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Humana and Cigna Partnering to Sell Medicare Humana Advantage Plans To Employers In Cigna’s Data Base

4/16/2010 06:10:00 PM  ,  

Here comes the marketing push, 2 carriers uniting to market Medicare Part D.  If Cigna can’t get them then maybe Humana can get the sale.  No matter who sells the plan Cigna will manage it, but it will provide Humana’s Advantage plan that is marketed.  Did you get all that?  I think if read this correctly you can purchase a Humana plan from either Cigna or Humana, but the administration will be done by Cigna.  image

The plans will be to offer coverage for retirees it appears or those who are ready to retire, what ever that is as so many of us don’t know what retirement is any more.  This is somewhat interesting in the fact that the folks from Cigna it appears will be able to sell either their own plan or one from Humana too.  No wonder everyone is so fed up with marketing and the intricate formulas with all the marketing and analytical algorithms floating around today.  We all know there’s a ton of money in selling Part D.  One small company in the northeast last year that does Medicare Advantage made a billion in profit.  BD 

Louisville, Ky. (WHAS11) - Humana is teaming up with Cigna to sell Medicare Advantage Plans to employees that offer retiree coverage.

The two health insurers say they plan to collaborate on a deal that provides Humana's Medicare Advantage insurance to employers in Cigna's customer base.

Cigna will then manage the accounts.

Those plans are privately run versions of the government's Medicare program.

The companies will split revenue from the deal.

Humana offers dozens of Medicare Advantage Plans nationwide and Cigna offers coverage to employers in every state.

Humana teaming up with Cigna to sell Medicare Advantage Plans | WHAS11.com | Louisville news, Kentucky news & breaking news | WHAS11.com | News for Louisville, Kentucky

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Dog Slobber Being Studied As a Source of DNA for Finding Cures for Rare Types of Cancer that Affect Both Humans and Dogs

4/16/2010 11:56:00 AM  ,  

DNA is going to the dogs literally with research and development but this is a good thing.  If the dogs can render some DNA that help cure some rare forms of cancer we can learn to live with their bad breath by all means.image

The study is also using blood samples and the American Kennel Club has approved the research as well.  Put on an apron and start collecting.  BD

Recently conducted research has revealed that DNA found on the tongue of a dog could prove out to be an essential breakthrough cure for rare type of cancers affecting both dogs and humans. According to www.foxnews.com, the study has been conducted by the researchers at the Van Andel Research Institute (VARI) and the Translational Genomics Research Institute (TGen).

As per www.ushour.com, these cancer types were essentially found in human beings and lately have been showing signs in dogs too. The team of researchers are hopeful of finding some success in determining the real genomic cause of the diseases. The DNA samples have helped the scientists better understand the disease and to work on its prospective treatment.

Dog slobber could help treat cancer - Health News - Celebrities with diseases

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Teneros Social Sentry Software – Enterprise Software Algorithms to Track and Monitor Employee Social Network Activity

4/16/2010 10:36:00 AM  , ,  

I’m guessing this post is not going to make anyone’s day.  We heard this week about all Tweets being archived so now we have a software service that will allow imageemployers to check up on you and see what you are doing during on social networks.  You may call this “risk management” for the enterprise. 

This is not just Twitter as Facebook and others are included. There are options to monitor all or just selected employees with the software. 

One of my old sayings with social networks and anywhere you post has been “what goes on the internet, stays on the internet” so keep that in mind when you speak out or especially when posting personal information you may not want discovered as the beholder of the information with analysis systems today may have an entirely different interpretation than what you intended.  Venture Capital companies seem to think it has a future especially since it is not limited to just your activity at work but will mine pretty much everything on the web in the social networks.  

This falls under the “behavioral” profiling area which we are also seeing in healthcare with behavioral underwriting and assessing risk, so the analysis process appears to have stepped up on level.    I wonder if some day soon insurers will have the capability to use an automated system as such, as they do currently look at these items on the web already.  BD 

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

When it comes to finding out what is shared and known about you, the MIB, Medical Insurance Bureau may have information even beyond healthcare to include driving records and more.  As consumers we did not place this information there in such data bases, but the responsibility to clean up errors has certainly been dumped right into our laps.  In God we trust, all others must bring data.

The MIB – Health Insurance Bureau Business Intelligence Mining May Go Beyond Just Healthcare Information

If you take some of the current information collected and add on social networking information one stands to have a pretty detailed profile on how they can look at you as a risk, perhaps not morally as a person, but the risk factor of dollars and cents.  Does this give us reason to roll out a blanket of non questioned trust?  I don’t think so and partly why trust in government and companies is currently at an all time low – it’s those risk management algorithms profiling everything we can potentially say or do out there. BD  

Social Sentry provides corporations the ability to monitor the social networking communications of their employees. Delivered as an easy to deploy SaaS offering, Social Sentry enables businesses to monitor employee activity on all major social networks such as Facebook and Twitter. It provides granular and real-time tracking to eliminate significant corporate risks related to:

  • Compliance issues
  • Leakage of sensitive information
  • HR issues
  • Legal exposure
  • Brand damage
  • Financial impact

image

Teneros Social Sentry Offers Breakthrough in Corporate Protection | Teneros

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New Tools for Genomic Sequencing Targeted at Translations and A Hand Held Sequencing Device in the Future

4/16/2010 09:47:00 AM  , ,  

The field of personalized information and genomic sequencing is growing at rocket speed with new information, translations and targets being identified it seems like almost daily  For a blast from the past, back in 2008 we were talking about an entire sequence costing 350k and now we may soon be seeing the cost go down to 2k or less soon.

