Aetna Gives Away File Cabinet Containing Personal Information – 4900 More Get Free Credit Monitoring

Boy they just keep coming and this one is human error and why all the information was not scanned and stored on secure servers is a good question.  Insurers pay enough for the latest and greatest technology and spend millions scoring us as consumers to determine what premiums we will pay.

This is starting to resemble something that went on with BP in a way, like where did they spend their money, not much on prevention or recover but all on the focus of where the dollar gets made.  They were lucky the “vendor” they hired was honest and brought back the information.  Does this show you how much they value your business and a premium payer. 

Rules on EHR Certification Should Take Back Seat to Certifying Insurance Algorithms At Present – We Need This First

We need to certify the security and the algorithms used by insurance companies next, as I mentioned a couple years ago as this thing just keeps building and in some areas the insurance companies are starting to balk at providing the free credit reporting services, so maybe the government will have to give it to all of us for free if this keeps happening. 

Maybe this is part of the reason that Goldman Sachs is ready to enter the healthcare consulting business, although their interest is to get the stock back up and not necessarily better healthcare.  

Goldman-Sachs Announces Their Intentions to Enter Health IT Consulting – Pitching Those Algorithms

Aetna will certainly be present at the 31st Annual Global Healthcare event being held in Los Angeles in a few days in Century City, press release below. 

Aetna Announces Appearance at Goldman Sachs 31st Annual Global Healthcare Conference

“Aetna’s presentation is scheduled to begin at 1:00 p.m. ET (10:00 a.m. PT).  Investors, analysts and the general public are invited to listen to this presentation over the Internet via Aetna’s Investor Information link at www.aetna.com/investor.  To listen to this presentation live on the Internet, visit Aetna’s web site prior to the presentation to download and install any necessary audio software.  A webcast replay will be available via Aetna’s Investor Information link at www.aetna.com/investor, beginning approximately two hours after the event, for 14 days.”

All the rest of the carriers will be presenting too, Wellpoint and others have also announced. 

Aetna is offering a year of free credit monitoring to about 4,900 people after a cabinet containing files with personal information was given away.

The health insurer said a vendor it hired to move old office furniture put the cabinet out for clearance in late March. The person who picked it up found the documents and contacted the insurer in May.

"The files were voluntarily returned to Aetna and the company has no reason to believe the information will be misused in any manner," the company said Thursday in a release.

Last year, Aetna also offered free credit monitoring to about 65,000 people after e-mails were copied from its job application Web site.

Aetna customer info left in free file cabinet - BusinessWeek

Technorati Tags: Aetna, security breach, Goldman Sachs, Health IT, credt reporting services, patients, HIPAA, file cablinet

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HMS Holdings Corp agrees to buy Allied Management for $26.2M – Algorithm and Transaction Income for Medical Billing Fraud and Auditing

Here’s more in the Health IT business, more on the side that you may or may not be aware of.  There will be more of these to follow I am sure as there’s tons of millions of dollars made in medical billing.  As billing and coding became more complex, so did the data systems and the ones who create fraud.  This is somewhat nice to know there’s an alternative here to reviewing claims with a company that is not owned by an insurance company for one.

When you hear of 3rd party auditing companies used by insurers and others, these are the types of companies that have grown over the years, and again have made millions with software and algorithms.  You can also see a big portion of their markets are selling algorithmic processes to HMOs and employers, a big focus there.  Allied Management speaks of over 100 parameterized reports (from the algorithms) they can produce for clients. 

HMS serves Medicare and Medicaid contractors, so again when you think of medical billing there may be a multitude of 3rd parties to where your claim travels before it is given the ok from your insurance company to pay.  This is big business and revenue is transactional, in other words for each claim audited, scored, evaluated for fraud, they make money.  Now if we could cut the cost that we all pay for healthcare in this area, we could all save money.

These folks too have to work and deal with the often confusing, complex algorithms of the insurance companies, but the big difference here is that they get paid millions for doing so.  We focus all our time on the electronic medical records side with certification while the algorithms run and make millions for others, thus we should look at certifying the other side of the fence you think?  It would sure stand to take one huge bite out of what we pay for healthcare.

Rules on EHR Certification Should Take Back Seat to Certifying Insurance Algorithms At Present – We Need This First

Nobody wants to fully streamline taking a huge chunk out of what we pay as there are too many software/algorithmic institutions make millions from it and thus we continue to pay and face limits set forth so as not to disturb the profit pools that are bought and traded on Wall Street.  The algorithms make millionaires and can take away from others and we are seeing more and more of this with profits from transactions where a study, report or an actual need creates huge expenses with healthcare as it is today.  BD 

From the websites:

“HMS Holdings Corp. (NASDAQ: HMSY) operates through its subsidiaries including Health Management Systems, Inc. (HMS), IntegriGuard LLC, and Reimbursement Services Group, Inc. (RSG). It is is the nation's leader in cost containment, program integrity, and coordination of benefits solutions for government-funded and commercial healthcare entities. Focused exclusively on the healthcare industry since our founding, HMS Holdings Corp. helps its clients ensure that healthcare claims are paid correctly and by the responsible party, and that those enrolled to receive program benefits meet qualifying criteria”.

“AMG created AMG-SIU to offer health care companies a fraud, waste and abuse prevention program that works.

Established in 1972 as a health care consulting company, Allied Management Group (AMG) provides management, organizational and auditing services to all Payers including: Insurance carriers, MCOs, HMOs and government organizations of all sizes. Through the urging of its clients, the SIU division was initiated to provide an affordable fraud, waste and abuse prevention program that fulfilled and exceeded  government requirements”

HMS Holdings Corp., which provides cost-recovery services to government health care programs, said Friday it will buy Allied Management Group in a deal valued at up to $26.2 million. 

