OptumRX (United Healthcare) Buys Home Infusion Company AxelaCare-Using Algorithms To Determine Your Care With Being Financed By A “Too Big to Fail” US Health Insurance Company…

We all know the home drug infusion business is growing as companies send out technicians and clinical personnelimage to administer treatments at home versus making a trip to the hospital or to the doctor’s office.  This is yet one more subsidiary added to the approaching 400 or so subsidiaries of United Healthcare, and of course this is one is “tiered” under the Optum subsidiary.

AxelaCare treats patients in 44 states and Washington DC.  Infusion medications are sent via mail to the patient to receive and then a nurse shows up to administer the medication.  You can see this goes right in hand with the OptumRx pharmacy benefit management.  By the time this gets rolled in, even those insured by Cigna will be having this therapy managed by United Healthcare.  Any one see any anti-trust possibilities here?

If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

Of course, you won’t be able to use cash to pay for this type of therapy as it will be mailed to you and there’s alreadyimage a big war on cash at the drug stores with CMS and private industry already scoring people as non compliant there to also get everything on a data trail of credit cards where everything you do is tracked.

Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…

So while everyone was worried about the big stir up with United Healthcare politically stirring up the news with the Affordable Act insurance policies , you had this purchase going on as well.  United/Optum has grown by acquiring other companies.  In addition if you can’t afford care, there’s another option at Optum (which you have to pay for) with a “discount card” called Health Allies.  This company was founded by current CMS head, Andy Slavitt and the daughter of Senator Elizabeth Warren, Amelia Warren Tyagi in California when both of them got together at a “beach house” as it was quoted in an interview in California from knowing each other at the McKinsey Group.  We all know what “The Firm” (McKinsey) group is today, the “CEO school” basically as written about in the book called “The Firm: The Story of McKinsey and Its Secret Influence on American Business”.   Being that Warren’s daughter now runs a company that is stated to compete with McKinsey, one could speculate if the agency had anything to do with the fact that a former United Healthcare Executive ended up running the NHS i the UK as well.  You can ponder that one if you like.  The company finds McKinsey like people to run companies. 

You can go here for the visual history on Health Allies and take a look.  I might guess both Warren’s daughter and Current CMS Head Andy Slavitt made a big haul here with United buying Health Allies and I think allowed Mr. Slavitt to go further and create the Ingenix subsidiary of United Healthcare, which has a huge history of not being honest with their math models and algorithms.  We also can’t over look Lois Quam who Hillary Clinton hired to work for her in the 90s and later in the State Department as well with her influence in allowing one insurer to gain so much power and authority as well.  Here’s a New York Times article announcing the Lois Quam marriage in 2014 to Azizali Mohammed, a correspondent, based at the State Department in Washington, so we’re back to Hillary Clinton connections again here.   Maybe today with all the uprising with Muslims this is worth a mention, as some of this does come into play with writing healthcare policy, just look at the news.  

Lois Quam was a high ranking executive at United Healthcare who was responsible for the AARP and PacifiCare acquisition that was also imagegiven the job of being head Global Health Initiative from Obama and that project failed after a couple of years and was dumped.  Here’s a background summary of how Ingenix operated under the leadership of Andy Slavitt and all the lawsuits filed over the use of their algorithms. 

Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…

With all the mergers and acquisitions today, I feel it’s important for consumers to be aware of who’s bottom line you are feeding with your healthcare today as United/Optum is pretty much just “hiding in plain site” and taking advantage of the fact that people don’t bother to look and read.  Here’s another example of the new Optum Clinical Labs subsidiary and we don’t know who jumped in to add the additional $32 million in funding here either.  With United’s current CEO now sitting on the board of Cargill, corporation, well one could speculate, was it one of the hedge funds that food company operates?  The investors in the new Optum Clinical Labs subsidiary was kept in secret with the SEC filing. 

If you read the article you can see the purchase of yet another company, MedExpress who blankets several states with many urgent care centers and advertises to buy even more doctor’s practices if they want out.  Two states in particular, Pennsylvania and Massachusetts are pretty heavily populated with the centers as well as West Virginia.  West Virginia is where our current HHS Secretary has her roots as well, before serving as chief of staff for former Secretary of the Treasury, Bob Rubin who just about killed this country while he was in office and worked both at Goldman Sachs and Citbank.  Bob Rubin these days, though, blames the polarity in the US on Facebook and that is good for a laugh and a half you could say. 