Is a complete personal genome sequence worth $350,000?

If you are not real familiar with how some of this works relative to personalized medicine, check out the link below as there’s a video that uses some easy to understand layman’s terms that will bring you up to date. 

The Future of Personal Genomics

Devices are developing rapidly too and in this piece from MIT, the potential of carrying around a hand held device some day to sequence is one of the areas being pursued.  With sequencing we can accurately prescribe drugs that will essentially target specific diseases and know up front what potential side effects a patient may incur as well.  

Pacific BioSciences Announces a 15 Minute Genome Mapping for Less Than $1000 by 2013

Not too long ago, George Church also commented on how personal health records via Google Health and HealthVault from Microsoft are also helping with the growth of personalized medicine, patients become better informed for better decisions. 

George Church Says Microsoft and Google are Helping with the Growth of Personalized Medicine

Also, I believe Mr. Church is still looking for the next round of volunteers who would like to have their entire genome sequenced.  If one is selected, part of the deal is that your information becomes public knowledge.  You can read more at the link below and see what others who participated in the original project have to say.  BD

Personal Genome Project looking for next wave of volunteers for an entire sequencing

Turner also described two new applications for Pacific Biosciences sequencing machines: detecting methylation patterns and tracking protein translation. Methylation is a key measure in the fast-growing field of epigenetics, broadly defined as molecular changes that affect gene expression but not the DNA sequence itself. It is these changes that enable genetically identical cells to develop into both brain cells and blood cells and have been linked to learning, addiction, cancer and obesity among myriad other states. Methylation is one mechanism for changing gene expression, turning on and off certain genes. The Pacific Biosciences technology reads DNA sequence by detecting the addition of single bases onto individual DNA molecules. Scientists discovered that the time it takes for this base to be added depends on whether the molecule is methylated at that position, enabling detection of methylation patterns in real time.

In a second novel application, developed in collaboration with Joe Puglisi at Stanford University, scientists adapted the sequencing technology to observe the ribosome--the molecular machinery that translates RNA into proteins. The research was published today in the journal Nature. Initially, the technique will be used to study the process of translation. But Turner said it might one day be used to examine off-target effects of drugs, for example, by examining how a specific drug altered translation of non-target proteins.

Both Church and Turner touched on the next brass ring for genomics technologies; a handheld sequencing device. Church predicted a demonstration device within the next two years, settling on Ion Torrent as the most likely frontrunner. Turner predicted that the next generation of Pacific Biosciences sequencing machine could provide the basis for a handheld sequencer.

Technology Review: Blogs: TR Editors' blog: New Tricks for Genome Sequencing

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S.E.C. Files Suit Against Goldman Sachs For Fraud – Did the Algorithms for “Desired Results” Create a Secret Investment Plan to Devise Mortgage Failures?

4/16/2010 08:38:00 AM  ,  

Is Goldman still worried about their “code” used to write algorithms, you bet they are and perhaps not only due to a programmer potentially using a portion of the code to create another software program but from what we read today, there could be other secrets on the algorithmic code used to calculate to attain “desired results”.  I did an interview this week where I mentioned the difference between “real” results and “desired results” and how algorithms are created that reveal both. 

If you get down deep into the algorithms and the processes with some very talented programmers as to how they were written in the code it will direct inquirers to the basis of how the design was created.  The algorithms are very complicated and feed and utilize a myriad of other financial algorithms and computations as well, so it’s not simple to back track and find each formula that created profit.  I still wonder about how much useable code this guy really took as from what I have seen on the size of the files it doesn’t appear to be more than a module, but when combined with other modules the rules change a bit. 

Goldman Sachs – Former Programmer Gets Indicted for Stolen Code – AKA Intellectual Property

Here’s a post I made last year as the stock market is not the only entity looking for “desired results” when it comes to algorithmic coding and the question of how this can enable the creation of fraudulent activities. 

Goldman Stolen Code – Has Algorithmic Fraud Become A Business Model in HealthCare Too?

This post also from last years adds a little more content in this area. 

AIG: You Bring the Nerds and the Algorithms and I’ll give you a AAA Rating…a little history from 1987

In the news today, almost daily we read about health insurance companies and their solutions for solving the cost of healthcare and it’s all algorithms and the issues we have is to determine what is a “desired” result versus “real” numbers so we can actually start living with factual information. 

Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

With all the “desired” algorithmic formulas today that seem to be producing less than realistic formulas for decision making processes today, no wonder we have additional “stress” all over the place and I think that in itself is one huge driving factor to a portion of the rise in healthcare costs.  It sells more drugs in one area for those who are depressed and we are now starting to see “depression” algorithms on the web, so you can take a self test and see if your are depressed, and that I question as some areas in life today are still better with a human to human interaction and not an algorithm that may carry the “power of suggestion” to potentially enable individuals to self diagnose. 

This is part too of what we battle today with “for profit” insurance companies too with regulation, are the algorithms for “desired results” to create profit or is the formula and program created going to yield better healthcare?  You might find a little of both in there but as always the yield for profit comes first and if some people happen to get healthier or get better healthcare, than that substantiates the algorithms and programs.  Anytime a company devises plans for better care, there’s always the 2nd hook for profit and sometimes the questions and methodologies used need to be questioned, as is happening with Goldman Sachs today with the SEC with investigating the scenario for “desired results” from complicated algorithmic formulations.  There’s a lot of money out there in that code and Wall Street is the heaviest investor with business intelligence and related software/hardware in the world.  BD  image

Goldman Sachs, which emerged relatively unscathed from the financial crisis, was accused of securities fraud in a civil suit filed Friday by the Securities and Exchange Commission, which claims the bank created and sold a mortgage investment that was secretly devised to fail.

