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United Healthcare Buys Humedica and Gets More Data to Analyze and Sell To Medical Device and Drug Companies–More Big Profits From Health Data

Yes United probably makes more money selling data out there than most do as it started years ago with Ingenix and they have a a full set of analytics where they sell data.  It started out selling prescription data and has grown big time since then.  Managing care and selling data are two big profit areas for the company.  United is so very large they have so many subsidiaries from a company in China that promotes Chinese drugs and devices to low income housing investments and cheap hearing aids that are sometimes used to entice seniors to sign up for their Secure Horizons plans in areas such as Florida. 

United HealthCare Issues Another Study, This One Telling Government To Aggressively Manage Medical Care For Seniors-An Area Where A Large Chunk of Their Revenue Comes From Today, Managing Care

United Healthcare Wants to Expand Predictive Modeling for Medicare and Medicaid–Billions in Savings Predicted in Report Only As Good as the Day It Is Published


The company looks for savings in many areas such as cutting compensation for doctors and perhaps that goes towards some of the money for some of these very large purchases and this one is said to be worth several millions.  See why I keep saying “excise tax the data sellers” here’s a huge one here.  Recently United also told Medicare they know how to manage and propose aggressive senior care management as they have already sued the DOD and won the Tri-Care contract (military Medicare) in the west with using their stance of their “superior” algorithms

The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job

UnitedHealthCare Looks at Doctor’s Pay for Savings, Nothing New There Been Doing It for Years But Keep In Mind We Have the Annual Medicare Cut Fix on the Floor Again with Congress–Timing?

 

We also have another big organization called the MIB that collects and sells data and all the major insurers participate and exchange data here too.  They tell insurers when you are expected to die.  Managing and fiddling with risk has been the Achilles heal of healthcare as people use numbers and stats to form opinions and decisions and some are accurate and others only have a profit mode.  So what will United do here?  The managed risk and cost by short paying doctors for 15 years, where they were fined but it was still analytics.  So when shareholders are the prime interest at times we don’t know what the model is and can’t check the math.  That’s a big problem today and I look good solutions that are accurate but I have seen too many that are marketed as good and have them be flawed for profits only.  You can watch insurers with claims adjust the parameters of what gets paid if the public screams too loud and when it dies down they roll the parameters of what gets paid right back up, it’s a numbers game. 

Hiding, Falsifying, And Accelerating Risk Has Become the Achilles Heel of the US Economy As the “Real” World” Clashes With the Values Created From a World of “Fictional Values” Of Formulas and Math


We might stand a good chance here with the information staying pure as we have Dr. Halamka at Harvard on the Scientific Advisory board.  With the recent announcement with Mayo, I guess Humedica will be able to package up the non identified data and sell it to pharmaceutical, device  companies and others.  Bain Capital is in here so looks like Romney made some more money. 

Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game


Humedica uses a portal service for the hospital analytics and the information sold from EMR records can show which products are doing better, worse, etc.  The intelligence will be there but not big savings like everyone thinks as you get a new left curve every day that takes what you saved yesterday and spends it today.  What hospitals save here may be eaten up with Medicare  re-admission fines or other such items.  With complex algorithms and analytics we get smarter but the huge savings they all look for are illusional.  Pharma and device companies now have another area to spend more of their money in buying the data to see the results. 


So what in healthcare do they not have an interest?  How much longer I wonder before the word divest might enter the picture?  Even the VA pays United for the anesthesia analytics from Picis as they company was in there before United bought them. 

If you are using an Epic medical records system, United wants some of that money too with creating a brand new subsidiary in 2011 to integrate with the EHR and this will put smaller clearinghouses out of business.  Of course they still have their original “Ingenix” clearinghouse services too.

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

The company can help and consult with a drug or device company to get it sent through the FDA with their Canreg subsidiary.  How does this work now with selling information to the same types of industries? 

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


Anyway one more point to be made here again, license and tax all data sellers in the US soon as they make billions selling data as Walgreen in 2010 made short of $800 million selling data to get a grip on how much will be made with Humedica selling the non identified data from the EMRs, a lot.  Money has to come from somewhere to pay the pharmacists in certain parts of the US who work for Walgreen the pay for performance money United dishes out for those who enroll patients in one of United’s service to include the YMCA.  Would you buy an EHR from them?  They have about three to include a couple they acquired in a couple other company purchases:)

Ingenix (Subsidiary of United Health Group) Marketing Care Tracker EHR To Community Health Centers–Subsidiary Watch


Some of their affiliations or companies they own have access to data from consumer devices that will “push’ compliance and I think education instead of the route this company goes is better.  Remember they are bought and sold on Wall Street and are part of that entire game and some things are good while others get marketed and sugar coated to get consumers to buy in. 

