Stanford Hospitals and Clinics No Longer Accepting Blue Cross Health Insurance–Contract Expire-Patients Have to Go Elsewhere While the Cost Algorithms Churn With Contract Negotiations

Here we go again, it’s the contracts and the costing algorithms of the insurance companies that are their business models that determine what reimbursement will be.  The article states that now they are “close’ to agreement so maybe this won’t last too long, but in the meantime you can’t go there as of Setember1st and letters went out back in February that this would come around, and it did.  See how long it takes to negotiate insurer contracts today?   This means for right now you can’t go there or visit some of their physicians to get care where Steve Jobs reported went for some of his care.  About a year ago they opened a premier medial school. 

Stanford University Opens State of the Art Medical School

It’s complicated and their algorithmic business models have to allow for the projections they have analyzed and determined with their predictive software. Blue Cross has an entire IT infrastructure for this to calculate and sell to clients too, have had it for a while.  Now Stanford is pretty advanced with everything they do all over and I would expect nothing less here so in essence we may have this with the contract negotiations…as a matter of fact Stanford is probably giving them a real run for their money:)

The battle of algorithms…that’s what contracts pretty much amount to anymore.

The care given relative to Catheterization is very superior and you should read about their advanced MDs and procedures and outpatient procedures.  Sounds like Blue Cross though says we don’t want to pay that much for it maybe? 

At Stanford Hospital Coronary Stent Processes Are Done On As an Outpatient Procedure–Using the Radial Artery in the Wrist

Stanford Hospital Gives Ipads To Patients in the Catheterization and Angiography Labs

And they have the very much anticipated clinical trials for stem cell treatment of the spinal cord.

Stanford Joins Geron Spinal Cord Clinical Trials Program as the 3rd Location in the US

Anthem filed a letter of transition with the State Department of Managed Care and as I read here access to the doctors will be extended until September 16th.  One nice plus though here is that transplant patients don’t have to make a change, thank goodness and the ER rooms don’t require pre-authorization so maybe Stanford ER rooms might be a little busier.  They have been going at this since before February on a new contract.  It further states that Blue Cross HMO has the right to send patients to another doctor.  If one is PPO you might face higher co-pays since I would maybe guess you could be subject to out of network charges.  Just a couple months ago HP committed $25 Million to the Children’s Hospital and Intel has kicked millions to the University as well. 

HP Commits To Invest $25 Million To Stanford’s Lucille Packard Children’s Hospital To Include HP Labs Collaboration

All of this with medical care today just really stands to strengthen the need for a Public Option for sure.  Contracts leave peoples lives, and in the case of the doctors, their livelihoods up in the air. 

Again Stanford is world known for their technology with healthcare, but we are like I said, back to those costing algorithms and with Blue Cross figuring out how to maximize share holder dividends.  Insurers can’t negotiate a contract in a years' time so its time for inconveniencing patients and consumers off in other directions as deadlines today seem to mean zero as far as getting that part of the job done.  BD 

Patients with Anthem Blue Cross health insurance stopped having coverage at Stanford Hospitals and Clinics on Thursday (Sept. 1) after contract negotiations were not resolved, according to an Anthem document Palo Alto Online received yesterday.
The contract termination means that Stanford University Hospital, Lucile Salter Packard Children's Hospital (LPCH) and Stanford Medical Group might not be in the Anthem insurance-plan network. Authorizations and copay amounts could change for patients with the HMO and PPO plans, Lucile Packard spokesman Robert Dicks said.
The hospitals sent Anthem a letter on Feb. 25 informing the insurance giant of the termination on the contract's Sept. 1 expiration date.

http://www.paloaltoonline.com/news/show_story.php?id=22374

Technorati Tags: Stanford,Blue Cross,Health Insurance,hospitals,healthcare,Heatlh IT,doctors,patients,in network,disruptions,co-pay,contracts

Read More

SAP Mobile mHeatlh IPad Application/Platform Debuted by Developers in Europe

It’s always interesting to occasionally look at what is being done outside the US and SAP has developed an EMR that connects to Siemens and other middleware use in Europe.  In addition SAP also has their Collaborative E-Care solutions to connect patients and doctors as well for remote monitoring and communication.  SAP is a big software manufacturer world wide and I was not aware of their mobile medical records business until of late, and they do have all types of other healthcare and other industry software they sell. .  The next release is to be fully two way as right now it’s pretty much just read only.  I think the US has so many EHR vendors here that in this industry perhaps they do a bigger market over seas, but don’t quote me on it as this could be a stepping stone into more business here. 

Patients will be able to enter information for their end with the PHR.  The format looks nice and easy to read and somewhat reminds me of the screens on a EMR demo from Microsoft from a few years back.  From what I am reading and seeing this looks like a mobile user interface that works with several back end data bases, with Siemens being at the top with already having connectivity.  BD 

Jan Korten, a solutions manager at SAP, and Thilo Berndt, the product development manager for SAP’s mobile healthcare apps, debuted the EMR app during an August 31 Webinar. You can watch the 1-hour presentation and slides here. But in the meantime, here’s an illustrated summary of what they covered.

Ten SAP developers in Europe have been working on the EMR app for the past 3 months. Just finished, the app - iPad today, Android tablets like the Samsung Galaxy Tab tomorrow - is about to be piloted by a trio of European hospitals and then released at the end of October, says Korten.

 

There’s a lot of talk about how a smooth, slick user interface is an important competitive advantage. In healthcare, however, an easy-to-use, powerful UI is mission-critical. While doctors are often very gadget-y, they are also impatient and too busy to deal with a lot of training. An intuitive UI that easily delivers the right information can actually “save lives,” says Korten, a former doctor himself.