The move marks the first time that regulators have taken action against a Wall Street deal that helped investors capitalize on the collapse of the housing market. Goldman itself profited by betting against the very mortgage investments that it sold to its customers.

The suit also named Fabrice Tourre, a vice president at Goldman who helped create and sell the investment.

Goldman was one of many Wall Street firms that created complex mortgage securities — known as synthetic collateralized debt obligations — as the housing wave was cresting. At the time, traders like Mr. Paulson, as well as those within Goldman, were looking for ways to short the overheated market.

Such investments consisted of insurance-like policies written on mortgage bonds. If the mortgage market held up and those bonds did well, investors who bought Abacus notes would have made money from the insurance premiums paid by investors like Mr. Paulson, who were negative on housing and had bought insurance on mortgage bonds. Instead, defaults spread and the bonds plunged, generating billion of dollars in losses for Abacus investors and billions in profits for Mr. Paulson.

It takes time for such mortgage investments to pay out for investors who short them, like Mr. Paulson. Each deal is structured differently, but generally, the bonds underlying the investment must deteriorate to a certain point before short-sellers get paid. By the end of 2007, Mr. Paulson’s credit hedge fund was up 590 percent.

Mr. Paulson’s firm, Paulson & Company, is paid a management fee and 20 percent of the annual profits that its funds generate, according to a Paulson investor document from late 2008 titled “Navigating Through the Crisis.”

S.E.C. Sues Goldman Over Housing Market Deal - NYTimes.com

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Phase Forward Clinical Trial and Healthcare Data Management Firm Purchased by Oracle

4/16/2010 07:54:00 AM  ,  

It certainly appears that business intelligence algorithms in healthcare are at an all time high today, and we have more data to analyze and study than every before as well.  Phase Forward has a suite of software solutions extending beyond just clinical trial data.  image

I talk quite a bit about devices that report data and in clinical trials we seem to be headed in the same direction as the text clip below from the Phase Forward website indicates “handheld” interface, so in the future we can look for clinical trials reporting to take on some new faces in the way that data is collected too.  For accurate clinical trial results data substantiating compliance is on the move.  A while back I had a post about a shirt that was being marketed towards companies that do trials as well. 

The purchase price is not cheap here as well as a 30% premium on the price per share is indicated.  BD

From the Website:

“OutcomeLogix ePRO provides an intuitive interaction to support patient reported or third party reported observational data collection via a web-based or a handheld interface. With OutcomeLogix ePRO, patients, parents, observers, caretakers, and others can easily navigate to and complete pertinent study questionnaires and surveys. Simple screen designs reduce confusion while built-in logic ensures reliable data collection. Users access our system via an encrypted SSL login with a unique username and password. “

“Data from various medical devices can be integrated into the OutcomeLogix Site Reported Data Capture or ePRO system. Using wireless technology, glucose levels, weight, peak flow, blood pressure, ECG, and other in-home monitoring device data can be integrated via a single Bluetooth® hub located in a patient’s home.”

On April 16, 2010, Oracle announced that it has entered into an agreement to acquire Phase Forward, a leading provider of applications for life sciences imagecompanies and healthcare providers. The proposed transaction is subject to Phase Forward stockholder approval, regulatory approvals and other customary closing conditions. Until the transaction closes, each company will continue to operate independently, and it is business as usual.
The life sciences and healthcare industries continue to focus on improving patients’ health and medical outcomes while addressing the cost of healthcare. 

With Phase Forward, Oracle expects to help health sciences customers better capture, access, manage and share clinical and medical data. Customers are expected to gain greater insight into patient outcomes during drug development and while providing healthcare services. The complementary combination of Phase Forward and Oracle products is expected to accelerate the delivery of innovative therapies to patients and help control healthcare  costs.

Phase Forward and Oracle

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Did Senator Coburn Hear Fox News Mention People Could Go to Jail for Not Buying Insurance (Video) – Sure Did

4/16/2010 12:55:00 AM  ,  

This is pretty interesting and funny here and I guess you better know what’s on tape before you open mouth and insert foot.  Good job at the Huffington Post here in bringing all this to light, and just shows how things can get distorted at times.  Glenn Beck says it at least a couple times here about going to jail over health insurance.  BD 

O'Reilly didn't take too kindly to that sort of criticism of his employer, especially coming from a conservative like Coburn. So O'Reilly defied Coburn to name a single person on Fox News who had ever said such a thing. And then O'Reilly dropped the gauntlet, saying, "We researched to find out if anybody on Fox News had ever said you're going to jail if you don't buy health insurance. Nobody's ever said it."

Really? Coburn said he was pretty sure he'd heard it before. And of course, he had

O'Reilly vs. Coburn: The Video Evidence (VIDEO)

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Health Insurance Medical Loss Ratios – How Will The Definitions Between Healthcare, Other Administrative Costs and Profits Be Spelled Out – May Need Some Algorithms to Figure It Out

4/16/2010 12:26:00 AM  ,  

In California this has been an ongoing battle for years with trying to ensure that medical premium money paid actually goes to spending on healthcare, but where willimage the lines be crossed here?  I think we would all like to agree on what is “healthcare” expense and perhaps not include additional areas like Venture Capital investments and even some software that is not directly related to healthcare included in perhaps some “gray areas” that may lead up to further and additional stagnating discussions that could cause delay.  Here’s a potential example with the Blue Cross Venture Capital division that invested in the “free” tablets provided to doctors to use in their lobbies to help them streamline input and is also funded by ads that run on the units.  Is this money directly going to “healthcare” or is it administrative and it could also fall over into the “profit” area with stated “VC” funds.

