Last year Healthways settled a whistle blower suit for $40 million. The whistle blower suit stated they were getting new enrollees in exchange for money supplied 
to the physicians to enroll patients in the diabetes program.
Healthways offers to settle subsidiary kickback charges for $40 million
Wellness sounds like it can get a bit aggressive when money is involved. The website quotes “sophisticated predictive modeling” and they “focus on desired outcomes”. You see this same information in a few different words on so many websites today it all run together as they all compete for the same consumers and want to make sure you get well, and it’s to the point of being over cooked as the education side of this is slacking. Companies want their money and profess education but that is secondary to paying out the dividends on Wall Street and as consumers we all question all of it any more with the lapse of corporate responsibility that lurks everywhere.
Perhaps this is why companies like United are going through their subsidiaries to work with pharmacists at Walgreens instead where they can get pay for performance with enrolling consumers? Is there a difference here as both represent marketing consumers to join wellness groups and United has their own pharmacy benefit manager as well. In light of the retail pharmacy wars, Walgreens doesn’t have their own PBM thus maybe this is why new partnerships are being explored here. We are also seeing a lot of investments overseas to bring drugs/devices to the US from China.
UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally
We all know there is money to be saved but frankly these projections are just that and there are new costs that technology will drive as well as savings, so to really get a finding of such is just a projection. The lawsuits above makes me a little nervous too with tactics that are being used and of course those underpaid by United based on the Ingenix data base are now able to file their claims and more suits are in the works. Recently HHS focused on Ingenix software as an example solution with their recent meetings relative to Health IT and it’s growth, and in that area HHS needs to do some hard rethinking here as IT solely cannot solve healthcare costs and if they participated themselves in some of this themselves we wouldn’t hear so much of “its for those guys over there”.
Do we actually have full trust in these companies and their algorithms? Are we getting what is “accurate” or “desired” numbers with the calculations in the reports they are producing? Again with technology, outsourcing, more generic drugs becoming available, who can really accurately project, and to me these reports only create a additional distraction and false sense of urgency, as that part is already there. Reports of such stand to certainly keep the pot stirred and 
later end up being used to substantiate risk and cost cutting efforts without real gain. We already have seen a ton of these types of reports, how many more do we need? BD
NASHVILLE, Tenn., Jun 09, 2010 (BUSINESS WIRE) -- A 25 percent improvement in the health risk profile of Americans would yield savings of up to $945 billion over the next ten years, according to a report -- Savings Potential from Prevention and Risk Reduction for the Commercially Insured [www.healthways.com/WorkArea/DownloadAsset.aspx?id=627] -- released today by the Center for Health Research (CHR) at Healthways. .
The principal finding of the report -- nearly a trillion dollars of potential cost savings -- is based on the application of various risk-reduction scenarios to a rigorous actuarial model of the natural progression of illness and associated cost developed by Ingenix Consulting. Based on the actual five-year (2003-2007) health care experience of over 4.2 million commercially insured individuals, from birth through age 64, Ingenix and CHR scientists applied actuarial science to calculate the estimated cost of healthcare from age 0 to 64, and the predicted impact to this cost from risk-reduction scenarios that represent reduction in the onset or progression of disease-related morbidity.
0 comments :
Post a Comment