systems. The RK360® App equips family caregivers and patients to own, control and share information with any U.S. health care provider without surveillance by or disclosure to third parties. Access to care is simplified by the RK360® App, allowing users to match with providers who fit their needs, schedule on-site visits, get telehealth consults, and exchange pre- and post-visit information.

Finally, the RK360® Cloud Health Record may improve the quality of care for the user. This is because the RK360® Record gives providers a more complete 360-degree view of a patient’s health than any one provider’s electronic health record system. By promoting data-driven health care decisions, the RK360® Record avoids needless treatment errors, encourages personalized rather than one-size-fits-all care and may, in turn, improve health care.

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