The next version will use the Sybase Unwired Platform (SUP) middleware to store more data locally for offline access, handy when doctors are in network “dead spots” within a hospital. It will also be able to download data via 3G.

Here’s the high-level technical architecture: app running on multiple devices (some now, some later), multiple applications and data sources on the back-end, and the SAP Mobility Platform in the middle. This lets the devices access servers via one of three ways: SUP, SAP Gateway, and Netweaver. SAP today ties into Siemens’ i.s.h. medical records platform. According to Korten, the roadmap includes the ability to tie into Picture Archiving and Communications Systems (PACS) and Lab results databases built by 3rd parties.

With Collaborative eCare app, patients can upload data on their symptoms and medicines taken to their doctors while at home. Doctors can adjust dosages and change prescriptions and set reminders for patients to take their medicines via the app. Alerts can even be sent via text message to the patients.

http://www.zdnet.com/blog/sybase/how-two-sap-mobile-health-apps-can-improve-patient-care-mhealth/1484

Technorati Tags: SAP,medical records,software as a service,healthcare,Heatlh IT,PHR,eCare,Ipad

Read More

Chasing Madoff–Official Movie Trailer (Video)–Time for a Department of Algorithms?

I can’t help but think back with covering Health IT to once again go back to what I said in August of 2009…but who in the heck am I, just someone who wrote code for a while and knows how this takes place and works against the digital illiterate or those in denial, not fair.  If you visit the link below you can go back and hear Harry Markopolos and his testimony in front of Congress, kind of timely right now.

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

The current administration still has a few executives hanging around that don’t appear to exercise any consumer IT literacy and they kill us and waste a lot of time being non participants, but worse over on the other side we have the Drama Queen antics of the GOP. 

Madoff's Scheme – One Reason To Put the “Smart People” in the Right Places So We Don’t Get Fooled Again

You know people who understand the complicated code process just sit and shake our heads while watching news being reported somethings more for OMG status and ratings, but that’s what we have right now and it’s not all that way, mostly the political news it seems.  Look who was one of the first to break the silence, the IT guy who of course had this long figured out but was paid well. 

Madoff Employee Breaks Silence – The IT Guy Talks about the “Root Kits” of Madoff’s Wall Street

“The three managers who ran parts of the businesses were getting $500,000 to $750,000 a year and they didn’t even know anything about modern computerized trading,” the employee said.  The employee was part of a trading group, which was able to break a security code that he says led them to a site that was supposed to be seen only by the Madoff family. It showed the profits and losses of the legitimate businesses. Even in years when they grossed $25 to $50 million, they calculated in the outlandish costs and thus concluded that the firm barely broke even and some years lost money”

The SEC has had to learn some hard lesson and now is working to correct that image and want coders around to help them too and this was from yesterday, September 1, 2011.  Give the SEC the coders they need as HFT is going to shift again as the hardware war is coming to a close and the next move is to rework the algorithms for the transaction, query and other factors to see if they can optimize with software over the next guy, but never mind the extra exposure to potential corruption and some of these folks over clock their server processors too, and you just thought it was kids that did that with the need for speed with gaming

FINRA and SEC Asking High Frequency Trading Firms To Hand Over the Algorithms of Their Trading Strategies And Code–Time for That Department of Algorithms?

So enough of my long article lead in…here’s the trailer and hopefully it will be a good accounting when the movie is released.  The trailer looks pretty good with actual footing in there. 

Chasing Madoff

Nobody wanted to do the math except Harry Markopolos and nobody listened to him, there are crooked algorithms in this world and healthcare got burned in several areas here too, a couple examples below.  BD

Madoff Scam Hits Harvard Medical School Grants and affiliate Beth Israel Medical Center

Mayo Clinic – Madoff connection with funding Gastrointestinal Research

http://www.thereformedbroker.com/2011/09/02/chasing-madoff-trailer/

Technorati Tags: Madoff,fraud,NASDAQ,healthcare,movie,Greed,Whistle Blower,Healthcare,Fraud,Physicians,Wall Street,Massachusetts,Charity,Donations,Investors,technology,SEC,Cancer Donations,Boston,Foundations,Ponzi,Beth Israel Deaconess of Boston,Harvard Medical School

Read More

FINRA and SEC Asking High Frequency Trading Firms To Hand Over the Algorithms of Their Trading Strategies And Code–Time for That Department of Algorithms?

Occasionally I step over into a bit of the financial side of things and the reason for this post is that back in August of 2009 I made a post about the US needing a Department of Algorithms…hmmmm…not far off now is it, call it what you like but audit functions for code should be upon us about now, we need it.  You can read the post at the link below which I created due to the Madoff situation and the Harry Markopolos testimonies. 

Tuesday, August 25, 2009

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

“In healthcare we have an agency that every likes to complain about called CCHIT that certified the safety, accuracy, and interoperability of healthcare records, just wonder why this process might not be explored in other areas where transactional data exchanges are taking place.  We want our medical records to be accurate and concise, so why not the same with our investing?  This is just a question I pose.”

---

Also we have tons of algorithms running like crazy in healthcare with insurers and other financial institutions that could also use the same auditing.  We go to great lengths to certify the software and algorithms contained within for medical records, but do we hold any of the accounting algorithms of the insurers accountable…no.  This has gone on a long time and not the first time I have suggested such a process here.   Algorithms should be written to give accurate results and many are written for desired results which are not always on in the same with the word accurate. 

FINRA reports to the SEC and focuses requests on flawed codes to understand how they are constructed.  This has moved up a notch from the original requests as more information is now being requested. FINRA has also beefed up their staff with more individuals WHO UNDERSTAND CODE.  I still think back to the Goldman case and I have often wondered how the entire case went down with having a full understanding of what actually happened. 

