The Tri-Care contract situation if you have followed it for the last couple of years has been interesting. Tri-Care has 3 regions and all 3 were contested on the initial awards and sent back out for bids again. I have a hard time keeping up with it as this is the battle of the big insurers here. The latest is the website from Tri-West, who was the incumbent who had serviced the military for a long time and recently lost the contract to United. United sued the DOD so did this have any impact? Who knows as I’m sure the costs of a full on lawsuit were in someone’s business intelligence analytics to project the time and money would estimate to come out to.
United Healthcare Secures Tri-Care Military Defense Contract for Western USA Presently Handled by Blue Cross Contractor TriWest
Humana Keeps Tricare In The South And Back in May of 2010 HealthNet Was Able to Keep the Northeast-Both Companies Filed Appeals
You can read below and see where Tri-West said their contracted rates were lower and I kind of summed it up in an opinion piece, “my algorithms are better than yours”..it is what it is with contracts today and the “sale” of analytics to prove their points. They all do it but United is so huge with tons of subsidiaries that nobody even thinks about. I have written about many of them and you can so a search here with the words “subsidiary watch” and find a big selection of blog posts. In southern California and in other areas too United is buying up physician’s group at speeds that seem to outpace the other insurers, and big ones too.
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?
If you were to break down and really look at all the subsidiaries under the United corporate blanket they almost have a company that could handle everything from introducing a drug to the FDA all the way down to physician/hospital reimbursement.
United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch
UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally
Will politics and lobbying enter the picture here, seems it’s everywhere else so keep your eyes open. One other little tidbit worth mentioning is the fact that they hired the former US Attorney General in Minnesota to work as general counsel a few months ago and then a couple weeks ago the executive at HHS who was credited with creating most of the healthcare reform laws left and went to United…some of this stuff just makes you go hmmmmm…doesn’t it. You can’t help but think that when one crosses over from government over to the private area, now more than ever with everyone looking at every cent you can’t but think “find the loopholes” might have a bit of impact. Former government employees could make for good corporate lobbyists in this area, you think? What else are they going to do over there, I’m open for any other input on this topic.
US Health Insurance Regulator Leaving to Take a Job at UnitedHealth Care As Vice President of the Optum Division – Moving to the “For Profit Side” With Business Intelligence Algorithm Dollars To Review
Meanwhile back at the ranch HHS director Sebelius is still looking for tech to save the day and fiddling around with social networks, while United looks for tech to take care of the shareholders.
Another United subsidiary was discussed on the web recently, Golden Rule Insurance company (one I have previously missed with subsidiary watch posts) being a “poster child” for price gouging with the medical loss ratios where it owes money in 25 states and they owe more money than any other insurer
It’s all in how “those algorithms” figure the pricing and analytics today. It looks like United threw Palmetto a bone here too as they probably need their services for at least a while until they figure out how to buy them or put in their own payment services. Palmetto is also a subsidiary of the Blue Cross Tri-West Group.
United HealthCare Awards Contract to One Blue Cross/Blue Shield Subsidiary to Process Tri-Care Claims While The Other BlueCross BlueShield Company Lost the Over All Tri-Care Bid To United In the West
So if you want to help Tri-West, the subsidiary of Blue Cross keep the contract you can visit the site and read up and see what’s going on at the website. The contract has over $20 billion in revenue at stake. Tri-West says the data was flawed and he might have a point there as I talk about flawed data at this blog all the time as it’s growing. Take a look at my series called “The Attack of the Killer Algorithms” for some real life examples. BD
Attack of the Killer Algorithms–Digest & Links for 35 Chapters–on How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 6-24-2012