United Healthcare To Begin Using CareSpeak Text Messaging for CareGiver Alerts and to Push Compliance With Requested Responses


Stephen Hemsley, the CEO of UnitedHealth, "Leading companies take advantage of disruptive change in the marketplace," he told reporters recently. "Our shareholders will prosper."

Last but not least the man who worked for HHS and is accredited with writing most of Obamacare now sits at United so when you want to pick on Obamacare look to United I guess. Think they control a big chunk of healthcare and ram their analytics every direction they can..

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

Humedica also lists Allscripts as one of their partners…if they get their code done and new aggregated product out there and hopefully won’t be suing anyone else over sour grapes over not getting a contract:) 

Anceta, the subsidiary of the AMA is in there too as a partner, so if you read this far you know the AMA has subsidiaries in the data business too and they sell data and that’s partially how they stay alive as Humedica might be buying data from them too or vice versa.
 Humedica also has a banker in there too with Leerink Swann so this is posed to make money and now they have United analytics and data if they want to add more, as subdiaries of big corporations certainly share an sell tons of data.  So if you have read this far, take a look at this post, part of the Attack of the Killer Algorithm series…

“Devaluate the Algorithm” And “Tax the Data Sellers”–A Cure for Both Healthcare and an Economy Based Heavily on Intangibles–We’ve Lost Our Balance

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You

We like data to make us smarter but publicly trading companies as the CEO of United said above, shareholders will prosper. Personally myself I like the Kaiser Permanente registry efforts a lot better than this and they are non profit.  BD



The deal is valued in the hundreds of millions, according to one source, and represents a significant payday for a large consortium of localimage venture investors including Bain Capital Ventures, North Bridge Venture Partners and General Catalyst Partners. Boston investment bank Leerink Swann and the Kraft Group, a consortium of businesses including a private equity arm as well as the New England Patriots, also are investors in Humedica.

The company, which has raised at least $63 million and was incubated at Leerink Swann before its 2009 launch, produces health analytics tools for hospitals, physician practices and life sciences companies that aggregate raw health data.

The company has not publicly disclosed its number of employees.

Humedica's products include Humedica MinedShare, a platform that enables clinical, operational, and financial benchmarking across the continuum of care and Humedica MinedStream, a real-time predictive clinical surveillance system that identifies high-risk and high-cost patients.



http://www.bizjournals.com/boston/blog/bioflash/2013/01/exclusive-humedica-acquired-by.html?ana=twt&page=all

Programmer Creates 800,000 Books Using Algorithms and Selling Them on Amazon, Some On Rare Diseases Where It Would Be Unlikely To Find The Same Full Content & Items You May Not Expect –OMG Compile Medical Records Like This in the Future?

This is fascinating and to think that he was able to release imagethis number of books on sale at Amazon is mind bending when we as humans work to get one out there.  Again as stated here the books will not be novels or others entertainment type topics but they do have the capability to bring many items that you would have to search for separately into one book. This is good when look for stats, reports, etc. and it even creates it’s own visuals.  Now he does have an experimental project with writing a fiction book so this is one to watch as with fiction we want to be entertained. 

He has a patent on the technology, called “Long Tail”  and who wouldn’t if they were creator and it can be used for creating imagecontent for videos and games.  It can be done in many languages too.  He’s also working on preparing information for television using the same format to provide content.  Humans get replaced with 3D characters.  He’s also working on education programs that can teach any subject in any language.  The video talks about the books and ventures on to the video side use with education.

We might see a flood of resource books that are personalized. image The computer mimics what a human would do and what information they would look for, an economist is used as an example.  You open up the software, give it instructions as to what you want to accomplish.  This could be very interesting to research a number of clinical trials for one example to compile  The algorithm finds the sources.  Like an author it opens a Word processing program, like Word and goes to work.  It cleans headers, footers, does pagination and creates tables of contents. 

Let’s get the left brain out here and think of electronic medical records..oh boy…a process like this could pull from designated areas and really compete a full patient record, and it could be given and shared with a patient as well.  Again with clinical information we would be necessarily be going to the web unless perhaps we were matching and including public information let’s say a clinical trial result that would be relative to the patient case.