Allied Management provides auditing and consulting services to health care payors to help them find fraud and prevent, waste, and abuse. Its services include a forensic claim editing system that it uses to analyze data for fraud, waste, and abuse. Its system allows investigators to compare providers, review histories, and identify unusual results, the company said. HMS said Allied Management also has its own special investigation unit.

HMS agrees to buy Allied Management for $26.2M - BusinessWeek

Technorati Tags: HMS Holdings, AMG, Allied Management, healthcare, medical billing, fraud prevention, stock, public, claims, Health IT, HMO, audit trails

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Purdue Pharma Receives FDA Approval for Butrans™ Transdermal System For Severe Pain Management

Purdue is the same company that brought us Oxycontin and the patches are supposed to be a safer way to release the pain medication and again, don’t put more than one patch on of course.  It does contain an opioid controlled substance so available only by prescription and is worn for 7 days. 

The warning below says Butrans (buprenorphine) could be habit forming.  BD 

STAMFORD, Conn., July 1 /PRNewswire/ -- Purdue Pharma L.P. announced today that the U.S. Food and Drug Administration (FDA) approved Butrans™ (buprenorphine) Transdermal System CIII for the management of moderate to severe chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended period of time.  Butrans Transdermal System is an analgesic product that delivers continuous release of medication for seven days.

"Healthcare professionals now have an important new option for appropriate adult patients suffering from moderate to severe chronic pain when an opioid may be needed to manage their pain," said Lynn R. Webster, MD, FACPM, FASAM, Medical Director of the Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah.  

Three strengths of Butrans are available: 5, 10, and 20 mcg/hour; each single patch is intended to be worn for seven days.  Do not exceed a dose of one 20 mcg/hour Butrans system due to the risk of QTc interval prolongation. Avoid exposing the Butrans application site and surrounding area to direct external heat sources.  Temperature-dependent increases in buprenorphine release from the system may result in overdose and death.

WARNING: IMPORTANCE OF PROPER PATIENT SELECTION, POTENTIAL FOR ABUSE, AND LIMITATIONS OF USE

Proper Patient Selection
Butrans is a transdermal formulation of buprenorphine indicated for the management of moderate to severe chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended period of time.

Potential for Abuse
Butrans contains buprenorphine which is a mu opioid partial agonist and a Schedule III controlled substance. Butrans can be abused in a manner similar to other opioid agonists, legal or illicit. Consider the abuse potential when prescribing or dispensing Butrans in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion.

Persons at increased risk for opioid abuse include those with a personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression). Assess patients for their clinical risks for opioid abuse or addiction prior to being prescribed opioids. Routinely monitor all patients receiving opioids for signs of misuse, abuse and addiction.

Limitations of Use
Do not exceed a dose of one 20 mcg/hour Butrans system due to the risk of QTc interval prolongation.

Avoid exposing the Butrans application site and surrounding area to direct external heat sources. Temperature-dependent increases in buprenorphine release from the system may result in overdose and death.

Purdue Pharma L.P. Receives FDA Approval for Butrans™ (buprenorphine) Transdermal System CIII -- STAMFORD, Conn., July 1 /PRNewswire/ --

Technorati Tags: FDA, pain, pain management, healthcare, drugs, patches, opioid, controlled substance, transdermal

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UnitedHealthCare – New Video Demonstrating a Remote Doctor Visit With Connected Care

If you are a regular reader here you know I have posted several articles about the big investment United has made with Cisco systems and a few other videos as well  The link below was from an article from about this time last year.  It kind of keeps us in check as to what is going on with both the technology and people side of the business at the same time.  This is where some of your health insurance premium money goes so it’s good to be informed. 

Update Cisco Lays Off Hundreds - UnitedHealth To Spend Tens of Million of Dollars with Cisco to Build Nationwide Telehealth Network –

With all the investments that are flying around it might make one ponder this:

Are You Insured by a Technology or Insurance Company – UnitedHealthCare

Here is a news announcement from last year that ran on Fox.  As I understand the company is looking for doctors to sign up all over the country to field calls during their off hours and have the opportunity to earn extra money with some of the telehealth services they offer.  The post below has some additional details on how the entire teleheatlh visit works with the doctors. 

OptumHealth (Subsidiary of UnitedHealthCare) Teams Up With American Well for 24/7 Physician Consults (quote from the link below)

“There’s a lot there and it takes a while to watch, but if you have the time it will discuss and focus on how physicians can save money and learn about using the “business intelligence” they have to offer, how you can analyze community statistics and be a better doctor for your community.  We see this happening everywhere, hospitals, etc. all pushing business intelligence down to the already over burdened doctor to analyze and help become cost effective, so this is nothing new here. 

Through having all this information to analyze the hopes are to save money and create better decision making processes, if it doesn’t end up muddying the water too much in the process, as a physician may be members of more than one health plan, so to keep up with 4 or 5 of these, which is not uncommon here in California, it could end up being overkill, unless you put all your eggs in one basket, but nobody does that.”

Doctor’s need to be onboard and be approved and there’s one other goodie that comes along with this for doctors and that is the “business intelligence” that will tell practices what they need to do to have a better practice and they will want to run some algorithms and have you reporting in for evaluations.  This is what one doctor told me when he inquired so he was not ready for the constant monitoring and reporting himself.  Now they may have other specific contracts set up to where patients are seeing their specific physician too and within the last few months, again based on contracts perhaps some of this as evolved. 

Here’s the big van they drive around to demonstrate and a couple of their executives answering questions. 

I have a few more posts on the blog which you can search and find if you like.  At any rate this is another video that shows what a telehealth visit would look like and how the trailers set up to see patients would work.  BD 

UnitedHealth is partnering with Cisco Technologies to develop Connected Care, the first national telemedicine network. Using homemade software and Cisco video conferencing equipment, the company, the nation’s largest private insurer, hopes to use its size and scale to sell doctor groups and employers its telemedicine technology and services.

