Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

Healthcare, at its essence, is not a system.

It's a financial exchange.

I learned this the hard way when my pain management doctor told me something illegal out loud. I asked to use an in-network laboratory for my monthly drug screens. They were billing over $1,000 per screen through their own lab.

The response: Use our lab or find another practice.

This violated Stark Law. They didn't care. Nobody was taking new pain patients. They knew I had no choice.

That moment crystallized two decades of working in healthcare access into one brutal truth: I wasn't a patient. I was a revenue stream.

I paid for insurance from my paycheck. Then I paid my deductible. Then copays. Then coinsurance.

Insurance covered almost nothing.

Practices were balance billing me, charging the difference between what they billed insurance and their contracted rate. In most states, including mine, this was illegal.

They didn't care.

Healthcare spending hit 17.6% of GDP in 2023 and is projected to reach 20.3% by 2033. We're spending $4.9 trillion while patients pay $505.7 billion out of pocket on top of premiums.

The system isn't broken. It's working exactly as designed.

From my work in healthcare access, I saw how providers and payers test boundaries. They'd try different CPT codes at double the standard rate just to see if it would get through.

Nobody thought about patient impact.

Hundreds or thousands of dollars out of your pocket. The system leaders focus on maximizing shareholder value, not educating or engaging patients.

When you're in crisis—dealing with chronic pain, unable to work, drowning in medical debt—you can't negotiate. You can't shop around. You can't refuse.

That's when they run their billing experiments on you.

I knew how the game worked. It pissed me off.

I questioned billing practices at another doctor's office. They labeled me a "non-compliant patient" and kicked me out.

The system weaponizes clinical terminology against patient advocacy.

Most patients don't have industry knowledge. They just sense something isn't right. Their gut tells them the exchange feels wrong, but they can't name what's happening.

That gut feeling is patients detecting the financial extraction beneath the surface of care.

Insurance companies pushed providers into seeing patients every 7-9 minutes. Research shows the median visit covers six topics—about 5 minutes for the main issue, then 1.1 minutes for each remaining concern.

Guideline-driven preventive care alone would add 7 hours to each clinician's workday.

Comprehensive care is mathematically impossible in this model.

The structure prevents the conversation that would make care work. It maximizes patient volume over patient understanding.

This is the financial exchange in action.

Patients represent the most underutilized data source in healthcare.

The system doesn't engage patients to capture their lived experience. It doesn't empower them to understand their experience matters.

When you engage patient voice, systems mitigate avoidable harm and waste. Clinical visits become more efficient. Trust builds. Decision-making improves. Treatment algorithms work better for patients and systems.

But nobody wants to take on educating the patient community.

The EMPWRD Patient Model changes this. It equips patients to navigate care options. It teaches them to ask "why" and "what other options are there?"

One question exposes how the system operates:

"Is there more information I can provide that would help you understand the actual issue causing my symptoms, not just treat them?"

That question shifts the dynamic from symptom management to root cause investigation. It requires time the system hasn't allocated.

Here's what I learned after my neck injury nearly ended everything:

Healthcare truly wants to help patients. But it doesn't have the time. And patients don't have the education necessary to make this an equal exchange economically.

Patients begin their journey in chaos. Healthcare operates in that chaos daily. Patients don't.

We must empower them with time and education to maximize their outcomes.

Just because one physician doesn't have an answer doesn't mean nobody will. You may have hit that provider's knowledge limit. You can find another one.

If you feel you're not getting the care you need, continue seeking the help you deserve.

As a patient body, we can push the system to change when we show that patient empowerment delivers better outcomes, drives system efficiencies, and maximizes revenue streams.

The financial exchange can become actual care.

But only when patients have the power to demand it.

For more on the EMPWRD Patient Model, head over to https://matttoresco.com to book a call!