What next, and I do have to say I have never heard of anyone wanting to drink in order to get a sufficient supply of vitamin, as you don’t go to a bar to normally seek out vitamins either.  Marketing, marketing, marketing….I would have no idea if this has any effect on the taste but there is a video you can watch with a couple folks saying it’s ok.  This was the dream of an MIT graduate and is being sold in San Francisco as the starting market place. 

The article also contains a second opinion that says the claims of a hangover being easier is false.  Well what’s next, vitamin C enhanced Scotch, or maybe I’ll be able to get my Vitamin A from a brew?  It seems like osteoporosis could be a target too for adding those vitamin elements, drink up and fix those bones.(grin).   Oh boy if this catches on will we be seeing “healthy” cocktails on the drink list versus those that are not healthy.  The FDA doesn’t have to worry about nutrition claims with alcohol because it not allowed, so you won’t be seeing the vitamin added listed on the label.  Food is still the best answer for nutrition and eating wisely.  BD    

Adding vitamins to their products in hopes of luring health-conscious consumers. But now one vodka maker is jumping in on the trend.
Rob Bailey, maker of White Lotus vodka, said the idea came from his travels for business, and the needed for something that would give him energy, but also ease the day after a few cocktails.

By adding vitamin-B, Bailey said the metabolism system speeds up, making it faster to process the liquor. But no mention of the vitamins are visible on the bottle. Bailey adds that the Federal Government does not allow it.
Nutritionist Joan Blake said consumers should not spend their money in alcohol just because it contains vitamins.

Even Bailey said consumers shouldn't drink more White Lotus simply because it contains vitamins

Company Claims Vitamin-Infused Vodka Can Curb Hangover - cbs2.com

Technorati Tags: Lotus, alcohol, FDA, marketing, vodka, healthcare, vitamins, nutrition

Well if you are a physician in Connecticut and were not sure who and what Ingenix is, you are now if you received a multitude of requests for patient records.  Big question too, why are the letters not going out under the United Healthcare letterhead and why Ingenix?  I might guess there’s a buck to be made here as that’s what Ingenix does, data services, business intelligence, algorithms and studies that determine who gets paid and how much.  They made heaps and so did other insurance carriers until Andrew Cuomo went after them.  Everything is a buck and profit with this part of United Healthcare and their services are entwined in so many facets of healthcare, and they say they fight fraud too, so which are they better at, fighting it or creating it?  They also make a ton of money selling your medication records too, that come from pharmacy benefit managers and do not fall under the protection of HIPAA. 

Little Progress on Fighting Healthcare Fraud – Look At Who’s Getting the Anti-Fraud Contracts

Before United gets the newly insured consumers perhaps they want the opportunity to “score” them first?  That’s what the algorithms of Ingenix and companies like them do best.  Now, on the other side of the coin, any compensation for the time for the doctors to yet add one more administrative task to their already overloaded red tape bureaucracy of dealing with insurers?  Is the information on file with HealthNet not good enough?   Insurance carriers will jump through hoops and stand on their heads to get more data to analyze as the big move now is to further develop behavioral underwriting.

Behavioral Underwriting With Biometric Employee Screenings – Red Brick Secures 3 More Clients

Red Brick is a client of Ingenix (a wholly owned subsidiary of United Healthcare) that specializes in data, data, data and more data along with analysis and recommendations.  Ingenix just settled a 9 year lawsuit with the AMA and there’s more suits in the works over the out of network compensation and probably more to come.  In reading the Aetna financial news they claimed that 20 million of their troubles were due to the fact that they are no longer using the Ingenix data base and that is why they took the 20m hit. 

The article states that the the group of patients they were seeking records for were the Medicare Advantage consumers, the ones they make bigger profit margins from as all the insurers have been reporting in the news of late, the government subsidized Advantage plans have been the most profitable.  At any rate, doctors were urged to also make sure the requests were legitimate since they wheeled in on fax machines instead of a formalized letter in many cases.  United and Ingenix according to this article just blew off the Connecticut Medical Society, who also happens to be suing the state over the buy out, has not responded from their request.  BD  

Feb. 6--Doctors around the state have been receiving "potentially deceptive" requests for hundreds of patient medical records from a company affiliated with UnitedHealth Group, an insurer that has been given state permission to acquire another insurer, HealthNet.

The Connecticut State Medical Society, the state's largest physician organization, announced late Friday it has warned physicians about the requests and that it has "significant concerns regarding the legitimacy of the letters." It said that on Monday it demanded that UnitedHealth and HealthNet stop these reviews and requests immediately, and that as of Friday afternoon had received no response.

Daryl Richards, spokesman for UnitedHealth, said the requests were made by Ingenix, a UnitedHealth subsidiary that provides health data review services to several insurers including both UnitedHealth and HealthNet, in keeping with standard practices and patient privacy laws. The requests pertain to claims of patients with Medicare Advantage, privatized Medicare plans provided by insurance companies.

The reviews are being done to ensure that the claims are "complete and accurate," he said.

Audrey Honig Geragosian, spokeswoman for the medical society, said the society has received hundreds calls from doctors with concerns about the requests. Some received requests for records for up to 100 patients.

