Electronic Transactions and Analysis
Step 10. The billing claim is automatically submitted to the payor for instant adjudication/approval.
A. Payment is processed overnight.
B. The patient authorizes payment of copay with the smartcard.
Step 11. The patient's data is aggregated into a HIPAA compliant data repository for analysis of codified encounter data (standardized terminology).
A. Providers measure/compare quality, efficiency, and cost.
B. Payors measure/compare quality, efficiency, and cost.
C. Pharmaceutical companies analyze the cost effectiveness of their medication versus other treatments.
D. Medical device companies analyze the cost effectiveness of their products versus other treatments.
Step 12. Patients continue "electronic dialog" with the physician via the Internet. Intelligent Agents assist the patient through the "continuum of care". Case management for chronically ill patients are also monitored by Agents.
A. Physicians remotely monitor patient conditions, such as the following:
1. Blood glucose for diabetics
2. Blood pressure, cholesterol, and arrhythmia for heart disease, etc.
B. Patients and physicians have access to on-line triage. Outbound calls are made with treatment results.
1. Nurse operators have access to patient records when necessary.
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Increasing efficiencies to lower administrative costs
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