OPTUM Clinics Holdings, New Subsidiary Incorporated In 2015 Raises Over 36 Million (Exchange of Shares) From Investors Unknown-Form D Used to Maintain Secrecy Of Who They Are For Now…

We also have Anthony Welters, the Executive VP Assistant to the CEO of United Healthcare who also has been elected to the board of the Private Equity firm Carlyle, who just experienced a loss on the last quarter reports that could have some impact in the direction of healthcare investments.  In addition to the Health Allies firm mentioned above, let’s not forget the Optum full custodial saving bank.  It’s an interesting read here as those who put their money in an HSA here when they reach $2100 in savings, also get marketed to put that money in Mutual Funds, so here you go, spend it on the healthcare you need or gamble in the markets with mutual funds for your care? 

United Healthcare Owns a Bank-Optum Bank That Will Collect Your HSA Money, Give You a MasterCard to Empty It Out-Which Enables Even More Data Mining and Selling Transactions About You

One has to wonder though on whether or not any anti-trust inquiries will appear?  Currently Loretta Lynch (see image on the right) who serves as the head of the Department of Justice used to represent United Healthcare with their anti-trust suits, so go figure.  It’s pretty interesting how all this seems to just circle back in one form or another to United Healthcare, you think?  You can read here too how this entire algorithmic process on “scoring” consumers on medication adherence predictions which are flawed had their roots with Ingenix algorithms as well.  Basically the link below tells about where all of this is going, with a lot flawed data being able to produce flawed profiles on consumers and what you get access too is or will be “scored”, so we’re back to the Attack of the Killer Algorithms where nobody looks at the data, on the results the queries pump out. 

Excess Scoring of US Consumers, US Citizens-Scored into Oblivion By Proprietary Algorithms and Formulas, Never Duplicated or Tested for Accuracy-Profits of Big Business And A White House Executive Command To Continue the Abuse..

The scary thing here is one health insurance company forming a monopoly at HHS and CMS today and we are seeing lack of competition here and again too much power from one US corporation.  There have been and currently are several executives of United who serve over at the CAP (Center for American Progress) who is the think tank that writes healthcare policy for HHS today.  That is scary too as you will also find folks like Dr. Zeke Emanuel and Jonathon Gruber over there as well as members, writing policy.  If you have ever read much of Zeke Emanuel’s books or articles, it’s hard to ignore the fact that he’s walking commercial for Optum and United Healthcare, been that way for a few years now. 

Anyway word to the wise here is pay attention to who’s acquiring and financing who as it does impact the type, quality and amount of healthcare services you will be able to receive.  We have a lot of models breaking over at CMS that were mentored over the years by United Healthcare, so pay attention as companies will continue to push broken models on consumers as they make money for the corporations with little care about whether they work for consumers.  As I said in another post “People don’t work that way”…and even Google can’t figure it out either as they are studying their own internal employees to learn. 

So be aware if you are a client of AxelaCare for your drug infusion needs, you get to put more money to the bottom line of United Healthcare, the “too big to fail” health insurer with a monopoly interest over the US government it appears today.  The link below kind of follows suit there as you can’t even find HHS/CMS really supporting the FDA, the agency that also falls under their jurisdiction.  It’ all about the 6 Degrees of Bob Rubin (Secretary Burwell) and a former Goldman Sachs Banker (CMS Director Andy Slavitt) running the show, while everyone else sleeps at the wheel.  BD

HHS Joins Optum Labs as Research Partner–Back Peddles Support of FDA Sentinel Program That Does the Same Thing-More Impact from the Six Degrees of Bob Rubin Running Healthcare in the US

Purchasing AxelaCare was a strategic move for OptumRx to further its strategy of improving care and reducing costs by integrating information and services.

AxelaCare's electronic patient outcomes assessment technology, CareExchange, reports real-time patient data on the clinical efficacy of drug regimens, which will work together with Optum's analytics tools to support treatment decisions.

"With an aging population accessing new and more medications, AxelaCare enhances OptumRx’s ability to deliver the best care to the growing number of consumers managing complex conditions through at-home infusions," a release said. "Together, AxelaCare and OptumRx will expand the scope of treatments that can be offered in the home rather than in higher-cost institutional settings."