BlueCross BlueShield Venture Capital Firm invests in Phreesia

How does wellness fit into the scheme?  It’s not actual money paid out on claims but as you can see we have devices and software now coming of age that are incorporating their way into healthcare and telehealth.  Is this healthcare or administrative costs that help keep claims down?  Certainly through some efforts we do end up getting more involved as patients which we should be doing anyway, but when it comes down to putting these types of expenses in a data base and assigning a category, where do they go? 

UnitedHealth Buys Another Wellness Company – Biometric Monitoring For Data With Employer Contracts

Last year I actually asked this question on a post about being insured with United.  We hear and see a lot about their technology investments and they make more money these days from investments in technology and have subsidiaries that handle the algorithms and formulas used by the claims processing and wellness side of the business.  United invested hundred of millions with Cisco last year with technology.

Are You Insured by a Technology or Insurance Company – UnitedHealthCare

I’m not saying that investing in technology is bad, I’m asking how do you commit to creating the black and white lines as to “what are healthcare expenses” and what is allowed in the 85% area?  I think we will be hearing some long discussion in this area in the upcoming months.

Is using Quicken Health to track and figure out your healthcare bills medical or administrative?

 UnitedHealthcare To Offer Quicken Health Expense Tracker to 700,000 Employer Health Plan Enrollees

In healthcare technology and payment are crossing over and intertwining in areas that we have not seen before due to new technology too, so again, I am just curious to see how this all gets spelled out.  Again I think an algorithmic formula that helps determine some of this could be helpful rather than just a guess so there is a calculation on what is considered actual “healthcare” – it’s getting complicated. On the software side I think you would definitely determine the patient value and benefit coming first too before profit as it can be both and not only software to benefit the payer only.  With billing software as an example it’s been clearly stated many times that the payers are the bottom line beneficiaries here, not the providers sending the data.  BD 

Most of the big publicly traded insurance companies spend less on medical care than the new health law will require of them, says a report issued today by the Senate Commerce Committee.

The committee, chaired by West Virginia’s John D. Rockefeller IV, has spent almost a year digesting data on each insurer’s medical-loss ratio, a metric closely watch by state regulators and Wall Street of how much health plans spend on benefits versus administrative expenses and profits. Starting next year under the new health law, insurance companies will need to spend 80% of premiums collected from individual and small-group plans on medical care and 85% of premiums from plans sold to large groups on care.

After combing through the numbers insurers file to states, the committee determined that what many of the companies spending on medical care last year didn’t meet the new thresholds. For plans sold to individuals in 2009, Aetna’s MLR was 75.5% while Humana’s stood at 68.1%, UnitedHealth Group at 70.5% and WellPoint at 74.9%.

The committee also drew attention to WellPoint’s decision, described here last month, to reclassify some expenses as “medical” that it had reported as “administrative” earlier this year. Reclassifying the expenses, which include nurse hotlines and wellness programs, can make it easier for insurers to reach the minimum MLR thresholds.

Panel Says Most Health Insurers Need to Boost Medical Outlays - Health Blog - WSJ

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21% Medicare Cut For Physicians and COBRA Funding Get Another Extension Until June 2nd

4/15/2010 10:30:00 PM  ,  

It looks like the next date on the calendar is a MayDay for the next decision process and perhaps this one could hold some potential of being permanent or at least give imagemore than 30 days as from the last extension this amount of days does not seem to allow Congress enough time to discuss and dispute.  In the meantime before the last recess we had some substantial items discussed (grin) that the enterprise dealt with years ago. 

Breaking News: House Passed a Bill to Prevent Government Employees From Using Peer to Peer File Sharing!

It looks eminent that somewhere down the line that government employees will no longer be able to swap music, videos and other items on line with peer to peer networks.  The Secure Federal File Sharing Act, introduced by Rep. Edolphus Towns, D-N.Y., in November, calls for the Office of Management and Budget to ban the use of applications like BitTorrent or Limewire on government PCs and networks.

Do these folks get security anywhere along the line here?  BD 

WASHINGTON -(Dow Jones)- The U.S. Congress on Thursday evening approved a near six-week extension of federal jobless benefits in a $18.2 billion bill that also continues health insurance subsidies for unemployed people. 

The measure extends the national flood insurance plan and funding to prevent a steep reduction in payments to doctors who treat Medicare patients.

The House of Representatives voted 289-112 to approve the measure after the Senate voted in favor of the package earlier Thursday.

The bill will now head to the White House for President Barack Obama's signature.

The benefits and other programs expired last week due to Republican opposition over the cost issue. Since they lapsed, Democrats have estimated that roughly 200,000 long-term unemployed Americans have seen their benefits run out.

All the extensions will be done retroactively to the date the benefits and programs expired.

US Congress Approves Extension Of Jobless Benefits, Health Insurance Subsidies - FOXBusiness.com

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Insurance Companies Hedging on Consumers Eating Fast Food – 2 Billion Invested with Food Companies Producing Products that Are Linked to Obesity and Cardiovascular Disease

4/15/2010 10:13:00 PM  , ,  

We are having this drilled into our heads today from insurers, and yet they feel a this compulsion to invest in the same companies they tell us to divert from with imagehealthier eating habits.  Is this the pot calling the kettle black and how sincere are those efforts to get us to be healthier.  

