As we all know today, it’s data, data and more data to enable information and decision making processes, so rather than just receive a blank report that “says” how 
this is calculated, an algorithm sample and sample files to show this would be right up on the agenda. This is needed any way to run audit reports to ensure that the information is being calculated as stated. Medicare will provide you all the information you need if you inquire so commercial insurers should be held to the same standards with the need and desire for transparency too.
Healthcare Reform Bill – Expect “Fraud Algorithm” Use to Increase With “Scoring” the Insured With Our Leadership Trapped Embellishing Old Paradigms
I still say we need some form of official department to regulate and determine that credible information is being calculated versus “desired results”. As everyone lobbies these days they all have a special interest and with formulas and calculations it’s possible that desire could tend to cloud issues where actual numbers are needed.
“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?
Patients, doctors and hospitals have had to live under the auspices of the “algorithms” run to determine who and what gets paid. We need a Department of Algorithms so this can be accurately projected. We have never had that option, but rather a world of not knowing or being able to project costs within a few dollars. Granted there are those times when you can’t project with emergencies, etc. at all too.
Promising new startup of 2009 - Executive branch of the US federal Government
With actual numbers it can help all be more effective rather than just throwing money here and there and hoping for a good outcome with grants and stimulus money too. We are at a point now where trust is at an all time low and it certainly wouldn’t hurt at all to see some real efforts in this area of transparency. The news today is full of new stories uncovering either dishonest or less than credible data evaluations and big profits made as a result of such formulas and algorithms. The government is working hard to get their infrastructure up to date to handle these types of inquires as well after many years of neglect and simply not keeping up. BD
WASHINGTON -- Health and Human Services Secretary Kathleen Sebelius has requested input from state insurance commissioners on a provision in the new healthcare reform law dealing with what percentage of health insurers' revenues must be spent on medical care.
The provision addresses the "medical loss ratio" -- how much insurers must spend on medical claims relative to other costs, including executive salaries and advertising. It requires health plans to report the proportion of premium dollars spent on clinical services, quality, and other costs. If the amount spent on medical services and quality is less than 85% for large group plans, and 80% for small group and individual plans, the insurance company must send beneficiaries an annual rebate.
"We anticipate that NAIC's assistance will be particularly useful in helping to determine the best approach, format, and time frames for health insurers' submission of [medical loss ratio]-related data, and for ensuring the accuracy of these data submissions," Sebelius wrote.
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