UnitedHealth bets big on building national telemedicine network « MedCity News

Technorati Tags: UnitedHealthCare, Cisco, healthcare, health insurance, business intelligence, balance, physicians, payers, monopoly, Congress, telehealth

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Trizetto Group (Wholly Owned Subsidiary of Apax Partners London Based Private Equity Firm) Says Their Study Indicates the US Healthcare System is Ready to Adopt Value Based Insurance Designs – Marketing At Its Best

Anyone can do a study today and sometimes they get mixed up with marketing ideas so you put that study out there to start working on people and to also create a flurry for more investors to see what you are doing to keep in the public eye and I think this story is exactly that.  As a practice, hospital, or what ever in healthcare this is good to know where the profits go from software and analysis services when processing your healthcare claims and in this case, they go to the UK. 

TriZetto Group, Owned by Apax Partners-London Based Private Equity Firm, Rolls Out Payer Based PHR

First of all do doctors know what “value based benefits” are?  Heck no, they just know if they are not getting paid on claims for the most part.  Now the part about the healthcare payer executives I’m sure is right on track as that is their business.  How many patients know what value based benefits are?  I’m just curious to where they found this highly educated group to survey as in real life, talking face to face I don’t find much of this.  This is the real world. 

I know one thing though that the investors in the private equity firm that bought Trizetto want to make some money though (grin).  The last paragraph is also a bit odd with saying the survey was at a 95% confidence level, so what does that mean exactly?  I can also understand the brokers and executives having a full understanding, but the doctors and consumers, not.  This is marketing at it’s finest. 

Here’s one more blurb about their one of their software programs and they have integrated it with Ingenix, the wholly owned subsidiary of United Healthcare and they just pop up all over the place with so many partners using their algorithms today. 

“Quality Care Solutions aligned themselves with Ingenix back in January 2006 to integrate the QNXT software system with the Ingenix Payor products and systems, in other words the algorithms that analyze and score claims.  It sounds like more money and profits for that division of United Healthcare.”  BD

A new study commissioned by The TriZetto Group, Inc. finds that doctors, health insurers, consumers and other constituents of the U.S. healthcare system say they are ready and willing to adopt value-based insurance designs and related payment programs. Such designs encourage patients and clinicians to make better choices to improve care based on proven best practices, using both better information and financial incentives.

“They concur that a systematic, collaborative approach will cultivate better health, reduce delivery of unwarranted care, promote patients' compliance with health improvement plans and reduce overall healthcare costs.”

"TriZetto's survey finds all constituents of U.S. healthcare in rare agreement," noted Jeff Rideout, M.D., TriZetto's chief medical officer and senior vice president of cost and quality of care. "They concur that a systematic, collaborative approach will cultivate better health, reduce delivery of unwarranted care, promote patients' compliance with health improvement plans and reduce overall healthcare costs."

Reliable at a 95-percent confidence level, TriZetto's study was conducted as a 60-day online survey. Opinion Research Corporation, a global market research firm, conducted 1,761 interviews with the following constituents: 157 healthcare payers, 200 brokers, 200 employer executives, 203 clinicians and 1,001 consumers. Health plan respondents included managers, directors and C-suite executives.

Constituents of the U.S. healthcare system ready to adopt value-based insurance designs: Study

Technorati Tags: Trizetto, healthcare, payers, claims, reimburements, EOB, business intelligence, healthcare cost, Ingenix, marketing, Apax, private equity, study

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Goldman-Sachs Announces Their Intentions to Enter Health IT Consulting – Pitching Those Algorithms

You know there’s a bit of tongue and cheek here but it is not far off of what everyone is promoting today and this is a very good example of what the monetary thought processes are, so apply these to healthcare and the jigs up as far as better care for anyone, it’s all about money and we are screwed.  In a few days all the big companies listed on the exchange will be attending the Goldman Sachs Thirty-First Annual Global Healthcare Conference, to talk up their business, look for money, investors and basically talk about making more profits.  This event is held every year; however the stakes due to economic conditions are very different now, especially in view of financial reform and responsibility.  

All the major drug companies will be there and the same with all the major health insurers.  You can Google up the conference and see pages of press releases on who’s attending, WellPoint is right up there in the top of the search and they might be explaining in detail as to why they had to succumb to a 20% premiums increase instead of the 39% that got investors all excited. 

Blue Cross in California Reworks The Algorithms and Announces a 20% Rate Increase Effective September 1st

There certainly stands to be a lot of talk about “those algos” (algorithms) as that is what runs Wall Street and investments an a ton load of healthcare too.
I like the part in the body below on the article written about the role of the CIO in the money making part of this by “double dipping” the IT staff and who knows perhaps some of this has already happened and we are just not aware of it.

Write those consulting reports too as later whether truthful or not you can use them for sales and marketing, ramp up those numbers on the medications and clinical trials, they only get published in medical journals anyway, and the doctors will get over it, beside it may takes years for them to catch on.  

This is the investment business whereby to make a profit just throw some computers and software at the facilities and sit back and count the money. 

If this is the case the truth is out – healthcare reform in this format is not anything about generating better care, it’s all about the money.  I’ll give you a good example here on cold and not caring attitudes and positions with the Century City Hospital that closed in October of 2008 as they ran out of money.

Desperate Hospitals - Century City Doctors Hospital (Los Angeles) begins shutting down, others file Chapter 11 to reorganize

This great facility was so close that the Los Angeles office of Goldman could almost spit on the building and it was re-opened as a state of the art facility and I’m sure saw some of the Goldman employees and the doctors that worked there.  Did they offer – Nope.  You know they were patients there with being able to order from the Wolfgang Puck menu and a lot of the movie “The Bucket List” was filmed here too. 