The former coder stated that he accidentally moved some code, and I have done that, but again I’m not writing anything as sophisticated as stock market investing software, so that part could have been true and again I wrote my opinion up when all of this was current, and stated you do need to understand the “value” of the code so as not to incriminate someone using a partial open source module for example. We all do that and build additional code on top of perhaps several open source models put together and have them fully function to fit the request of the software.  Also, a couple of other relative posts from the Medical Quack in 2009 below: 

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

Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!

This is really a good time to start asking questions on CODE as more personal data and profile information is sold on the internet and while it may be good for gathering statistics, we have those who narrow some of these queries down to an individual level and you end up with flawed data and algorithms that are sold beyond what they can really deliver in the way of business intelligence.  In healthcare I am always happy to see HP or Microsoft provide their services as they do not have a stake with another subsidiary who can profit with algorithm designs of a subsidiary when it comes to reimbursement or revenue cycling. 

Again, I stand on my suggestion for a Department of Algorithms that I wrote about 2 years ago all the way around for financials and healthcare, as we want accurate and honest code that will not fleece consumers as we have had our fill of that and the economy and the redistribution of the money speaks for itself.  Call it whatever you want but get some auditing done with some REAL CODERS who can dig in and find both the flaws and the accuracies. 

In the healthcare/insurance side of regulation we have actually had one state legislature begin to question the same thing with insurers and ask for their CODE.  Back in October of 2010 I wrote about their inquiry here:

New Jersey Legislature Getting Smart– Bill to Modify Claim Procedures to Include Asking For Insurance Company Algorithms-Bill A3334

If you are lost in the math in this article, pick up a copy of this book, “Proofiness, the Dark Side of Mathematical Deception”…more at the link below and that will explain enough to perhaps bring a basic understanding of how math and algorithms if not done accurately can be far from reality at times. 

“Proofiness–The Dark Side of Mathematical Deception”–Created by Those Algorithms–New Book Coming Out Soon

One other bit of back information, some insurers get sued over their algorithms too.

Insurance Companies Under Attack with Lawsuits – Generated by Their Algorithms

We all remember the AMA legal case against United which was 15 years of paying lower than customary fees for doctors and patients who required out of network services and lawsuits are still going on that one as so many of the insurers subscribed to the data base used by the subsidiary of United.  There are outstanding cases against Blue Shield, Aetna and more who licensed use of that data base.  It was just about a two years ago that HealthNet finally agreed to pay claims at a level of 14% above what the data base called for.  It all comes back around to those algorithms. 

So after reading this far, again it seems fair to link the algorithm audit processes here to both the financial and healthcare sector as they are all transactions where someone gets paid and we want accurate and correct formulas used.  One more mis match that has bothered me of late is the credit agency FICO claiming they can sell analytics with free information from the web combined with a consumer credit score to sell this to insurers and pharmaceutical companies as predictive analytics to determine by a score if a patient will take their meds.  You don’t have be a coder to figure out that while this might make a good report for overall statistics if you want to query the information for relevance, but to take it down to a one on one bases with flawed data, it’s wrong and it’s mis matched false intelligence algos being sold.  Don’t be fleeced on this one, no matter how good the marketing looks.  My write up in FICO was carried over by a reader to the Daily Kos. 

FICO Analytics Press Release Marketing Credit Scoring Algorithms to Predict Medication Adherence–Update (Opinion)

So while FINRA is opening the door to audit code, we could certainly use some of that in healthcare transaction audits as well.  We had the case last year with Blue Cross running the “breast cancer” algorithm that was reported in Reuters that had to be corrected. 

And one one last closing note here, we have so much of our personal data being sold and million and billions made from all of this, and there’s no way you can stop the algorithms so next step, license those folks and tax them, healthcare could use a bit of this money coming back to help doctors and hospitals on the brink of bankruptcy with reduced contracts signed with insurers created by algorithmic business models.  Big business uses them all the time and laws just can’t keep up.

Privacy Wanted–So Let’s Require Those Who Sell Web Data to Register and Tax the Transactions and Publicly Disclose Who They Sell To With a Federal Registry

There’s nothing wrong with using algorithms and software today for analytics, and we need and depend on them to run so many areas of our lives and business, but if they are not accurate and are only created for “desired” results where monetarily someone has to lose, well it’s time for that Department of Algorithms to certify that they are in fact fair and creating fair game for all. 

Further more we need lawmakers to also make the effort to use technologies that are up to date and allow for better decision making to stop some of the intellectual fleecing that we have seen for the last number of years.  We have lawmakers who want to put data out for public use that has tons of flaws and errors and have no clue on the cost.  HHS and enforcement agencies by all means need access but again with what is proposed here and the ROI on the expense of this is just not there.  We have for profit MD and hospital rating services all over the web with flawed data to include dead doctors and other information thieves can mine for fraud and correcting that information certain supersedes this project by all means.

Digital Illiteracy Is Killing Us With New Bill Wanting MD Medicare Compensation Put Online-No Clue on the Cost, Time and Truckloads of Errors to Audit and Correct

So let’s beef up our IT infrastructure and get lawmakers and the audit enforcement agencies the intelligence they need to investigate and ensure that the “secret sauce” algorithms used today are all on the up and up.  If lawmakers used better technology to study and query, we would also have better laws for the agencies to work with from the beginning, it’s a technology team effort here.  BD   

IBM Watson Capabilities Being Pitched to Financial Industry-Congress Must Not Have Felt They Needed This So Further Behind We Fall With Effective Intelligent Lawmaking

(Reuters) - U.S. securities regulators have taken the unprecedented step of asking high-frequency trading firms to hand over the details of their trading strategies, and in some cases, their secret computer codes.