When I think of the new HIPAA rules that they just finished, imagea real revision might be needed and why HIPAA should not be in a compartment related  to healthcare information only and it should be incorporated in an overall US privacy law.
  We all aggregate information and links that touch beyond what is in front of us.  Recently in my opinion due to some of these facts all current and proposed laws are going to fail anyway as they don’t reach beyond rules for each government entity, combine them all to reach to all departments as needed.  What in the heck do you think IBM Watson is capable of doing, this stuff by all means.  Let’s create a book that can identify image“data sellers” so we can excise tax them and fund the NIH and FDA and more.  This process appears to have real potential there with identifying a lot them.  Watch the video to see how this works, amazing stuff. Is this the new model for college term papers (grin)?  See what financial analysts will do with this to (grin #2).  BD

Privacy Relative to Tracking Apps and Data Mining Legislation Will Fail If There is No Regulation Path Created–License and Excise Tax Data Miners & Sellers Otherwise It’s “Laws With No Balls”






When we think about writing books, especially the technical kind, we think about a person or small group of people hunched over their keyboards typing away. There’s a good reason for that mental image: that’s how the majority of books are written. That’s not the way it has to be, though. Philip M. Parker, a marketing professor at INSEAD, has a patented system for algorithmically compiling data into book form. Thanks to Parker’s system, Amazon now has over 800,000 books for sale from his company. Other organizations pay for this service to compile data for their reports, so the system clearly has flexibility.

image

Specifically, he points out that in the case of very rare diseases, it’s unlikely that any books would be written in the first place. Especially when you’re looking at statistics and data, having a computer compile and find potentially significant data is very useful. While the books won’t be particularly creative, they absolutely do have a place.

image

This is a perfect complement to human creativity — not something for creatives, researchers, or consumers to fear.

image

http://www.extremetech.com/extreme/143382-programmer-creates-800000-books-algorithmically-starts-selling-them-on-amazon

German Soldiers Growing One Breast Due to Hormone Stimulation When Performing Drills And Slapping Rifles on Their Left Side…

This is an odd story but there are about 35 men who have grown one boob and it’s on the side where the rifle slaps down.  I guess if one wanted an equal set you have to start slapping the rifle on the other side right?  I guess this would be odd to just have a boob of size on one side. 

The other alternative as the article suggests is to change the way they perform their rifle drills, which that could work too.  BD



A new military report published in the German Medical imageScience journal and obtained by the German Herald finds that dozens of soldiers in the Wachbataillon unit have developed the condition because the drills they perform stimulate male mammary glands.
The director of plastic surgery at the military hospital in Berlin, Professor Bjorn Krapohl, said it's likely the repeated slapping of the soldiers' rifles on the left side of their chests during drills stimulates the glands to produce hormones, which creates the one-sided-boob effect.

http://www.huffingtonpost.com/2013/01/24/german-soldiers-growing-breasts_n_2536939.html?ncid=edlinkusaolp00000003

Costco Selling Aetna Health Insurance Plan to Members–A Few Days Ago Costco Became a Pharmacy Benefit Manager

It was just a few days ago that Costco announced their unique Pharmacy Benefit Manager program focusing on small businesses that are near their retail store locations. 

 

Costco Becomes a Pharmacy Benefit Manager

Aetna and Costco have worked together before with prescriptions plans and I dug this one out from 2008 (line below) and it goes back to when many of the retail stores were offering the $2 and $4 generics. 


Aetna and Costco create yet another prescription program

As far as other retail locations, you can jump over to Best Buy where Aetna consumer healthcare software is sold.  BD
 


NUT CREEK, Calif. --

Aetna (NYSE: AET) is now offering individual health insurance plans to Costco members in California. The Costco Personal Health Insurance program, of which there are five plans to choose from, offers broad major medical benefits; dental options; an extensive network of doctors and hospitals; and a variety of helpful services, tools and information, tailored to meet the needs of Costco members.

In addition to California, the Costco Personal Health Insurance program is also available to Costco members in Arizona; Connecticut; Georgia; Illinois; Michigan; Nevada; Pennsylvania; Texas; and Virginia. Aetna plans to expand the program to other markets in the coming months.

http://www.fortmilltimes.com/2013/01/24/2455180/aetna-offers-individual-plans.html

Missouri, Kansas and Nebraska Connecting Medical Records Via the NHIN, Direct Secure Messaging

Against all odds, some of the state information exchanges are starting to work.  The NHIN secure network can be utilized by any hospital or provider and here we have the state projects connecting their connected entities.  Here’s yet another example of a medical records vendor setting up their network where anyone with an EMR can connect to any other medical records system that is also in network.  This is the network and there is also the “Connect” program that helps entities get started, or you can join a network such as the one from e-Clinical Works to where they do the leg work for you.  Even HealthVault set up for the Direct project back in February of 2009 and again there are many more that wrote their interface to the Direct program.  More information on the implementation on the NwHIN portfolio can be found here. 

