When you read this article entirely, it’s like what in the heck is this now?  Seriously read the analytics that will be taking place and the company Anthem has contracted with of course is seeing some big dollar signs.  Your medical records are up for review and risk assessment from this third party company Inovalon, Inc. to conduct the “chart reviews”.  It’s supposed to run for a year on each patient.  That’s a lot of data and there won’t be an ROI on this at all and all those patients who’s medical records are “scored’ now will have the government involved in having a copy of such.  We are completely over scored in the US and this type of activity leads to greater inequality.  I don’t care what the purpose here is, once CMS has this data, what else will they do with it is the question as it won’t stop with just this study.  This is not going to stabilize premiums.  If you are going to do this, just set up an risk assessment pool. 

Health Insurance Business Is Driving Itself Off a Cliff & Doesn’t Know When to Stop With Collecting, Analyzing and Processing Non Relevant Data With Little Or No Impact On Giving Good Care..

This is a shame as those who enrolled are not getting any privacy here at all.  Also remember Anthem and the big data breach? Exactly the company and vendor assistant you want doing this right?

Is it any wonder people aren’t taking care of their health, they’re too busy trying to stay under the radar.  Education works much better every time rather than another big data mine to help the insurance company.  They’ve buried themselves in analytics that don’t pay off over the years.

Anthem Data Breach–Crooks Want to Sell Data Too–The Impact of the “Data Selling For Profit Epidemic” That Exists in the US With Scoring Consumers Removing Access and Human Dignity

Besides the medical record audit you can probably also expect this proprietary medication adherence nonsense score to be added.  We are not talking normal adherence monitoring here, like seeing if someone filled a prescription, etc. we are talking 300 metrics that have nothing to do with taking medications.  If you are a male, you get dinged so flawed data with this portion of the audit as you can count on CMS wanting every tiny bit of data as they are suffering from what I call “Stat Rat Fever” after years of Untied Healthcare mentoring their models and sadly are headed in the same direction that hurt the VA in this effort.

Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy

This is the trade off for subsidies, you get your data traded and sold all over the place.  They want the data to help manage you and your care and thus far outside of the obvious of what works, they are digging a data hole here of no return and this will be reflected for all to share in the cost of this expensive project.  Doctors are going to love this one as they are already are over loaded with red tape to make room for some data gathering folks, right?   The way this is set up is a complex accounting nightmare as you are dealing with people and trying to use linear analytics when the real world situation is non linear.  People don’t work that way so we have a world of broken software models that people keep trying to force upon others. 

“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..

Again, none of this is related to actually giving and getting care, just a bunch of folks in DC that live in virtual worlds and hang on to every statistic they can get their hands on, broken models included.  Just one more way the government is putting a dollar sign on your head to predict how expensive your care could be and there will be plenty of error bars by the time the quants run through and create some wild ass models based on this.  BD 

VA Crisis Just The Tip of the Iceberg As US Needs a Full On Healthcare Culture Change Everywhere To Get Back In Touch With the Real World of Patients…


In July, Anthem Blue Cross will begin chart reviews on enrollees who purchased Affordable Care Act (ACA)-compliant plans in either the individual and small group insurance markets (both on and off the exchange, known as “Covered California”).

The records requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to meet the needs of a diverse population.

During the risk adjustment audit, Anthem will review diagnosis code data obtained from the medical records of ACA-compliant individual and small group patients. This is not a typical audit on the physician practice; rather, Anthem is looking to identify conditions/illnesses that demonstrate patients who are at risk for being sicker or patients who are predicted to be healthier. This information will be utilized to determine a risk score, which is a measure of how costly an individual is anticipated to be, and will be reported to the Centers for Medicare and Medicaid Services. If at the end of the annual risk adjustment assessment, Plan A has a lower risk average score than Plan B, then Plan A has to issue a payment to Plan B. In a nutshell, the program is intended to prevent payors from cherry picking only healthy enrollees.

http://www.cmanet.org/news/detail/?article=anthem-blue-cross-begins-medical-chart

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