Insurance News Net -Doctors warned about records request [The Day, New London, Conn.] - Insurancenewsnet.com

Technorati Tags: Ingenix, United Healthcare, Connecticut, Medical Society, Medicare Advantage, Algorithms, scoring health claims, health insurance, doctors

One of the first areas that pops into my head is Genomics, being data heavy and intense.  The link below explains more about how to enroll for the program for anyone doing research in a new or approved project.  This is an independent federal agency to promote the growth of scientific discovery and according to the website their budget is over 6 billion.  In addition to healthcare they also fund all types of other project too, so if you are in research, go grab a cloud if you can.  BD 

REDMOND, Wash., and ARLINGTON, Va. — Feb. 4, 2010 — Microsoft Corp. and the National Science Foundation (NSF) today announced an agreement that will offer individual researchers and research groups selected through NSF’s merit review process free access to advanced cloud computing resources. By extending the capabilities of powerful, easy-to-use PC applications via Microsoft cloud services, the program is designed to help broaden researcher capabilities, foster collaborative research communities, and accelerate scientific discovery. Projects will be awarded and managed by NSF. More details about funding opportunities are available at http://www.nsf.gov/dir/index.jsp?org=CISE.

Microsoft will provide cloud computing research projects identified by NSF with access to Windows Azure for a three-year period, along with a support team to help researchers quickly integrate cloud technology into their research. Windows Azure provides on-demand compute and storage to host, scale and manage Web applications on the Internet through Microsoft datacenters. Microsoft researchers and developers will work with grant recipients to equip them with a set of common tools, applications and data collections that can be shared with the broad academic community, and also provide its expertise in research, science and cloud computing.

“Cloud computing can transform how research is conducted, accelerating scientific exploration, discovery and results,” said Dan Reed, corporate vice president, Technology Strategy and Policy and eXtreme Computing at Microsoft. “These grants will also help researchers explore rich and diverse multidisciplinary data on a large scale.”

Microsoft and the National Science Foundation Enable Research in the Cloud: Agreement will offer free access to new computational and collaborative services to accelerate scientific discovery for research communities.

Technorati Tags: Microsoft, National Science Foundation, Cloud, Azure Platform, Healthcare, genomics, Algorithims

Funny!  He doesn’t need insurance.  BD 

http://www.businessinsider.com/no-no-this-is-the-greatest-super-bowl-ad-of-all-time-2010-2

Technorati Tags: Humor, advertising, medical humor, surgery

This is the strangest story here and in reading it, the procedures for investigating were wrong.  I look at the Sheriff who got a search order and went to confiscate the computers of the nurses from their home.  Certainly it sounds like there’s unanswered questions on both sides of this story, both the doctor’s side with complaints, the nurses side with their spotless reputation certainly creates doubts. 

I think the Sheriff’s action stopped this from being handled with normal investigative procedures that are normally followed.  The sheriff, granted had been a patient of the doctor and thus felt gratification to the doctor, but he’s one patient of many, so again looking at everything and the whole case should have been done.

It’s a shame this case seems to have escalated to this level of not only disruption, but the fact that how do you go back and try to do a proper investigation to be fair and get the facts all the way around.  Some type of counseling is needed for the Sheriff and due to the fact that he muffed the entire process, the nurse should not have to go to trial, as the article states there are areas of question for the doctor on prior incidents that need to be investigated and compared to the issues the nurses were reporting.  This sounds like “redneck” justice in my opinion which is not the way we as civilized citizens should handle such disputes.   Read the full accounting at the link at the end of the post for all the details.   BD 

KERMIT, Tex. — It occurred to Anne Mitchell as she was writing the letter that she might lose her job, which is why she chose not to sign it. But it was beyond her conception that she would be indicted and threatened with 10 years in prison for doing what she knew a nurse must: inform state regulators that a doctor at her rural hospital was practicing bad medicine.

But in what may be an unprecedented prosecution, Mrs. Mitchell is scheduled to stand trial in state court on Monday for “misuse of official information,” a third-degree felony in Texas.

The prosecutor said he would show that Mrs. Mitchell had a history of making “inflammatory” statements about Dr. Rolando G. Arafiles Jr. and intended to damage his reputation when she reported him last April to the Texas Medical Board, which licenses and disciplines doctors.

Mrs. Mitchell counters that as an administrative nurse, she had a professional obligation to protect patients from what she saw as a pattern of improper prescribing and surgical procedures — including a failed skin graft that Dr. Arafiles performed in the emergency room, without surgical privileges. He also sutured a rubber tip to a patient’s crushed finger for protection, an unconventional remedy that was later flagged as inappropriate by the Texas Department of State Health Services.

When the medical board notified Dr. Arafiles of the anonymous complaint, he protested to his friend, the Winkler County sheriff, that he was being harassed. The sheriff, an admiring patient who credits the doctor with saving him after a heart attack, obtained a search warrant to seize the two nurses’ work computers and found the letter.

Until they were fired without explanation on June 1, Mrs. Mitchell and Mrs. Galle had worked a combined 47 years at Winkler County Memorial Hospital here, most recently as its compliance and quality improvement officers.

The nurses, who are highly regarded even by the administrator who dismissed them, said the case had stained their reputations and drained their savings. With felony charges pending, neither has been able to find work. They said they could feel heads turn when they walked into local lunch spots like El Joey’s Mexican restaurant.

“It has derailed our careers, and we’re probably not going to be able to get them back on track again,” said Mrs. Galle, 54, a grandmother who is depicted around town as the soft-spoken Thelma to Mrs. Mitchell’s straight-shooting Louise. “We’re just in disbelief that you could be arrested for doing something you had been told your whole career was an obligation.”

The hospital administrator, Stan Wiley, said in an interview that Dr. Arafiles had been reprimanded on several occasions for improprieties in writing prescriptions and performing surgery and had agreed to make changes. Mr. Wiley, who said it was difficult to recruit physicians to remote West Texas, said he knew when he hired Dr. Arafiles that he had a restriction on his license stemming from his supervision of a weight-loss clinic.