EClinicalWorks Launches “Join the Network”–Invests $10 Million Over the Next Year to Expand Peer to Peer Sharing Via NHIN Program for Users with eClinicalWorks and For Those Using Other EHRS


The Nationwide Health Information Network (NHIN) is being developed to provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare. This critical part of the national health IT agenda will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve health.”

image


Hospitals and Providers Using NHIN (Nationwide Health Information Network) To Connect and Share Medical Records With the VA and DOD And Even With Each Other


With the networks supporting the NHIN this helps to bring more on board at once.  BD



COLUMBIA, Mo. - The Nebraska Health Information Initiative (NeHII), Kansas Health Information Network (KHIN), and Missouri Health Connection (MHC) today announced they are now connected and able to exchange Direct secure messages across state lines. 

"By connecting with Kansas and Nebraska, Missouri Health Connection is leading the way towards improved care for patients who cross state lines for medical care," said Mary Kasal, President & CEO of Missouri Health Connection. "We're excited to now be connected to Kansas, Nebraska and Illinois and look forward to connecting with all our border states." 

This milestone announcement from Missouri, Kansas and Nebraska comes on the heels of Missouri and Illinois recently announcing they successfully exchanged test messages.

http://missourihealthconnection.worldsecuresystems.com/_blog/Press_Releases/post/Missouri,_Kansas_and_Nebraska_Connect_via_Direct_Secured_Messaging/

Salk Institute for Biological Studies in La Jolla Receives $42 Million Dollar Gift from Hemsley Charitable Trust Directed Towards Genomic Research

imageYou probably may remember the queen of mean, Leona Hemsley who died several years ago, but the trust lives on and this gift will allow the Salk Institute to invest in new genomic machines and other equipment needed to continue cancer research.  The Trust reached out to La Jolla for the gift due to the number of ground breaking discoveries that have been made here.

Cancer is not the only research done here at the institute as Parkinson's and spinal cord  regeneration are just a couple of other items of research and study.  Two of the researchers are considered candidates for the Nobel prize. 
This is the largest single donation the Salk Institute has received.  With NIH grants slowing down and going away the institute depends more than ever on donations and philanthropy.  BD


The Salk Institute for Biological Studies in La Jolla has received one of the largest single research donations in county history, a $42 million gift that will be used to explore common links between some of mankind’s most insidious afflictions, including cancer, diabetes and Alzheimer’s disease.

The gift was made by the New York-based Helmsley Charitable Trust, which says it reached beyond its base in the Northeast to help Salk because of the institute’s record for groundbreaking discoveries.

The institute has been operating in the black. But there’s been concern about its financial health because it has become increasingly difficult to obtain National Institutes of Health funding, as budgets have remained flat.

http://www.utsandiego.com/news/2013/jan/23/42m-gift-to-salk-will-fund-genomic-center/

Pediatrician in Philadelphia Found Murdered in Her Home, Strangled, Bound and Set On Fire

This is really a sad and creepy story as she was well liked by allimage, lived in a good neighborhood.  The crime was committed during broad daylight.  Her hands and ankles were also bound.  Her “dogwalker” found her and called the police.  She worked at Children’s Hospital in Philadelphia and had completed her internships at Johns Hopkins and New York University.  Her boyfriend is also a doctor from New York.  Her body was still smoldering when police found her. 

They are saying it’s probably someone she knew as there was no sign of any forced entry.  Nothing was stolen or disrupted and her dog will have to find a new home.  The time frame of the murder was between 11 am and noon.  Why would anyone create such a horrible crime?  She was only 35 years old.  BD 


Investigators in Philadelphia are trying to unravel a baffling mystery after a hogtied pediatrician was found dead and on fire in the basement of her home.

Police found Melissa Ketunuti, 35, a beloved doctor at Children's Hospital of Philadelphia, Monday in her Center City basement after her dog walker called 911. Her wrists and ankles were bound behind her back, and she was on fire, police said.

http://abcnews.go.com/US/pediatrician-murder-case-melissa-ketunuti-found-hogtied-burning/story?id=18291248

Allergan to Buy Map Pharmaceutical Company, Pipeline Includes Inhaled Version of 60 Year Old Drug to Treat Migraines

There’s more drugs moving towards being inhaled today from treating depression and bi-polar to growth hormones and if it is not inhaling it is spraying  in your nose.  There’s even one for hypertension that is inhaled.


