If you read here often enough then you have seen the references and addition information relative to the World Privacy Forum and their report on “The Secret Scoring of America” while the rest of the world watches.  This is right along the same lines here with physicians being eliminated from insurer networks with no reason given as to why, they have been “scored” somehow and it’s proprietary so nobody knows and United mostly and other insurers are not giving any explanations either, other than the fact there’s money being saved, but how.  Below is the World Privacy Forum report link if you have not read it.  It was a great and fair report with the discussion of “scoring”.  In it you will also find the Affordable Care Act explanation on how a score is used to determine eligibility and subsidy amounts.  The ACA score is right there as it’s part of government so they have to divulge how their scoring takes place. 

World Privacy Forum Report - The Scoring of America: How Secret Consumer Scores Threaten Your Privacy and Your Future - One Big Element that Fuels the Continued Attack of Killer Algorithms & Demise of the Middle Class Creating Profiteering And/Or Denial of Access

The report also makes the notations too about what is legitimate types of “scoring” and then relates to the whole underworld of “secret” scoring that we don’t even who, what or when we get scored as consumers.  You get the entire history on how credit scores began, as one time they were a secret as well, and parts of them still are today for consumers as you never get the full report sent to someone who is inquiring.  This is a big issue out there today as what happens when your score is not within certain designated parameters, you get denied access to something along the line and if you don’t know who’s scoring you or even a little bit about the parameters, heck you have no clue on what happened and this appears to be the same fate of the doctors that are being fired, probably algorithmically, based on some kind of scoring system.  You almost really have to assume this when no explanations are offered and that’s what all the doctors are getting as answers. 

In addition you have scores like the FICO medication adherence “scoring” and how many people have ever been given that score?  I would guess probably none and they brag they have scored over 3 million people.  Now I assume the FICO medication adherence scoring is used more in the area of clinical trials, just common sense tells me that as they want adherence on a trial by all means but again as the World Privacy Forum points out in their report, FICO says all they need is a name and address to use a proprietary methodology to score anyone?  So what is their formula?  Nobody can replicate it since it’s proprietary so do you just say “well I guess it’s so”?  Not today I don’t with all the data selling going on and when a score is derived, well guess what, you have a new piece of data to sell about a consumer.  It’s the best racket in the whole world for making money as nobody gets a chance to replicate and see how accurate the proprietary score is as it’s compiled and just runs it’s magical formula.

FICO Medication Adherence Scoring Should Be Banned As It’s Quantitated Justifications for Profit That Hurts US Consumers Using Proprietary Algorithms That Cannot Be Replicated For Accuracy or Audited

Over the last few months we have been seeing one state after another firing doctors who take care of Medicare Advantage patients.  Doctors have been given no reason and sometimes not a lot of warning as well as the patients affected.  We know of course that insurers do analytics on a regular basis on every aspect of their business and this is no different.  Cost of course is what United has been stating as the cause, however when doctors state they will honor what ever rates needed to keep the patients under care, and nothing changes or there’s no allowance for conversation, we know there’s more to the analytics and decision making processes, in other words, doctors are getting scored. 

Since the 90s doctors have been kept under a microscope relative to the drugs they prescribe for more than one reason and a lot of it goes back to the drug companies for sale use.  That’s been around for years.  Insurers also do big risk assessments on those they insure as well so there’s nothing stopping them from getting a mortality assessment on the doctors and for that matter looking at their credit card expenditures since insurers are doing it to us anyway.   The latest doctor firings in Tennessee features a video to where the doctor states he would honor whatever rates were needed to keep the patients and on top of that he specializes in geriatrics, but he got cut and that was that, no reason given.

Patients In Tennessee Speak Out About United Healthcare Firing Their Doctors As the Effort Continues To Reduce Their Own In House Overhead With Managing Fewer Doctor NPI Accounts, Contracts and Billing…More Killer Algorithms At Work Hurting Seniors

So based on this and some other activities of the same types we could pretty much assume there’s quite a bit to the “scoring of the doctor” with United Healthcare, again just like we get scored from sources where we have no clue.  When the insurer fails to even want to give a reason, we can pretty much assume we have some quants working at United, building models to meet certain parameters based on the doctor him/herself as well as the scope of patients. Doctors like patients in the US are facing a huge amount of “scoring” and they doo have no clue on what kind of scoring takes place.  When it comes to P4P, there might be some information released on those parameters of course, as that’s something like a credit score that has to be up front but on the rest of it, a big mystery.

Certainly by narrowing down the networks there’s fewer doctor NPI accounts to manage and claims coming from fewer sources so again United is notifying their own bookkeeping processes in essence, but nothing on the other side with patients and doctors other than more items and complexities to go look up all the time. Sometimes though their algorithms mess up as we had this situation in Maryland where United bid and won a contract but found out there were no providers in network for the contract they bid on, narrowed down just a little too tight.  Of course too you have to remember that United makes money on selling data and once a score is created, they have another stick of data to sell. 

Howard County School Board in Maryland Rescinds United Healthcare Contract As Retirees Didn’t Want the Medicare Advantage Plan, No Providers Available..

In summary, not only do we have to deal with “secret scoring” ourselves as consumers, this practice has now moved into the area of physicians to where they too are scored and some of it is a big secret, just like we deal with.  So as a patient and a doctor, “scoring” is what insurers do and you have to rush and makes changes just like they are herding the cattle as the “algorithm says”…and you know what this is dangerous.  When people have to keep making changes as such, and I’m not the first one to say this, you are putting patients in harms’ way by all means with constantly shifting physicians and other things that come up. 

So I might venture to say here too that along with firing the doctors, there could also be some “scoring” information that United might be selling as well, but again this is all secret and how many other insurers will begin doing the same thing with the same or similar methodologies?  When there’s no communication or at least a reason given, we can all all figure it’s their internal Quants creating the models for narrowed networks. 

Groups such as the AAFP have spoken up recently as this has the potential to create harm with patient care.  Another real concern is again the fact that all of this is “secret” and in the example above you can see to where the algorithms went south and there were not doctors in the business area United bid, so again, what kind of algorithms are these and what kind of scoring are they doing?  We get no explanation other than to stop and quit and send patients away?  Is this the way to better care?  It certainly sounds like the way to bigger profits but how long can you keep doing this?  Patient care quality is going downhill and not up and this has to be be a contributing factor for sure. 

Nobody is happy here except share holders and life for both patients and doctors becomes a big disruption and adds yet one more level to the lack of stability of healthcare in the US today.  What’s scarier yet is that HHS and CMS see no problem and have not addressed this and yet are stuck in their “stat rat” virtual frames of mind thinking numbers will create better care when in fact it’s failing, just as pay for performance is failing as that belongs in sales, not in healthcare. 

I’ll leave you with one final thought and link “People Don’t Work That Way”….and trying to quantitate every area of a person’s life just won’t work. 

People Don’t Work That Way” A World of Broken Software Models That Don’t Align To the Human Side,Too Much Push At Times With Only A Proof of Concept That Fails in the Real World..

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