The requests for proprietary code and algorithm parameters by the Financial Industry Regulatory Authority (FINRA), a Wall Street brokerage regulator, are part of investigations into suspicious market activity, said Tom Gira, executive vice president of FINRA's market regulation unit.

"It's not a fishing expedition or educational exercise. It's because there's something that's troubling us in the marketplace," he said in an interview.

Most of the algo-related requests, he said, have been made to hedge funds that use quantitative trading strategies.

Technorati Tags: FINRA,code,SEC,trading,algorithms,developers,high frequency trading,healthcare,insurance,math audit trails,software

Read More

Johns Hopkins Receives $30 Million Donation from Commonwealth Foundation To Research and Fight Cancer

This is a breath of fresh air as cancer donations have not been in the news as much as they have been in the past due to economic conditions.  The research money will center around genomics at Johns Hopkins relating to finding cures for cancer. 

With opening the Center for Personalized Cancer Medicine at the Johns Hopkins Kimmel Cancer the donation could not have come at a better time.  In addition the Goodwin's have also made other major donations to other centers relative to providing funds for cancer research.  BD

Philanthropists William H. Goodwin Jr. and Alice T. Goodwin, known for their generosity in supporting local causes, have given $30 million for cancer research to Baltimore-based Johns Hopkins University.

The money from the Goodwins' Commonwealth Foundation for Cancer Research is being used to establish a research center focused on gene-based, personalized cancer treatments.Goodwins' Commonwealth Foundation

"We are now entering into a new phase or era of cancer research, and it's going to center around genomics," Goodwin said last week.

Over the years, the Goodwins' foundation, which was established in 2002, has made generous donations to other cancer centers, including Massey Cancer Center at Virginia Commonwealth University, the University of Virginia Cancer Center, Memorial Sloan-Kettering Cancer Center in New York City, and M.D. Anderson Cancer Center in Houston.

"The Commonwealth Foundation of Virginia and the Goodwin family have been very generous to VCU Massey Cancer Center and to Virginia Commonwealth University as a whole," Massey Cancer Center spokeswoman Jenny Owen said. "We're very grateful for their ongoing support.

William Goodwin sold AMF Bowling for $1 billion in the late 1990s.

http://www2.timesdispatch.com/business/2011/aug/28/tdmet01-philanthropists-give-30-million-to-johns-h-ar-1268861/

Technorati Tags: Johns Hopkins,cancer,research,Commonwealth Foundation,philanthropy,donations,hospital,genomics,personalized medicine

Read More

Patient/ MD TED Discussion on How Judging Others Can Skew Clinical Study Results–Don’t Kick Out Participants When Personal Biases May Call Them A “Bad” Guy

I like this video and it has some important messages and boy do we see this today.  Gee I see it all over Twitter every day with judgments and a little less caring than what we used to have.  If someone’s numbers is skewing a study, let’s kick him out, he’s the bad guy making a mess out of our study.  In reality the bad guy maybe just needs help and there within lies this conflict of interest.  I don’t put posts on this blog that tells everyone what to do and repeat “Magpie” news items where everyone feels they need to repeat to reach those “bad” guys, as education is so much better and you just make those folks feel bad or they get mad. 

It’s like if I see one more article on how medical records improve care, I want to scream, that battle has been won a long time ago and we know they do, but people continue to feel this burning need to keep reiterating it all the time.  I’ve even had other folks on Twitter agree with the fact that they are tire of it too, so let’s move on and go to the next level and work on the mechanics, security, implementation and so forth as there’s a lot of work there to be done.  The message in this video kind of tells us to be aware of our own “Conflicts of Interest” and take a different view here and there and that’s not a bad idea.  Check out the video on the black spots on his face and his recovery process here as he was badly burned in an accident.

Conflicts of Interest

In life we encounter all kinds of people, many biased and sometimes we too get blinded with conflicts of interest.  He found he was interfering with his own science with his bias.  Something to give some thought too with trials and studies.  BD 

http://www.youtube.com/watch?v=n8Y8FK8gonc&feature=digest_refresh_thu

Technorati Tags: Guitl trip,study,conflicts of interest,healthcare,burn,psychology,treatments,doctors,patients,procedures,paper,clinical trials

Read More

Social Network for Patients, Doctors and Caregivers Begins Clinical Trials at 3 San Diego Hospitals, Prescribed by MDs for Outpatient Chronic Care Follow Up

This is different in the fact that a social network is going through a “clinical trial” to see if the extended care and offerings helps reduce re-admission to the hospital.  All security standards and HIPAA compliance entities are in place and the patient’s records would be coordinated with those at the hospital.  The doctor sets up the plan for the patient, and it looks pretty straight forward and is all about communication and records with being able to use both the patient and clinical input. 

Patients would be able to upload their information for review so remote monitoring would be possible.  Messages sent to medical teams would all be encrypted.  With knowing the diagnostic codes the clinicians can build the plan consisting of learning, monitoring and support.  Nurses, caseworkers and health coaches could also be involved with adding support.  This looks a bit different than what I have seen thus far with actually using the patient information.  The difference here from what I have covered about other systems that are out there is the involvement of the physician after leaving the hospital with the patient not feeling they have not been the baton being passed to the next person.  In addition having the ability to communicate with a “peer” patient is a plus too as that has been a missing puzzle piece that has lead patients to the internet and if you have someone in a group with a similar or same issue who is also local, it could be a good thing.  If one is not available though, the internet is still there as well.  BD 

A social network that doctors can prescribe to their patients: that's the idea behind a new San Diego startup called Wellaho. The company creates software to manage and support patients after they leave the hospital by bringing together different parts of a patient's support system. Doctors, family, and friends could all be part of the network, which can be customized for individual patients. The system will begin clinical trials in three large San Diego hospitals next month, with a larger rollout planned for 2012.