Levadex, the inhaled drug from Map in the pipeline would work in coordinating treatments for migraines with Botox, which is one of Allergan's best selling drugs.  The drug has been through several clinical trials and has been submitted to the FDA for review.  Levadex also provides relief late in the headache stage and for “cluster” attacks.  The two companies have already been working together as partners on the development of the drug.  BD 

FDA Approves Hypertension Drug (with Conditions) that You Inhale - Tyvaso

 image

From the website:

The TEMPO inhaler is designed to offer the following attributes:

  • Automatic release of therapy: Our triggering technology is tuned for each particular drug so that drug release is synchronized to a specified point in the breathing cycle to allow the released drug to reach the targeted area of the respiratory tract.
  • Plume speed control: Our TEMPO inhaler controls and slows down the drug plume to match the speed of the patient’s inhaled breath, so that more of the drug is entrained in the inhaled air and carried into the lungs.
  • Reliable dosing: The TEMPO inhaler also includes a dose counter to display how many doses remain available for use, so that patients can track their medication use and remaining supply. The dose counter can prevent dispensing of additional doses after a maximum number of doses have been delivered.
  • Convenient, multiple-dose use: The TEMPO inhaler does not use electronics or batteries and can conveniently contain multiple doses. It can include up to a month’s supply depending on the drug, in a small, handheld inhaler approximately the same size as a conventional MDI and it may be used with small molecule drugs and biologics.

Allergan Inc., the Irvine maker of the wrinkle filler Botox, agreed to buy a Silicon Valley pharmaceutical company in a deal valued at $958 million to gain an experimental inhalable migraine treatment.

Allergan imagewill pay Map Pharmaceuticals Inc. investors $25 a share, a 60% premium over Tuesday's closing price of $15.58 in New York, the companies said in a statement. The deal was unanimously approved by the boards of both companies and is expected to close late in the first quarter or in the second quarter, the companies said.

Map, based in Mountain View, is seeking U.S. regulatory approval for Levadex, an inhaled form of a 60-year-old migraine drug, to treat those who have acute attacks.

http://www.latimes.com/business/la-fi-0123-allergan-20130123,0,3203012.story?track=rss&cid=dlvr.it&dlvrit=52116

“The Untouchables-Too Big to Jail” Frontline Documentary Shows Department of Justice’s Fear of Prosecuting Big Banks–No Confidence In Using Current Day Technologies To Investigate –Video

This ran on Frontline tonight and to me listening to the DOJ and the man running it was pretty scary.  I read a lot of body language imageor I try too and what came out stronger than anything was a lack of confidence.  Now you have to remember that none of this would have happened without the use of technology and loans all have data attached whether it be credit or other sectors of processing.  Eliot Spitzer was right on when he said you start in the credit department.  Watching the people they hired and how this all took place was very interesting indeed.

Again all of this works on huge IT infrastructures and granted there were the boxes of paperwork for the loans but the DOJ said they could not prove a fraud case beyond a shadow of a doubt.  They also had not spoken to any of the whistle blowers who had been writing to the government either.  This was sad and again what I took away was a complete lack of confidence inimage having some technology knowledge on how to find areas to where they could prove a case.  If they would have had had some decent computer scientists on the case I could almost guarantee you they would find the fraud one way or another be it the sale of the securities, flawed data on the transmission or sale or a number of other areas.  Now when you find that kind of evidence, you are getting closer to black and white here.  Sadly this just goes to show that relying on a couple wiretaps and little of much else just won’t make a case for you. 

So what do we do, keep putting attorneys in charge where high levels of technology and algorithmic models are used to commit such crimes.  We have the same issue at the SEC and HHS and these folks do not have the talent to recognize and identify how to investigate such high tech crimes.  This is really a very sad showing and this is why the banks run us over and use their algorithms to shift the money.  PBS did a great job with documenting this and again showing that without knowledge we are not going to put a dent into any of this.  In a day where we all want our doctors to use the latest technology the DOJ couldn’t use technology to find the fraud!!  It’s there or was there. 

.

 

Let

s go back and look at the case where a developer supposedly stole some of Goldman’s code.  This was a rip and I don’t know if he was innocent or guilty but they ran a sham and there was no jury that could have understood the complexity of this crime. Eventually a judge saw this and had his case overturned, and now we have another “dumb” prosecutor from the state of New York trying it again..geez…folks with no computer science or IT in their background..attorneys at work again where they shouldn’t be and that’s what runs most of our executive departments…time to rethink such choices.  Obviously for the Supreme Court, they belong there but not for running the SEC and the government is so unprepared at the types of cases they are working, what a huge disappointment. 

Goldman Sachs Programmer Who Went to Jail for Stealing Code Has His Conviction Overturned–You Can’t Get A Jury of Peers Off the Street for Crimes With High Tech Algos

We go back to this study and there’s more out there afraid of math other than just consumers…this is why Wall Street wins and why they are winning here.  Watch another PBS interview and hear it from someone who did risk management at a Hedge fund and they ignored her work and took big risks anyway. 

We can’t get real trials nor now can we get decent investigations…it’s that fear of math:)  They are afraid of those corporate algorithm balls too. 



