Maybe the timing of this article wasn’t too good:)  They are still hanging on to their pay for performance model it appears but patient demographics skew some of those numbers for doctors too and kind of in a weird way encourages doctor t cherry pick patients, which fortunately irritates them as that’s not their business, as thank goodness they are way to “human” for that, and that was a compliment.  I do understand everyone looking at ways to save money of course and who is not in healthcare today.  If you read this though with doctors taking a cut with the plan in Minnesota they have to work to get back to 100% of their income and this is based on pay for performance. 

The crap on the study of $1 trillion can be saved here, hogwash as nobody can say that as the world changes like daily anymore and just when you think you have cost nailed down in one area, another pops up so don’t be suckered in to numbers tossed out as such.  There may be some new life saving devices get approved or again it’s unexpected so PR press releases containing such are trying to suck you in to a little fiction here.  We all know and have seen the videos and the news from United with the CEO stating “….

UnitedHealthCare CEO – “Our Shareholders Will Prosper”

“Stephen Hemsley, the CEO of UnitedHealth, is not intimidated. "Leading companies take advantage of disruptive change in the marketplace," he told reporters recently. "Our shareholders will prosper."

Kind of strange to not see the world patient or doctor in there? 

Insuring people makes up at last I read less than half of their revenue but that with recent enrollments could have changed a little.  They make money with their managing care for HMOs and governments and with their Optum (family of algorithm and business formulas) division.  If you look around though with all the subsidiaries, which I have lost track of as there so so many, they get a chunk out of almost every area of healthcare.  Here they started a clearing house too with Epic Medical records, right in pushing, the clearinghouse a new subsidiary that will compete with smaller such companies until they maybe gobble them up.  They see Epic winning medical record contracts and here they are getting ready to get a share of that too.  Even the VA pays them for and they do follow the money, Picis, another subsidiary.  So they are there at the VA when you go under for surgery at the VA as Picis is anesthesia record keeping software.   This must really big for them as they created a new subsidiary to do this.   

OptumInsight (A Wholly Owned Subsidiary of United HealthCare Optum Division) Creates Medical Clearinghouse Integrated With Epic Practice Management Software-Subsidiary Watch

One thing that surprises me too is that how did they get away with hiring as a major VP, the man credited with writing most of the healthcare law?  I am kind of surprised that none of the other insurers called foul play on that one unless there’s some potential collusion here where others benefit?  I have seen drama over less but back when I was in sales a competitor would pay big time to get a sales rep as they want to pick your brain and there’s nothing different in this respect either as they all want to know about the other side, same reason attorneys leave the government and go defend criminals. 

Larsen’s position made him one of the country’s most powerful regulators of the health insurance industry


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

This wouldn’t be the first time though that other carriers benefited from some of the analytic work done by United or one of their subsidiaries though as we can go back to the 15 years and the legal case the where the AMA settled of short payments to doctors and patients.  Other insurers licensed the technology on the data base and paid to do so and they short paid claims too. I remember a while back doing a story on HealthNet to where they were boxed into a corner and announced that they were paying claims at around 15% higher to accommodate the low ball payments on out of network charge.  With all the analytics they sell and develop I would imagine their “quant” payroll has to be up there a bit.   On the out of network there’s still all kinds of lawsuits out there unsettled with insurers besides United as they too paid short by licensing the data base and formulas that Cuomo found to not be accurate…keep an eye out on those algorithms and queries I always say.

AMA Announces Doctors And Patients Can Expect To See the UnitedHealthCare/Ingenix Class Action Settlement Checks In the Mail Soon - Out of Network Short Payments–Attack of the Killer Algorithms Chapter 19

A couple other examples..they are bank with over a billion on deposit…

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

They can help a drug company or device company get their product introduced to the FDA and consult on many levels there…

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

So when you contrast the above with news like this, what do you think?  How does this fit with the headlines on this post?  They might offer doctors a few bucks for their practice?  For the one below it’s too late but United is going to lower that doctor pay, remember?  Who writes these press releases by the way?

Doctors Going Broke–You Can’t Even Give a Practice Away–Only Folks Buying Them Are Hospitals and Insurance Companies As It Relates to Reimbursement and/or Profits

Cardiology Doctor Closes Office – Access for Patients to Records Resolved – Practice Ran Out of Money To Keep the Doors Open


In the OC where I’m at we had several big IPA bought by United, right where ones who make a profit are located. 

