What other industry has independent for profit companies that are accountable to one another and required to share revenue?
I don’t agree with shared risk because healthcare providers don’t have the expertise to manage risk pools and often end up loosing their shirts. I explained the problem with risk pools in this post.
Duplicate services can be squeezed out without bundling payments to providers if providers share information. Insurers just have to deny the charge for duplicate tests to encourage providers to share.
I also agree that legacy system vendors are a problem because they want to do it all. They have probably been blamed for problems that customers didn’t have the technical expertise to solve so vendors likely found it easier to just do for them. Most providers won’t have the money to replace those systems unless newer systems are paid for on a transaction basis.
We have standard transaction sets in use for claims and payment. We should have been leveraging those transactions sets to facilitate patient estimates rather than building other solutions with historical claims data. We need more standards — standards of care which should then drive standards for information sharing across the ecosystem.