This to me back in August of 2008 was one huge red flag when you have a state of the art hospital on the outskirts of Beverly Hills, in Century City where all the big corporate offices are (AIG is right there too) and they couldn’t raise any money and get financing, they don’t give a darn about healthcare so keep that foremost in the front of your mind. 

So perhaps anyone taking them up on their offer might want to keep it quiet (grin).  This is everything that healthcare “is not” about. 

Well is this the next system to launch, the Goldman Sachs EHR system, like everything else it will have to be branded.  BD 

___________

Hard on the heels of Congressional testimony into their unbridled corporate avarice, executives from Goldman-Sachs announced their intention to enter the HIT consulting field.

Stacked Deck – you get paid to sell your next product(s)! While writing “consulting” reports, you load them up with recommendations for the client to buy your next product/service:

* If you are doing an RFP for a system selection, stack it with features for the HIS vendor your staff is trained to implement.

* If you are conducting an I.T assessment, recommend they either switch to that same HIS vendor, or outsource their I.T. department to you.

* If you are writing a strategic plan, make sure it includes a “clinical transformation” project that your staff R.N.s and M.D.s perform.

* If you are serving as an “interim” CIO, recommend they hire several other members of your firm for director/manager slots.

Revenue Mania – you can generate amazing numbers for Wall Street through outsourcing, which is the latest fad in I.T. management anyway:

* Say you to take over the 20 FTE staff of a hospital’s IT department, whose salaries and benefits total about $2 million per year,

* You tack on a 25 percent profit margin, now costing them $2.5 million a year, but getting far “better” results because of your expertise …

* Write a contract with SLAs as soft as frozen custard, with minimal penalties or remedies,

* If you sign a 10-year deal, you can book $25 million in revenue and $5 million in profit to your bottom line, all for the only cost of a sales presentation!

* Sell two or three of these gigs a year, and in three to five years, you’re a major player, and all with almost zero capital investment or risk!

But Wait – There’s More! – you can make even more money “double-dipping” the hospital’s I.T. staff you acquired through outsourcing:

* Every I.T. shop has a few superstars, experts in nurse informatics or Internet security, who are extremely talented and marketable.

* Since they now report to you, you can offer them “career opportunities” by selling them to other hospitals at high rates.

* Either transferring them full-time, or charging them out by the hour or the day, and all while the original hospital is paying for them!

* They report to you now, so no one can ask where they are or what they are doing, that’s your business …

* As long as you can keep up with the paltry SLAs you agreed to in your one-sided contract, with a pittance in penalties if ever violated.

What’s It Take? – But, you say we don’t know anything about health care? That hasn't stopped a bunch of hardware manufacturers lately:

* All they had was a big name and a billion-dollar balance sheet, just like us! Only time their executives were ever in a hospital was for youthful tonsillectomies …

* Yes, our main business is investment, not health care, but their main business is manufacturing computers--what’s that got to do with running a hospital?

* We’ll just buy up a few mid-sized HIT consulting firms to get a core of pros to start selling, motivate them with stock options, and away we go!

Sound a little amoral or underhanded? No more than selling investors mortgage derivatives, while at the same time short-selling them yourself. Yes, we think we’ve found us a new home: HIT consulting, here we come!

Goldman-Sachs To Enter HIT Consulting!

Technorati Tags: Goldman Sachs, Heatlh IT, consulting, Goldman Saches Annual Global Healthcare Conference, algorithms

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MedAptus Gets US Patent for Coding Intelligence Software – Intellectual Property for Insurers to Benefit With Healthcare Claim Coding – Sold as a Medical Records Solution

Everyone knows I am pretty straight forward with what I say here and this is a new product to market for EMR systems that hospitals, doctors, etc. will have to add on to their IT budget and it does nothing to benefit healthcare other than getting the bill coded correctly so your EHR program price will rise as the website states it will work with AthenaHeatlh, Cerner, Epic, GE, McKesson and more. 

What you can expect here is “radical revenue improvement” (heard that one before) in the first year of use and increased cash flow by getting your coding done with a somewhat automated process. 

“Back-office data entry of charges is time-consuming and error prone. Thirty-seconds at the point-of-care can mean the difference between a denial and maximum reimbursement.

Free your coding and administrative staff from data entry, coding manuals and time wasted hunting down missing encounter forms. Usage of our RCA Engine means at 5:00, you’ll know where your charges are – ready for billing.”

It just confuses me as we are trying to bring healthcare costs under control and yet we patent and add another layer of software to the price when items as such should be open source collaborations where everyone can benefit as coding should be universal and not grow larger for profit.  BD 

BOSTON, July 1 /PRNewswire/ -- MedAptus®, the market leader in charge capture technologies, announced today that it has been awarded U.S. patent number 7,685,002 entitled "Method and System for Processing Medical Billing Records." The patent pertains to MedAptus' automated process for completely and accurately capturing both professional and facility charges in outpatient settings. More specifically, this patented process, incorporated within MedAptus' Facility Edition software solution, maps procedural codes to hospital charge data master files, translates rendered professional charges into facility charges, assists in the determination of the appropriate level for a facility visit charge, and supports back-end charge reconciliation.

The MedAptus Facility Edition provides hospitals and integrated delivery systems with the ability to actively and comprehensively manage technical charges. While outpatient services are growing in scope and importance to the hospital bottom line, they continue to involve manual processes, within a silo, at most institutions. Typical struggles for these centers include paper-based coding and billing processes, complex split-billing workflow, lack of back-office reconciliation transparency, and/or consistent evaluation and management (E&M) code leveling. MedAptus developed its patented solution to directly address these commonplace market challenges.

Another benefit of Facility Edition is its ability to compute consistent technical/facility E&M levels. Since the Centers for Medicare and Medicaid Services (CMS) has limited formal guidelines around E&M code leveling, individual hospitals are expected to develop and follow their own internal guidelines consistently across departments and according to general CMS coding principles. Facility Edition yields both technical coding consistency and compliance, reducing the risk associated with RAC audits.