In a surprise inspection last September, state investigators found several violations by Dr. Arafiles and concluded that the hospital had discriminated against the nurses by firing them for “reporting in good faith.”

Texas Nurse to Stand Trial for Reporting Doctor - NYTimes.com

Technorati Tags: Doctor, Nurses, healthcare, Texas Medical Board, heatlhcare, lawsuit, whistleblowers

He speaks out for the public option and how it is needed and was one of the youngest Congressmen elected and represents a district in New York.  He says he has one of the jobs that Obama created.  Joe Lieberman is discussed, “is he a dick”, Jon asks, Anthony Weiner says yes, funny!

What is nice here too is seeing a young, not overweight or semi obese Representative in the US Congress discussing healthcare.  He made the decision to fight for healthcare instead of beating the pants off of Bloomberg in an election (grin).  BD 

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Anthony Weiner
www.thedailyshow.com
Daily Show Full Episodes Political Humor Health Care Crisis

Anthony Weiner chose to fight for health care reform rather than beat Mike Bloomberg like a rented mule in the New York City mayoral race. (06:52)

http://www.thedailyshow.com/

Technorati Tags: Anthony Weiner, health, healthcare reform, insurance, Joe Lieberman, Medicare, new york, Mike Bloomberg, Barack Obama, friends, Daily Show, Jon Stewart

I have posted about Windows Tag and their potential use for identifying recalled medical device and their use with keeping a lid on drugs too, but the FDA won’t even give me an answer. Read the link below for a rather lengthy post I did on the suggestion.  This is free and has the potential of saving lives so I guess it’s easier to let folks die than to maybe open up a level of curiosity here?   If you want to get the full picture on some of this information, read the links for more.  Yes I am on the case here for the use of this technology in healthcare and will keep blasting it at every opportunity I have.  Take time and read the links here if you can and it will create a better understanding of what the potential is here. 

Tags for Use in Healthcare – Medical Stents, Medications - One Scan Away From Safety Information in Real Time

Does it not make sense to scan a device, medication, etc. before use.  I addressed the medical devices as there is no way to really stay on top of this, even hospitals that have registries may miss pulling one off the shelf unintentionally!  If you scan the Tag on the package of the device, like a stent, you know right on the spot, and heck with all the cell phones out there, and the fact that this is free, there is certainly no shortage of phones around to scan!!  It’s just a matter of creating interest for a human application in a world of “tech denial” individuals who have low levels of curiosity, which has been stated in studies, leads to a lower level of intelligence, get it? 

Tracking Medical Device Recalls – Sounds Like A Good Place for a Microsoft Tag Data Base at the FDA

Recently in the news Microsoft employees will have a pilot program to try out getting their EOBs in HealthVault too.

Microsoft Employees Using HealthVault Will Receive EOB (Benefit Statements) From Premera Blue Cross

Ok so you have used your phone to access your EOB but want a larger view, take it over to a Surface Computer and have a look, move it around,etc.-the frog dressed up in EOB clothing (grin). 
When you see the second video, this is what is going on with the frog.  Now keep in mind with healthcare information these tags will be encrypted and will require authentication to view, unlike the frog.  You can read more at the link below to see how HeatlhVault, Google Health and Dossia are working with this technology.

RazCode/Windows Tags – Bar Coding to Add Information to PHRs, EHRs, and More…

Of course everybody does not have a Surface Tablet sitting around to do this, but information from a paper article or something other article can use your cell phone as the vehicle to transport, and then when you open your PHR on your computer, there it is, securely filed away where it should be in your PHR. 

Watch what happens to the frog here, you really need to watch both videos to grasp the concept I think. 

 

This video was done in France so there’s part of it you may not understand but the visual says all.  I welcome any and all comments or questions too!  Again, I see this as an opportunity to save lives by embracing some very easy and simple to use, and free technology.  BD 

Technorati Tags: Windows Tags, healthcare, technology, EOB, 2D Bar Code, FDA, recalls, PHR, personal health records, Surface, cell phone, medical records, RazCode

This is definitely a step in the “right” direction.  Ultimately the high risk area are going to need the availability to work with carriers as well to fully incorporate a useful system that stands to catch more of these types of shipments.  I spent many years in logistics and had this to say back in October of 2008. Blind shipments should really not be allowed but it goes on in the transportation business all the time.

Blind shipments are what causes confusion and additional time and red tap when it’s time to locate recalled products for an example.  Once again too I have a suggestion in that area that has been totally ignored by the FDA, tech denial and time at work here I guess. 

More Candy From China – Are “Blind” Bills of Lading adding to the confusion and delay in locating the products for recall?

Companies may not lie about the product on a certificate of origin, but individuals packages may not show the country, city etc. on where the product comes from and in the age of transparency we need to know this as the global economy continues to grow.  I hope the data base does contain a full listing of those certificates for the research to be successful and help promote better safety, a again, a local bill of lading could very well be “blind” to all the data contained.

Actually carriers would be very happy not to have to deal with blind bills of lading, but with contract negotiations to handle a huge account, companies wheel this into the contract, then the carrier has to determine how to connect data and maintain records.  Did you know that when product recalls occur, be thankful to the carriers as sometimes companies who negotiate these contracts rely on their IT system to help locate products!  Who would ever thought a little logistics information way down the road here would have some useful information to add (grin).  US Customs data bases here are also part of this puzzle for focus as they carry on normal inspections in just the nature of their business with imported product that is coded with the harmonizing data base to identify product. 