Optum employs 10,000 people total, with 1,200 of them in Overland Park. AxelaCare will bring 1,500 people to the company.

http://www.bizjournals.com/kansascity/news/2015/11/17/optumrx-buy-axelcacare-health-solutions.html

HHS Joins Optum Labs as Research Partner–Back Peddles Support of FDA Sentinel Program That Does the Same Thing-More Impact from the Six Degrees of Bob Rubin Running Healthcare in the US

We know Optum Labs is there to make money, selling slots to drug, device companies and others to have the “use” of mining imagetheir data.  So far all we have had of any significance reported is the same thing Kaiser reported from their registry information on hip and knee replacements.  A big part of how Optum makes their money is selling data and access to data.  What’s really interesting is that the same type of data mining operation was set up at the FDA and it in turn gets very little press, the agency that approves the drugs and devices that are allowed to be sold in the US.

Boston Scientific is also a research member here and pretty much what we have seen there is the closing of a few California locations and manufacturing moved from the US to Costa Rica for stents. 

Boston Scientific Joins Optum (United Healthcare) Labs - Research for the Good With Profits Built In For Those Providing Medical Records And Data…

Here’s a bit from the archives on the FDA data mining effort at the link below.  So, this kind of tells me there’s more to this than just research for better drugs, care, and devices, it’s all about money and what gets spent on our healthcare. 

FDA Sentinel and “Mini”Sentinel Data Base Is Growing and Becoming A Very Useful Tool

Speaking of the FDA, United/Optum also owns a consulting firm that helps drug and device companies get their products approved by the FDA and there’ some trial information mixed in there too.  There’s also the ChinaGate United Subsidiary in China that works to get more Chinese drugs and devices distributed within and outside of China as well. 

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

Anything out of Mayo on their use of the Labs with ground breaking research....so far nothing…but they make money letting the Labs use patient electronic medical records.  It’s kind of strange that HHS is not even supportive of their own FDA efforts with the Sentinel Data Base, right?  Again this goes to show the long time relationship and a bit of cronyism with HHS and United Healthcare as well.  If you poke around a bit more than you might read about our current head of the DOJ, Loretta Lynch, she used to represent United Healthcare with anti-trust suits, so you can just about figure she’s do nothing with insurance carriers when it comes to anti-trust, or at least this company.  Of course we all may or may not know by now that Secretary Burwell was a former Chief of Staff for Bob Rubin that was one of the big three that turned the US economy on it’s ear with abandoning Glass Steagall and furthering the allowance of derivatives in the stock markets.  If you want more background on all of that, visit the “Killer Algorithms” page where there are some videos from people smarter than me that will give you the history and explain the fact. 

Optum Labs Add Four Additional Data Miners To the Collaboration Looking for Data…
UnitedHealthGroup and AARP Get Cozier, AARP Still Gets Paid for Marketing Use of AARP Name As AARP Becomes an Optum Labs Data Selling Promoter Amidst Doctor Complaints Received Relative To United Firing of 5500 MDs–Subsidiary Watch

Not too long ago as well Mayo decided to outsource their revenue cycling to Optum 360 as well, so more money for United there.  I read a few of the job reviews from folks about how they were fired from the hospital and re-hired by Optum 360 to work in this area and most seemed to be really disappointed in the loss of benefits 360 provided versus the benefits they previously enjoyed when employed directly from the hospital.   image

Mayo Clinic is the Latest to Outsource Revenue Cycling to Optum 360, A United Healthcare/Dignity Health Company Pursuing Hospital Contracts All Over the US For Profit…
United Healthcare Adding Yet One More Subsidiary to the Very Large Number of Subs They Already Own/Operate-Optum and Dignity Healthcare (A System Wide Cerner EHR Client) Form New Venture Called Optum 360–Subsidiary Watch

The subsidiary game along with mergers and acquisitions as well it getting so bizarre that people insured by Cigna probably have no clue that their new pharmacy benefit manager is United Healthcare via the Catamaran PBM acquisition. 

If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

We truly have some folks in top places in government that seem to live way too virtual and forget about the real world half the time.  You can see it all the time on Twitter with posts of selfies and other such nutty stuff.  I knew when Obama and Biden jumped in to posting selfies, we lost them to virtual world values and chances were slim of either coming back.  Look at Secretary Burwell and all the selfies she posts, looks a bit lost, especially the selfie with a bicycle helmet on a few days after John Kerry fell of his bike in France.  What’s wrong with these people?  They just create noise and now think being a member of this big Optum data base is going to save the world or the US?  It’s crazy that HHS and CMS don’t even support their own efforts of the FDA under current government structures?  Optum supports and pay for a bicycling team so is this where all the bicycle focus comes from, to where all at the White House think they need to talk about their bicycle habits? 