MedAptus Awarded United States Patent for Technology to Process and Reconcile Professional and Technical... -- BOSTON, July 1 /PRNewswire/ --

Technorati Tags: patent, medical billing, MedAplus, software, healthcae reform, CMS, audit, coding Errors

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Sanofi Buys TargeGen For $560M – Company Using WuXi Pharmatech for Clinical Trials In China Which was Purchased Earlier this Year by Charles River To Be Finalized by 4th Quarter

If you are not familiar with the buy out earlier this year, check out the 2 links below to get up to date.  It appears Sanofi sees an advantage here with getting clinical trials done overseas versus here in the US.  We all know that diminishing clinical trials in the US are a big concern. 

WuXi To Benefit from Global Outsourcing – China

Charles River Announces Plans to Acquire WuXi AppTec in Shanghai China

“WuXi AppTec is a leading drug research and development outsourcing company with significant expertise in discovery chemistry. It was established in 2000 and has steadily grown to more than 4,000 employees with operations in China and the United States. Together with Charles River, a leading global provider of both research models and associated services as well as preclinical drug development services, the combined company will have 12,000 employees, providing unparalleled support for your early-stage drug development needs.”

It appears in reading this business story here that there are a few folks going to cash in pretty big and the movement of developing their pipeline rests on contracts in China with clinical trials and data used by the FDA here on those results.  Does this make one start to wonder also why US health insurance companies are buying up Chinese Gateway companies to facilitate getting Chinese drugs/and devices to the US?  Give that one some thought as all the businesses are enter twining for profits. 

UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally

I3 customers will be given expertise in over seeing clinical trials licenses, etc. and assistance getting through regulatory processes, like the FDA.  ChinaGate is located in Shanghai, China . United has been very outspoken on keeping cost down so this appears to be an acquisition not only for facilitating clinical trials but also as an arm to oversee getting products, drugs and medical devices through the US FDA and the European CE market requirements. 

In case you missed the connection I3 is a subsidiary of Ingenix, a subsidiary of United Healthcare and you can see their interest with their I3 subsidiary who markets and oversees clinical trials, I am trying to connect the dots here to help all of us understand where business it taking place today.  Under a subsidiary name it’s easy not to recognize the efforts of insurance companies and all their investments outside of just paying healthcare claims.  BD

Ivor Royston is catching the opera tonight in Paris, and he has some reason to relax. The managing partner of San Diego’s Forward Ventures was in France as the press release hit the wire announcing his portfolio company, TargeGen, has been acquired by Paris-based drugmaker Sanofi-Aventis for as much as $560 million.

This deal, like many other acquisitions we’ve seen lately, will take time to prove its ultimate value rather than traditional deals that provide a one-time windfall. TargeGen’s investors will get a $75 million upfront payment and the total deal could be worth $560 million if TargeGen can hit a series of regulatory milestones, Royston says. Those milestones are key for determining just how successful TargeGen will be financially, since it has raised $118 million since its founding in 2001, according to CEO Peter Ulrich. The group of investors includes another San Diego firm, Enterprise Partners Venture Capital.

TargeGen has 11 employees in San Diego, and their roles with Sanofi-Aventis are still to be determined, Ulrich says. Both he and Royston reminded me of a story Bruce wrote here in March about how TargeGen was able to discover its lead drug candidate, TG101348, in-house, and was able to bring it into clinical trials in 18 months with the help of a China-based contract research organization, WuXi Pharmatech

TargeGen Sells to Sanofi For As Much As $560M, Offering Returns to Forward Ventures, Enterprise Partners | Xconomy

Technorati Tags: Charles River, outsourcing, healthcare, research and development, WuXi App Tec, China, pharma, clinical trials, medical devices, Sanofi-Aventis, TargGen, I3, United Heatlhcare, ChinaGate

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The Hospitalist Company Acquires Austin Hospital Physicians Group – Contracted Physicians for Hire

In case you have not heard of this company, they provide physicians for hospitals, in other words doctors that work on staff but are not direct employees of the hospital, contracted instead.  In 2008 the company was awarded the Physician Entrepreneur of the year award.  This is a public company that is traded on the stock exchanges.  As you may or may not be aware, when you are admitted to a hospital you may not be seeing your primary care physician, but rather your treatment and case is turned over to a doctor who works full time at the facility and then coordinates all your records and care back to your primary care MD when you are released. 

Physician Entrepreneur of the Year 2008 - IPC-The Hospitalist Company

I did a very simple search and there are even opportunities for “moonlighters” here, working additional hours as a second job I am assuming.  As physician pay with contracts dwindles and here’s where a second job can be had, I think. 

If you don’t quite understand what is happening with young physicians today, check out this new documentary called “The Vanishing Oath” and it will help make the picture a little clearer as to what the future holds.  The 4 minute video shows a young doctor here who moonlights at Blockbuster so she can have health insurance.

“The Vanishing Oath” – Documentary About the Diminishing Doctor-Patient Relationships When the Environment Does Not Allow Doctors To Care - Exhaustion As Well As Struggles to Take Care of Themselves Sets In

As “for profit” mergers and acquisitions continue, it is taking it toll in more ways than one.  BD 

From the website:

“IPC is a leading national physician group practice focused on the delivery of hospital medicine. IPC hospitalists manage the care of hospitalized patients in coordination with primary care physicians and specialists. The Company provides its hospitalists with the comprehensive training, information technology and management to support systems necessary to promote the highest quality of care for patients.”

