The healthcare system in the United States is complex, with many different stakeholders playing key roles in the provision and management of healthcare services. It is a $4 trillion industry, or close to 18% of American GDP. Essentially, we can put this huge industry or domain into 4 types of Ps:
Payers (P1)—Health Plans, Health Carriers, Commercial Health Insurance, PBMs, Gov-Health, Medicare, Medicaid, Medicare Advantage (MA), MAPD, PDP, Medicaid Long Term Care (CHIPS), VA, etc.
Providers (P2)—Health Systems, Hospital Systems, SNP, Labs, Doctors, IPAs, Assisted Living, etc.
Pharma (P3) – Life Sciences, Pharma Companies, CRO Companies, MedTech, DME, etc.
Platform (P4)- product software companies that help P1, P2, and P3 deliver better patient care and outcomes.
Payers (P1): Payers include health insurance companies, Medicare, and Medicaid. They are responsible for paying for healthcare services and managing the financial aspects of healthcare. Payers negotiate rates with providers and determine which services are covered under a specific health plan. Payers collect premiums from individuals and employers to fund healthcare costs, pay for claims, and manage risks and outcomes.
Providers (P2): Providers include hospitals, clinics, physicians, and other healthcare professionals, including doctors, DOs, PAs, NPs, RNs, and medical technicians. They are responsible for delivering healthcare services to patients (members). Providers diagnose and treat illnesses, perform surgeries and procedures, and provide preventive care. They also work closely with payers to ensure that they are paid for their services.
Pharma (P3): Pharmaceutical companies develop and produce drugs and medical devices that are used to diagnose, treat, and prevent diseases. They invest heavily in research and development to bring new products, safe drugs, and DME to the market. Pharma companies also work with payers to negotiate pricing for their products and with providers to ensure that their products are used appropriately.
Healthcare Platforms (P4): Healthcare platforms include but are not limited to telemedicine providers, health information exchanges (HIEs and HIXs), and patient portals. Product platform companies use digital technology to facilitate communication and coordination between patients, providers, and payers. Healthcare platforms can help patients access care more easily, share medical information securely, and manage their healthcare needs more effectively.
GHIT Digital’s healthcare consultants, engineers, and experts deliver services, including but not limited to assessment, implementation, integration, configuration, testing, production, and support for enrollment systems, claims systems, care management systems, population management systems, patient engagement, patient security, electronic health record systems, practice management systems, health information exchange systems, clinical decision support systems, health analytics and reporting systems, health clouds, health ITSM, health CRM, health claims, and health data platforms to improve the following areas:
Advancing Research and Development: Technological advancements have led to the development of new treatments and drugs that have improved patient outcomes. Additionally, technology has enabled researchers to share data and collaborate, leading to faster drug development and improved healthcare outcomes.
Enhancing Efficiency: These services led to streamlined processes and reduced paperwork in healthcare, saving time and reducing errors. Electronic health records (EHRs) have made it easier to access and update patient data, enabling healthcare providers to make informed decisions.
Improving Communication:Our services made it easier for healthcare providers to communicate with each other and with patients. Teleconferencing and video conferencing have facilitated remote consultations, while email and messaging systems have improved communication between patients and healthcare providers.
Patient Care: Medical imaging equipment, such as MRIs and CT scans, has enhanced diagnosis accuracy, while telemedicine has enabled remote consultations and monitoring of patients.
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