This Web site presents a complete solution to the many problems associated with the delivery of healthcare, a solution with several notable achievements. One of the most important is eliminating or significantly mitigating virtually every major healthcare cost-driver. For example, our solution eliminates the third-party payer problem (patients largely shielded from the true cost of their medical choices), unnecessary treatments and even defensive medicine (doctors ordering excessive tests to minimize their risk of a malpractice suit). We consider 22 of the worst cost-drivers and prove their elimination or reduction. The combined cost-savings are at least 40 percent of the cost of hospitals, doctors and clinical laboratories, retail prescription drugs and administrative costs.
In addition to bending the cost curve down sharply, our solution includes a major advance in measuring and promoting healthcare quality. We have developed a methodology for measuring the unbiased, risk-adjusted outcomes of patients by diagnosis and by individual provider. This means we can compare how well patients with a given medical condition and prognosis recover under the care of different doctors. Our process for collecting and processing the required information is streamlined and automated, so we can readily include in our database every non-routine medical episode of every member of our health plan.
When we process claims that doctors submit to us for reimbursement, we extract the prices they charge. By combining doctors' prices with their outcomes, we can measure the value that each patient receives: i.e., the outcome per dollar spent. Another important result of our approach: virtually every provider's financial interest is perfectly aligned with the value expected by each of his well-informed patients. Doctors whose patients do well will prosper under our system; if their patients don't do well, they'll not prosper.
Under our solution, members are better informed than under any other health plan. We present in a unique, personalized document called The Doctor Shopper [Side 1; Side 2] the prices, outcomes and credentials of several doctors who offer the treatments the patient requires. Then we hand The Doctor Shopper to the patient immediately before she needs to select a doctor for her treatment. However, before explaining how we are able to accomplish this, we note a very powerful feature of The Doctor Shopper: the Value Chart.
The Value Chart combines the prices with the outcomes information for each of several doctors and presents this information in a way that makes it very easy for patients to identify the doctors and hospitals offering the best treatment values. It is patients reviewing their Value Charts that compels doctors to compete vigorously for these patients with low prices and good outcomes. This competition is what eliminates or curtails most of the cost-drivers and increases healthcare quality.
How are we able to present The Doctor Shopper to the patient before she selects a doctor for her treatment? By separating diagnosis from treatment. The doctor who conducts the diagnosis—the diagnostician—determines first whether the patient requires more than just routine (inexpensive) care. If she does, the diagnostician prepares a formal, written treatment plan. Once this plan is entered into his computer, the computer searches its database and identifies several doctors who can treat the patient's medical condition. The database also contains information on these doctors, including their prices, outcomes and credentials. The computer organizes this information and prints it out in The Doctor Shopper, which can now be handed to the patient. However, the patient is free to choose any available, licensed doctor in the world for her treatment without any reduction in benefits.
Even patients with a routine condition will receive The Doctor Shopper and obtain their treatment from the marketplace if their treatment cannot be completed during the same visit on which their diagnosis is determined. If the treatment can be completed at this time, it saves the patient the time and expense of an extra visit to a different doctor.
Diagnosis and treatment are separate activities relying on different skill sets and knowledge bases. Up to now, they have been combined for convenience. However, this separation will allow the patient to receive several major benefits. Besides the opportunity for her to receive valuable information before she selects a doctor for her treatment, she also receives a free second opinion—one from the diagnostician and the second from her treating doctor, who must concur in the diagnostician's primary diagnosis. Treating the wrong diagnosis can be costly and potentially harmful to the patient.
Another benefit from separating diagnosis from treatment is the elimination of self-dealing—doctors prescribing unnecessary or inappropriate treatments and then profiting when they perform them. Moreover, our superior method for measuring outcomes also depends critically on separating diagnosis from treatment, as do other important benefits discussed elsewhere.
