We have had retail clinics and this is a tiny bit of a clinic in the fact that you can get your blood pressure taken and a few common screenings.  How does this work, do you now buy your health insurance by the pound <grin>.  Ok I was being a bit funny here as the policy would not sit well on the scales with your apples and oranges that we do pay for by the pound, although with doing body mass indexing at the store, you might be paying in the long run by the pound.

This is the first retail store in the west and other carriers have a few locations across the US and United just opened on in the Queens are of New York a few days ago along with getting a new General Counsel who was a former US Attorney for the state. 

United Healthcare Opens Retail “Employer Benefits” Store in Queens New York And Hires Former Minnesota US Assistant Attorney General As General Counsel

I did see consults available but not sure if you can march in with a medical claim dispute or are those on aisle 6?  How many would love to walk and in discuss a denied claim in person?  I would say that would definitely get some foot traffic.  BD

At a Lucky supermarket in San Francisco, shoppers will be able to pick up some health insurance along with their fruits and vegetables.

Blue Shield of California will open a 500-square-foot brick-and-mortar store within the supermarket Monday as a way to attract new customers and serve existing members who may want to talk to an insurance representative face- to-face rather than over the phone or by e-mail.

The concept is not brand new. In recent years, similar retail outlets for health insurance have cropped up in other parts of the country. But Blue Shield is the first health insurer in California to have a retail presence.

In addition to selling insurance and answering questions about bills or coverage, the insurance store in the city's Western Addition will offer automated body mass index and body fat measurements, on-site blood pressure, glucose and cholesterol screenings, personal health assessments and consultations with a registered nurse. The screenings will be free to members and will cost nonmembers $45.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/11/05/BA1G1LPB22.DTL

Technorati Tags: Blue Shield,health insurance,Lucky,grocery store,consultations,assessments,agents

Nobody likes fraud and all those folks and their actions need to be caught for sure but in the midst of all of this a lot of questions arise too when analytics come into play.  Hospitals and doctors use services that promise them maximum reimbursements too so sometimes you get down to some fine lines when reviewing claims and other information outside of the over all realm of out and out fraud. 

Insurers also use 3rd party companies here too so we have the battle of analytics and sales go through the sky to check and balance all over the place.  You can just read down further in the text here as they state “they have the best” just like all the analytics companies seem to say today.  Here’s a case that has been recently in the news with Prime Healthcare and other hospitals.  Did anyone do this on purpose, no, it was the algorithms that connected this, not bad doctors for goodness sakes, sold by 3M in this case that did the dirty work, so see where this is going?  One set of analytics competing with another set on the other side.  They all survive due to the complexity of today’s billing in the US with healthcare. 

Prime Healthcare Responds to Billing Practices–Flawed Data and Algorithms Once Again-Who Got Sold a Bill of Goods as Kaiser, Stanford & Other Hospitals Had a Ton of Kwashiorkor Malnutrition Billings

Back in July of 2010 HMS Holdings bought Allied Management, another similar company in the medical claim business.

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

Nobody really monitors the algorithms used and thus so it is becoming a battle of the math, again outside of the areas that are straight out fraud.  A couple years ago I suggested some of the math used could be looked to certify what algorithms insurers are using today either their own or those from 3rd parties.  We certify medical records but the payers have a free hand to apply what ever math they come up with relative to their costing algorithms. 

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

So did the hospital or physician commit fraud or was it the 3rd party they used to secure “maximum” reimbursement…this is a good question today I think. 

Bad Algorithms in Healthcare Payment Systems and Risk Assessments–Did the Hospital Bill Fraudulently or Were They Sold Formulas That Did Not Conform

We have a ton of marketing going on today and granted auditing software is needed but many skew the numbers to present abilities that are flatly over rated in many area and marketers get paid big money to make a case for all the software too, meanwhile you and I just can’t get the care we need without everyone getting and analyzing their data first. Have you been suckered in?  Sometimes it’s hard to tell but listen in to the professor below who explains how numbers lie and how the marketing spins we have today make it hard. 

“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government

Government gets fooled all the way around it seems and the sooner we come to the reality of what’s going on here, the sooner we might recover. Again there’s a need to find the people who commit fraud and get them out of the loop but when the analytics go on steroids to have hospital accounting systems battle it out with 3rd party auditing, we have not much more than “one more battle of the algorithms” and we all pay for that in our care for sure. This is part of what is driving up what we pay for care in the US. BD

NEW YORK, Nov 07, 2011 (BUSINESS WIRE) -- HMS

Holdings Corp. HMSY +17.91% ("HMS" or the "Company") today announced a definitive agreement to acquire privately held HealthDataInsights, Inc. ("HDI") for approximately $400 million. The transaction is not contingent upon financing and is expected to close by December 31, 2011, subject to regulatory approvals.

HDI, a technology-enabled healthcare services company whose mission is to ensure claims integrity, identifies and recoups improper payments for health plans and government payers. Applying rules approved by the Centers for Medicare & Medicaid Services (CMS) and commercial health plan clients to identify fraud, waste and abuse, HDI reviewed more than $300 billion in paid claims last year. HDI is the exclusive Medicare Recovery Audit Contractor (RAC) in 17 states and three U.S. territories (CMS Region D), covering approximately 22% of all Medicare claims in the nation. According to CMS's FY 2010 Report to Congress on the "Implementation of Recovery Auditing at the Centers for Medicare & Medicaid Services," HDI's efforts in Region D accounted for 47% of the total dollars corrected by all four Medicare RACs.