United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County

We had a little bit of hope here with Richard Cordray but again if he’s not a math and formula guy who can keep up with corporate quants, we’ re screwed. I’m actually glad that we may finally have a shot at getting someone in at the SEC who may have a little computer science in their background as the current person like Mary Shapiro will get buried.  You have to have executives with some know how in those positions or nothing happens.  I said the same thing with Sibelius I 2009 and got my head chewed a little but same thing there and this is nothing personal but that lack of hands on knowledge is just what Wall Street wants, we know it and the result is lot of Algo Duping.  I just said the HHS job is going to become so heavily dependent on IT that in a couple years she will be over her head..again nothing personal but time for some Computer Science folks that are a “hybrid” that has another focus to step in, both here and at the SEC.  Still waiting to see what Richard Corday is going to do, he needs this stuff too. 

President Appoints Richard Cordray as New Consumer Financial Protection Chief - Hope He Knows And Understands Correcting Flawed Math and Formulas To Battle the “Financial Attack of Killer Algorithms” On Consumers With Banks and Corporate USA

Occasionally I get to add a little from what I hear from doctors too and in this case in addition to reduced pay they can’t even figure out a the hospital what United wants and they are trying to comprehend…like I said with all these complexities the “quant” portion of the payroll has to be substantial. 

Hospitalists, Peer Committees and Utilization Struggle to Comprehend United HealthCare Algorithms

Their contract negotiations can get pretty tough to beat as well, as they take the DOD to court for the Tri-Care agreement and in the process this subsidiary of Blue Cross is going out of business, so squash the competition when there's millions at stake here and get that contract?  This is kind of sad to see this happen but they are giving companies that are subsidiaries of Tri-West some contracts as they need the IT services during the transition taking place.  So after a battle like this, no wonder the WellPoint CEO said I’ve had it:)  On the exchange contracts some of the states too realize that having your own state exchanges requires contract negotiations with insurers, so let the feds do it, I would if I were a state with the status of what is happening in the economy as you can see the complexities are just a nightmare. 

Tri-West Won’t Challenge Tri-Care Military Contract Loss To United Health - Legal Decisions & Contract Awards Allow Machines To Move Money for Profit As Company Will Likely Close Down-Subsidiary Watch

When subsidiaries exchange information today identifying sales leads might be easier and when one division cuts a party off or whatever the case is, send in another one.  There’s lot of subsidiaries to choose from:)  With controlling too much of this action the reimbursement discussions and rates can be controlled from point A with a contract all the way down through what the doctors get paid, kind of scary to know that exists out there. 

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

We have the Chinese company they own to promote more Chinese drugs and devices and they just bought the biggest HMO in Brazil. 

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

If any of this helps with the annual trip to Washington to stall of the Medicare payment cuts, if you are a doctor, take this to your Congressman and tell them you already have on insurer crawling up your back side with cutting your pay, how much more? 

On another topic they make millions selling data so United and their subsidiaries are definitely one to be up to pay a license and quarterly taxes on the huge amounts of money they make in this area, they were one of the first to make big dollars selling data, help the FDA and NIH out.  If they are really into science and improving healthcare this should be not problem on their end, right?

One More Good Reason to Tax the Data Sellers– Create Additional Funding for the NIH and FDA From Sources That Otherwise Are Too Greedy to Share & Contribute

And what did I say about accurate math and formulas, aka algorithms 3 years ago (see this link below) and watch the video..who get’s to control all of this, who’s King Algorithm going to be from the author of “Automate This” , Christopher Steiner a great video on how Algorithms are taking over the world and he mentions medicine …ok I’m done now.  BD

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

A new report from UnitedHealth Group Inc. takes aim at the way U.S. doctors get paid, saying the nation could save up to $1 trillion over the next decade in health care costs if it were possible to "unleash the potential of payment reform initiatives."

The report, which comes out Wednesday, analyzes the savings as well as likely pitfalls to adopting a number of different methods to move away from the current "fee-for-service" approach, which pays doctors based on the number of services they provide.


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