One other major problem needs to be resolved. Our outcomes measure makes healthcare quality transparent to our members. If we were to pay healthcare benefits in the conventional manner, patients would search out and opt for the highest quality care, which also would likely be the most expensive care. Because the current reimbursement system requires only modest co-payments, most patients would simply choose the highest quality treatment, thereby driving up the cost of care even faster.
Instead of the conventional approach, benefits under our approach are paid as follows. A fixed benefit amount is assigned to each procedure, medical condition and pharmaceutical. If the provider charges more than the benefit amount, the patient has to pay the full difference out of her pocket. However, if she finds a provider who charges less than the benefit amount, we send her a check (or credit her Health Savings Account) for the full amount saved. Thus, if Dr. Smith charges $45 more for a procedure than Dr. Jones, the patient will always end up with $45 less if she chooses Dr. Smith over Dr. Jones, no matter how large her benefit amount.
This method of paying out benefits, which we call Reference Pricing plus Rebates, will make patients cost-sensitive, since they must bear the full cost difference of their treatment choices, though not the full cost. It is noteworthy that this is a necessary condition for efficient markets as long as, in the language of economics, prices reflect marginal costs. Finally, a patient will always have at least one treatment option with no out-of-pocket expense.
By making consumers much more sensitive to medical prices, Reference Pricing plus Rebates eliminates the third-party payer problem mentioned earlier, and which many healthcare experts believe is the single greatest contributor to high healthcare costs.
Another important technology is FAHPA, our fully automated health plan administrator. Except for a computer operator and customer service representatives to field telephone inquiries, this technology can operate without any other human intervention a complete health plan with a vast membership. It is very inexpensive to operate.
Research Enterprises' healthcare system has been developed around a set of carefully constructed incentives that yield optimized results. Consequently, we have called it Research Enterprises' Medical Incentive system, or the RE·MEDI (pronounced remedy) system. After studying the contents of this Web site, it will be clear that, compared with other healthcare systems, RE·MEDI offers members: the best cash incentives, the most useful information, the best quality measures, and the greatest freedom. Employers benefit from lower medical costs, lower administrative costs and happier and more productive employees. Providers enjoy reduced administrative costs, the quickest reimbursements, the lowest claims denial rate and the ability to receive market prices for the services they provide. This is why we call the RE·MEDI system an optimized healthcare solution.
RE·MEDI also provides members with several benefits in addition to low prices and high quality care. For example, members physically possess their own medical records on an encrypted flash drive, which they take with them to each medical visit so that the records can be automatically updated. They can access these records on their home computer. Members who require non-routine treatments receive a written report from their diagnostician explaining their diagnosis, prognosis and treatment plan in a letter written in easy-to-understand language.
The RE·MEDI system offers a substantial value proposition to nearly all of the major players in our healthcare system. Whether a healthcare consumer, an employer, a doctor, a hospital administrator, a union official, a health insurer, an administrator of a government healthcare agency, or simply a taxpayer, there are substantial benefits to be gained from it. Articles describing the benefits for each of these players can be accessed from the Value Proposition drop-down menu.
Details of the RE·MEDI system's main concepts can be explored in the four articles listed under the "RE·MEDI Concepts" drop-down menu. It is recommended that they be read in the order in which they are listed.The Doctor Shopper is the heart of the RE·MEDI system. The Doctor Shopper packet can be downloaded from here; it includes a sample copy of a) a cover letter to a patient from her diagnostician; b) the patient's treatment plan, and c) The Doctor Shopper.
The Policy Solutions menu provides access to articles describing solutions regarding current policy issues. The first article shows how the RE·MEDI system significantly enhances the power and effectiveness of Health Savings Accounts. Research Enterprises also has a bipartisan plan for universal healthcare reform. It is the only plan that can provide healthcare to every citizen without new taxes and without raiding (or even touching) Medicare. The last article presents our proposal for a replacement for the Affordable Care Act (ACA).
An annotated PowerPoint presentation is also accessible from the main menu.