Lucia added, "We expect that HDI's assets will accelerate our multi-year strategy of investing in new but related products and markets, and program integrity in particular. As the Medicare RAC with the highest recoveries and highest accuracy scores, HDI has best-in-class processes and technology, purpose-built for recovery auditing. Like HMS, HDI's services are primarily offered on a contingency-fee basis. In addition to expanding our Medicare business, the acquisition of HDI will provide us with expertise we can leverage in our state Medicaid RAC business."

http://www.marketwatch.com/story/hms-holdings-corp-to-acquire-leading-medicare-recovery-audit-contractor-healthdatainsights-inc-for-400-million-2011-11-07

Technorati Tags: HMS Holdings,healthcare,medical billing,CMS,Medicare,Fraud,algorithms,software,HeatlhDataInsights,HDI

Yes there is greed with social algorithms and if you read the article in it’s entirely you can see that.  Sure some jobs come along but not enough as we are back in the “intangible” mode here.  A social network is not going to cure or treat you when you are sick and the biotech companies that are exploring and developing in that area are hurting.  Kind of makes one really stop and think as to what we see as being important today.  Sure social networks allow some great communication and so forth, but when intangibles (a bunch of algorithms that run on the web) surpass the value of medical cures and treatments, do you not think something is wrong with this picture? 

There were 13 IPOs this year in healthcare, and over all look at some of the other facts, many drugs being developed to extend life that are not affordable, drug shortages, and so on.  Health IT analytics are still being sold and marketed like crazy and we need such programs but it’s way over done and their potential clients, doctors and hospitals are having a difficult time affording many of the Health IT services, so what’s up with that?  Groupon had a $20 initial price, biotechs were between $4.00 at the low end to $19 for one at the high end with most averaging around $9.00 or $10.00.  This is both drugs and devices.  We read every day where big pharma is cutting back their research and development departments with layoffs so I guess they can all go look for a social network job somewhere?  Sad, when talent goes by the wayside. 

If you want to see something that I think is a bit whacked out, see where Urban Airship raises $15 million from Verizon and Salesforce.  Do we really need Urban Airship software when people are not getting their needed medications and devices?  It just points out where the imbalance is today.  Keep in mind these same companies are mulling over what type of healthcare benefits to provide employees, so as we saw the strike with Verizon over benefits, they seem to have plenty of money to throw around for airships.  Sure software has value but like this?  They are just one of many so not to pick on them in particular.  Mobile apps are on the rise and gosh we have a ton load of them in Healthcare that get little attention on the consumer side as there just are so many. 

Good Science, Investments and The Chase for Social Algorithms Has Become a Dangerous Mix-Healthcare and The Creation of Jobs Continue to Suffer

Good science has not caught up with the financial push

Also in the news today were some big corporations named that paid zero with income taxes for 3 years and Verizon was on the list, along with other such as Wells Fargo, need any more proof here?  I saw too where someone wrote an article that the IPO saved Groupon from bankruptcy and of course made many rich as it’s generating money. 

Life and Healthcare A Big Batch of Non Balanced Algorithms With Insufficient Intellectual Interpretations–Tax Breaks Maybe For Those Producing Tangibles Vs Formulas

In order to get jobs back we need as a country to produce something besides algorithms to base an economy on as we see it falling through the bottom here.  A big part of the problem too is having lawmakers who are so digitally illiterate that they can’t even begin to see this and thus so all the “Occupy” movements live and for good reason to speak out against such math and the imbalance of priorities today in the US.  They are non participants in this arena and are oblivious as to the impact with technology and the financial algorithms created that just continue to shift the money around to the 1%. It’s all about the math and those algorithms.  BD

Groupon raked in so much cash through its initial public offering last week that it could buy the entire class of life sciences companies that have gone public in 2011.

For those of you who aren’t following the Groupon melodrama, the Chicago-based online daily deals site raised $700 million last week in its IPO after overcoming serious questions about its accounting practices. Groupon shrugged that off and saw its stock (NASDAQ: GRPN) boom 31 percent on the first day of trading. TV news commentators cheered, just like when social networking site LinkedIn (NYSE: LKND) went public in May.

The biotech IPO market, by comparison, has been about as exciting as the average Seattle Mariners game was this year

http://www.xconomy.com/national/2011/11/07/groupon-the-ipo-with-more-sizzle-and-money-than-the-entire-biotech-ipo-class-of-2011/

Technorati Tags: algorithms,math,Groupon,healthcare,biotech,investors,Health IT,cures,treatments,technology,politics,digital illiteracy

Xarelto is normally prescribed as a blood thinner and now the FDA has given the stamp of approval to use for preventing strokes with patients that have irregular heart beats.  Warfarin has been the drug of choice for years that is hard to regulate and Xarelto also has a “black box” warning.  Bayer actually developed the drug along with J and J.  Speaking of Bayer it was on the net this week that Bayer DX was also laying off around 5% last week.  DX is a very different business model than straight pharma.  BD 

WASHINGTON — More than 2 million new U.S. patients will be eligible to receive a next-generation blood thinner drug called Xarelto, after the Food and Drug Administration approved the medication to treat a common heart problem that can lead to stroke.

Federal health officials approved the drug from Johnson & Johnson and Bayer to prevent strokes in patients with atrial fibrillation, a condition that causes the heart’s upper chambers beat chaotically and ineffectively. The irregular heartbeats can cause blood clots which travel to the brain, blocking blood flow and occasionally causing a stroke.

The FDA also added a restrictive "black box" to the drug's label, warning people against discontinuing use of Xarelto without consulting their doctors, as stopping abruptly may increase risk of stroke.

http://www.washingtonpost.com/business/fda-broadens-approval-of-jandjs-xarelto-for-patients-with-dangerous-irregular-heart-beats/2011/11/04/gIQArOtbmM_story.html

Technorati Tags: Xarelto,FDA,Johnson and Johnson,black box warnings,healthcare,drugs,pharma,strokes,blood clots,heart

Say What?  This was an interesting survey and if you read the entire context of the survey there’s a lot of good points made here about the public’s perception and of course all the recent security breaches we have in the news do not do much to gain more favor with consumers.  As the article points out, one can pick up a stack of files and charts and walk out the door with paper charts as well. 