CMS Chasing Wild Virtual Horses-A Big Distraction on the Hope of Finding Some “Algo Fairies” By Giving Entrepreneurs Access to Medicare Claims and Other Data…Marketing & Astro Turfing “The Sebelius Syndrome”..

Look who’s running CMS?  We have Andy Slavitt, the former Goldman banker and United Healthcare executive that everyone sued over his crooked algorithms?  I have a few former CMS folks that have taken time to fill me on on quite a bit of history with both HHS and CMS and this is not good with one company having such a huge monopoly.  The link below will tell you more about Mr. Slavitt, who President Obama has nominated to run CMS.  If you have paid attention to the news in the last few days, he seems very much distracted with social networking comments and just not in touch at all.  Seriously why does the President of the US need a personal Facebook page?  I see an addiction here perhaps and virtual and real world values being confused. 

Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…

Here’s another option from the Optum Bank with Health Savings Accounts…be aware as when you hit the magic number of $2100 in savings, on comes the marketing to get you to place some or all of that money in mutual funds instead of using it for healthcare when you need it. 

United Healthcare Owns a Bank-Optum Bank That Will Collect Your HSA Money, Give You a MasterCard to Empty It Out-Which Enables Even More Data Mining and Selling Transactions About You

You also have United/Optum poking around in the medical records arena too and this archives article tells you a bit more and for goodness sakes the ONC portion of HHS hired a former United Healthcare lawyer to investigate and write policy on privacy…good luck there as so far there’s been nothing but a paycheck handed out to this individual. 

United Healthcare (Optum Insight Subsidiary) Wants To Be Your Allscripts, Epic And GE Centricity EHR Consulting Service Starting With Implementation And Beyond

So again cronyism and one big healthcare insurer that’s become too big to fail it appears here.  Just recently Vermont voted on universal healthcare and guess what, if it has been successful, Optum was right at the door wanting a contract to manage it.  Colorado should be aware of this potential when they take their vote on the same topic. 

There’s absolutely little or no benefit for us as consumers with this partnership at all, other than just more ways to algorithmically play God and deny access to services or other benefits we may need for our care.  Again, this looks really bad doing this and not even being in full support of their own FDA agency with the Sentinel Program.  It’s all about making money, selling more data. 

We need to index and license all data sellers in the US as this is getting out of hand and the data in many areas has become flawed, profiles created about us are flawed..but the cash registers keep on putting money in the banks.  BD 


CAMBRIDGE, Mass.--(BUSINESS WIRE)--OptumLabs, the collaborative health care research and innovation center co-founded by Optum and Mayo Clinic, announced that the U.S. Department of Health and Human Services (HHS) has joined the collaborative as a research partner.

“We are grateful to have HHS as a new partner and welcome its active engagement as we focus on new initiatives that can directly translate to improvements in patient care.”

Agencies under HHS’s purview will now have the opportunity to develop and lead innovative health care research using OptumLabs’ big data resources, which link de-identified medical claims and clinical data to provide holistic views of populations and patient care.

“As HHS and its affiliates seek opportunities to improve the health, safety and well-being of all Americans, we believe that partnering with private-sector organizations such as OptumLabs will help accelerate the discovery of new health care models and practices,” said Susannah Fox, chief technology officer of HHS. “We are eager to collaborate with OptumLabs and its partners on a variety of initiatives that harness the power of health data to improve patient care and outcomes.”

The first research project to be conducted through this arrangement is with senior scientists at the Agency for Healthcare Research and Quality (AHRQ), the lead federal agency charged with improving the safety and quality of America’s health care system. The agency will compare and contrast health care trends identified in its Medical Expenditure Panel Survey (MEPS) with those identified in real-world administrative health care claims records for the commercially insured population in OptumLabs’ databases, with the goal of increasing the value of MEPS to researchers exploring health care costs. MEPS collects data on the health services that Americans use, the cost of these services and how they are paid for.

HHS and its agencies also will work with OptumLabs on other projects, including research related to population health and the economics of health care – such as identifying whether disparities exist and can be measured in health care delivery at the national and local levels. All research is performed using de-identified outcomes-based data that can help answer questions about improvements in health care quality and delivery.