Just like healthcare, everything is coded and there are people who work for compliance in this area called “customs house brokers” that do just like billing and research companies do with healthcare.  Who knows one day the food you consume could even be linked back to a diagnosis based on the document number referenced upon import (grin) and you will know that it has been certified scanned by the FDA at the port origin.  Whoa….a few too many algorithms for me on a Saturday!  BD 

Carriers also have pallet exchange agreements with companies too and perhaps some of these may have been helpful in the recent Johnson and Johnson recall of to help locate where some of the affected treated pallets were throughout their system.

Tylenol Arthritis Formula Recall Expanded to All Product Lots with Red EZ-Open Cap – Johnson and Johnson

From October 2008:

“The reason for mentioning this is that a vendor of a food product could have a shipping document that shows a US point of shipping, in other words, the delivery document that is signed at the time of delivery on “blind” shipments would not indicate to the vendor where the product originated, as well as a purchase order, thus the tracking and delay time in getting this information to the end consumers.  

A “blind” shipment is when you have ABC Company in let’s say Chicago, IL that has product made overseas and distributes all over the world. The product may only show Chicago as the address wrapper, label, packing slip, and on a bill of lading, when in fact it could come from many locations. When the bills of lading are created from a warehouse shipping the product, the origin shows Chicago, even though it came from a 3^rd party warehouse in Los Angeles for example where it was offloaded from a container from China. Companies do that to hide the outsourced manufacturing agent for branding purposes. That is called a “blind” shipment so by the time you match up an invoice to see where it came from, etc. it can take a few days, just like we are starting to see here.

Transportation companies don’t normally like to do that, but cave in when it means loss of business if others do it. Years ago was not an issue, but not by today’s standards and I can almost bet all of these incidents involved some “blind” bills of lading making it a nightmare to trace. FDA has done their bit on fresh food, but should really clamp down on this as I don’t think we have seen anything near the end of this. Actually there should be no food or drug products shipped without a full label showing complete origins, city, state, country, etc. and no “blind” shipments. Once it has cleared customs and is in a local US warehouse, and the bills of lading show a“ blind” origin instead of let’s say a 3^rd party bill when the product ships, we have one big mess.”

The project follows recalls of tainted toothpaste, pet food, seafood and other products from China, as well as a contaminated blood thinner blamed for dozens of deaths in 2008.

About 20 million of shipments of food, medicine, medical devices and cosmetics are expected to arrive at U.S. ports this year, FDA Commissioner Margaret Hamburg said. That is up from about 6 million a decade ago.

With the growing flood of products, inspectors typically examine less than 1 percent.

Under the new system, border staff can check products in a computer database that gives a score for the risk level. The score is calculated in part based on whether the maker has a history of recalls and how susceptible the product is to contamination.

High-score products can be set aside for further checks.

Border inspectors to check for risky food, drug imports | Reuters

Technorati Tags: FDA, data bases, inspections, safety, blind shipments, Los Angeles, business intelligence, medical devices, food safety, technology, harmonizing tariffs, US International Trade Commission

One more interesting article here about the huge profits made by companies providing HMO services and according to the article here, the major backbone of revenue lies within Medicare supplement plans.  Organizations of such of course are very much alive and watching the healthcare reform movement before they can even think of an IPO and discuss the liquidity of the company.  

Certainly if an IPO opportunity became available then we bring stock holders into the picture, along with the responsibilities to the Venture Capitalists who are already in heavy here and from the headline posted above it appears they should be enjoying some returns on their investments.  The company also offers prescription drug plans in 43 states so from a profitability stand point only, it would appear to be very profitable to align your business with one or more of the hugely profitable pharmacy benefit managers.  See how Medco faired for the 3rd quarter. 

Medco Health Solutions $14.8 Billion 3rd Quarter Profit – Automation Is Part of Their Solution

The VC investors of course would love to see an IPO to get some cash.  Once on the market we have one more company for profit on the stock exchange and the continuing focus on “profit” versus a true healthcare focus.  One more thought here is that when you look at where the money comes from, again we are back to government subsidies with Medicare again, so those who think there’s not a lot of government money falling into private companies, think again as here’s one company who built their business models around HMO services for seniors.  A couple weeks ago they announced the patient-care website to work with both their Medicare and Medicaid members.  They also use electronic services from Emdeon to check for eligibility.  Emdeon is another 3rd party company that supplies business intelligence software to hospitals, providers, etc. in the area of claim payments and more.  Here’s a part of the package is that is marketed, “Denial Manager”.  You might want to read up and check this out.

Healthcare claim denied, there’s an app for that in managing denial processes, quote from the website below, “streamline” denial management.  Makes you wonder as a consumer at times when disputing denied claims how you can stack up your information as you need to just get care, but this is the reality of some of the processes denied claims go through and the business intelligence strategies created for ultimate risk management that consumers have to battle, the algorithms of healthcare for profit.  BD 

“The Emdeon Denial Manager solution allows providers to organize and manage remittance inventory; helps staff arrange, prioritize and monitor denials and underpayments; and allows the accurate reporting and viewing of the denied and adjusted amounts. With the information produced by Emdeon Denial Manager, providers streamline the denial management process by determining root causes, patterns and process breakdowns responsible for denials, and establishing corrective steps to prevent future revenue loss or delay.”

Bravo Health Inc. did something in 2009 that most venture-backed companies can only dream about: It had revenue of more than $1 billion. Yes, that’s right, billion.

To put that into perspective, Google Inc. had revenue of $963 million in 2003, the year before it went public.

Even more impressively, Bravo, which up until 2007 was known as Elder Health, is projecting that revenue in 2010 could be close to $2 billion, said Charles “Chip” Linehan, a general partner at New Enterprise Associates, who co-founded the Baltimore company in 1995 with health care industry veteran David Carliner. The company, according to Linehan, also is generating solid profits.