Practice Fusion, who offers free medical records to physicians and is growing quickly did the survey.  The survey indicated that those in an age group of 50 and over were more likely to feel that paper records were more secure and also less distracting.  They could have a point on the distraction level though.   The survey also somewhat pokes at the fact that many consumers may not also be aware of the government push for electronic medical records.  The PHR is the bridge that fills the gaps with the patient having a copy of their records but those efforts have been slow to catch on.  I even a part of this blog with over 500 posts dedicated to PHRs too and promote them actively too. We all know the electronic chart is the future of healthcare but again this was an interesting view on how consumers as a whole, other than the folks who are technically advanced, see the electronic versus paper charts.  BD 

There's a bit of a gap between patients and doctors when it comes to electronic health records (EHRs). A new survey indicates that, by a slight margin, the majority of doctors think EHRs are safer than paper records. But more than half of all patients prefer paper. A closer look at the data can help explain the difference of opinion.

The recent omnibus survey by EHR vendor Practice Fusion was conducted by GfK Roper OmniTel. More than 1,000 patients were phone surveyed between Oct. 21 and 23, as were 1,220 medical professionals who were polled online with the same questions on Oct. 28

Of the physicians surveyed, 54% said they thought EHRs were safer. Only 18% selected paper as the more secure option. The remainder didn't answer or didn't know.

As for the patients surveyed, 47% said paper records are safer, with 39% saying digital records are more secure. The rest were unsure.

So, I think consumers are likely more "pure" in their responses. The answers from patients seem to reflect: 1) they're probably not all that aware of the push for U.S. healthcare providers to give up paper; 2) they haven't given too much thought about why digital records could be better than paper; and 3) they're probably a bit spooked about the possibility of having their own digital medical records hacked, lost, or snooped.

Of that same group of patients favoring paper, 87.2% said they think paper is more private and allows more control over who sees the records. Also of that same group, 86% said they think paper is more secure because it's less likely to be hacked or lost. Finally, nearly 65% of those paper-loving patients just prefer the tradition of paper over digital records and see no reason to change systems.

Fears about digitized health records aside, I think the patients' feelings about paper medical records seem to reflect two larger themes, one about U.S. culture and the other about human nature: Americans like tradition and people don't like change.

http://www.informationweek.com/news/healthcare/security-privacy/231902296

Technorati Tags: Medical Records,EHR,EMR,electronic records,doctors,patients,survey,privacy,healthcare,Health IT

The disc was encrypted but there was a reported piece of paper nearby missing too that contained the password.  If the password is there to use then the encryption may not mean much.  This reminds me of the story last year from the UK where a flash drive, which was also encrypted was stolen and the password was taped on the drive:)  If you take time to encrypt be careful where you leave a password laying around.  Nobody expects to be burglarized in their home though. 

The hospital was working to get their Epic medical record system installed and perhaps all was not done and ready yet to have access for all information from a VPN yet.  Back in January I interviewed one of their MDs who told me they were anxious to get the entire sign on done so all records would be accessed from one area.  BD 

If You Take the Time to Encrypt Medical Information – Don’t Tape the Passwords on the Container or Flash Drive – NHS Security Breach

The UCLA Health System is warning thousands of patients that their personal information was stolen and they are at risk of possible identity theft, officials said in a statement released Friday.

Officials don’t believe the information has been accessed or misused but are referring patients to a data security company if their name and credit are affected.

Altogether, 16,288 patients’ information was taken from the home of a physician whose house was burglarized on Sept. 6, according to the UCLA Health System.

The physician works for UCLA Faculty Practice Group, whose doctors see patients at the outpatient clinics and the four inpatient hospitals: Ronald Reagan UCLA Medical Center, Santa Monica UCLA Medical Center and Orthopedic Hospital, Mattel Children’s Hospital and Resnick Neuropsychiatric Hospital.

The data were on the physician’s external hard drive, officials said. Though the hard drive was encrypted, a piece of paper with the password was nearby and is also missing. The physician notified UCLA the next day and officials began identifying patients affected.

http://latimesblogs.latimes.com/lanow/2011/11/ucla-patient-identification-stolen.html

Technorati Tags: UCLA,hospital,medical reocrds,healthcare,HeatlhIT,doctors,clinic,encrypted,identify theft

Governor Brown signed a new law that is retro-active to June 1st, and the federal government approved, so does this mean hospitals and doctors will have to pay back payments they have already received?  I don’t see where this is going to allow greater access at all as many doctors will not see Medi-Cal patients already and this will make it worse.  For Medi-Cal patients who are under an HMO umbrella it’s even worse for compensation rates. 

The lawsuit also names Toby Douglas the department director in this area for HHS.  This gets stranger all the time as a law is passed and we have hospitals going broke or in the red all over the place.  What will be the future of Medi-Cal?  California is already at the bottom of the barrel when compared to what doctors and hospitals receive in other states from Medicaid.  When the Supreme Court rules on the Healthcare Law, which when it was created we had a different set of economic standards in place, they will need all the help they can get with compiling all the information they need, such as this lawsuit to be among one of the areas to be considered. 

Supreme Court Likely to Rule on Healthcare Law Early Next Year–This Gives The Justices Time to Rent Some Computing Space from the DOE As They Will Need It

With as complicated as things are today, I do wonder if there is really any judge that can truly get all the information together for an accurate ruling here.  BD

Healthcare Reform Law– Is Any Judge Fully Capable of A Decision on a Law That is Challenged By Constantly Changing Algorithms?

The trade group for California’s hospitals has sued state and federal officials to block a 10% cut in government reimbursements for healthcare providers who treat low-income patients.

The California Hospital Assn. said in its suit, filed in federal district court in Los Angeles, that cuts to the Medi-Cal insurance program will threaten the ability of many hospitals to continue operating skilled nursing facilities.