“Government is a key stakeholder in health care, and through this partnership now has a seat at the table of our collaborative community at OptumLabs,” said Paul Bleicher, M.D., Ph.D., CEO of OptumLabs. “We are grateful to have HHS as a new partner and welcome its active engagement as we focus on new initiatives that can directly translate to improvements in patient care.”

OptumLabs, with one of the largest de-identified patient databases in health care, is the first open, collaborative research and innovation center designed to accelerate health care innovation, leading to improved patient care and patient value. More than 100 research projects are currently underway or in development, and members of OptumLabs and its partner organizations have published more than 20 articles in leading health research journals.

http://www.businesswire.com/news/home/20151118005115/en/U.S.-Department-Health-Human-Services-Joins-OptumLabs

Where to Find Cheap Generic Prescription Drugs Less Than a Lot of Co-Pays-Use Cash-And Leave the Insurance, Reward Card, And Pharmacy Benefit Credentials at Home..

I have been asked this question many times and with the war on both cost of drugs and the war on cash, I thought this might be helpful to put some links in as a reference.  Granted all the drugs you need won’t be on the lists perhaps, but there’s enough of them that cover a lot of what is commonly prescribed.

You want to make sure that you do not show the insurance or pharmacy benefit manager credentials as somethingimage might go a bit awry in the processing of your prescription.  Some of the stores now have a pretty big reporting system that track when you fill your prescription, how you pay for it (those eternal credit card records that are bought and sold) and more.  I’ll put links at the bottom of this post that will explain how that work with selling your prescription data and “scoring” you for “predictive” medication adherence, a very flawed program out there.

Filling your prescriptions using Cash and without any access to your insurance and pharmacy benefit manager can actually save you money as the co-pays from the PBMs are higher than the generic prices listed here.  These are the latest updates I could find and some do change from time to time. 

Wal-Mart has a ton of $4.00 and $10.00 prescriptions, go get your prescription filled and no questions asked.

Wal-Mart Generic Drug List

Sam’s Club, also a part of Wal-Mart offers the $4.00 and $10.00 prescriptions.  You need to be a member and pay an annual fee, but they do have some “free” prescriptions available as well.

Sam's Club Generic Drug List

For now anyway until CVS takes over the pharmacies at Target stores, you can still get your $4.00 and $10.00 generic prescriptions there.  Again this will be changing soon as CVS takes over their pharmacy operations.

Target Generic Drug List

Here’s the news on Target and CVS from a prior blog post.

Target Stores Sells Pharmacy and Clinic Business to CVS, Uses Debt to Finance and Drops $1 Billion From Stock Buy Backs, Gains a Lot More Consumer Data to Mine and Sell..

Kroger stores also have quite an extensive list of $4.00 and $10.00 prescription refills.

Kroger Generic Drug List

CVS and Walgreens have “valued” priced generics but most are not this cheap and of course you will need to have a membership card or be wired into the Pharmacy Benefit manager. 

CVS is really getting tough with their PBM Caremark management and will charge you higher co-pays if you go to a store that sells tobacco, and that takes care of the places to where you can get a $4.00 or $10.00 prescription.  Read the blog post below on what they are doing.  Most are going to get prescriptions and could care less about the tobacco products in the store anyway and it was nothing more than a big PR campaign for the most part. 

CVS To Charge Consumers Higher Co-Pays With Prescriptions Filled at Drug Stores That Still Sell Tobacco Products–Killer Algorithms Attacking Once Again To Make Sure CVS Gets the Prescription Revenue And Your Data To Score And Sell

Here’s the CVS list. 

CVS Generic Drug Listing (no prices)

Walgreens has a $5.00, $10.00 and $15.00 tier plan and you’ll probably have to “join” their club to get the savings, which means they will have all your data to sell in the process.   I didn’t see a list for Rite-Aid but if regulators give the approval Walgreens is taking those stores over soon and you can look forward to some store closures and cut backs in the near future. 

Walgreens Generic Drug Listing

CVS/Caremark is really into making money as well as Walgreens with selling prescription data, each chain making about $ 2 billion dollars a year selling your data and it all gets connected via those rewards cards and your insurance plan cards.  They both send data to big companies like IMS who stores about 85% of the world’s prescription data. 

