Side-by-side
The old way charges the sick.
The new way pays them.
For a century, the legacy stack — insurer-owned PBMs, 1980s EHR vendors, billing middlemen, ad-funded patient portals, data brokers — has built one thing brilliantly: extraction. Charge to bill. Charge to chart. Charge to know what's in your own body. Then sell that knowledge — to advertisers, drug-makers, data brokers — and you never see a cent. Conceptual Health is built the opposite way. Patients earn. Clinicians keep what they bill. Researchers pay patients for data. The platform is free, forever.
The old way
The legacy stack
Insurer-owned PBMs · 1980s EHR vendors · billing middlemen · ad-funded patient portals · data brokers
The new way
Conceptual Health®
One free patient app · one free EHR · one wallet · one ledger · one Master Equation · paid back to the patient
Section 1 — money
Where every $1 of healthcare spending actually goes.
U.S. national health expenditure is approximately $4.9 trillion per year (CMS, 2024 actuarial). About a third never touches care — it's eaten by administration, billing arbitration, network haggling, and pharmacy-benefit spread.
The legacy stack
Of every $1 a patient or employer pays in:
Patient receives in cash, rebates, or rewards: $0.00. De-identified data (labs, claims, prescriptions) is resold downstream — the patient sees none of it.
Conceptual Health®
Of every $1 settled through the ledger:
Patient additionally earns from data licensing (HCC) — researchers pay per signed consent, with the majority of revenue flowing to patients in the cohort. The patient is paid, not the broker.
Old-stack breakdown ranges are derived from CMS National Health Expenditure data, NAHCQ studies, and published 10-K disclosures of the major payer + PBM operators. Conceptual Health column describes architected behavior; current per-surface go-live state is on the compliance posture.
Section 2 — line by line
Eight lines on the bill. Look at every one.
The old stack hides its extractions in opacity — line items only the billing department sees. We laid them out, plain.
| Issue | The legacy stack | Conceptual Health® |
|---|---|---|
| Patient cost to use the chart | Hidden in premiums & copays. "Free" portal funded by ads or claims revenue. | $0 forever. No premium, no ad, no upsell. Funded by ledger fees and research licensing. |
| Provider cost to use the EHR | $300–$1,500 / provider / month. Multi-year contracts. Per-module fees for orders, billing, e-prescribing. | $0 / provider / month. Every module included. No seat math, no implementation fee. |
| Patient earnings for healthy behavior | $0. Maybe a 5% discount on a gym voucher. | HCR for every verified action. Walk, sleep, vaccinate, fill an Rx, attend an appointment — paid at the public ladder rate. |
| Who owns the patient's data | Health system or insurer. Patient gets a 30-day "right of access" — sometimes by mailed CD-ROM. | Patient owns the DataVault. Cryptographic keys, per-record consent, revocable any time. |
| Who profits when the data is sold | Data broker. EHR vendor. Insurer's analytics arm. Patient: $0. | Patient. Paid in HCC for every approved query. Researcher pays the patient directly. |
| Audit trail of who saw what | Internal to the EHR vendor. Patient request takes 30 days, comes as a paper printout. | HMAC-chained, public verifier. Anyone can re-verify the chain at /proof/chains.html. |
| Prior-authorization labor | 3–7 hours / week of physician + nurse time, lost to paperwork. | Zero. Prior auth is structurally absent — the chain is the authorization. AI scribe drafts the note; the clinician signs. |
| Surprise bills | Routine. Out-of-network, in-network-but-non-participating, balance billing. | Architecturally impossible. The patient never sees a bill from us. Insurance reimbursement, if you have it, flows to clinic operations — not to patient invoices. |
Provider EHR-cost range from KLAS Research + 2023 AMA practice expense data. Prior-auth time from AMA + NEJM Catalyst measurements.
Section 3 — the extractions
The old stack runs on five quiet extractions.
Each one is engineered, profitable, and aimed away from the patient and the clinician.
01
The premium skim
Insurers retain ~14¢ of every healthcare dollar as overhead + medical-loss-ratio float. The patient pays the premium. The skim funds the building.
02
The PBM spread
Pharmacy benefit managers buy drugs from manufacturers at one price, charge plans a different one, and keep the difference. Patients see the higher price. Manufacturers see the lower.
03
The EHR tax
Per-seat licensing + per-module fees + 1980s integration costs. A solo clinician spends $4,000–$18,000 per year for software that makes them slower than paper.
04
The data resale
De-identified records resold to advertisers, drug-makers, life insurers. Industry estimated in the billions. The patient never sees a dollar of it.
05
The time tax
Hours per week per family on prior auth, claim disputes, appointment juggling. Hours per week per clinician on documentation that exists only because the billing system requires it.