Healthcare’s Data Dilemma: A Call for Patient-Centric Solutions
In this episode of the HIT Like A Girl podcast, host Joy Rios welcomes Dr. Nick Van Terheyden, a principal at ECG Management consulting and host of the podcast shows “The Incrementalist” and “Healthcare Upside Down.” While Dr. Van Terheyden is not a woman, he joins the show as a special guest to discuss his experience with healthcare data, insurance, and the patient experience. He shares a personal story about his struggle with hip pain and how his family practitioner suggested he may be vitamin D deficient. After being prescribed a year’s supply of vitamin D supplements, his insurance provider, Cigna, rejected the claim for being “medically unnecessary.” Dr. Van Terheyden fought the denial and ultimately had it reversed, but was shocked to learn that his case was just one of 199,999 others that had been rejected by the same physician over a two-month period. The denial process was automated and patients had only a slim chance of successfully appealing the decision. Dr. Nick’s experience led to an important piece published by ProPublica. This conversation highlights the need for better healthcare data management and a more patient-centric approach to healthcare.