Ok so the deal to keep a little of the privacy we have is to pay cash and don’t use any of those rewards or insurance and pharmacy benefit credentials.  Every time you fill a prescription you are scored to predict on whether or not you will take your meds.  By using cash, you may be called an “Outlier” in your score and get a score to defaulting you to non compliance.  I’ll include a link below that describes how that process works via an interview I had with a pharmacist that told me all about it.

Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…

Just for conversation purposes, here’s a look at how Express Scripts secretly scores you (a secret as you can’t see it or have that score even though it is sold to pharma and insurance companies) on whether or not their algorithms think you will take your meds.  This goes on everywhere with all pharmacy benefit managers and with data sent to big healthcare data brokers like IMS.  As you can see from the image here, none of the metrics shown have anything to do with taking medications.  One that stands out is “children in the household”..why single this out as watching too much TV, spending a lot of time at the gym, and so on could also distract anyone for example.

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

Here’s a bit about IMS and the data they buy and sell.  Have you ever ended up on a clinical trials potential list where your name has been bought and sold?  I am on a list of “known blood thinner” users, and it’s a big problem as I get called and solicited and have never been prescribed blood thinners in my life but have to live with the flawed data sold about me all the time as I can’t fix it and find all the sources selling it. 

Need Any More Proof That Data Selling is An Epidemic Out of Control IMS Health Files for an IPO And Holds 85% of the World’s Prescription Data

So there you have it and and I hope this is helpful and through adding some information on prescription data selling I hope this might also help you see yet one more angle to war on cash, in other words get patients to use and electronic transaction via a credit card so they can “score” you and might even play a role in denying you access someday to a drug you may need.  The link below tell even more about “scoring” and denying access in many areas that you may not even know exist.  BD

Excess Scoring of US Consumers, US Citizens-Scored into Oblivion By Proprietary Algorithms and Formulas, Never Duplicated or Tested for Accuracy-Profits of Big Business And A White House Executive Command To Continue the Abuse..

Catholic Hospital Takes Horizon Blue Cross Insurance Company to Court-Tiered Hospitals With Additional Policy Discounts Unfair to Hospitals of Faith–Killer Algorithms At Work..

Well what’s not to say we’ll see more of this.  Yes indeed it’s getting complicated to get healthcare today.  We have the elite list and the cheap list it appears with insurance plan offerings.  I said a while back that there are armies of Quants hired from banks and other financial firms, i.e. high frequency trading companies who are now creating the models for the contracts and you see it more every day.  When you can take an insurance policy model and apply a Quant model on top of an actuarial model and check the impact on policies with stock, yeah they’ll do it.  It’s being done already.  Horizon of course is not alone as it’s all over the industry.  image

The ability to get healthcare and math models for profit are reaching some very interesting plateaus you could say.  Before you venture out and get care, you have to go to your computer and see if anything has changed as things do change rapidly and what was in network today could be out tomorrow or in a case like this, switched to another algorithmically created tier.  Math and healthcare are tied at the hip today with contracts.  The link below goes back about a year.

Data Scientists/Quants in the Health Insurance Business–Modeling Beyond the Speed and Capabilities of Humans To Keep Up With The Affordable Care Act–Turning Into A World of Killer Algorithms That We All Hate..

What’s even more interesting with all of the changes, CMS thinks fining insurers will make a difference-not.  It doesn’t work as this form of mathematically rating doctors and hospitals along with allowing access unfortunately looks like it’s here to stay as nobody will do a thing about it. 

CMS Considering Fines for Inaccurate Doctor Listings, Not a Realistic Fix As Complex Doctor Scoring Algorithms Are Found At The Root of the Problem-Enter the Health Insurance Quants…

So with this story, we have Catholic Hospitals who are being placed in a tier that is out of reach for certain health plans.  If this is not proof of being able to get care based on what you can afford to pay, I don’t know what is.  What makes this even more interesting is the fact that Horizon held on to and used the old Ingenix calculations that were short paying doctors all across the country.  The formulas were still being used when other insurers, after being sued, discontinued the practice.  The Ingenix formulas were licensed to almost all major insurers and for a number of years provided additional income for United Healthcare until caught by then NY Attorney General Cuomo. 