“Algo Duping” – PLOS One Journal Publication Explains Why The Fear of Math Plays a Big Role As One Underlying Reason We All Get Duped And Those Who Don’t Fear Math Take All the Money, Gradually, Using “Mathematical Formulas & Algorithms”

Now that you have read this far watch this video at the link below or it’s on the left hand side of my blog and listen to the developer, Mike Orsinski  who wrote the software that all the banks used in the mortgage models and bought and used in models.  You can find old articles on the New York Times with papers interviewing Mr. Orsinski as the one who broke Wall Street and he’s really not as he didn’t have control at all as far as how the banks modeled it.  This is where the DOJ missed their calling.  Remember this is like buying a copy of Word, the software designers have no control of how it gets used in business models, and that’s what happened here. 

Quants: The Alchemists of Wall Street Video Documentary - Why It Needs to Matter What Companies Do and Not Focus Only On the Price of Stock With So Called Value - Attack of the Killer Algorithms Chapter 44

Don’t forget or overlook this image below..it’s true and made trillions for the banks and as he says “you can do anything with software, but not so in real life”. 


image

”I’m a genius” the mentality Mike says and yes any developer gets a bit of this…he left in 2000 so that’s how far back this goes…making a lot of money is like a drug he says.  So why didn’t the DOJ investigate here for goodness sakes and inquire about the business models that make this work for the banks?  Are they lacking in the intelligence needed to put on such a case?  BD

Glendale Memorial Hospital Announces Layoffs Due To Cuts in Government Insurance and Recession

imageThis is the second hospital in the Glendale area to announce layoffs to reduce staff size.  More uninsured numbers added to the situation.  The hospital is owned by Dignity Health.  It was just in July of last year that Dignity announced acquiring Healthworks Medical Group that has 140 medical centers in 15 states with 2000 employees.  BD 


Dignity Health Signs Agreement to Acquire US Healthworks Medical Group With Over 140 Facilities in the US


Glendale Memorial Hospital this week announced plans to undergo a round of staff reductions, roughly two months after the city’s other major hospital, Glendale Adventist Medical Center, laid off 21 workers in response to federal healthcare payment reform and other industry shifts.

Glendale Memorial on Monday pointed to an increase in the number of uninsured patients caused by the lengthy economic recession and cuts in government insurance programs in announcing its own workforce reduction. The 334-bed hospital also reported seeing fewer patients in recent months

http://www.glendalenewspress.com/news/tn-gnp-0122-glendale-memorial-is-second-major-local-hospital-to-announce-layoffs,0,1803343.story

MMRGlobal Provides Listing of Health IT Patents As They Pertain to Personal Health Record Technologies

MMRGlobal is a sponsor of the Medical Quack and if you have kept up with a couple of the prior posts you may be aware of the patent licensing they are pursuing relative to PHR licenses and technologies. Below is a list of the current filings as information. As far as I know there has not been a full complete listing so I am providing the pdf document as a reference for anyone wanting any additional information.  Here’s the link below from last year that gives some additional details as it pertains to Personal Health Records patents with Mymedicalrecords.com.  BD


MMRGlobal Patent Portfolio, Bob Lorsch, CEO Answers Questions Relative to Patented Technologies



United Healthcare Wants to Expand Predictive Modeling for Medicare and Medicaid–Billions in Savings Predicted in Report Only As Good as the Day It Is Published

We all use predictive analytics and when looking a medical claims to find patterns of abuse and fraud, this is good thing and why HHS has incorporated this into the processing of Medicare claims. Those patterns are there to find but all keep in mind depending on how much the parameters of these queries are utilized, imageyou can also get some false positives and the company through many years has had the time and expertise to look at those.  Data is data an depending on how the queries run and what they look for, that determines the results you see.  You will never have 100% in this area by any means.  If anyone could completely get rid of false positives in this area, everyone would be knocking on their door but this is analytics with humans, so it will never be, but can be improved.

Health Insurance Underwriting Practices With Prescription Data – How Does This Work


The company has had success with predicting for many years and profits from it very well.  The old Ingenix MedPoint Prescription Profiling has been bringing in money for years and is used for underwriting policies, again to assess risk.  I’ll repeat again such numbers and information should always be used in context.  When you go non linear with some of the models that are out there you create “relations” in data that really do not exist and thus the decision to go this route or stay with linear data comparisons is always a question.  The old data base that was used for 15 years to short pay doctors and hospitals was also in a way predictive analytics as when United and all the other major insurers used it, they could see and predict what their expenses would be in this area for percentages of out of network charges based on “known” pricing factors that were already determined.  Of course later this didn’t work as New York found those analytics were faulty and resulted in short payments and the AMA finished with that class action suit not too long ago.  Aetna recently announced their settlements in this area as they also took advantage of the predictive analytics built into the out of network charges. 