Initially backed by NEA, Frontenac Company and Coleman Swenson Hoffman Booth, the company for its first five years was “bumping along” while growing its business, said Linehan. Things, however changed some eight years ago when an insurer that Bravo was working with decided to exit from the Medicare business in Maryland.

Since its founding, the company has raised roughly $150 million in venture financing, according to Dow Jones VentureSource of which $118 million has come since the the recap, including a $52 million round in 2004 and a $49 million round in ‘07. The company’s venture investors would obviously love to see an IPO, but are willing to let things play out in Washington.

The $100 Million Revenue Club: Bravo Health - Venture Capital Dispatch - WSJ

Technorati Tags: Bravo health, Medicare Advantage, Medicare HMO, healthcare reform, venture capital, invesments, IPO, profits, busines models, Congress, algorithms

It sounds like it cherry picking time again – run the algorithms and and cut the most unprofitable portions of the business, like all companies do but this business leaves people without healthcare when the pricing goes beyond what consumers can afford.  There’s a comment from a podiatrist and his wife paying over 27k a year for himself and his wife.  The letter stated increases will come every 12 months and increment increases can occur anytime in between, so when they want more dollars out go the letters.

Individuals with individual policies are at stake too for being scrutinized for pre-existing conditions.  In other words they are the group with the most algorithmic “scores” run to determine the potentially less profitable portion of the business.  Changing to another carrier is risky as there might be something listed in the MIB files (Medical Insurance Bureau) that would be outside the eligibility algorithms created to determine if coverage will be offered.  

It certainly appears that creating healthcare for everyone is not going in the same direction as the carriers.  It appears you can make more money with fewer patients and again the formulas have been created to figure this out.  I certainly hope that all the carriers have their “rainy day” or “reserves” in place to keep insolvency from occurring.  We all remember the AIG story who’s reserves were non existent.  We all know what shows on paper, but where is the money invested and how secure is it?   With current economic conditions there are fewer that will be able to afford the higher prices and some will have to opt for plans that cover less.  BD 

California's largest for-profit health insurer is moving to dramatically raise rates for customers with individual policies, setting off a furor among policyholders and prompting state insurance regulators to investigate.
Anthem Blue Cross is telling many of its approximately 800,000 customers who buy individual coverage -- people not covered by group rates -- that its prices will go up March 1 and may be adjusted "more frequently" than its typical yearly increases.

Many policyholders say the rate hikes are the largest they can remember, and they fear that subsequent premium growth will narrow their options -- leaving them to buy policies with higher deductibles and less coverage or putting health insurance out of reach altogether.

"I've never seen anything like this," said Mark Weiss, 63, a Century City podiatrist whose Anthem policy for himself and his wife will rise 35%. The couple's annual insurance bill will jump to $27,336 from $20,184.

Insurers are free to cherry-pick the healthiest customers in the lightly regulated individual market. They can raise rates at any time as long as they notify the state Department of Insurance and prove that they are spending at least 70% of premiums on medical care.

She and others voiced anger about the increases as Anthem's parent company, WellPoint Inc., sees big profits. Last week the company announced an eightfold increase in profit for the last three months of 2009, a surge attributed largely to the sale of subsidiaries.
Broker and insurance industry analysts said the California rate increases will leave individual policyholders with few good options: Anthem subscribers such as the Fellers can switch to a company plan with a higher deductible. Or they can try to switch insurers, a dicey proposition because carriers in the individual market can reject applicants who have preexisting medical conditions.

Anthem Blue Cross dramatically raising rates for Californians with individual health policies - latimes.com

Technorati Tags: Blue Cross, individual insurance policies, healthcare, health insurance, policies, rates, algorithms, cherry picking

With the new HIPAA laws, business associates will now be scrutinized for fault in security breaches when they occur.  Last week I posted a short announcement on how the HIPAA laws have changed.  In cases of security breaches the investigation process and areas of responsibility is going to get a bit more detailed with penalty stakes rising.  Business consultants may become much aggressive too in the way the work with IT and IS departments in the future as far as compliance with the new laws.  BD

New and Upcoming HIPAA Rules – Read Up You May Now Be a Covered Entity

Business associates can be directly liable for a breach of unsecure protected health information (PHI) and could have to pay OCR directly, a top OCR official told HealthLeaders Media at the 18th Annual National HIPAA Summit Wednesday afternoon.

HealthLeaders Media asked Sue McAndrew, deputy director for Health Information Privacy for OCR, if a business associate could end up paying out of its own pocket for a breach. The answer is yes.

However, she went on to say OCR would consider waiving—or decreasing—some of the penalties after an assessment of the financial state of a violating hospital. She also said that the "settlement door is always open."

Business Associates Can Pay Directly for Breaches

Technorati Tags: business associates, HIPAA, healthcare, security breaches, PHI, medical records

A few months ago I  wrote about CareMore in southern California investing in business intelligence claim and cost software services and now we have another in northern California.  Companies as such are making a ton of money with providing software that evaluates and presents business models to save cost and hopefully improve health care outcomes. As you read through here, an audit trail of all activity for each patient is created. 

CareMore Health Plan Invests in Business Intelligence for Acute and Chronic Illness Management

Notice the emphasis below:  Claims Pricing.  Certainly with the complexity of healthcare and who gets paid for what today, companies who provide this transactional related service are making big dollars.  As you can read from the links below Trizetto works with many of the algorithmic formulas created by Ingenix (a wholly owned subsidiary of United Healthcare) for their reporting, “scoring” and algorithmic formulas to verify enrollment, pay claims and so on.  