NORTH HOLLYWOOD, Calif., July 1 /PRNewswire-FirstCall/ -- IPC The Hospitalist Company, Inc. (Nasdaq: IPCM), a leading national hospitalist physician group practice company, announced today that it has acquired Austin Hospital Physicians, PA, (AHP) based in Austin, Texas. The acquisition represents a new market for IPC in Texas, adding to its well-established presence in the state.  AHP has an annualized volume of approximately 9,000 patient encounters. 

R. Jeffrey Taylor, President and COO of IPC, commented, "We are very pleased to enter the Austin market with this high-quality practice. We welcome this opportunity to offer our hospitalist services both to local referring physicians and to Austin community hospitals."

IPC The Hospitalist Company Acquires Texas Practice Group -- NORTH HOLLYWOOD, Calif., July 1 /PRNewswire-FirstCall/ --

Technorati Tags: The Hospitalist Company, hospital, healthcare, partners, physician, practice group, mergers and acquisitions, Austin Hospital Physicians, Vanishing Oath

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Coventry Health Care Acquires Mercy Health Plans – Part of the Catholic Healthcare System With Focus on Increasing Shareholder Value

Yes you read this correctly and I try to include those comments on the blog as they are published to bring an awareness around to what is happening here with the “business side” of healthcare as it is changing.  We have one more example of “losing the religion” here with Mercy Health Plans affiliated with Catholic Healthcare selling off their administrative functions in administering their health insurance to a “for profit” company, Coventry.  We seem to continue to see an exodus of Catholic healthcare in bits and pieces.  Recently in the news a hospital chain in Massachusetts was purchased by a private equity firm that was coming out of bankruptcy.

Caritas Christi Health Care Sold to Private Equity Firm Cerberus For $830M – Massachusetts

As health systems continue to be strained for money who knows how many more like this we will see.  When you read further here, there is a notation that Coventry is also one foot in the door with a provider solution for the entire Sisters of Mercy Health System too, but not many details were revealed.  As the article states, the focus is “shareholder value” and maybe some decent care might come along with it?  BD 

Sisters of Mercy Health System has agreed to sell its Mercy Health Plans, consisting of MHP Inc. and its subsidiaries, to publicly held Conventry Health Care Inc. for an undisclosed amount.

As part of the deal, Bethesda, Md.-based Coventry also is entering a long-term provider and customer relationship with Sisters of Mercy Health System and its affiliates.

Coventry said the transaction is expected to close in the next 90 to 120 days, subject to customary closing conditions and regulatory and other approvals. Coventry said the acquisition is expected to be slightly accretive to its 2011 earnings.

Mercy Health Plans has nearly 420 total employees: about 270 in St. Louis, 140 in Springfield, and eight in Arkansas, according to Mercy spokeswoman Barb Meyer.

“This acquisition reaffirms Coventry’s commitment to broadening its health plan footprint and is consistent with our focus on our seven core businesses,” Wise said. “Mercy Health Plans’ businesses are ones that we understand well and we are confident that they will increase shareholder value over the long term.” 

Sisters of Mercy Health System has self-funded plans for its employees, Meyer said. Mercy Health Plans serves as the third-party administrator of those plans for claims administration, and Coventry will assume that role once the sale is complete.

Bethesda's Coventry Health Care buys Mercy Health Plans - Baltimore Business Journal

Technorati Tags: Sisters of Mercy Heatlh System, Mercy Health Plans, health insurance, dividends, Catholic Healthcare, Coventry

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Healthcare.Gov Site Opens To Assist Consumers in Finding Health Insurance – Video and Preview

The site looks nice and very user friendly, compared to most of the sites we see from the government.  There’s a video below that explains how the site works and there are additional tabs with information across the top.  As mentioned in my prior post, there’s no pricing on the page, but rather you can either link to or use a phone number provided to contact the insurance company.

HealthCare.gov Portal Set to Launch July 1, 2010 To Help Consumers Research Policies – Insurer Proprietary Algorithms Will Not Allow for Pricing Information to be Included

In addition you can view the You Tube page for additional videos from HHS.  Additional information about the “Patient Bill of Rights” can be read here. 

One other page of interest is the “timeline” that shows when the different provisions and changes in the laws take place. 

The format is useful and seems simple to navigate and at least is a good place to start and then use the link or phone options and go from there.  In October, pricing “estimates” will be included as it’s one big job to work with all the complicated algorithms of the various insurers. 

http://finder.healthcare.gov/?state=CA&x=3&y=9

Technorati Tags: HHS, health insurance, websites, Healthcare.gov, consumers, patients, insurance, algorithms, pricing, certification, Healthcare.Gov

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California Prison Health Care Signs 3 Year Contract with HealthNet

Health insurance goes to the prisons, well not exactly as we think of it with our policies, rather the company will administer the services and data analytics to ensure claims, services, etc. are handled accordingly.  Many big companies who are self insured also contract with health insurers to run their programs and it’s not much different to the consumer but the big difference is where the money comes from.  BD 

SACRAMENTO, Calif.--(EON: Enhanced Online News)--Health Net Federal Services, LLC (Health Net), a subsidiary of Health Net, Inc. (NYSE:HNT), announced that the California Prison Health Care Services (CPHCS) awarded Health Net the contract to administer the Preferred Provider Organization (PPO) Network Services on behalf of CPHCS. The terms of the contract are for a three-year base period which commenced June 29, 2010, with two one-year option periods.

“Health Net is honored to partner with the California Prison Health Care Services as the contracted representative to provide cost-efficient access to quality health care services for the state’s 33 prison institutions,” said Steve Tough, president of Health Net’s Government & Specialty Services division, which includes Health Net Federal Services. “In addition to providing access for health care services through a network of providers across the state, Health Net will administer support around claims repricing, medical management, data analytics and reporting, and information technology services such as telemedicine.”