Other patient-based networks, including PatientsLikeMe, HealthCentral, Inspire, CureTogether, and CaringBridge, are gaining popularity with the chronically ill. But this one is different, says Wellaho's founder, Naser Partovi. "It's prescribed by a doctor, and it involves clinicians as well as friends and family. It's much more controlled."

Social networking is only one aspect of the system, says Partovi. It also gives each patient access to information about treatment options and clinical trials, and a place to record and monitor ongoing health progress in addition to communicating with doctors or caretakers. "All three of those parts—learning, monitoring, and supporting—are personalized for each patient," says Partovi. "We know their diagnosis and treatment codes, and we can build a special system around each diagnostic code."

http://www.technologyreview.com/biomedicine/38456/?p1=A3

Technorati Tags: Wellaho,San Diego,clinical trials,hospitals,re-admissions,healthcare,doctors,patients,outpatient management,peer patietnts

Read More

LabCorp Settles with State of California Over Kickback Marketing Scheme–Lab Wars

Both Quest and LabCorp were doing this and this is funny in the information here from BNET that he had the actual PowerPoint slides.  Quest settled up for $241 million for their portion of gaining market share. 

Quest Diagnostics Agrees to Settle California Medicaid Suit for $241 Million-Overcharging for Lab Tests

Quest does not appear to be done yet though as now they have a whistle blower alleging even more fraud, maybe a billion and this case is a little more complex and has to do with billing during the time of the Uni-Lab purchase. 

Lawsuit Filed Against Quest Diagnostics–Whistle Blower Case Alleging Medicare and Medicaid Over Charges of $1 Billion Or More

Labcorp is to pay up $49.5 million to settle the claims billed to Medi-Cal during a 14 year period.  A whistle blower was also who brought it to the attention of the State of California in this case as well.  To get a discount doctors were told to refer to LabCorp versus the other lab companies.  BD   

Labcorp’s (LH) $50 million settlement with the California attorney general over a kickback scheme highlights the federal government’s bizarre lack of interest in whether Medicare is being ripped off for hundreds of millions of dollars nationally by companies that provide diagnostic tests for doctors and hospitals.

The scheme wasn’t difficult to figure out — the company described it in PowerPoint slideshows that told employees what “not” to do. Prohibiting employees from breaking the law is fine, of course, but the Labcorp slideshows only made sense if the company knew how to execute a complicated “pull-through” kickback scheme, and knew it was wrong. One PowerPoint had a chapter labelled “Kickbacks.”

http://www.bnet.com/blog/drug-business/meet-the-company-that-outlined-its-kickback-scheme-in-powerpoint/9532?utm_source=twitterfeed&utm_medium=twitter

Technorati Tags: LabCorp,lawsuit,fraud,marketing,Medi-Cal,whistle blower,medical claims

Read More

Another New Portable Device Slated to Make Fitness Fun - A Keychain to Reward for Exercise and Donate To Charities

How many more of these things are we going to see.  Folks I know that bough the Fitbit tried it for a while and got bored.  I don’t have one and this is just what others told me as they said it was something else they had to do and they had enough overload with all the other consumer IT stuff and gadgets to worry about.  I think from what I hear on these devices is just like the consumer, the attention span is short and again it something you have to do something with and most all have a smartphone today, so I guess we will see when it arrives on the market. 

You know I just try and report on all of this and that in itself makes me tired <grin>.  What I found out too that most of the time the developers and the folks who work at some of these companies don’t use their own products, one of those “it’s for those guys over there” but send money please.  You have to wait until October so we see the proverbial promo to tease and generate interest here and the price shown is $99.  BD

REDWOOD CITY, Calif., Aug. 31, 2011 /PRNewswire/ -- Fitness is about to become a lot more fun with Striiv. The Silicon Valley-based start-up today revealed its first product which takes active gaming outside of the living room to turn everyday activities into fitness opportunities.  A sleek, portable fitness device, Striiv motivates activity throughout the day via games, personal goals, and donation opportunities -- all powered by physical activity.

Striiv offers a playful approach to fitness. Comprised of social game and technology industry veterans, the team behind Striiv brings a wealth of business and development experience to defining this new product category at the forefront of gaming and personal health.  Whether it's a real workout or simple daily interactions like walking to lunch, taking the stairs, or shopping – with Striiv any activity is earned, tracked and transformed into an opportunity to get fit, give back, and have fun.

"Fitness and health are top-of-mind today. But for many people, especially moms juggling careers and family, finding time for exercise is hard to fit in to a busy day," says David Wang, CEO and co-founder of Striiv. "We've combined charities, gaming, and personal challenges with cutting-edge technology to create a seamless way to motivate physical activity.  We're building a playful and inspiring 'movement around movement' so that fitness now fits throughout your day."

Small, convenient and designed to easily move between a key chain, belt clip, or pocket, Striiv is always with you and always on.  Striiv features a high-resolution color touch screen to track your progress.  Key features include:

• Walkathon in Your Pocket:  With Striiv every step counts toward a donation to charity.  At launch, Striiv is partnering with GlobalGiving to donate clean water to children in South America or a polio vaccine to a child in India. New charitable partners will be added over time.
• Activity-Based Games: Unlike traditional time-based social games, Striiv games are completely powered by physical activity. In the first game, MyLand, the more you move, the more your enchanted island fills with exotic wildlife and plants. More games will be added.
• Daily Challenges and Trophies: Earn rewards and bonuses for walking to lunch or taking the stairs. Unlock daily challenges based on real-world distances, from climbing the Eiffel Tower to crossing the Golden Gate Bridge.
• TruMotion Technology: Striiv's proprietary TruMotion technology is always on and can sense if you are walking, running, and even climbing stairs or hiking. 