This is a good study from Harvard, practice what your preach would you?  This is just one more reason or area that causes distrust within the insurance business, their door swing both ways based on a dollar to be earned, so do they earn more with healthy or unhealthy eaters is the question here?  Certainly there’s some good information and goals with insurance plans but how far do they go before crossing the line for profit and how is profit built in ahead of truly working towards good health?  BD

(CBS) The investments of large insurers of health, disability and long term care in fast food chains like McDonald's and Pizza Hut have raised the interest of a study in the American Journal of Public Health, reports CBS Radio News' John Hartge.
The Harvard Medical School's Dr. Wesley Boyd, an author of the study, finds it ironic that these firms would invest nearly $2 billion in companies that sell food often linked to obesity and cardiovascular disease.
"The insurance industry, so far as it seeks to make a profit, it does so in an amoral way," Boyd said.
Boyd said health insurers should be held to higher corporate standards.

Health Insurers' Fast Food Holdings Raise Flag - CBS News

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'You Don't Know Jack' – Movie About Jack Kevorkian Premiers on HBO Next Week – Al Pacino

4/15/2010 09:37:00 PM  ,  

It was back in July of 2009 the movie was announced and I posted it here.  The movie trailer has been released too.  I do have to say the title is very interesting choice too.

In looking at the trailer, Al Pacino is in fine form as always.  HBO also has a script of an interview here talking about how Al Pacino became acquainted with the role he played and a few more comments and he never got to meet Jack.  BD 

Dr. Kevorkian Movie to Star Al Pacino

'You Don't Know Jack,' a film about Jack Kevorkian, premieres on HBO next week. In our Big Interview tonight, Anderson sits down with Kevorkian in one of his first interviews since his release from prison three years ago. Anderson will talk to him about the movie and about how he became known as "Dr. Death."

Anderson Cooper 360: Blog Archive - 'You Don't Know Jack' « - Blogs from CNN.com

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What Is Going to Help Protect Your Privacy with Using EHR Data for Research – An Algorithm

4/15/2010 11:04:00 AM  ,  

This is good news here and will certainly help quite a bit.  If you notice the wording here it will “decrease” the risk of linking two data sets together.  I have done my share of queries and know how the processes works to attain data, so this is a good thing all the way around.  image

The real trick here is to still have enough information available to evaluate and research without compromising identity.  For the most part too, it is not the researchers as a whole that we need to be concerned over, it’s more or less those who use these data bases for profit as that is one big carrot hanging out there with tons of data to be analyzed. 

I think we need a 12 step program for those who are addicted to “analysis”processes too as just like alcohol at times if the data is sitting there in front of them, they can’t help themselves and start writing SQL queries and searching for elements that can help cash in on some big bucks.  Gee, that last comment reminds me a bit of Wall Street (grin). 

I made this comment in jest but there really could be some substantiation to some of this as just like diagnosis in the clinical world leads to treatment, data in the IT world leads to analysis, more algorithms created.

Two words in the last couple of years have become very prominent in the world of journalism and blogging and those are “might” and “may”.  We report on some of these analysis stories and are sure to use those words as we don’t know either on some of what gets presented.  There’s the OMG stories like one that might say if you stand on your head more than once a week you “may” have a 25% greater chance of developing brain cancer (silly example) but indicative of what we see out there.  There’s is is also good substantiated data information presented by all means, but we get a real mix in the news today. 

Back on track here the folks at Vanderbilt have done some other neat things too, especially with a process of algorithms that help alert medical staff immediately to the onset of Sepsis. If you compare this latest project with working to anonimize data to what has been done in the past there, they may be on to something pretty substantial. 

Vanderbilt University Makes Massive DNA Data Base Available for Researchers To Study Use With Medical Records

All DNA samples and medical records have been de-identified so use in research can take place.  The research will be able to determine if genetic information in the medical records could help improve patient care via using personalized medicine, based on genomic information added to a medical chart.  With a de-identified record, researchers will be able to study and evaluate a medical record and see if personalized genomic information added would have perhaps created a better or different outcome with treatment.  

Vanderbilt University Sepsis Detection Technology Update – Added Management to Detection Process

After deployed the very first alert initiated  an attending physician to begin antibiotic therapy for a patient.  They average 3-4 alerts daily in a 25 bed ICU unit.  Work has just started on adapting the language and knowledge to chronic heart failure.  I originally posted this story back in March of 2008 with the start of the project.

It’s all about those algorithms in analyzing, reporting and making money for some in some areas of healthcare today.  BD 

Electronic medical records are being hailed as a tool to aggregate patient data and advance research, but questions remain about how the vast sharing and compiling of this critical medical/genetic information will remain de-identified to protect patients’ privacy and security.

Researchers at Vanderbilt University have found a unique algorithm to make electronic medical record information anonymous for genome-wide association studies (GWAS), according to a paper that recently appeared in the Proceedings of the National Academy of Sciences.

Their approach is called Utility Guided Anonymization of Clinical Profiles (UGACLIP), and it involves generalizing some of the diagnostic information from electronic medical records to make it more abstract and anonymous. The method was validated using data from nearly 3,000 patient electronic medical records from the Vanderbilt University Medical Center.

