The Story Behind Our Story

DO YOU know a practice owner who wants more patients in her clinic, a better pay-per-visit, and better collections?  We all know healthcare practice owners who want to remain independent and grow and yet are frustrated by insurance companies and continuous battles to get paid and stay compliant.  

Now, as a patient, do you like visiting a healthcare practice, receiving bills, and reconciling them with your insurance company?  You are not alone. As it turns out, most other people do not like their patient experience.

The problem is that patient and independent practice needs have evolved in step with society and technology but management methodology remained in the 19th century.  There’s a fundamental mismatch between how healthcare practices and patients are managed — and the practice owners’ and patients’ expectations.

ClinicMind was founded to address the basic mismatch between patients and providers: patients have transformed how they expect healthcare to be delivered, but practice owners have not adapted their practice management methodology.

From the outset, we knew that healthcare costs are spiraling out of control.  We also knew that insurance companies, medical equipment manufacturers, pharmaceuticals, and hospital executives, have been all making handsome returns and benefitting from healthcare cost growth. One question bothered us: why are the practice owners unable to participate in that growth?  How was it that the key contributors to healthcare service were excluded from fair compensation for their work and grew exceedingly frustrated with rules and regulations?  Some providers were selling their practices to join hospitals, and others were moving to different industries.  

We also noticed that with experience, medical billing managers start cherry-picking insurance companies for easy follow-up.  So the practice owners could not get paid on time and in full by a growing number of insurance companies (payers). The more obstacles payers pose – the less paid the providers are. Insurance companies were winning the game against the providers.  Payers were stacking the game by continuously adding new rules to reduce payments and increasing the frequency of provider audits.  Payers have a two-pronged resource advantage:

1. attract Ivy-league MBAs to build sophisticated claim-processing protocols and discover every little pretext to deny or delay claim payment
2. leverage the most powerful digital technology to implement those protocols on ever-growing volume of claims.

In summary, we came to a startling observation: patients no longer want their care to be managed the way it used to be managed in the previous century.  And yet, practice owners still use their old methods to memory-manage their practice. Who is taking advantage of this mismatch?  The insurance companies – payers.