Technorati Tags: Striiv,exercise,consumer IT,games,rewards,walking

Read More

Non Profit HEALTHeLINK Partners with United Healthcare Subsidiary Optumsight to Remote Monitor Diabetics In Buffalo in Pilot Program

I try to keep track of mergers and acquisitions here and the partner Axolotl was purchased by Ingenix in August of 2010, about a year ago, so when you hear of insurers buying up technology companies here’s one and where bottom line revenues end up contributing to for profit insurers. 

Ingenix Acquires Health Information Exchange Services/EHR Provider Axolotl-United Health Group Behemoth Continues to Grow–Subsidiary Watch

Here’s another post from the past that gives a little more background on the HIE and business intelligence algorithms used by United subsidiaries. 

Axolotl (A Subsidiary of Ingenix) Creates Reporting and Analytics Solution for Health Information Exchanges–Algorithms for HIE–Business Intelligence -Subsidiary Watch

In addition other subsidiaries sell electronic medical records as well and Care Tracker has been around for a number of years, sold by Ingenix, now under the Optum name.  

ClickFreeMD Selling Software EHR, Practice Management Bundled Records Solution–Emphasis on AMA Endorsement And Software “Powered” by Ingenix–Tethered or Untethered

At a cost of $250 per patient per month that adds up to some additional income and yes it is less expensive than visits to the ER room if that can be avoided.  If this ends up being a workable solution with proper implementation for a national model, that’s a lot of profit for the subsidiary to add to the corporate bottom line too. Buffalo has has their IT issues reflected too in this story from a year ago where it was found that the City paid over $2 million in premiums for dead city employees and from what I understand, they were having to go to court to get it back?  I’m sure all the folks being monitored though are not in that group.  I’m just curios too as to who all really has access to the data as analytics are are part of the deal here as that’s the way it works out there today with everyone wanting data.   

City of Buffalo Has Paid Over $2 Million to Provide Health Insurance for Hundreds of Dead People-Some as Many as 4 Years

I’m just curios too as to who all really has access to the data as analytics I’m sure are part of the deal here as that’s the way it works out there today with everyone wanting data. Another division of United sells prescription data for underwriting and other purposes. 

The RHIO didn’t want to be in the monitoring business though so it appears this is where the technology subsidiaries of United came in to play here.  The article said there was some resistance but again if they are United approved MDs and have had any recent cuts, then that could maybe stand to reason for some of it and I don’t know how many United policy holders are in this part of New York.  BD 

BUFFALO, NY – One hundred patients with diabetes have signed up for a telemonitoring pilot spearheaded by HEALTHeLINK, the regional health information organization (RHIO) serving Western New York State. The nonprofit’s innovative approach to telemonitoring could serve as a model for the rest of the nation, according to Todd Norris, Western New York Beacon Project Director.

HEALTHeLINK is one of the 17 Beacon Communities tasked by the Office of the National Coordinator to positively impact quality, cost and population health through the use of healthcare IT. The RHIO is focusing on several initiatives to "move the needle in a positive direction" for diabetes care management, which is its specific goal under the Beacon Community Program. With more than 60,000 diabetic patients under the care of 250 healthcare providers, Western New York has one of the largest diabetic populations per capita in the country, Norris said. The telemonitoring pilot, which will accommodate 150 patients, is one of 12 interventions the RHIO is deploying for diabetic care.

Blood pressure readings and other vital signs pertinent to diabetic management are downloaded from mobile devices and transmitted to healthcare providers in the form of alerts through HEALTHeLINK's health information exchange platform, which is powered by OptumInsight, formerly Axolotl. The RHIO, however, has adjusted the traditional model to address known barriers to telemonitoring adoption.

The cost is approximately $250 per patient per month. Norris pointed out that the elimination of one emergency department visit per patient pays for the program and also contributes to better health of the diabetic population. With economies of scale, the cost per patient per month for 40,000 patients would be $150 per month. At this level, Norris said, "You're going to see lively acceptance."

Technorati Tags: HEALTHeLINKS,United Healthcare,RHIO,healthcare,health IT,remote monitoring,data,diabetes,Buffalo,Beacon,Health IT,Communities

Read More

Abbott Labs to Discontinue Distributing FreeStyle Navigator Glucose Monitor in the US

The FDA just approved the Freestyle easier to use monitor in June of 2010 and received the European CE Mark in May of 2011.  In December of 2009 there were strip recalls for the old version of the Freestyle, however other Abbott models had a lot more strips recalled in December of 2010. 

Abbott Diabetes Care Recalls Tons of Glucose Test Strips–The US Has the FDA Recall Blues-Solution Has Been Touted Here for a Year-It’s Time for a Fix–Readers Have Voted

Supply interruptions was the reason given for the discontinuing in the US; however in Europe they will continue to sell and market, so not enough money here in the US is the first question I ask and glad we have enough other glucose monitors available for diabetics.  I just hope glucose monitors don’t take the same path as some of the drugs we can’t get today and hope this is an isolated instance.  Abbott still has many other Freestyle monitors they sell and market besides this model, but this one with wireless looked to be pretty advanced.  BD   

Abbott Laboratories (NYSE:ABT) announced that it permanently discontinued its FreeStyle Navigator glucose monitor due to an inconsistent supply chain that has amounted to several disruptions in product availability for U.S. patients.

"We know FreeStyle Navigator System customers in the U.S. have lived with some uncertainty and frustration," the company wrote in its official statement. "We are grateful for the commitment patients and providers have devoted to the FreeStyle Navigator System over the years, and we are sorry that we have been unable to consistently meet their needs."

