Well here’s one more not for the consumer.  If you read through the article in the LA Times the bill died as lobbying efforts claimed here would not allow for a majority of votes to pass.  It will be tried again next year.   It’s funny that we go through great lengths and trouble to audit and certify medical records, but the payers in all of this run their business intelligence models and reconstruct and change them with their analytics and laws can’t keep up.  I said back in August of 2009 we need a Department of Algorithms but until we get lawmakers that understand how business models worth and how math moves money, we are kind of stuck here.

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

You have to some day sooner or later start auditing this stuff or we are all screwed.  It’s easy to fleece the digital illiterates and I see it all the time with those in denial who can’t get this function yet.  On another note, we are looking at the same on Wall Street too as the hardware wars are almost over and then….we have data and the algorithms that process it and it will get really tough then with writing code that can no longer be read with layers of aggregation, so remember you heard it here first.  It too Medicare long enough to get to that point with using technology to audit medical claims for fraud. 

CMS Announces Anti-Fraud Algorithms Will Begin Auditing Claims on July 1, 2011 Just As Insurance Companies Have Done For Years

We don’t have an executive in charge of HHS that has enough Health IT in her background and thus 2 years ago when she took office she could not forecast how this was going to move forward, but folks that write code do and that’s what you see here and I’m just a tiny ant in the coding world for that matter but I can predict easy enough and add on a number of years in PR and Sales and it just flows.  Granted HHS has hired some really spiffy folks, but again as a director she has to go to them and needs additional reports where as someone with on hands experience thinks a lot different and can picture the future with the mechanics of code, so executives without this ability are just flat out behind an 8 ball when it comes to such decisions.  When she was nominated I made that call, nothing personal at all but said in 2 years the director of HHS was going to be about 80% health IT, so here we are today and I don’t think I’ll get any arguments there

Times were a little different back then too but again the code heads can see and project where others cannot.  This is what I said in February of 2009 and it makes it hard for people in those positions to function with the crazy unpredictable world we live in today and others just eat their lunch and we all suffer.  I think was politically correct and just stated facts as a coder sees them.  Are people just now starting to listen to folks who know math?  So once again we are late coming to the table but we can’t go backwards and have to some how work with what we have, and it changes every day.  image

Kathleen Sebelius, Kansas Governor for HHS – Please not! Put the “Smart” People in these key positions

In the meantime, California lawmakers are kind of behind this 8 ball too and don’t get the math here with how the algorithms with insurers work.  If you look back and read on the recent couple of years, look how many times they adjusted them and ran back to the table with justifying their increases and some were way off too.  It’s all about the math and we have lawmakers in California that don’t get it just like we have in Congress, too complicated, I don’t want to deal with it right?  I think we are seeing a lot of this today.  The COs and folks that do have this in their background are stressed and dropping like flies too all over and I understand that very well as I have dealt with that for much of my time in technology, it’s thankless, misunderstood and you deal with people who have shut off their learning faucet and fabricate a lot and its’ hard.  There are also those who read and want to learn and work with you too but we all have the folks that feel threatened and well look what we see in the news today with the GOP, craziness and to me it all comes back to not knowing what to say or do with not participating in at least a medium level of consumer IT literacy.  Makes for good OMG news but that's about it.  BD 

A bill that would allow California officials to regulate health insurance rates for millions of consumers has died in the Legislature after forceful lobbying campaigns by insurers, healthcare providers and other groups.
Assemblyman Mike Feuer (D-Los Angeles) said he is pulling his measure, AB52, because he could not muster a majority of votes in the state Senate, the final stop in a months-long effort to increase state regulators' authority over health insurance premiums.

Feuer said he is putting his bill on hold until next year, when it can be taken up again. It marks the fourth time in four years that Democratic lawmakers have failed to win support for insurance oversight that would mirror the type of regulation already in place for auto policies.

http://www.latimes.com/business/la-fi-insurance-regulation-20110901,0,4400280.story?track=rss&dlvrit=52116

0 comments :

Post a Comment

 
Top