Ingenix (Optum-United Healthcare) Lawsuits Still Bouncing Around Out There–One Recently Settled in New Jersey With Horizon Blue Cross Blue Shield That Was Still Using the Flawed and Corrupt Data Base for Out of Network Payment Calculations

As you can read more below and at the link for the full story, the Bishops have sent a letter asking Horizon to at least allow the Catholic hospitals the opportunity to apply for Tier One status.  Life and healthcare is just one big lawsuit sadly.  BD


TRENTON — Arguing it was "wrongly excluded" from a line new of discounted insurance plans, Saint Peter's University Hospital Friday sued to stop Horizon Blue Cross Blue Shield of New Jersey from selling the policies without giving the New Brunswick hospital a chance to participate.

The hospital's attorney, Jeffrey Greenbaum, confirmed he filed an injunction in state Superior Court in Middlesex County asking a judge to prevent the state's largest insurance company from selling OMNIA Alliance policies that will offer consumers a 15 percent discount from their other products in 2016.

Horizon announced the OMNIA Alliance plans in September and described them as offering affordable and high quality care with a focus on preventing illness and managing chronic conditions. Other carriers, such as Aetna, also offered tiered networks to curb costs. But with 3.8 million customers, Horizon wields considerable buying power.

Horizon has stressed that it will continue to offer most of its existing plans – giving consumers a variety of choices, and Tier 2 hospitals and doctors plenty of business.

The excluded hospitals — many of them Catholic, located in cities or serve many uninsured and Medicaid clients — say they fear they will fall into economic crisis.

New Jersey Catholic Conference, an organization that represents the bishops, sent a letter last week asking Horizon CEO Robert Marino to let hospitals apply for Tier 1 status.

http://www.nj.com/healthfit/index.ssf/2015/11/nj_hospital_sues_horizon_to_stop_new_discounted_in.html

CVS Laying Off 150 Employees at Headquarters, Meanwhile at the CareMark Florida Ranch A New 500 Personnel Facility to Add Support for Mail Order Drugs In the Works..

You can’t make this stuff up and of course this is a big push to save money and get more folks on mail order prescriptions.  That sector of CVS is growing and it makes money as you can refill prescriptions easier on an automated basis.  Insurers can get billed as soon as “the pills go in the bottle” so as a patient you get loaded up faster.  I used to watch this with my mother as she had CVS Caremark mail order drugs and she had drawers of medications with 3-4 month supplies all shipped in the big prescription bottles.  She was also a diabetic and boy the strips were way more than imageshe needed as well and those too were sent in bulk.  Here’s the story on what’s happening in Florida.  So we have a minus 150 at the headquarters and a potential plus of 500 in Florida to focus on more mail order and data selling business. 

“Officials in Orange County, FL, have awarded an incentive package to Caremark, a division of CVS Health, to bring in a pharmaceutical operation that could create up to 500 jobs in the county. County commissioners approved Caremark's request in a vote of 6-1. Caremark, which is headquartered in Rhode Island, plans to establish a support operation in Orange County for its pharmacies in the southeastern United States. The jobs to be created include 100 pharmacists and 350 pharmacy techs. The company would add 275 jobs by the end of 2016 and another 225 jobs in 2017. The incentive program requires the average salary of the new jobs to be at least 115% of the county's average salary of $42,604. Meanwhile, Caremark would be in line for $1.5 million in tax refunds from the state—or about $3,000 per job—with the county contributing up to $300,000.”

Let’s not forget the higher co-pay that CVS will use if you go to a store that still sells tobacco…keep reading and see what interests CVS has with alcohol below at the end of this post.  It’s like we have the fox guarding the hen house at times. 

CVS To Charge Consumers Higher Co-Pays With Prescriptions Filled at Drug Stores That Still Sell Tobacco Products–Killer Algorithms Attacking Once Again To Make Sure CVS Gets the Prescription Revenue And Your Data To Score And Sell

We knew their entire program was nothing but market

We all know CVS makes a lot of money selling our personal data as well.  It has to be going beyond the 2 billion a year by now as they keep expanding this all the time.  You can read about the IBMWatson partnership here, which is just about everywhere now as IBM has suffered 13 quarters of declining losses and their huge stock buy backs might be catching up to their financial engineering schemes.  IBMWatson by all means is not the only show in town with mining big data and running queries. 

