Under fee-for-service payment models, making the decision to move forward with many surgeries – such as total knee replacements – was not a difficult one to make.
Here’s an example of how it would commonly unfold: A patient experiences knee pain. The patient receives a prescription for painkillers. The condition deteriorates, and MRI is obtained and eventually the patient undergoes the total knee replacement as a matter of course. Because such surgeries were profitable for hospitals and orthopedists under the long-held fee-for-service model, no one bats an eye.
"Two heads are better than one." It's a common axiom that is widely accepted.
Healthcare payers and providers, however, have traditionally been a bit reluctant to embrace the concept in the past, as they preferred to tread their own paths while working to improve care, enhance patient experiences and reduce costs.
Intuition is often thought of as a somewhat magical, innate personal quality that some people are born with – and others lack. When people make decisions based on intuition, we assume that they are moving forward based on some type of “gut feeling.” Analytics, on the other hand, is often thought of as hard science. When people make decisions based on analytics, they are moving forward based on data that has been scrutinized and studied, explored and examined – again and again.
Healthcare fraud waste and abuse is big. As in hundreds of billions of dollars per year big. That’s why healthcare payers need to go big or go home in the fight against what’s become an unfortunate nemesis.