California Prison Health Care Services Awards Health Net Network Services Contract | EON: Enhanced Online News

Technorati Tags: Healthnet, California, Prisons, PPO, HMO, health insurance, administator

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Drug Enforcement Agency Investigating San Diego Charger/Major League Baseball Physician

Dr. David Chao is the target of the investigation after one player was arrested on suspicion of possessing controlled substances, Vicodin , 100 tablets in his car.  No hearing has been set and it seems to me this is standards procedure as sports players could get the medication from other doctors as well.  The doctor could face losing his license depending on the outcome.  BD 

As a federal drug investigation that involves the San Diego Chargers and San Diego Padres continues, the state medical board's attempt to revoke the medical license of the Chargers' team doctor has gained renewed attention.

The National Football League's Chargers and Major League Baseball's Padres said they are fully cooperating with the Drug Enforcement Administration investigation, in which agents served 10 search warrants Tuesday on physicians and pharmacies affiliated with the teams.

Tuesday's actions came after former Chargers safety Kevin Ellison was arrested in Redondo Beach in May on suspicion of possessing a controlled substance after police said they found 100 Vicodin tablets in his car. Ellison was recently released by the Chargers and signed by the Seattle Seahawks.

In a statement, the Chargers said that "the Vicodin in Kevin's possession was not provided by the Chargers, its physicians or anyone affiliated with the team."

San Diego Chargers' team doctor faces complaint from California medical board | L.A. NOW | Los Angeles Times

Technorati Tags: San Diego, Vicodin, heatlhcare, Chargers, MLB, NFL, physician, doctor, drugs, warrant

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Blue Cross in California Reworks The Algorithms and Announces a 20% Rate Increase Effective September 1st

With current laws in California, insurers can raise rates as long as at least 70 percent of premiums are spent on medical claims. With other carriers, Aetna is asking for a 19% increase and Blue Shield is asking for 18%.   We still are not sure what the exact Medical Loss Ratios are.

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

This is a drop from the 39% increase that was announced in April; however with economic times the increase may still put health insurance out of the reach of many.

HHS to California Blue Cross – Bring Your Algorithms to Washington And Explain

With the last increase the company was requested to visit Washington and explain.  We spend all this time certifying EHR medical record systems, and yet we have to live with “whoops” and other areas of potential corporate responsibility that is questionable.  Last year I posted about needing a Department of Algorithms so we can certify how the transactions and calculations should project and it looks like we are getting closer to having a real need for this or something similar along this line.

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

If you missed the post below it’s worth a read as some of the subsidiary actions of insurance carriers are discussed and who they are.  It’s not all just about health insurance any longer as health insurers, just as private equity firms do are bringing more companies together to work as teams, in other words one subsidiary shakes the hand of the other when it comes to data and business intelligence. 

Consumer Watchdog Warns Sebelius on Health Insurers – Good Reason for This as Insurer Subsidiaries Are in The Game to Play Just As Private Equity Groups Diversify and Collaborate Holdings

When press releases come out it sometimes gets by us as we may not be familiar with the subsidiary company name, but they are working together today and it is changing the face of health insurance as some subsidiary companies produce software, some move products and goods, some consult with the FDA and more.   It’s not the same simple business it started out to be years ago.  BD 

Embattled health insurer Anthem Blue Cross is reviving its plan to raise rates for tens of thousands of California policyholders, some of whom could see their premiums rise as much as 20%.

California's largest for-profit insurer submitted new rates Wednesday amid pressure to scale back increases of as much as 39% that had provoked fury from consumers, lawmakers and even President Obama.

Eager to avoid another public backlash, Anthem and its corporate parent, Indianapolis-based WellPoint Inc., now are seeking a maximum increase of 20%, with an average hike of 14%. The original proposal called for an average increase of 25%. The new rates would take effect Sept. 1.

Anthem Blue Cross again seeks rate hikes for Californians - latimes.com

Technorati Tags: Blue Cross, algorithms, California, Health insurance, health insurance reform, rate hike, premiums, consumer, patients, rate increases

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FDA Clearance Given for MiniArc(R) Precise Single-Incision Sling From American Medical Systems – Treatment for Incontinence in Women As A Minimally Invasive Procedure

The best news here is only requiring one incision versus several and the launch of the MiniArc will start on a limited basis with a full commercial launch by the end of the year.  The procedure can be done as an outpatient.  The procedure is covered by most insurance carriers.  BD 

MINNEAPOLIS, June 28 /PRNewswire-FirstCall/ -- American Medical Systems® (AMS) (Nasdaq: AMMD), a leading provider of world-class devices and therapies for both male and female pelvic health, today announced the Food and Drug Administration (FDA) has cleared the MiniArc® Precise Single-Incision Sling System, a product for the treatment of female stress urinary incontinence (SUI). MiniArc Precise is the next generation sling in the MiniArc family sling system, the number one selling single-incision sling in the United States.

Over 33 million women worldwide are affected by SUI, a condition in which activities such as coughing, sneezing, or heavy lifting put pressure on the bladder resulting in unintentional loss of urine. SUI is more common in women than men and is caused by weakening of pelvic floor muscles often tied to tissue and nerve damage resulting from pregnancy, childbirth, radiation, hormone changes or a prior surgery.

MiniArc Precise system is a next-generation sling procedure, which is minimally invasive and requires only one small incision (as opposed to multiple incisions in traditional sling surgeries) mitigating the potential for tissue trauma, resulting in faster recovery. American Medical will soon commence a limited launch of the product followed by a full commercial launch planned in late 2010.

American Medical Systems Announces FDA Clearance for MiniArc(R) Precise Single-Incision Sling -- MINNEAPOLIS, June 28 /PRNewswire-FirstCall/ --

Technorati Tags: American Medical Systems, Incontinence, Sling, FDA, MiniArc, surgery, incision, bladders, tissue repair, women's health

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Dendreon Announces CMS Evaluation of Provenge for Late Stage Prostate Cancer Patients

Provenge costs a total of $93,000 for the full treatment of three infusions so this was no surprise that consideration would be needed before giving a blank check for all participants of Medicare with prostate cancer who would be in a position to require the treatment.  Provenge is used to help extend life of individuals with late stage prostate cancer and compared to other treatments is much easier tolerated.  A few months ago I did a post explaining the processes of how the treatment is given. 