Patients, particularly those in rural communities and other medically underserved areas, will likely face delays or gaps in healthcare services, the lawsuit contends.

Other medical providers also have warned that cuts to the program, which is funded by state and federal governments, would deprive low-income patients of access to care. Among those targeted for the cuts are physicians, pharmacists and optometrists.

http://latimesblogs.latimes.com/money_co/2011/11/state-hospital-group-sues-over-cuts-to-medi-cal-program.html?utm_source=dlvr.it&utm_medium=twitter&dlvrit=71041

Technorati Tags: CMA,lawsuit,healthcare,physicians,doctors,hospitals,government,pay cuts,Governor Brown,Obama,California

Wellness started out to be a good thing, but here we have our old friend the Marketer just wreaking havoc with presentation with employees.  In addition, many wellness programs are owned by insurance companies.  We all know we live in the age of data and analytics and do the various division share data?  Here’s a couple past posts from the Quack in my archives I searched out. 

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

Humana To Purchase Concentra Wellness In Texas Offering Coupons and An Entire Portfolio of Health Programs and Clinics

We don’t know for sure but heck we read tons of these announcements with various companies sharing data so only the algorithms know for sure what is being share and analyzed.  The last line here in this article says some companies limit short term disability for those employees with chronic conditions…yup you are screwed there as how many of us have what is called a “chronic condition” at least half of us as it doesn’t take much anymore with coding etc. to fall into that category.

The algorithms run, pick up that bit of data and bingo, you are limited.  It’s all about those algos running on servers 24/7 that make these decisions. 

Nobody seems to value the consumer time we have today and thinks that we have nothing better to do than learn tons and tons of new software systems but there are some that are working to make it easy to “dumb down” and get your information with games…insults my intelligence and glad I don’t have to “dumb down” in this fashion.

Health Insurer Humana Introduces a New Game Called FamScape–Making It Fun to Get And Maybe Mine Your Data?

Actually I made a post not too long ago about these insurers games…would you see Ben Bernanke “dumb down” to do this?  Of course not but the marketers want to suck you in and keep you bliss and oblivious.  Heck the developers writing this stuff just want to become millionaires and if you were to ask most of them they wouldn’t use their own software as it’s a job and they want to get rich:)  That’s the problem with all of this is that it is always “for those guys over there”…folks at the top can’t stoop to this level but “let’s see who we can market and drag in here":)

Insurer Software Games Continue to “Dumb Down” Consumers–Would You See Bernanke, the President, CEOs and Other Executives Playing an Online Insurance Game–No, Part of the Focus Of Occupy Wall Street Frustrations

Actually I borrowed the phrase “dumb down” from an executive at Homeland Security as he says too that’s what is going on. 

Not every employer is playing this game though, thank goodness but some are and interestingly enough, when it comes to the analytics used by employers wouldn’t you just know it’s another subsidiary of an insurance company there ready to sell them some additional software so we go back in a little different fashion here once again to the “Attack of the Killer Algorithms”. This is all about math and algorithms and the parameters your little body has to meet when stuffed constantly into data tables…my fanny hurts from being stuffed and bit so many times with all these algorithms and their parameters <grin>. 

In the meantime though we also have this “silly” situation with HHS running a Facebook contest…what the heck?  This is what you get today when you have figure heads without any Health IT hands on background, they don’t which end is up ether but can be controlled very easily by those who do and those who do code as they market our government executives and they think they are doing a good thing and later it will come back as chewing on their butts too.  Who sold this bill of goods to HHS?  Next thing we will have an act of Congress to determine what a disaster is…is a riot a disaster?  If so, I would not recommend a Facebook application there by all means, remember the UK?  <grin>. 

HHS Seems To Be Confused on Social Networks–Facebook for Disaster Support Contest, Give Me a Break Use Twitter Like Everyone Else Does

Somebody around the internet has to make this statement so I guess it’s me with looking at reality and trying to maintain some sanity with all the marketing and misuse of data today.  You have to give people REALISTIC goals and the digital illiterates that work with numbers all day are not capable of doing this, why?  It’s not for them, “it’s for those guys over there” and they never put themselves in someone else's shoes and just drive to make a million.  You can read more of this on my 4 posts about the “Attack of the Killer Algorithms” at the links below, see what you think, as these algos with parameters too high and the digital illiterates that think we can somehow have all the time to do all of this are out of their minds. 

We would love to work with incentives that are created by people and companies that are realistic and not just there to drive consumers nuts just for corporate profits…Occupy Wall Street initiative here and I sure wish some members of the press would educate themselves too and stop the articles about not knowing why they are there.  The series I wrote will answer a lot of questions below and shoot even some of the Occupy folks might want to read too as they may not get it all, but they do know things are not right and are following a lot of gut feelings and expressing their thoughts on “Discrimination by the Algorithms ”.  BD 

Also check out what Wendell Potter has to say too, he worked in the industry for years so if what I have said doesn’t make sense, read what he wrote today…

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Killer Algorithms Part 1

Killer Algorithms: Part 2

Killer Algorithms  Part 3

Killer Algorithms Part 4

---

Maybe you’re not aiming to live to 150 like Chris Traeger, the health nut city manager played by Rob Lowe on NBC’s Parks & Recreation, but if your employer offers a wellness program at work there’s good reason to pay attention. In an attempt to get employees to sign up and live healthier, more employers are imposing financial penalties on employees who say “No thanks.” It’s just another thing to worry about during open enrollment season (usually November) when employees choose workplace benefits for the upcoming calendar year.

The use of wellness penalties by employers more than doubled from 2009 to 2011, rising from 8% to 19% of employers, and is expected to double again by 2012, when 38% of employers expect to have penalties in place, according to Towers Watson’s 2011/2012 Staying@Work Report. Why are employers socking it to employees? They’re desperate for ways to reduce health care costs, and they’ve found that financial incentives go only so far in motivating employees. “When it’s a penalty, it increases changes to people’s behavior,” Wolff says. “People hate to lose more than they like to gain.” (The report is based on a survey of 335 mid- to large-employers in the U.S. and Canada with a total of 7.8 million employees.)