The team tested this UGACLIP algorithm on two real patient data sets from Vanderbilt University Medical Center’s electronic medical records system and found that the algorithm did decrease the risk of linking an individual to their GWAS data while also maintaining much of the clinical and diagnostic information needed to permit data sharing and follow up studies. Building upon this success, Vanderbilt researchers are continuing to improve the algorithm and plan to develop software so that other investigators can safely and securely extract electronic medical record data in future GWAS.

Vanderbilt Research Identifies Algorithm to Protect Privacy of EMR Data Used in GWAS | EHR Scope Blog

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CMS Dashboard Beta is Up and Running – Transparency in Medicare Spending Library and Visualizations

4/15/2010 10:19:00 AM  ,  

If you want to look up cost of admissions, this is the place to check.  There’s also information available for researchers and journalists.  What is visible here is the amount that Medicare pays to hospitals based on a number of formulas that are input into the system.  I have not had a chance to fully go through the site yet and will be diving deeper in the next few days.  The System shows the top 25 DRGs per state.  This is a nice set of algorithms. 

image

I looked up “severe sepsis” statistics in California for one example and the volume of cases are reported by rank for California hospitals or any other state you select.

image

Watch the video below for additional information from the CMS site.  There are some spreadsheet format downloads available as well. 

As mentioned, this does not include data for patients participating in Medicare Part D.  In the upper left hand side, click to start the dashboard.  The video above is the same one that is on the website.  BD 

The CMS Dashboard BETA is a beta release and offers statistical views of the Inpatient Prospective Payment System (IPPS) data as it relates to claims payment and volume as collected by CMS. The data contained in this beta version is current as of March, 2010, for inpatient discharges from January, 2006, to December, 2009.  Future releases may contain additional CMS Program data.

In addition to the DRG  payments, the amounts displayed also include payments that Congress has determined support important public policy goals, imageincluding, the provision of medical education, additional funding to hospitals that take a disproportionate share of low-income patients, additional payments to rural hospitals, additional funding to hospitals with high cost outlier payments for cases that incur extraordinarily high costs of treatment, and adjustments for the underlying costs in different geographic regions.  In addition, the data on the number of patients and the total dollars may vary from year to year based on the number of beneficiaries who choose to participate in the Medicare Advantage side of the program.  These data only include fee-for-service beneficiaries.  

Please see the upper-right corner of the dashboard for information pertaining when the data was updated, and on the inpatient discharge reporting timeframe.  The CMS Dashboard BETA will be updated on a monthly basis starting in 2010.  The data for 2006 and 2010 does not represent a full year, thus should not be compared as such to 2007, 2008, and 2009.

Overview CMS Dashboard BETA

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Prostate Cancer Treatment Hailed 100% Effective In Germany – St. George Treatment Center

4/15/2010 09:21:00 AM  , ,  

This is a press release today about the treatment used in Germany to fight prostate cancer.  I did some looking around the web and found one site at the image imagebelow that gives a few additional details here and is a center in Germany using the the procedure developed by Dr. Douwes. 

From the St. George Website Center in Germany

Their standard cancer protocol is a week of detoxification and the strengthening of the immune system with diet and nutritional supplements, followed by two weeks of localized hyperthermia treatment and low-dose chemotherapy.

In addition to conventional medicine (surgery, radiotherapy and chemotherapy) they offer nutritional supplements, detoxification, biological/nontoxic treatments that include phytotherapy, mistletoe, hormones, cytokines, biological response modifiers, immune therapy, hyperthermia, Galvanotherapy, and psychological therapies including group therapy, guided imagery and art therapy. 

The treatment is not used in the US and the article states that many have traveled to Germany for the procedure as it is non invasive.  The press releases cites a couple stories from those who have been treated at the facility.  Dr. Douwes spent his internship here in the US in Philadelphia and then returned to Germany.  BD

SARASOTA, Fla., April 15 /PRNewswire/ -- During a routine physical in September 2006, retired airline pilot Jeff Albulet's doctor thought he 'felt something' when he did a digital rectal exam, although Jeff's prostate specific antigen (PSA) was only 2.  Six months later, Jeff's PSA rose to 3.5, and a biopsy showed pre-cancerous cells.  In discussing his options with his primary care physician, he learned about a treatment that would save his prostate and not cause impotence or incontinence.  According the Dr. Friedrich Douwes, Medical Director of St. George Hospital in Bad Aibling, Germany, image president of the German Oncological Society and the author of several hundred scientific articles and books, trans-urethral prostate hyperthermia  has a 100% initial response rate.

Albulet's doctor had heard Douwes speak at a medical conference in Las Vegas, NV.  Douwes helped to develop the Oncotherm radio-wave hyperthermia treatment, which heats the entire prostate without harming healthy tissue.  He has successfully treated thousands of prostate cancer patients, many from the USA.  In use for over 25 years, radio-wave hyperthermia is the treatment of choice in Europe for many cancers.  When Albulet learned that the treatment took only one week and had a dramatic success rate without side effects, he was elated.

In this treatment, a small probe is introduced through the urethra into the prostate.  Radio frequencies are pulsed into the prostate, heating the cancer cells to between 113 and 158 degrees.  Because cancer cells have a different blood supply than normal cells, they either die or become so damaged from the heat they can no longer reproduce.  Normal cells are not affected.  This treatment is non-surgical, so no pain medications are needed and only local anesthesia is required.  And there are no side effects.  Patients stay in the hospital for five days, and receive two trans-urethral treatments during that time, along with limited hormone modulation and other non-toxic medications.