"The discontinuation of the FreeStyle Navigator System in the U.S. is not for safety reasons," Abbott wrote. "The System is safe and effective and continues to be available to patients in seven other markets outside the U.S."

http://www.massdevice.com/news/diabetes-abbott-takes-freestyle-glucose-monitor-us-market

Technorati Tags: Abbot Labs,recalls,FDA,medical devices,drugs,pharma,technology,Twitter,Microsoft,MicrosoftTags,cell phones,Freestyle

Read More

Non Profit Social Interest Solutions Group and Microsoft Partner To Advance State and Government Health Exchange Initiatives

Back in February of 2011 Microsoft Government also announced their low cost State Insurance Exchange solutions.  Microsoft’s HIX solutions eliminate the need for states to evaluate numerous point solutions from various firms to find one that works well with government policies or existing IT infrastructures.

Microsoft Announces New Low-Cost Turnkey State Health Insurance Exchange Technology Solutions

From the Social Interest Solutions Website:

“Wherever possible, Social Interest Solutions utilizes the standard HIPAA transaction sets to form the basis of our interfaces as we have found that many of the entities with whom we share data have already adopted these standards. Our HIPAA companion guides are available upon request.

Social Interest Solutions is able to support a variety of data formats, including, but not limited to: HL7, HL9, X12, XML, Flat files, Comma Separated files and many others.

Social Interest Solutions is proud of our system integration capabilities and believe it is a key differentiator in making sure persons in need of benefits are efficiently supported. To learn more about the interfaces we support see interfaces. “

“Systems using a web service to communicate with each other don’t need to go through a great deal of change, as long as they adhere to the common message format. Services that can be used by multiple systems are more easily shared through web services because of the flexibility and reusability they provide. This shared usage is more cost effective because web services allow seamless integration and use of functionalities across multiple systems without the need to make significant changes to the systems that need to exchange information”

Social Interest solutions e-apps have been deployed in Arizona and California and connects low income families to programs ranging from Medicaid to food stamps.  One-e-App has screened nearly 7 million people and generated over 9 million applications for programs so far.  The PAL application is a web based tool that allows both doctors and patients the ability to apply for co-pay assistance for medications and other services.  From what I am reading in the press release though the focus here lies with insurance exchanges.  It’s nice to see a technology company involved here instead of the technologies of the insurers as we don’t know as we can’t audit and see if the procedures and algorithms are accurate all the time ad Microsoft doesn’t have a conflicting interest of healthcare claims that are processed for bottom line share holder profits either.  BD   

Press Release:

Social Interest Solutions and Microsoft Work Together to Leverage Social Interest Solutions’ Thought Leadership, Policy, Enrollment and Integration Expertise to Advance State and Government Health Insurance Exchange Initiatives

SACRAMENTO, Calif.--(BUSINESS WIRE)--Social Interest Solutions (SIS), a mission-driven, nonprofit organization dedicated to leveraging technology innovation to improve consumers’ access to health and human services, today announced a strategic alliance with Microsoft. The relationship will involve working collaboratively to help government entities save time and money in the design and deployment of the technology and processes underlying health insurance exchanges.

“We are pleased to be working with Microsoft at this historic time”

“We are pleased to be working with Microsoft at this historic time,” said Claudia Page, co-director at Social Interest Solutions. “Both organizations have a successful track record of working closely with state agencies to help them achieve greater integration across health and human services silos and both view the implementation of health insurance exchanges as a way to reform the health delivery system and improve health outcomes.”

“With the passage of the Patient Protection and Affordable Care Act (ACA), states have new mandates to follow, deadlines to meet and risks to mitigate that require significant process improvements combined with innovative technologies,” said Brian Russon, national practice leader for Health Insurance Exchange, Microsoft.

“We are pleased to join forces with Social Interest Solutions and look forward to working collaboratively to help our clients meet the demands of implementing effective health insurance exchanges.”

For the health insurance exchange collaboration, Microsoft will be providing technology and state government expertise, while Social Interest solutions will be providing valuable knowledge and experience focusing on enrollment, standards, interoperability.

For nearly a decade, Social Interest Solutions has been instrumental in helping to modernize the process for identifying and enrolling in health and human services programs. In early 2003, Social Interest Solutions developed One-e-App, a Web-based system streamlining the complicated eligibility and enrollment process by making it possible to transparently connect and share data across otherwise disparate state and local social services systems and programs. Today, One-e-App is deployed in Arizona, California, Indiana and Maryland and has served nearly 9 million individuals. The innovative integration and process improvements achieved with the One-e-App platform will play a critical role in helping states using One-e-App to develop and deploy health insurance exchanges.

Social Interest Solutions is also focused on effective policy development and helped to craft language in Section 1561 of the Affordable Care Act (ACA). Section 1561 requires the Federal government to establish enrollment standards to facilitate access to coverage. Subsequently, SIS directors have served as consultants to the Office of the National Coordinator for Health IT to support the development of ACA enrollment standards and protocols. Social Interest Solutions has also worked with states to conduct ACA IT gap analyses, assessing the current status of IT systems against where the state plans to be in 2014. Gap analysis work has been completed for Arizona, Maryland and New York and is underway in Alabama.

About Social Interest Solutions

Social Interest Solutions (SIS) is a nonprofit organization dedicated to leveraging technology innovation to improve consumers’ access to public and private health and social services. As an active influencer and promoter of policy reform, SIS has successfully developed and deployed pioneering technology solutions having a positive impact on the quality of life for the nation’s underserved population. www.socialinterest.org

http://www.businesswire.com/news/home/20110831005482/en/Social-Interest-Solutions-Microsoft-Join-Forces

Technorati Tags: Social Interest Solutions,Microsoft,coding,algorithms,analysis,policies,coverage,ONC,Health IT,ACA,Affordable Care Act

Read More

California Bill to Regulate Health Insurance Rates Dies Due to Lobbying By Insurers and Other Groups So No Serious Audit Algorithms for Now to Control Premium Hikes

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. 