United is not the only company touting analytics on steroids today and again there’s some value in some of what they say, but the savings numbers are all out of whack as there’s economists around today to predict this stuff either.  It kind of looks like economists are slowly becoming a dying breed as they just relay on the numbers the Quants model these days.  Paul Wilmott makes that pretty clear in the video documenting how Quants work today and you can view it in the left hand side of this blog, an eye opener on how the progressions of Quants and their technologies has evolved.  It’s much more difficult to be one today as everyone’s in on the game.  In addition we have this other agency out there, the MIB  that collects and markets all kinds of insurance information.  You will find almost any type of insurance company subscribing to their data and were basically the beginning of insurance data collecting for underwriting. 

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

“MIB, Inc. is the premiere provider of fraud detection information for individually underwritten life, disability income, long term care and critical illness insurance.  MIB member companies rely on its Checking Service for the fast, secure aggregation and  exchange of data to combat fraud, improve underwriting effectiveness and increase product line profitability while ensuring fair pricing for all applicants.”

If you look a little further here with the MIB you can see where they are now marketing data that gives a risk assessment on how long they anticipate you will live.  So again we are not short on analytics out there today and we will continue to see reports and studies promising billions in savings but it’s just not there in those amounts as companies tout.  Sure there are savings to be had but everyone wanting a sale is exploiting numbers beyond belief so don’t get “Algo Duped” with some of this.  Think of the stock market if you will with algos and think of the Knight Capital case too and see how algorithms can quickly make or break a company and we do have rogue algorithms running around out there today and one of those can shoot a good portion of analytics right down the tubes, so again these savings numbers are only as good at the day they are put out there as complexities and the uncertainties of how algorithms work will keep it that way. 

MIB Solutions and Hooper Holmes Working Together to Assess Mortality Risk – Analytics and Consumer Files Used for Underwriting And To Estimate How Long You May Live And What Your Body Will Cost Over Time

Again I am not saying that there’s not room for improvement as there is, but nobody and I mean nobody can accurately predict some of this as the money you save today might be spent on a new drug, device or crisis tomorrow and that is the unknown…better know as life. The MIB has their write up on diabetes too with predictive algorithms and risk assessment so they can take your numbers and mxi them with other data they have around and supposedly are able to predict about when you will die or how many years you have left, but the human body has been known to fool many, so again not 100%. 

On the readmissions, UCSF is already doing what is outlined in this report, so what they are doing is using medical records to work with patients and using humans to make sure the patient gets the treatments and care they need, and an EMR did this, which is where clinical care is, and by such use they can pretty much develop the best care methodologies with clinical data, unlike the outrageously quoted cost savings like in this report from United.  Medical records have been using predictive analytics since they have been around but it has been called this:)  In other words it gives the clinicians the information they need to evaluate patient care.  Let’s model their example and give all hospitals a grant to do the same. 

UCSF Medical Center Reduced Readmissions With Heart Failure And It Was Not That Magical Flipping Algorithm Everyone Is Looking for That Did the Trick


So with all this being said about models and predictions I think it’s time I hussle over and get a copy of Emanuel Derman’s book “Models Behaving Badly” , which was reviewed here by the Wall Street Journal, to see what else I might learn about modeling.  Here’s a few paragraphs of what was said in the review…

”He then migrated to the center of the financial world in the 1980s, using a mix of mathematics and statistics to value securities for the trading desk at Goldman Sachs in New York. He had hoped to use the methods of physics to build a grand, unified theory of security pricing. After 20 years on Wall Street, even before the meltdown, he became a disbeliever.

The basic problem, according to Mr. Derman, is that "in physics you're playing against God, and He doesn't change His laws very often. In finance, you're playing against God's creatures." And God's creatures use "their ephemeral opinions" to value assets. Moreover, most financial models "fail to reflect the complex reality of the world around them."

It is hard to argue with this basic thesis. Nevertheless, Mr. Derman is perhaps a bit too harsh when he describes EMM—the so-called Efficient Market Model. EMM does not, as he claims, imply that prices are always correct and that price always equals value. Prices are always wrong. What EMM says is that we can never be sure if prices are too high or too low.”

Enough said for me here with these 3 paragraphs and he’s the expert on models and humans as “God’s creatures”…as it’s true and especially in healthcare so we need to keep that human element alive and well in healthcare.   We had a small Twitter chat where he stated that only medical doctors should carry the “MD” credentials after their names and PHD folks should not be in that arena:)  I tend to agree with that too.  Let’s face it we are loosing a bit of this as why else would the AMA come out with this statement…

AMA Reaches Out to Doctors To Remind Them Patient Welfare Must Come First As Rising Pressures From Insurers and Hospitals Can Surmount At Times

I also wonder if their analytics are so right on target, how this happen with the AAFP confronting them on the fact that in many areas of the US through complex contracts that they are paying doctors less than Medicare?  Is that legal?  I don’t know but United said they were surprised this was happening?
 