TriZetto Announces New Feature for Personal Health Records – Auto Populated for the Consumer But Payer Access for Eligibility Questions from Providers

As the article reads on, Trizetto is hosting the software and again these are all companies providing services that are traded on the stock market with share holder responsibility for profits and when I read their prior announcement it appears that payers have some access too, so I am not sure on how this works for privacy.  As mentioned prior, the information can be exported to Microsoft HealthVault with Trizetto. 

In addition Trizetto works with Ingenix (a wholly owned subsidiary of United Healthcare) to use business intelligence software to utilize additional algorithmic scoring to determine claim status.  

TriZetto was purchased by Apax Partners, a London based private equity firm for 1.4 billion so somebody wants a return on their investment somewhere along this line.  They also have a large agreement in the Netherlands for processing claims and other financial interests.

You can read more about what the 2 companies say about their collaboration here.  One thing about all these partnerships it becomes a bit cloudy as to who is there to help create better healthcare and who is there to run formulas or algorithms on transactions to create profits on the stock market.  It seems everywhere I read these days I keep seeing the algorithmic claim formulas of Ingenix involved with business intelligence with not only other insurance carriers but many of the 3rd party business consultants as well.  Many of the 3rd party businesses also buy and sell your prescription medicine for data analysis from pharmacies and pharmacy benefit managers, all in the search for for data to analyze.  The Trizetto page advertises “power to the employer” as shown on the image below.  BD   

The TriZetto Group, Inc. today announced that Chinese Community Health Plan (CCHP) has successfully implemented several TriZetto systems, including the Facets^®, NetworX Pricer^® and Clinical CareAdvance^® applications. The products are enabling the health plan to more efficiently administer its enrollment, membership billing, claims and customer service, as well as its network and health management programs. TriZetto is managing and hosting all of the applications for CCHP.

“For each CCHP member enrolled in a disease management program, TriZetto’s application is tracking the enrollee’s activity and providing an audit trail that helps extend the reach and benefit of CCHP’s diabetes, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure and hypertension disease management programs”

CCHP provides managed care plans for individuals & families, employer groups and Medicare beneficiaries, including those with Medicaid. CCHP currently serves more than 13,000 community members in San Francisco and Northern San Mateo County.

CCHP uses TriZetto’s Facets system as its core administrative platform to help improve efficiency, increase accuracy and reduce labor costs. TriZetto’s NetworX Pricer application helps ensure accurate and precise claims pricing. TriZetto’s Clinical CareAdvance system provides comprehensive health monitoring and reporting tools; provider and nurse-manager alerting; template-based, secure messaging between members and case managers; near real-time member identification and stratification; customized real-time statistics and reports; and outbound communication methods tailored to CCHP’s members.

CCHP implements TriZetto systems to improve its network and health management programs

Technorati Tags: CCHP, Trizetto, business intelligence, PHR, HealthVault, Ingenix, claim processing, healthcare, algorithms, profits, stock holders, United Healthcare

American Well began their first pilot program in Hawaii and since then has expanded into additional areas.  United Healthcare has also chosen American Well as a partner and has been soliciting for physicians to join their network for a few months now.  Ascension offers care at over 500 facilities in 19 states in the US. 

It has been a while since I have visited the American Well web site and there are 2 services they offer, one for patients and doctors to collaborate and a second service for physician to physician to consult.  You can watch a video at the website where you have options of using just the computer, and adding a web cam and determining your charges before you even connect.  Once you have consulted with a physician, you can add them to your network and the next step is to share with your primary care physician.

In addition you can also export your information to Microsoft HeatlhVault.  BD 

Press Release:

As part of its efforts to improve the healthcare experience of those it serves and better meet their needs throughout their lives across the entire healthcare continuum, Ascension Health has reached an agreement with American Well™ Inc. to bring Online Care services to communities served by Ascension Health’s local Health Ministries. Ascension Health will be the first health system in the United States to offer American Well’s Online Care.

“Ascension Health’s Strategic Direction guides us to establish lifelong relationships with patients. As a result, we have been working with our local Health Ministries across the country to assess community needs and explore new models of healthcare,” said Hyung T. Kim, MD, MBA, Managing Partner of Ascension Health Transformational Development. “Our goals include finding new ways to connect people with the services they need and enabling our affiliated physicians to provide care that is more efficient for them and more convenient for their patients. This new technological capability will allow us to advance both those goals, improving the lives of those we serve and the physicians with whom we work on a daily basis.”

The Online Care service will allow eligible patients to engage in immediate live encounters with primary care physicians and other clinicians affiliated with Health Ministries of Ascension Health. Patients will be able to initiate these encounters from their home or workplace at any time, via the Web or a regular phone. During each live interaction, care providers will be able to review the patient’s clinical information, speak with and usually see the patient, prescribe medications as appropriate, and suggest follow-up care.

In keeping with the mission of Ascension Health, a key focus of the deployment will be the creation of an Online Care offering specifically for poor and vulnerable populations. This service eventually will allow eligible individuals to receive online medical services at no charge. In addition, participating Health Ministries will identify physical sites in underserved areas where individuals will have the option to conveniently access Online Care services.

“As we explore innovations in care delivery for the benefit of all individuals, a major focus always is to find ways to expand those innovations to those who are poor or vulnerable,” Dr. Kim said. “As Online Care evolves, we hope to provide even better access to quality primary care for those who need it most.”

The service will begin in spring 2010 at a yet-to-be-named local Health Ministry of Ascension Health, with plans to expand the service following the successful initial deployment.

“We share Ascension Health’s goal to increase access to quality healthcare,” said Ido Schoenberg, MD, CEO of American Well, Inc. “As the first health system to offer Online Care, Ascension Health will pioneer the use of this innovative technology to serve those patients in greatest need.”