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

Technorati Tags: California,lawmakers,digital literacy,healthcare,premiums,consumers,complcated,Health IT

Read More

United Healthcare To Buy Huge Chunk of Orange County, California Managed Care Business with the Purchase of Monarch Healthcare–Subsidiary Watch

This is in my back yard in the OC and for a few doctors I know this just might be the big push to start a Concierge Medical Office.  Newport Beach which is south of where I live has a ton of affluent residents and the Boutique practices there do well as money for many in the area is not a problem.  Monarch has been around for many years and they are at all the Hoag Hospital money raising events and is very active, so things might be changing in time. 

What will be interesting though is to see if the reimbursement changes and of course that’s at the top of every MD’s mind, so I don’t see much excitement about this at all here.  I know have friends that won’t be excited with the news who are patients.  Back in March of this year they closed a big office in Orange County and you can read more about how that went down, employees bused to a hotel and given their papers after an instant message. 

UnitedHealthcare Lays Off 180 Employees In Orange County-Initial Notification Sent By Instant Message to Those Affected

With 2300 doctors in the HMO, with recent mergers and acquisitions is this a basket full of doctors to sell an EHR too as they do sell and have sold a medical records system for years under the former name of Ingenix, now known as Optum.  Sometimes you run into situations like this to where one division of a big conglomerate cuts rates with one subsidiary and then the other rushes in to sell software. 

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT

Also the company recently bought another huge HMO group in Long Beach and I would say the two are perhaps close in size but bottom line is both are huge

OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch

We never did get our government REC center started in the OC either and I just kind of wonder where the money went on that too, and again with the post above with selling medical records, does this give anyone an unfair advantage for sales?  It does make you wonder and again why the REC center never got off the ground and I’m just speaking out loud here but there’s no REC center to offer any help to the doctors in the OC. 

Orange County California REC Center For Doctor Assistance with Medical Records Appears to be a Bust So Far…

I have heard from a few doctors on how the deductions of claims that get rescinded after payment have been a hassle with United as they just take a deduction out of a check and the claim that is not being paid does not even include the patient who is being denied, a nightmare for doctors and a recent study said it costs a doctor about $83k a year to keep up with the likes of all of this.  We have one first class hospital that kicked United out the door when it came to employer provided insurance and companies all over the OC were looking for another carrier when the United/Pacificare contracts were re-negotiated.

Employers in Orange County Looking for New HMO Contracts as St. Josephs and Some Others Begin Cancelling Agreements with Pacificare (UnitedHeatlhCare) – Employer Capitation Contracts

I guess Hoag Hospital though is happy to have the affluent residents to help make up for the other side of things as who knows how new contracts will end up shaking out when they come up for renewal.  When it comes to patents too with Health IT, United is right up there too so things don’t come cheap in that department or some subsidiaries either. 

QualityMetric/Ingenix (United HealthCare) Receives Patent for Patient Health Survey Algorithms-Subsidiary Watch

And here’s a few more back posts on their subsidiaries…think they are only insurance, well they are very heavily invested in Health IT these days as well and the acquisitions have been steady for them over the last 3 years or so. 

UnitedHealth Group Owns a Bank With Deposits Surpassing a Billion – OptumHealth Bank FDIC Insured

“OptumHealth offers three types of HSAs, as well as tax-advantaged health care savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.”

There’s also the Chinese investment the company bought early in 2010.

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

These are just a few examples of some of the subsidiaries of the company and why even sometimes judges find themselves in some potential conflict areas as the daisy chains of subsidiaries grow, they don’t even keep track or are cognizant that the company they have owned stock in for many years, due to quickly adapting business algorithms used today, is not the same.  The former Ingenix division (now Optum) makes money with pretty much just selling data and creating software algorithms. 

Back a year or so ago the AMA fought and won a lawsuit against the Ingenix division for short paying doctors and patients for almost 15 years and it was Andrew Cuomo of New York who got the ball rolling there.  In some parts of the country through wellness subsidiaries pharmacists even get to earn pay for performance money from signing people up in wellness programs, and what that amount is we don’t know but the retail drug chain, Walgreens says their data selling business is worth just under $800 Million. 

UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P for Walgreens

Last but not least, let’s not forget the CEO is the highest paid in the US for public companies, and they are still making record profits.  I just try to break down the business areas for awareness so consumers and others understand a bit more about the big corporate world of subsidiaries today that normally may not be thought about, seen or recognized.  BD 

UnitedHealth Group Inc. will acquire the operations of a major southern California physician group, in the latest example of how lines are blurring between insurance companies and health-care providers.

The purchase of the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties, establishes United's Optum health-services unit as a formidable presence in the region. Optum had previously taken over the management arms of two smaller southern California groups, AppleCare Medical Group and Memorial HealthCare Independent Practice Association.

Monarch said in a statement that it "has agreed to enter a strategic relationship with Optum to support our physicians in providing high-quality, cost-effective patient care in Orange County, California."

United has said in the past that providers acquired by Optum will not work exclusively with United's health plan, and will continue to contract with an array of insurers. But in one sign of the potential complications that might ensue, Monarch is currently in an arrangement with United competitor WellPoint Inc. to create a cooperative "accountable-care organization" aimed at bringing down health-care costs and improving quality.

Technorati Tags: Monarch Healthcare,HMOs,UnitedHealthcare,revenue,profits,layoffs,Orange County,Medicare,health insurance

Read More