According to Douwes, this treatment combined with a temporary androgen blockade is 100% effective. The ten year disease-free survival rate is 80%.  The 20% of patients who have a PSA relapse in three to five years after the initial treatment can simply repeat the treatment for longer lasting good results.

'New' Prostate Cancer Treatment 100% Effective -- SARASOTA, Fla., April 15 /PRNewswire/ --

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Cayman Islands Partner with India Surgeon To Build Medical “City” Facility With Focus on Attracting US Patients

4/14/2010 11:19:00 PM  ,  

The project is being overseen and coordinated by Dr. Shetty of India.  Building will begin in January of next year.  There are certainly many other countries in fact vying for a portion of the US healthcare expenses.  One other reason cited for the agreement was to also spike the Cayman economy as did the financial services imageinvestment back in the 60s. 

Dr. Shetty is the chairman of a group of hospitals in Bangalore, India.  The plan also calls for building a medical university.  BD 

Excitement seemed to crackle among the words of Premier McKeeva Bush as he announced at a press conference Wednesday, 7 April, that the Cayman Islands Government has entered into an agreement with renowned surgeon, Dr. Devi Shetty of India, to build a major medical facility here. 
“This development will bring a third leg to our economy,” said Mr Bush. “What we have signed here today is the start of something new,” comparing it to the launch of the financial services industry in the 1960s that transformed the Cayman economy.

Dr Shetty signed the agreement during the press conference with senior government ministers present, including Minister of Health Mark Scotland, who assured the gathering that the planned facility would “complement, not replace” primary health care facilities already in Cayman.
After six months of negotiations, representing “a significant investment by Dr. Shetty and his group,” said Mr Scotland, “the potential economic benefits are immense, and social benefits are significant as well.” Dr Shetty and his partner investors have personally inspected several potential sites, he said, but the final location of the proposed facility has not yet been decided.

Dr Shetty, chairman of the Narayana Hrudayalaya group of hospitals in Bangalore, India, revolutionized medical care in that country by implementing business practices that resulted in high-quality, yet cost-effective care at state-of-the-art facilities.

Medical tourism deal sealed

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CVS Minute Clinic Locations Will Double In the Next Five Years

4/14/2010 11:05:00 PM  ,  

Competition among drugs stores and clinics appears to be increasing as well as their partners.  They too have offerings relating to Medical-Behavioral care management too and a quick summary from a prior post is listed below.  The growth is in the anticipation of family practice physicians approaching. 

Humana and CVS Minute Clinics Partner To Add More Services for Members such as Life Synch and InnoPsych

Part of the agreement will encourage Humana members to use the Minute Clinics for routine screening tests, ie. blood pressure, etc.  Also by using a Minute Clinic facility, members will be encourage to use the wellness coach subsidiary, Life Synch of Humana which provides a 24/7 phone number for help and question as well as the website.  

Minute Clinic Visits Pricing and What you Should Bring with You – Medical Information and History

They too want information and data, so after the United information released this week, what’s the next step and/or partners for CVS with insurance I wonder?  BD

April 13 (Bloomberg) -- CVS Caremark Corp., the largest U.S. provider of prescription drugs, will double the number of in-store medical clinics it operates within five years because of new health-care legislation and the aging U.S. population.

CVS is adding clinics as baby boomers reach Medicare age and 32 million individuals are added to insurance rolls following passage of the Patient Protection and Affordable Care Act last month, CVS Chief Financial Officer Dave Denton said yesterday in a phone interview. In addition, there are fewer primary-care physicians, he said.

CVS to Double In-Store Clinics After Health-Care Law (Update2) – BusinessWeek

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FDA Approves Generic Morphine Formulation to Answer Shortage After Pulling Unapproved Opiod Pain Products

4/14/2010 10:45:00 PM  ,  

If you remember last month the FDA pulled a number of products from the market so here’s an oral solution that is now approved. 

The morphine elixir is widely used by terminal patients in hospital and home hospice care settings and is manufactured by Lehigh Valley Technologies Inc., Mallinckrodt Inc. Pharmaceuticals Group, Boehringer Ingelheim Roxane Inc. and Cody Laboratories, Inc.  BDimage

The FDA has approved a generic formulation of 100 mg/5 mL (20 mg/mL) morphine sulfate oral solution from Roxane Laboratories, which will now allow the agency to follow through on an initiative to pull unapproved opioid pain products from the market.

On March 31, 2009, as part of its ongoing Unapproved Drugs Initiative, the FDA sent warning letters to the makers of 14 unapproved opioid products, citing possible enforcement action if manufacturing and distribution of unapproved prescription pain products was not halted within 60 and 90 days, respectively.

Concern centered on the potential for making pain control for patients receiving end-of-life care more difficult by removing the easy-to-swallow 20 mg/mL morphine liquid from the market.

“This is the only FDA-approved morphine sulfate oral solution available at this concentration,” the FDA said on its Web site in announcing the new approval. “The firm [Roxane Laboratories] has sufficient supply to meet the entire market demand and no shortage is anticipated.”

Morphine 20 mg/5 mL and 10 mg/5 mL remain available as approved products.

FDA: Morphine Approval Will Resolve Drug Shortage

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UnitedHealth CEO Compensation Triples From 2009 to $9 Million – 3.9 Billion Profit for UnitedHealthCare

4/14/2010 10:26:00 PM  ,  

In a down turn year with a struggling economy these numbers belong right on Wall Street, wait a minutes that’s where they are traded for profit so the alliance and business plans appear to be one hand helping the other to big profits.  I also read this week where one of their top executives, the President of Yellow Freight is imagenow leaving and returning to United Healthcare.  Yellow, in another life is where I spent a few years as a sales person.  