Ascension to Offer Online Consults

Related Reading:

OptumHealth (Subsidiary of UnitedHealthCare) Teams Up With American Well for 24/7 Physician Consults

American Well – Video Consults for Physicians

American Well Video Physician Conferencing becoming available in Minnesota

Technorati Tags: American Well, Ascenscion health, web visits, healthcare, telehealth, personal health records, PHR, United Healthcare, Hawaii

If you read below, the numbers collected and analyzed show that one out of every 14 claims are initially denied, that’s a pretty large number, when you stop and think that one person with health issues can line up 14 claims pretty quickly.  The doctor told the patient that United Healthcare had approved the same procedure for 8 other patients that year.  What made the difference – the algorithms and not fitting the exact criteria.  When you think about the formulas used to deny claims, don’t think they stay the same either, they change.  

For the patient and doctor, look at all the time it takes to go through these processes.  United when they finally agreed to pay, went to work negotiating a reduced rate and out of 21k for the bill, they paid 12k after working out the discounts with the doctor and hospital and the patient co-pay was $500.00. 

In addition, it may be difficult to reach the carrier until the “middle company” the one who audits and looks for data errors and is in the risk management business for the carriers may be where the initial claim denial occurred. These can be the “primary” algorithms that are run on your claim.  Insurance carriers pay for third parties to audit and sometimes scrub claims, some check only for billing and coding accuracy and some dig deeper into the actual “scoring” of your claim.   Here’s an example of of a Health Plan that works with a company named Trizetto, now owned by a European company, that scrutinizes and analyzes claims.

CareMore Health Plan Invests in Business Intelligence for Acute and Chronic Illness Management

In addition Trizetto works with Ingenix (a wholly owned subsidiary of United Healthcare) to use business intelligence software to utilize additional algorithmic scoring to determine claim status.  

You can read more about what the 2 companies say about their collaboration here. 

“Supports Professional and Facility claims editing for both commercial
    and Medicare applications

Unique Rules Creation Module allows users to customize the software’s editing
    logic to reflect specific rules and reimbursement policies

Integrated edit sourcing provides transparent disclosure to help providers better
    understand edits

An adapter enables seamless integration of the Ingenix Claims Editing System into
    the existing Facets workflow “

You might remember the legal cases and corrupted data base news over the data base used by United and most of the other health insurance carriers for out of network customary charges that has pending class action and other suits in court.  You can read more below, but keep this in mind that the claims auditing and scoring is done by companies traded on the stock market and have shareholder profit responsibility. 

“Fair Database” to Replace Unfair Ingenix Data Base – Run by Non Profit

The same types of companies are also hired to fight fraud with the use of extensive algorithmic formulas and sometimes like anything else, you might be looking at some false positives.  Ingenix has the contract for the state of Washington with Medicaid to fight fraud and reduce costs and recently in the news, Walgreens has pulled out of honoring any Medicaid claims for prescriptions in that state.  Again, keep in mind that there are 3rd parties involved that receive transaction fees for these algorithmic processes and the stall of your claim could have also very well began here. 

Little Progress on Fighting Healthcare Fraud – Look At Who’s Getting the Anti-Fraud Contracts

At this point one begins to question as to why the same companies who paid millions on under paying patients and physicians on out of network charges are the same companies that help score and analyze claims.  This is part of the red tape when fighting a claim denial that takes place.  Of course the insurance companies as well as the business intelligence partners are on the market and have shareholder profit responsibility and the algorithms that create profit have a huge priority.  We do not get to see or really get full explanations of how the determinations are made.  Electronic medical records software has to be certified and the formulas they run for charting but on the other side, with the exception of Medicare, we do not get to see exactly how we are scored.  I think we almost need one of these to help govern and set some standards on how the qualifying algorithms can be used.  Wall Street has been rebuilt on unregulated algorithms.  BD 

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

Maria Carr, a 43-year-old school administrator from Tulare, Calif., could not believe it when her insurer, UnitedHealth, denied coverage for arthroscopic surgery she underwent last year to treat a bone spur on her hip.

Her doctor told Ms. Carr he had successfully performed this procedure for eight other UnitedHealth patients suffering from the same ailment in the same year. To Ms. Carr’s mind, arthroscopy seemed a much less invasive and cheaper way to treat the problem than open hip surgery, the traditional treatment for bone spurs.

“When the denial came I was shocked,” Ms. Carr said, “but I figured I’d just have to find a way to pay.” The total bill for the hospital and surgeon fee was $21,225.  Of those, according to data collected from health insurance industry sources, 100 million are initially denied. In simpler numbers, that is one of every 14 claims.

Patient Money - Fighting Denied Claims Requires Perseverance - NYTimes.com

Technorati Tags: algorithms fraud, healthcare, formulas, claim denials, Ingenix, Trizetto, scoring health claims, health insurance, contracts, patients

The FDA has been under fire ever since I started writing this blog about 3 years ago, and when under our former administration there was not a lot they could do as the form head of the FDA Andrew von Eschenbach was  not in line with technology and the pace it is moving at today  Actually he was grilled by Congress at one point as to why he “didn’t” ask for more funds.  Now Mr. von Eschenbach has joined Newt Gingrich’s health think tank, the Center for Health Transformation, as an adviser.  It was only 2 years ago I was posting articles like this, from Jacob Olcott of the House Homeland Security Subcommittee on Emerging Threats, Cyber Security, and Science and Technology. (Thursday, April 10, 2008)

Congress to industry: 'We need your help' 

which was followed by this:

FDA Head: We're Boosting I.T.