CVS and IBM Watson Project–Please Make It Stop-13 Quarters of Declining Profits for IBM, Is This Is What We Get, More Algorithms Biting Us Constantly So More Data Can Be Mined and Sold Resulting In Excess “Scoring” of US Consumers..
CVS to Share More Medication Adherence Love With New Contracts–Will Have More Data to Sell…

As another contrast, look at the money CVS is putting in the e-commerce data selling business..not one, not two, but three centers so they can figure out which area of the country can write the best algorithms to capture and sell more consumer data and soak into all of it on the web.  You can see Rhode Island was left out here and they went to Boston and the Silicon Valley instead for computer code to make more money for them selling our personal data.  New York was also mentioned as there’s a ton of code hosers there as well, look at the stock exchanges and there’s code hosers that used to work for banks and high frequency firms who can spin up algorithms to get more of your money as that’s what they have done for years.  There’s quite a few of those looking for work as banks continue with their layoffs. 

CVS to Open New E-Commerce Technology Centers in Boston, New York and Palo Alto– Need “New Code” to Make Bigger Profits While They And Others Continue to Destroy “US Consumer Dignity” With the Exploitations…

There’s also a “war on cash” that exists with pharmacy benefit management too and I wrote about that a while back and CareMark is right in there with Express Scripts, Optum RX and a bunch more with not being able to find enough data about you and thus you get “scored” as an outlier by default who’s not medication adherence compliant with a metric of predictions that have nothing to do with taking meds.  I wrote this post after having a long talk with a pharmacists who told me what’s going on from their neck of the woods and how it impacts their jobs and pay for performance.  These “pharmacy techs” now employed by the groves are becoming a massive area of decision making and even push pharmacists at drug stores

Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…

I had the same pharmacist tell me about dealing with CVS techs and almost demanding that the drug store put the patient on automatic refill, stating a conversation with the patient had taken place with getting the patient ok.  Having been burned on this a few times, the pharmacist replied “no” and said that a call to the patient first would be the appropriate line of action versus taking the word of a CVS tech that the patient had said ok.  If you go back a little bit on this, CVS got in hot water about this exact same topic at the drug stores a while back with giving pharmacists “quotas” to meet on converting prescriptions to CVS from other pharmacies.  Some good journalism exposed that story with internal CVS emails.  We should also remember that Nancy Deparle, the White House chief architect for Obamacare sits on the CVS board with shares of stock and makes some money there as well. 

The Prescription Auto-Refills Still Out There With CVS and Others as Pay for Performance Efforts Ramp Up at US Corporate Retail Pharmacies To Meet Quotas and Make Those Profit Numbers for the Shareholders
The Automatic Prescription Refill Algorithm Causing Havoc at CVS When Not Personally Authorized By the Patient–Attack of the Killer Algorithms Chapter 40

CVS also kept losing pain reliever prescriptions in California and were under the heat on that charge as well.image

CVS Drug Stores Could Face $29 Million in Fines For Losing Track of Prescription Pain Killers At California Stores - Don’t Worry About Tobacco So Much And Go Hunt Down That Missing Vicodin..

In addition, we had the DEA raids in Florida a few years ago that closed a couple CVS stores and brought on a case with their drug distributor, so it is interesting that Florida once again is being chosen for a new CareMark distribution facility.  They make money selling drugs and filling prescriptions by all means, either in the stores or by mail order. 

DEA Raids 2 CVS Stores in Florida and Suspends License of Drug Distributor Cardinal Health–Lots of Oxycodone

So it appears via automation or whatever criteria used by CVS, that their profits and money makers are located outside of the corporate offices for now.  We don’t know exactly what areas in the main office were impacted.  By the way in an unrelated story, CVS in California under fire for selling homeopathic medicine that was just basically alcohol and water at their stores.  A woman drank 6 bottles of the CVS Constipation Relief medicine and got drunk in camera.  Maybe time for CVS to really look into what’s the shelves today as well?  If they video does not play, use this link to view at the site as it was having issues when I posted.  BD

 


WOONSOCKET, R.I. — Drugstore chain and pharmacy benefits manager CVS Health is laying off 150 people, a spokesman said Friday.

The company has informed the workers it is eliminating their jobs in December, spokesman Michael DeAngelis said. Seventy of the jobs are at the company’s headquarters in Woonsocket.

DeAngelis said the cuts follow a “thorough evaluation process” and represent a small fraction of the company’s more than 200,000 employees in the United States, 7,000 of whom are in Rhode Island.

http://timesleader.com/news/492753/cvs-health-laying-off-150-people-in-operational-review