Sutter Hospitals and Ingenix working together on Business Intelligence Software

It appears this is another solution for physicians to look at cost as it is business intelligence. Although the AMA had this to say on the topic:

“Cohen also warns against paying for data from a source that isn't entirely transparent. Like many smaller health plans, some physician practices relied on data from the UnitedHealth Group subsidiary Ingenix.

Physicians paid Ingenix for the same data as a way to benchmark their own fee schedules. Unfortunately, as New York Attorney General Andrew Cuomo's office found in its investigation, the fees in the Ingenix database tended to be lower than the true "usual and customary" charges. Cuomo alleged that the insurers used a "closed loop" system to shortchange out-of-network physicians, feeding skewed charge data into the database to undercut what the same companies would turn around and cite as the basis for payments to out-of-network doctors.”

Would you trust them? They are a subsidiary of United Healthcare and the related comments below contain some history on the data base that was determined to be not accurate and led to many issues with both physicians and patients as far as cost. The lawsuits are still continuing with other states joining in. As the AMA stated, there may be a lack of true transparency here. Patients received balance billings and doctors were short changed on the fees.

UnitedHealth Executive testified at the Senate – Rockefeller was not very satisfied

The Ingenix Inquisition – Hearing Requested by Senator Rockefeller

From the Senate hearings the reports are not all back yet. Sutter signed a 5 year contract. BD

EDEN PRAIRIE, Minn., – April 30, 2009 – Ingenix, a leader in health information solutions, today announced that Sutter Connect, a Sutter Health affiliate and health care management and administrative services company, has signed a five-year contract for Ingenix Impact Intelligence™ and services from Ingenix Consulting. Through the agreement, Sutter Connect will offer physicians in the Sutter Medical Network access to performance metrics and services they can use to measure and improve medical care and delivery.

By selecting Ingenix, Sutter Connect will implement solutions and services that enable its physicians to:

Measure health care delivery against best practices and evidence-based medicine to understand key drivers of efficiency and effectiveness and to recognize high performance

Assess care delivery resources using a comprehensive, clinically-based approach to identify unique medical conditions for a patient and grouping all related services into episodes of care

Facilitate strategic planning efforts by identifying “total costs” and “total utilization” for different types of services (e.g., inpatient, outpatient, pharmacy, lab, radiology)

Improve quality of care by identifying high-risk patients and initiating condition management (including disease management) efforts accordingly

Identify disease categories that require additional management efforts