Study Calling For Medical Device Information To Better Serve Patients And Doctors from the FDA

“On a prior post it was noted that the FDA needs some new technology...as the article states that key employees were still writing these things out in longhand...on paper...as technology continues to grow, those in responsible positions could certainly benefit with some technology updates, at least with hardware for a start...”

“Hello Intel...anybody listening...maybe Craig Barrett...could we get some Classmates over there to help out??  BD”

So in a couple of years they have had to really pick up the pace quickly and I’m sure all key employees have computers today as that is hardly an option any where you work.   The old familiar dividing lines of which agency will cover what is also changing and collaboration between various government departments is needed too.  Your cell phone someday, depending on what medical information it collects and delivers may need to be approved by the FDA.  I still think they are overlooking some areas in technology where they could advance rapidly too.

Being software is the king pen today with algorithmic formulas running some part of everything we do, I might guess that when it comes to medical device software there might need to be some beefing up in that department as well, perhaps some programmers who can do more than just test, but dig in and get a better physicist’s opinion as that’s who’s taking care of the MRIs, CT scanners and so on.  As software gets more complex we may need physicist opinions in more than this area too.  Granted too there is travel and you can’t bring every MRI to Washington for approval either, they don’t a lot of moving around for one. 

Bottom line is that software applications and how they work with devices to include new biometric type drug delivery systems is a new big area of focus that you can’t over look as people die from some of this stuff, called recalls for one example.  They are pressured and lobbied a bit too with VC funded companies with a short string of financing too so that is another area to deal with too.  They also have the overseas offices to administrate too and that has basically just begun.  BD 

The U.S. Food and Drug Administration sought to increase its operating budget by nearly a quarter, to $4.03 billion, to renovate its medical device, food safety and tobacco use prevention programs, the agency announced this week. 
As set out in President Obama's 2011 budget proposal, the new plan calls for a 23 percent increase of the agency's current budget of $3.28 billion.
The request, which covers the 2011 federal fiscal year beginning October 1st, 2010, will help pay the salaries of more than 1,000 new workers, raising the number of employees at the agency to 13,586.

Currently, the FDA swells its budget with nearly a billion dollars in fees it levies from drug and tobacco companies.
But under proposed laws, the FDA would also get close to $289 million dollars from fees collected from food companies and firms making specialized generic biotech products.

DOTmed.com - FDA Wants $4 Billion to Overhaul Medical Device, Food Safety Monitoring

Technorati Tags: FDA, budget, funding, software, healthcare, medical devices, food safety, drugs, business model

Ok paper folks, so you thought scanning a piece of paper and making a copy was safe, well think again as depending on the type of copier you have each scan might be stored on a drive.  In this article the news agency saw a medical record that showed someone’s HIV file.  Copiers are a major loophole for privacy.  Wiping the drive or getting a sledgehammer would fix the problem, but unlike computers many do not even think about the drive in a copier.    

You just power up the machine and there’s a list of past print jobs, to reference and re-print if you want.  If you are getting a new copier this might be something to think about if you are trading it in, ask the company if they are going to wipe the drive before trading in for a new one.  You see the memory on copy machines all the time for reference.  The machines being discussed are the all in one machines that fax, scan print and some can email, so if they can do all of that, there’s a drive in there to create memory.

They called the office called Caroline Kennedy as they found records with her phone number and other information.  The phone number was correct.  Now if you in a medical practice, think twice about trading in that machine by all means!    Have you called a company asking for your information to be sent to you via fax, well like me internet faxing holds the image, all big companies do that.  If you look and see an IP address, the individual talking in the video tells you it has not been cleared.  Remember so many of the new copiers go right on a network and function with an address, just like a computer. 

All you do is connect a computer to the hard drive in the machine and you have all the documents.  Use the link and watch this video.  There are no laws or regulations on how to clean the hard drives.  In the video they show documents clearly marked “confidential” and some have signatures high ranking individuals at places like Google, etc. so nobody seems to be safe here, as even if it was not you who did the copying, but rather let’s say an insurance company sending information to a pharmacy benefit manager as an example, or that pharmacy benefit manager doing the same, or a retail pharmacy faxing prescription confirmations, and then later getting rid of the machines for a newer model with a full drive, up to 25,000 documents that could be there.  Those were your records sent, but you were not involved in the transmittal in any shape or form, so who knows what could be found! 

What causes this, “tech denial” and lack of awareness!  Now some folks have woken up to this fact but there are so many that have no clue, so it’s a haven for identity theft.  Just think of a hospital dumping a copy machine without wiping a drive.  Copier dealers don’t necessarily want to discuss this as it involves more cost for them to educate customers on wiping drives or having to provide that service.  Gee, all about money and making a buck standing in the way again.  

Ok, this is a privacy issue, but who’s going to police it, HIPAA for the medical side with perhaps some new regulations, but this goes way beyond just medical so like everything else today we have an issue that require more than one agency to work together, something that has been such a chore for so many today it seems.  BD   

SAN FRANCISCO, Calif. (CBS-5) - Copier warehouses across the country are filled with row upon row of used machines ready for resale. But CBS 5 Investigates found many of them hold private and sensitive information never cleared from internal hard drives.

What most people think of as copy machines are these days known as "multi-function machines" that also scan, fax and even email. But to do all that, the machines store copies of documents on hard drives in a range of sizes. 

John Juntenen founded a Sacramento-area company focused on securing copier data. He said the hard drives can hold as many as 25,000 documents.

http://cbs13.com/local/tony.lopez.Keeping.2.1471827.html

Technorati Tags: security, privacy, multi function printers, scan, drive, healthcare, copiers, used copiers, medical records, used copy machines