Up and coming this week is a conference call and announcement from United with “their”plan on how

UnitedHealth Group to Release New Report Identifying Billions of Dollars in Potential Savings For States Facing Unprecedented Medicaid Expansion

“The report is the third in a series from the UnitedHealth Center for Health Reform & Modernization, which seeks to offer policymakers “real-world” options on how to improve the quality of care while reducing costs.”

They have even gone to the extent of a website for posting their opinions and services as relates to healthcare reform.  In 2009 the company spent 82.3 percent of premium money on medical expenses, but without seeing full accounting it appears we have to take their word for this.  85% in California has been the goal here and it never seems to be met.  One big expense is lobbying whereby close to one million was spent during the 4th quarter of 2009.  We still need the formulas to regulate and see how they are going about them, we regulate software for medical records, so why not the other side? 

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

Also in the news are a couple retail folks that are set up to be paid through pay for performance with identifying “potential” diabetes patients and there’s some privacy issues here too with the data in my opinion and where it will be shared. 

UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools

Numbers like this still convince me that healthcare insurance needs to be a non profit business all over the US.  BD 

UnitedHealth Group Inc. CEO Stephen Hemsley received nearly $9 million in compensation for 2009, an increase of almost $6 million from the previous imageyear.

Hemsley’s salary remained unchanged from a year ago, standing at $1.3 million. However, he received more than $5 million combined from stock-award and stock appreciation reward (SAR) compensation in 2009. He didn’t receive either SAR or stock-award pay in 2008.

In 2009, Minnetonka-based UnitedHealth awarded Hemsley nearly $2 million in non-equity plan compensation, up from $1.8 million in 2008. Non-equity compensation pay is tied to a company’s performance.

UnitedHealth reported a profit of $3.8 billion in 2009, up 27 percent from $2.98 billion in 2008. The health insurer's revenue rose to $87 billion, up from $81 billion in the previous year.

UnitedHealth CEO receives $8.9M in ’09 - Minneapolis / St. Paul Business Journal:

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HHS Looking for Input From Insurers on How Loss Is Calculated – Get Those Algorithms To See Actual Methodologies

4/14/2010 08:15:00 AM  , ,  

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.

Medical News: HHS Seeks Input from Insurance Regulators on Medical Loss Ratios - in Washington-Watch, Reform from MedPage Today

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UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools

4/13/2010 06:52:00 PM  ,  

In my book I thought my doctor should be doing this for me, ok so now’s who’s the doctor here?  Will the primary care doctor also be supplied this information as imagewell as the patient as to what parameters were use to determine a patient is at risk?  What about a case of false positives?  When you work with data you get a fair amount of those too, so in this case even if it is a false positive, Walgreens and the YMCA still win with P4P.

Who’s doing the analysis services too, is it United or one of their wholly owned subsidiaries?  We want credible data and not a scare tactic that creates revenue pools where they didn’t exist before if this is going to drive up cost as someone has to get paid for the analysis transactions.  Again the part that somewhat bothers me here is where’s the doctor in all of this and maybe there’s not enough information released yet on the pilot program.  One other question too that arises here is the area of privacy too and will the YMCA and Walgreens be given the parameters that targets the patient to suggest the program from the claim records?  Again, I question as I look out and ask questions and never assume any more as sometimes we end up finding out things are different, we see that in the news almost every day in some form or another, healthcare or otherwise. 

Will some of this begin to fall under what is called behavioral underwriting as well to attain additional “risk” projections?

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

Will such analyzed information be included and sent to the Medical Insurance Bureau too?  Sometimes the information in some of those files goes back years and patient fight like crazy to get it removed too, so again will an analysis showing “risk” become part of the file here?  These are just privacy issues and concerns that should be answered up front so people know what is being placed in a file up front and how it was determined that they are a “risk”. 

The MIB – Health Insurance Bureau Business Intelligence Mining May Go Beyond Just Healthcare Information

I thought we already were paying doctors on pay for performance in this area so again how many need to be compensated for pay for performance to tend to a “risk” matter and shouldn’t the pharmacist and doctor be partners?   As I read this article, it is “risk” and not a confirmed case of diabetes so I just want to know what constitutes “risk” and what algorithms and what parameters are specified to attain this.  BD 

The program, which will be announced Wednesday at the CDC Diabetes Conference in Kansas City, Mo., will have two parts, says Tom Beauregard, executive vice president of UnitedHealth and executive director of the UnitedHealth Center for Health Reform and Modernization. The prevention arm will use UnitedHealth claims data and other demographic information to flag people at risk of developing diabetes and invite them to a free, 16-session exercise and nutrition class at a local YMCA. They’ll have monthly follow-up after the class is over, and instructors will be paid bonuses if participants meet certain modest weight-loss goals.

The control part of the program will be administered with Walgreens. Participants who already have diabetes will receive a 45-minute assessment and then other health-care coaching sessions, covering both medical and lifestyle management, says Colin Watts, chief innovation officer at Walgreens.

He said UnitedHealth would pay the YMCA around $300 for someone who completed the program and it could rise to $500 for someone who met weight-loss goals. Neither he nor Watts would disclose the reimbursements to Walgreens, but Watts says it includes a strong pay-for-performance element.

UnitedHealth to Pay Walgreens, YMCA, for Progress on Diabetes - Health Blog - WSJ

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