Dendreon “Intellivenge” Algorithmic Software Supporting Administration of Provenge – Seeking FDA Approval by May 1st

Blood is taken and then sent to the Dendreon facility and incubated and returned back to the doctor/patient for 3 injections.  This is a new class of drug.  Completion of the analysis from CMS is expected by the end of June 2011 so there’s a year’s wait before a decision is made.  BD 

SEATTLE, June 30 /PRNewswire-FirstCall/ -- Dendreon Corporation (Nasdaq: DNDN) announced that the Centers for Medicare and Medicaid Services (CMS) today initiated a National Coverage Analysis (NCA) of PROVENGE® (sipuleucel-T), an autologous cellular immunotherapy for the treatment of asymptomatic or minimally symptomatic metastatic, castrate-resistant (hormone-refractory) prostate cancer (CRPC). PROVENGE is the first in a new therapeutic class known as autologous cellular immunotherapies.

In CMS's announcement of the NCA, CMS is requesting public comments on the effects of PROVENGE on health outcomes in patients with prostate cancer.  It is not a change in Medicare coverage policy. 

Dendreon Statement on CMS National Coverage Analysis -- SEATTLE, June 30 /PRNewswire-FirstCall/ --

Technorati Tags: CMS, Dendreon, Provenge, prostate cancer, software, Intellivenge, biotech, FDA, technology, algorithms, Microsoft Tags, bar codes, active cellular immunitherapy

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Washington D.C. Council Creates Nonprofit Corporation To Seize Control of United Medical Center At Foreclosure Auction

More hospital news, this time right under the nose of Washington and Congress, so if this doesn’t generate some attention here, I don’t know what will, again as most are non participants in consumer healthcare IT so it’s kind of of hard to see this I guess.  The city  will have to subsidize as the hospital can’t meet their debt and bills. 

It appears the “for profit” organization that owns the hospital is in default on the bills and they don’t expect anyone else at this point to bid on the hospital as it is on the block.  They expect the current owner though to show up and try to block this effort, go figure?  From what is posted in this article, it appears some bad management is in the picture from years past.  BD  

The D.C. Council voted Tuesday to establish a nonprofit corporation to seize control of United Medical Center at a foreclosure auction next week, even though the District's chief financial officer warned members that the city might not be able to afford it. 

After months of wrangling between the city and Specialty Hospitals of America, the hospital's owner, Attorney General Peter Nickles plans to auction the Southeast Washington hospital on the steps of the John A. Wilson Building on July 9.

Nickles has accused Specialty, a for-profit company that took over the hospital then known as Greater Southeast in 2007, of defaulting on its loan agreements with the city. 

"Because the hospital cannot meet its operating expenditures, given its current streams, it is likely the city will have to continue to subsidize the hospital into the future," wrote Gandhi, noting the city is near its debt limit.

D.C. Council creates nonprofit to take over SE hospital

Technorati Tags: hospitals, Washginton DC, United Medical Center, finances, foreclosure, heatlhcare reform, non profit, for profit

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VA Awards 3 Year Contract to the City of Hope For End-of-Life Nursing Education And Hospice Care

This is a 3 year contract and everyone knows the City of Hope is the foremost institution for cancer and cancer research.  Recently in the news the debate and lawsuits with the City of Hope and their doctors over contracts and physicians groups.  The award of this contract may bring some revenue into the hospital while at the same time provide good training for the nurses at the VA. 

City of Hope And Doctors Dispute with Law Suits - Board Representation Issues At Hand And Of Course the Money

In order for nurses to provide end of life training, they need a strong partnership with the doctors for sure to understand all elements of care that are needed for the patients so hopefully agreements are created so patients will not need to shift to new physicians for their care.  BD 

DUARTE, Calif.--(EON: Enhanced Online News)--The Department of Veterans Affairs has awarded the City of Hope a three-year contract to educate nurses on how to provide better palliative care for Veterans with life-threatening illnesses. This work will be conducted through the End-of-Life Nursing Education Consortium (ELNEC), a national nursing education initiative administered by the City of Hope and the American Association of Colleges of Nursing (AACN).

More than 54,000 American Veterans – mostly from World War II and Korea – die each month, and the Department of Veterans Affairs Hospice and Palliative Care Initiative (VAHPC) is trying to improve hospice and palliative care for them. Given that the number of Vietnam-era veterans over 65 will continue to grow through 2034, so too will the need for hospice and palliative care in the VA system.

During the three years of the ELNEC-For Veterans project, 600 nurse educators will enroll in national “train-the-trainer” courses. The expertise gained there promises to improve the quality of palliative care for thousands of veterans in 153 Department of Veterans’ Affairs Medical Centers across the U.S.

The ELNEC-For Veterans project is collaboratively administered by City of Hope, the American Association of Colleges of Nursing (AACN) in Washington, D.C., and the Department of Veterans Affairs. Co-investigator on this project is Pam Malloy, MN, RN, OCN, FPCN from AACN. For further information about this project, go to: http://www.aacn.nche.edu/ELNEC.

Veterans Administration Awards Contract to the City of Hope to Expand the End-of-Life Nursing Education Consortium (ELNEC) Program to Improve Palliative Care at U.S. Veterans Hospitals | EON: Enhanced Online News

Technorati Tags: City of Hope, hospitals, lawsuit, California Medical Assocation, CMA, doctors, employment, for profit. hospital, for profit foundation, Cancer, reserach and development, VA, nursing

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