On Episode 89 of Astonishing Healthcare, we are talking about some "visual treats," as the title suggests! Our guest, Andrew Tsang, has been posting some very cool things on LinkedIn of late, including Sankey and other dynamic charts highlighting where the money flows in healthcare (from the premium dollars to the care plan members receive), and which stakeholders win or lose in different scenarios via a 5-Way Seesaw he developed using AI! If you're a [healthcare] data nerd, this episode is definitely for you, and you'll want to check out:

• How many layers are between your employer's healthcare dollars and care? on LinkedIn (you can see where every $100 an employer spends goes!)
• What would happen if power actually shifted in healthcare? on LinkedIn (5-Way Seesaw)

Andrew discussed how and why:

• A significant portion of the healthcare premium is consumed by administrative layers and middlemen before ever funding patient care.
• Employers can combat wasteful spending by demanding full access to their claims data, then identifying and eliminating things that extract value from their plans (or don't work for their populations).
• Integrated care models (like Kaiser Permanente) and direct primary care help eliminate friction by aligning provider and payer incentives, allowing doctors to focus on practicing medicine (vs. revenue cycle management).
• New technologies like AI-powered prior authorizations may reduce administrative costs for payers but risk creating new burdens for providers and patients, if we're not careful.
• Hospitals face a fundamental conflict: core, life-saving services like ICU and emergency care are often unprofitable and must be cross-subsidized by higher-margin procedures.

Related Content

• How to obtain Rx data and what to do with it
• AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan
• Capital Rx Unveils Healthcare’s First Unified Pharmacy and Medical Claims Processing Platform
• Pharmacy Benefits 101: Prior Authorizations
• AH048 - High-Cost Orphan Drugs, Securing Claims Data, and More, with Dr. Eric Bricker

For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.