So again when reading reports and looking at models in healthcare, I think Mr. Derman has some good advice to offer and keep this in mind when you see what all are touting today with analytics and savings that are just a projection and again in agreement with him the models do not reflect the complex reality of the world around them…again take a hard look at what you projected in healthcare.  Here’s the latest below on their latest report and you can read the article and link below on what United claims with yet another model for Medicare and Medicaid and it kind of sounds like they are really clamoring for more business from CMS and Medicare?  BD 


“UnitedHealth touts predictive modeling as solution to healthcare fraud and preventable hospitalizations”


http://www.unitedhealthgroup.com/hrm/UNH_WorkingPaper9.pdf

http://www.healthcarefinancenews.com/news/predictive-modeling-solution-healthcare-fraud-and-preventable-hospitalizations?topic=04,14,19

HHS To Rebrand “Exchanges” as Marketplaces, Guess This Might Help Decipher What It Is As Everyone Wants to Be an “Exchange” for Health Insurance, Those Marketing “Branding” Go Back to the Drawing Board

This is kind of interesting and more to confuse the consumer although I understand what is trying to be accomplished here to separate government programs and the steroid marketing of “we have an exchange” going on out there.  Insurers have their own private exchanges…so what in the heck is an exchange:)   You know the average consumer could careimage less and just wants to buy a policy and the rhetoric created here is beyond comprehension at times.  It caused by making a buck and luring consumers to buy, plain and simple.  Wal-Mart just said the other day they want to be an exchange and are thinking about it.   Big companies model this stuff and come up with the marketing and models to figure out how to make more money, been that way for years but now with technology they also cloud the waters and keep folks in a vast ocean of the unknown. 


Everybody Wants to be Health Insurance Exchange, Wal-Mart Considering the Idea for Small Companies And Oracle Can Sell You a Software Exchange Platform


Wellpoint bough a company so they could be a private exchange in addition to participating in the government exchanges, so I guess now according to this article we have “Marketplaces” coming up on the agenda.  Who cares, just sell the darn policies and cut the lingoes.  Is there any way possible we can make this more difficult, someone will find a way…no wonder consumers doubt so much of what it out there today.  We need more computer scientists in government instead of attorneys running things as they are under rock as well with not being up to date with current technologies used by business.  The executive staff at the White House is beginning to show a lack of knowledge here and you needs some real hands on folks and not just figure heads as that went away a few years go.  So here you go, new terminology and I hope it’s not too confusing when you begin to hear both terms until the marketing of a new brand is complete (grin).  Hey branding is not all that is has cracked up to be when it is done in groves like we have today, so you folks selling “branding” as a huge solution, go back and put your thinking caps on as too much of a good thing with branding just muddies the waters today.  BD



In the language of American health reform, “exchange” and “marketplace” have been pretty much interchangeable. Now, though, the Department of Health and Human Services is embracing the word marketplace in official communications, as part of a revamped public outreach effort.

Eagle-eyed Beltway media outlets like The Hill spotted the PR switch, coming amid lingering political opposition to the Affordable Care Act and as HHS prepares to operate federally-facilitated health insurance exchanges in 31 states.

http://www.govhealthit.com/news/hhs-rebranding-exchanges-marketplaces

17 Year Old Plays Doctor at Florida Hospital For 9 Days in the ER, Crazy Enough to be Movie, Used Cellphone Medical Apps for His Information Sources –Video

This is a video to watch as he’s a “serial imposter” and does a fewimage other little jobs as well. He has no education other than an online high school diploma and being he is under 18 does not help him as he gets convicted of 4 felony charges. He was actually a physician's assistant in his role and he worked in the ER for 9 days.  He performed procedures on patients and administered CPR on one patient.  HR finally caught up with him when he wanted more access.  When you watch the video, he’s very confident.  He has no problem talking and goes on and on and shows how he used his cell phone apps to look up anything he needed. 

He had a summer job at a doctor’s office and this is how it started with running errands to the hospital and used an ID tag to get in to all the places in the hospital.  When he was 13 he posed as a nurse at another hospital in Florida.  After he gets charged they arrest him later for impersonating a police officer next.  He will serve a year in jail.  Everyone is wondering if his career as an imposter is over? 

Anyone still think doctors are on their way out and technology will replace them?  The one woman where he provided CPR died.  Food for thought..BD