Yet even with incentives participation rates are underwhelming, meaning employees are leaving cash on the table. Average participation in completing health risk assessments is 46% with incentives versus 19% without. Average participation in biometric screenings is 45% with incentives and 25% without. More lucrative incentives are often offered for signing up for disease management programs, but average participation rates are low at just 14% if no incentives are offered, rising to just 16% with incentives.

http://www.forbes.com/sites/ashleaebeling/2011/11/02/employers-ramp-up-wellness-penalties/

Technorati Tags: Wellness,employers,incentives,healthcare,Health IT,software,human resources,data,privacy,editorial

I have been wanting to address this for a while and yet we have one more contest to entice consumers to use an application to improve their health.  What is really funny about these contests is that almost none of the folks who write them will ever use it themselves, in other words nobody will eat their own dog food here and developer want to make a few bucks.  We also have the other side with the naïve folks that think apps cure all evils and they don’t.

If we had consumers that were motivated and had information that was not flawed or skewed with marketing maybe this wouldn’t be so bad, but geez, nobody gets this.  When it comes time to create a simple personal health record, which I think is great, nothing wrong there as all to have life saving information and a simple history to help the doctors treating you.  The absolute basics are allergies and medications for starters and then additional information from there is great, like past surgeries, illnesses, etc.  That information is helpful all the way around.

Now here’s where all of this becomes work.  You have services that bring in your medical claims and make that information available and guess what, we have errors and the consumer today should not be responsible to do all the extensive leg work to fix all of this.  This is one big reason why consumers don’t want to mess with it at all.  When you have flawed data in claims going back 20 years or so and you have to fix it that’s a lot of work so insurers can have “perfect” history data files on you. 

The next step is their analytics and there’s some good that comes from some of it as it is not all bad, but when some of the new areas of predictive behavior comes in and you are scored and assessed with an algorithm that is only 60% correct and it is take down to an individual level, we have a problem. This is “flawed data discrimination and it’s happening all over.  We thought we were done with that years ago, right…wrong…same crap just done by the numbers today.  If you want to take numbers and crunch them to run reports, fine as we see those all the time, but again when refined down to a personal level with who knows what type of algorithm, we have problems. I can understand there has to be some filtering but today we have companies with business analytics that have it down to some very specific parameters of which some are needed but some are not needed. 

This is what is happening today and the reasons for the madness and frustration.  We don’t get the “whole truth” and are judged “on the curve” and when you are talking healthcare and money, “that curve is not good enough” for consumers or anyone; however “curves” lead to profit and that’s the issue. Here’s a good example of WellPoint giving you some new web algorithms so you can “fix yourself” and God forbid some of these mistakes get into the MIB as you may be screwed for life if they don’t fix it as all insurers take those records as gospel.  I know a couple of people who cannot get insurance as they can’t get their files corrected at the MIB and their doctors are dead who would normally help them so they are screwed. 

WellPoint Puts More Algorithms Online So You Can Go Fix Yourself and Understand What a Grandfather Is

Take someone looking for a job that doesn’t have their resume that is in the exact format to get through the “job application algorithms”.  If nobody adjusts it to make it through, they end up in the endless circle of resumes that go nowhere.  You still need a human in this process and an algorithm cannot do the entire process.  I’m sure some of the folks in the Occupy Wall Street group have been through this scenario.  A human never gets to see it and the applicant never gets to talk to a human.  You cannot believe all the reports you see today as marketing has come in to spin the numbers.  We are too trusting and still think that math will prove accuracy 100%, it does not.  This is called computer coding and one can write for “accurate” results or “desired” results and the 2 are not always the same. 

When you get your insurance claim denied, chances are the algorithm did it as it looks at data only, not a human and they run 24/7 on servers all the time.  This is a good place to put the trailer again for Sicko and look again.  The woman in the ambulance example was a great example of an algorithm that denied payment.  As she says when was she supposed to approve it…algorithm doesn’t know but data was lacking…algorithm says claim denied. 

Sick Trailer

There’s another part in the movie to where a woman’s money was rescinded on a claim already paid..why…algorithm says you forgot to include reporting a yeast infection you had several years ago! It’s the algorithms folks.  If their data is not flawed or contains errors, then how come this happens…automated mailings and somehow the envelope stuffer algo had a problem that day.  Things like this happen but if there’s information in your file you have to prove them wrong, even though you entered none of the data they are looking at. 

Rogue Algorithm Strikes Coventry Healthcare in Missouri-EOB Statements Sent to the Wrong Patients-Fried Data or Wrong SQL?

Let’s take a look outside of healthcare for a moment…how about this Quant on Wall Street who for 3 years used flawed software with clients…and knew it…and didn’t fix it…I figured he/she had to be somewhat flagrant for the SEC to make this catch. 

SEC Sues Quant–Undisclosed Error in Trading Algorithm- Miscalculating “Risk”-Healthcare Software Evaluates This Factor Too

Let’s come back around to the MIB who has been collecting information about us for years, before there were computers.  They used to do just that but with modern times and marketing, guess what, they sell too and now records contain more than just healthcare information.

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

Here’s a screenshot from one of their web pages and guess what the “problem applications” are…it’s us…we are problems in their eyes if we don’t match the exact parameters.  Does this not make you feel real good to know that when you apply for insurance or their services are used for any reason that just going in the door that “we are potential problems”.  It’s pretty disgusting but that’s how the analytics sales folks make their pitch. 

Now I like analytics and how smart it can make us too, but I can also see when they are abused.  Again we have people out there that think a set of algorithms can solve everything for decision making…not. 

