By optimizing America’s provider and payer marketplace, new healthtech is already healing a fragmented and overpriced system.
When a technology platform is working to solve a problem as enormous and unwieldy as American healthcare spending, having a similarly oversized impact needs to be the ultimate goal. As tempting as it is to take a business-as-usual approach, and to declare that the U.S. system is “too big to fail,” new healthtech presents opportunities for lowering the overall cost of healthcare, and improving access to care, that are simply too beneficial to overlook.
No matter how you slice it, American healthcare spending is out of control. After a 10-percent year-over-year increase, it hit USD $4.1 trillion in 2020. That works out to $12,530 per capita, which is more than double the Canadian amount.
The reason America shells out so much has little to do with frequent doctor visits. On average, Canadians see their docs nearly 60 percent more often than Americans do. Rather, it has everything to do with outrageously high healthcare prices. As is the case in countries such as Canada, France, Germany and Sweden, inpatient and outpatient care is the largest category of U.S. health spending. This includes payments to hospitals, clinics, and physicians for services ranging from primary care and specialist visits to surgical care and facility fees. Americans spent $6,624 per person on this in 2018, which is almost two-and-a-half times as much as in comparable countries.
The pricing problem is exacerbated by the fact that the multitude of American healthcare providers all charge different prices for their services and procedures. All told, salaries for workers who play no direct role in providing patient care account for around 20 percent of health spending in the U.S. In Canada, where a single-payer system has been in place since 1962, the cost of administering healthcare is just $551 per person — less than a quarter as much as it is in the U.S.
HealthTech to the rescue
A more direct and effective approach to the buying and selling of healthcare can be taken by harnessing the power of scaled connectivity and data analytics. Before MacroHealth came along, no organization had approached the problem at a large-scale level or used the power of streamlined connections and powerful analytical insights to manage and leverage the huge amount of data flowing through the U.S. system.
Developed by a team that possesses a unique mix of healthcare and computer engineering experience, MacroHealth’s new connectivity solutions, machine-learning algorithms and cloud-based data analytics are enabling health plans to understand and efficiently navigate the aforementioned variations in prices. After all, with $4 trillion in transactions flowing through the sector each year, even small fluctuations can add up to multimillion-dollar savings.
By providing payers with a clear picture of network performance, as well as an unbiased view of provider networks and healthcare services, MacroHealth’s data-driven platform optimizes healthcare spending and streamlines the tech burdens associated with managing claims, enrollment, and other administrative tasks. This Shopify-like intelligent marketplace allows the many sellers of healthcare services to connect with thousands of buyers that suddenly have the power to pick and choose the best coverage for their members based on data-driven insights. More competition, plus more information, equals better care.
Better care for more people
As alarming as America’s 13-figure annual healthcare expenditure is, it pales in comparison to the sector’s economic and social disparities. According to the National Institute for Health Care Management, about half of U.S. health spending is done by 5 percent of the population. On average, these Americans use $40,000 of healthcare annually. The lower-spending half of the population, meanwhile, accounts for just $236 per person each year. Again, MacroHealth’s data analytics platform can play a key role here by lowering the prices that insurance companies, and in turn plan members, pay for healthcare, while improving access to care by providing objective views of Provider Networks and the healthcare services that best fit the needs of a particular population of members.
Leveraging this new healthtech creates a win-win situation for U.S. health plans and the hundreds of millions of people they serve. How’s THAT for having an impact?