Presentation (CTI)

OBJECTIVES: In USA, approximately 10% of population does not have commercial or government funded health insurance. An innovative Patient to Patient (P2P) healthcare payment network based on pairing member algorithm was proposed by Bose in 2020. It has been claimed that the proposed P2P payment strategy could eliminate the high cost to hospitals due to Emergency Room (ER) visits by Patients without Insurance (PwI) who are unable to pay for their hospital bills. This could be accomplished by allowing PwIs to have access to a Primary Care Provider (PCP) in the early stage of their illness. By having access to a PCP at an early stage would prevent the PwI population from revisiting ER services in a community hospital. Further, this P2P strategy, if adopted by the community health systems, would reduce the economic stress on the health systems by lowering the cost of ER services due to reduction in ER visits by PwI population.
METHODS: AGR Health has developed a Budget Impact Model (BIM) evaluation tool to analyze the ER patients data to determine the Return on Investment (ROI) of P2P strategy for health system. In this paper, we shall discuss the design and application of the BIM evaluation tool to assist hospital executives in adopting P2P strategy.
RESULTS: For one of our hospitals, the Un-recoverable Expense/PwI-visit is estimated to be $620. Further, the total P2P strategy cost/PwI/Year is $320. Since the P2P strategy cost is less than Un-recoverable Expense, we propose that P2P strategy would be feasible for the hospital.
CONCLUSIONS: Based on the preliminary data collected by our team, it appears that a higher value of ROI is attainable for hospitals which are located in the central area of a large city where a significant percent of ER patients visit for high temperature and other non-critical symptoms.