Well now that you have been given your claim information with errors possibly, we have other folks now writing software to help you work with it. Are consumers jumping on the bandwagon to learn yet more software to fix errors and get into the confusing pricing of healthcare….nope.  Do I even have any interest myself in doing this…nope…and I deal with and learn a lot of software. Does this grab my attention…nope.  Well I guess I’m like every other consumer out there that says give me some value and this stuff isn’t doing it. 

Let’s go a little further, would you venture to see HHS Secretary Sibelius using such software…I would love to be wrong but I don’t think she would touch it at all as she is very busy like the rest of us and who has time!!  It’s always for “those guys over there” and the software developers just want to make a buck.  Doctors have had this battle longer than we have as consumers with flawed data and all the “rating” web sites and their flawed data.  I jus wrote another chapter on that flawed data today.  When I found my former MD who had been dead for 8 years still listed and taking new patients…Houston we have a problem. 

HealthGrades to Merge with CPM Marketing–Will Their Data and Questionable Algorithms Will Be Improved For Consumers?

Sometimes we struggle to get insurance and boy does it not make us mad to see wasted money with situations like the City of Buffalo who didn’t keep their algorithms going in the right direction and paid out $2 million on deal employees with insurance premiums.  But when it comes back to the consumer…nope you wrong as we have our data and we are right…just because it’s on the computer screen does not make it accurate. 

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 going to pitch my favorite mathematician/professor again from NYU and if you have not heard this radio interview, do it.  He’s right with flawed data and marketing and once you listen up you may not be as gullible next time someone throws numbers and reports in your face, and oh by the way, read his book too if you can.

“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government

So when it comes to Occupy Wall Street, how do those folks fight this battle?   How do we all fight it?  You can’t see those algorithms, you can’t touch them and most of the time you can’t talk to them so what do you do…it’s frustration at the highest level.  So this is the movement on their part, how do they address this?  They belong on Wall Street as Washington is too digitally illiterate to realize they need greater technologies to make laws and get their data sorted for them.  I have several posts around this blog about the Congressional lack of digital literacy.  Here’s one flaming example… as we just talked about all that flawed data we have in our health information going back years…these two folks think this should all be put out on the web and as taxpayers we should pay millions to have this done?   They think money grows on trees for IT infrastructure project.  Law enforcement should have access but this shows 2 really bad digitally illiterates with these 2 senators. 

Two More Senators Propose More Bills to Publish Medicare Claims Data Without A Hint of Digital Literacy Relative to Cost and Time

So what do you do when you have algorithms at one end and digital illiteracy at the other that can’t make laws!  You go sit on Wall Street where all the code was written that re-arranged the money in this country and the world.  I get a kick out of journalists that don’t get this and I guess there’s some more digital illiteracy or maybe putting the OMG ratings in front of good reporting so they can keep their jobs. 

There has to be some level of forgiveness with the parameters of how the algorithms run, otherwise we have ethics problems and they are everywhere you turn today.  At the Los Angeles CareNow Free Clinic, he summed it up well seeing a woman with advanced breast cancer who did not have insurance and perhaps it could have been caught earlier.  By the way he had to be there as a “consultant” as the California medical board could not get their “algorithms” together to allow doctors from out of state to volunteer. 

Dr. Oz Says “Enough is Enough” As He Volunteered at the CareNow Free Clinic In Los Angeles “Failure of Basic Morality in the US”

This system of algorithms for care is not working and the Occupy Wall Street folks are right on the money with the healthcare side of this and we all hate it.  We don’t care if insurers are making profits for shareholders and it’s almost time that President Obama pull a “Roosevelt” as in at the end of World War II to where Schering was so corrupt that the US government took over all their US assets.  It’s drastic but where else are we headed with all of this…can someone give me a better answer as we are constantly uncovering inconsistencies with mathematical formulas today and nobody is minding the shop? 

Back in August of 2009 I made a post about needing a US Department of Algorithms to ensure everybody’s math was correct and maybe that time has come.  I have sure had a lot of folks agree on that topic as with the complex sophisticated systems we have today, nobody knows when accuracy leaves off and marketing comes in to sell us a bill of goods. 

If you listen to the President of late, he says the the same thing “its in the math”, so how do the folks at the Occupy movement take a solid stand, other than the fact that as humans we all know something is not right and it’s time to ask questions and get answers on how the math moves all the money around to create the 99% and 1% groups we have today. 

If you want to give consumers something of value with healthcare, get those bar codes out there so we can find recalls with an app and either save a life or prevent illness when recalls occur and stop the insanity of trying to fix all of us with an app that we and the folks who also develop the app are not going to use.

Healthcare Bar Code Posts

Below is an article I wrote where a man died implanted with a device that was not pulled and used in surgery and it failed.  I call this a good app that will have consumer interests and is not one of “its for those guys over there” apps.  Stop with the insanity of apps that have little or no value and save some money.  Parts 1, 2 and 3 of the “Attack” are listed below.  We have folks that don’t listen to consumers when it comes to consumer IT.  If you start with something that has value for consumers other apps will follow and this is the ticket.  BD 

Micro-Cap FDA Recalls Never End

The Robert Wood Johnson Foundation (RWJF) has announced a $100,000 contest for a health IT application that will help consumers use published quality data to choose among physician groups and hospitals in 16 areas around the country.

These 16 communities--ranging in size from rural counties to metropolitan areas to whole states such as Maine, Minnesota, and Wisconsin--have all been involved in RWJF's Aligning Forces for Quality program since 2006. The 10-year, $300 million initiative focuses on improving the quality and reducing the cost of healthcare. An important facet of the program is the public reporting of data on the cost and quality of individual hospitals and medical practices (but not individual physicians)

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Occupying Wall Street–It’s All About the “Attack of the Killer Algorithms”–The Unfair and Marketing Exploit of Ethics Using Math–This Could be a Subject for Michael Moore to Explore and Document In a Movie

“Killer Algorithms: Part 2” Disturbing News for Consumers With Credit Scoring Adding New Data Analytics–Some of the Same Methodologies Used by Insurers With Flawed/Potential Erroneous Data–One More Reason to Continue Occupying Wall Street

“Attack of the Killer Algorithms” Part 3–Vatican Doesn’t Like It Either–Occupy Wall Street Belongs in New York As They Don’t Do Code or Algorithms in Washington–Only Find time To Talk Abortions

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http://www.informationweek.com/news/healthcare/patient/231902101?cid=InformationWeek-Twitter

Technorati Tags: Proofiness,algoirthms,mathmatics,healthcare,desired results,rogue algorithm,Occupy New York,politics,math,ditigal literacy,Congress,credit,Michael Moore,CoreLogic,Vatican,health insurance

This is a wild image and yes you can see the face:)  I hope the man really was not screaming and that all was ok.  The image has been named “the face of testicular pain.  I can imagine this image jumping out as being unique when looking at a number of scans for sure.  BD  

http://www.theglobeandmail.com/news/national/doctors-see-screaming-man-in-testicular-ultrasound/article2222541/

Technorati Tags: Dicom,images,ultrasound,testicular,hospital,Canada,healthcare HealthIT

One thing I can say for sure with the daisy chain of subsidiaries the company has going today with assorted Health IT and other companies, no wonder they needed an expert in the legal area here. I thought with such a large mixture of different types of companies that they had to have some good anti trust attorneys on staff as this stuff gets very complicated today when you look at potential conflicts of interest and having sufficient competition in various business markets. 

You almost can’t find any entity of healthcare not providing a few pennies to United’s bottom line, even the VA with Picis who was doing business before the acquisition now contributes to the United bottom line.  That is just one example.  The General counsel announcement was made today at the website called “Main Justice”.  They have this big lawsuit against Tri-Care ongoing so I don’t know if this will be in the area of general counsel for him to handle.

Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?

One example of diversity is the purchase of HMOs and IPA groups and we had one big acquisition in the OC from United a short while back.  Crying towels were out as all kind of suspect that this may mean lower compensation for MDs but time will tell as things move forward and I would guess this is about 20% of the HMO business in Orange County.  Don’t quote me but that is a guess only as Monarch is huge.

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

In addition with so many various entities owned under one conglomerate we now have one division that could cut compensation and then rush in with another division let’s say in the IT area to sell analytics solutions to help them keep what business they have.

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

For some of those analytics entities they own patents too on the software and when we hear patents well we all think cost today. 

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

Pharmacists at Walgreens in some areas can benefit from pay for performance effort with signing consumers up to the YMCA and perhaps other programs under the partnership.  Perhaps will we be seeing more “retail” locations in other areas soon? 

UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P for Walgreens

At any rate you can read the full details who knows maybe those “cheap” hearing aids will make their way into the stores along with branch locations for their bank for HSA accounts? 

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

In some areas if you sign up for one of the United insurance programs, you basically get a hearing aid for free, which is distributed through yet one of more of their subsidiaries with being a zero co-pay. 

UnitedHealthCare Throws in Free Hearing Aids for Those Who Enroll In AARP Medicare Advantage, HMO & POS Plans in Miami-Dade County From Their New Subsidiary

They are offering an online hearing test which may or may not be the best thing but it’s there. For United customers with Medicare Managed care and drug plans there will be no out of pocket expense and of course when taking a hearing test on line all that is documented and stored so the company can store it and use to tune the device. HiHealthInnovations is a newly formed subsidiary.

United HealthCare Gets In the Medical Device Business–Distributing Cheap Hearing Aides Sold Via Hi HealthInnovations Division –Subsidiary Watch

The hearing aids eventually are designated to show up at WalMart at some point in time to be purchased there as well.  I believe some of the action started here with buying China Gate which works to bring more Chinese drugs and medical devices to the US and world wide and already has a line of communication with the FDA. 

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

If you are not under their plan the device cost will have a co-pay of $649.  This is interesting as I wonder how this works with other insurers as well because every time one is sold outside of the United clients they make money.  They make money all the way around with being a supplier on who ever gets one, plus they have full control of their reimbursement. 

Here’s the division of United that was at AdvaMed this year looking to partner with companies needing to bring a drug or device to market so you can see in just the few short paragraphs here, theoretically  the company could handle everything from initiating a filing with the FDA all the way down to what the doctor gets reimbursed for prescribing…sound like some kind of price controls?  You be the judge. 

United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch

So in summary is this why the new General Counsel is there?  It’s just a question to ponder and wonder about with all the diversity happening here and competition with other companies too.  Perhaps soon they will have all of their products in retail stores to cover everything from buying a policy to getting a hearing aid before you walk out the door from the consumer side.  From the business side, how do or will other companies compete?  Will they be buying up small biotechs and device companies next as they already put the new subsidiary in place for hearing aids so what’s next?  BD 

NEW YORK--(EON: Enhanced Online News)--UnitedHealthcare today opened its first comprehensive health benefits store in the nation at 136-02 Roosevelt Ave. in Flushing.

With a focus on serving the Asian-American community, the new UnitedHealthcare Asian Plaza in Queens will provide residents with information and customer service on a variety of UnitedHealthcare benefits programs as well as health and wellness services and free public health education programs.

The 16,000-square-foot consumer-support center gives UnitedHealthcare employer-sponsored, Medicare, Medicaid and individual health plan participants access to customer service professionals who can answer questions in their native language about health care benefits, assist in resolving claims issues, and help with other health insurance-related matters.

Computers and iPads are available for visitors’ use to obtain and print health-related information, and a “health screening kiosk” measures blood pressure, pulse and body mass index (BMI) – all important indicators that help people better understand their health status. UnitedHealthcare also will host an ongoing series of education seminars, which are free to the public. Topics include nutrition and exercise, disease management and financial planning.

In 2009 UnitedHealthcare opened its Alhambra, Calif., storefront to serve as a trusted one-stop shop for culturally and linguistically appropriate health care information and services for Chinese-American Medicare beneficiaries in the community.  Most recently, the company opened a walk-in center for Long Island Medicaid members in Hempstead, N.Y., as well as a temporary pop-up store in Kingston, Tenn., to help eligible individuals select Medicare health care benefits during the annual enrollment period, which ends Dec. 7.

Technorati Tags: United Heatlhcare,health insurance,legal,corporate offices,Queens,wellness,sales,customer service,education,Medicare,Medicaid,Claims,HealthIT

If you are a regular reader here then you know I look for accuracy with data and gee sometimes you wonder, where is it?  With all data being connected today, it’s easy to blame shift and say “well I’m just using their data” which must be flawed.  That is all over healthcare today, like or not, it is what it is.  It’s not easy updating data and it takes time and costs money.  The latter is more than likely the true focus here on how often information is updated.  Back in May of this year the company said it identified it’s own flaws…more at the link below. 

HealthGrades 'Best Hospital' List Algorithm Needs Work Again - Flawed Data

If you want to dig back you can see where I originally found my former deceased doctor who had been dead for 8 years still listed on their site and the fact that she honored HealthNet.  I know they have fixed some of this since this was a hot topic with accuracy and I even had the AMA interview me about it.  How can that be, dead for 8 years and still listed?  Yup that goes back to updating information.  The New York Times had a similar business and they sold it and got out of it, again it’s a lot of work, time and money to provide real time consumer information that is accurate.  My original post came at a time when HealthGrades was being sold to a private equity firm and being taken off the market for trading so I’m sure I was not real popular with my post:)

HealthGrades And Other MD Rating and Referral Sites List “Dead Doctors” on Their MD Information Pages And Even Include the Insurance Plans the “Dead Doctors” Honor

HealthGrades is not the only one with flawed data as I found a few more, again all using the same sources of flawed data will result in more end user flawed data out there until someone along the line updates it.  You can read the comments at the link below as I had some great doctors look themselves and their medical groups up to see what was out there, we found dead doctors, some listed at hospitals where they had never set foot in and so on. 

Avvo Physician Rating Service Can’t Get Accurate Information Listed on Doctors - One OC Oncologist Sitting in Jail for Fraud

We have the Social Security Death Index which is a great tool and even it has some flaws with around 30k in there who are still living, but still is a good resource except for those folks who I’m sure would like to be out of there.

Social Security Master Death Index Data Flawed–Over 31,000 Living Found in the Index

We also have errors too made by governments, like the City of Buffalo that didn’t check their record and update them, so again paying out over $2 million in insurance premiums on “dead” employees too? It happened and the insurers may not have been too anxious to find this error either as this was just pure profit, dead people don’t file claims:)

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

Now let’s add a little more insanity here and get the Medicare Claim data that is flawed to the hilt with years of data input and really mess things up?  This is actually a case of digital illiteracy with law makers in not understanding all of this and you know just because it exists does not mean it maybe useful.  Some don’t get this and Dow Jones saw it as an opportunity for some company to take on this massive project to clean it up and make some big bucks on the government’s tab too, so what the heck?  You have to stop and ask the question, “is there value in doing this and secondly, would it be used properly or serve just to confuse and exploit more flawed data”.  Law enforcement needs it by all means and so does HHS to analyze, but to make a case to throw this out to the public is a bit stupid in my opinion. 

Two More Senators Propose More Bills to Publish Medicare Claims Data Without A Hint of Digital Literacy Relative to Cost and Time

Weill CPM dive into getting more accurate data out there with this endeavor?  I guess time will tell when we see the changes made.  I just hope this is not yet one more marketing area to “cloud” issues for consumers and doctors.  The answer too is not to have doctors take their valuable time to chase down what others put on the web to correct as well.  Consumers are now getting a taste of this too and we don’t like it and there will be more on a later post on that forefront. 

Actually take this from a higher source than me, NYU professor Siefe who is a mathematician and a journalists.  Numbers don’t lie but people do and he does a very good job in making you think when it comes around to all the stats and reports that are tossed in our faces every day.  One more popular post from the archives at the Quack below:)

Why Is Almost Everyone In Healthcare Marketing Their “Ass” Off

When you use algorithmic formulas today, guess what, you can make the numbers lie if you want to.  I used to write code, good honest code but there are those who spin it out there too, so be aware as straight math is no long a 100% methodology that can be used anymore to prove accuracy.  Don’t feel bad, the government get sucked in too as we are sometimes just way to trusting as that’s how we have been wired for years, but times are a changing.  The link below has an audio of a radio show that will definitely cue you right in to think about asking questions when your inner sense tells you something is odd.  There’s also a stellar video about how algorithms are shaping our lives, again not to be missed.  

“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government

So time will tell if we get better data and fewer skewed or marketing algorithms here for better consumer tools I guess.  If you don’t believe it today, ask is my word of advice and do some alternative research.  BD 

HealthGrades has signed a definitive agreement to merge with CPM Marketing Group, a Madison, Wis.-based provider of customer relationship-management services for hospitals.

"Hospitals are under increasing pressure to improve their clinical as well as financial performance," HealthGrades CEO Kerry Hicks said in a news release. "CPM is the relationship management platform hospitals trust to measurably improve the performance of their patient health management and physician alignment initiatives.”
The combined company will retain the HealthGrades name and headquarters in Denver. CPM's products and services will be merged into a business unit with an existing HealthGrades product, the spokeswoman said

http://www.modernhealthcare.com/article/20111102/NEWS/311029957?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMZmFWZjBERWxiNUtpQzMyWmFxNTM0WUpibW0=#

Technorati Tags: HealthGrades,data bases,health insurance,human resources,tech denial,infrastrucure,lazy,employer insurance,CPM