CMS Medicare Proposing More Data Selling of Both Private and Medicare Patient Claim Data - A New Dignity And Privacy Attack on Both Consumers and Doctors

Just when you think it can’t get any worse it does.  If you read here often enough then you know I am a privacy advocate and have had an informal campaign going for a few years on indexing and licensing data sellers, that take your data, without your permission or with a legal statement that you agree to that says they can that you don’t understand.  When you read this article, it says exactly what I have been talking about with “Excess Scoring” of consumers.  This is huge as your data gets used, queried and sold to supposedly create all these worthless rankings of doctors, care and services. Actually it’s been a very poplar post as more consumers are beginning to learn and understand the “secret” scoring that’s taking place for profit all over the US.  Now we have Algo Man Andy Slavitt head of CMS , a former Goldman Sachs banker wanting to make it easier to sell patient claim and other data for money.  Read the link below and links in that post to see exactly what’s going on. 

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..

We all know Slavitt’s  Ingenix background and how he was sued all over the place for algos that don’t help care but rather just make money with little concern for doctors and patients.  A few months ago, another of the Ingenix lawsuits just finally settled up to where doctors were being shorted on out of network pay.  There were tons of lawsuits over the Ingenix algorithms. 

What this is talking about here is again selling and scoring your healthcare data and you don’t get to have a say in any of this.  If you have looked over the last few years we have the “useless” ranking of doctors and hospitals that CMS has been putting out.  Is this of any use?  Not really as narrow networks pretty much control what doctors and hospitals you can use and be covered, so why keep putting this “ranking” data out there?  It only serves to be a negative when folks see rankings of hospitals that they can’t go to as their are not in their network.  It doesn’t take a rocket scientist to figure that out.  The news media in looking for click bait keeps trying to put out doctor quality data and nobody cares anymore and for that matter might not want to even think about looking to see if the doctors they are limited to are not at the top of quality lists.  This is just another broken model that is pushed to the limit as government is drunk on stats and algos that do little or nothing for the average consumer.

Actually to quote Dr. Halamka, CIO  from Harvard Medical from a recent post of his, he has this to say in speaking about transitioning from Meaningful Use..

“There is only one part of the draft legislation that I think is truly unhelpful - creating a government sponsored rating system  for healthcare information technology.    I cannot think of another industry in which the government provides the “Yelp”-like function.”

This is in reference to the Senate HELP committee to draft legislation to change Meaningful Use, a model that broke a long time ago that has not been changed as we have a full on ONC division at HHS that’s totally over their heads and stuck on what to do and seems to focus on fairy tales like the perception of “information blocking”.  Things like this happen with people who have never written code and get all whacked out on what they “think” is out there.  I used to get that all the time when I wrote my simple EMR years ago with the doctors and their perceptions.  I’m not picking on doctors but the way anyone outside of engineering and programming views software versus the folks that write it perceives how the code works is off base quite a bit of the time.  I solved that by showing a few doctors what code looked like and what I had to do to facilitate a simple change in the software:)

Let me clarify something in all of this as well as I am not talking about big data in genomic research as that’s where big data belongs in scientific research and is needed there and that’s a science, but what I am talking about here is the awful ranking of doctors and use of patient data that gets used out of context to make money.  Selling patient data is all about that.  Sure we get some reports on trends and those are useful but that’s not where all of this is going at all. We also do need some quality reports to degree but this is going way past where it needs to be. As someone stated a while back, if you don’t monitor and keep Quants in check, they spin out of control and that’s exactly what we are seeing here with Slavitt at CMS, he’s a quant that spend time at Goldman and McKinsey who learned how to spin numbers for profit.

Actually having Senator Warren on this HELP committee could represent somewhat of a conflict of interest in my opinion as her family, and speaking of her daughter Amelia’s business in particular have had long term ties to United Healthcare as of course so does Andy Slavitt.  You can read about Amelia Warren at this Bloomberg link  and hear about the book she and her mother wrote that talks about solving the issues of the poor, and of course there’s been nothing new on that frontier either, but a lot of books sold of “All Your Worth”. 

The Bloomberg link talks about the company Amelia Warren co-founded with Andy Slavitt, Health Allies, a company that they sold to United Healthcare, which is nothing more than a card you pay $25.00 a month for to get discounts. You read that right, look it up on United Healthcare’s page.  In essence what it being said here is the relationships over the years and the fact that Amelia Warren founded a company that competes with McKinsey to find executives for big corporations.  I don’t exactly know why but every time I blog about the NHS leadership being someone from United Healthcare, I seem to get a lot of hits from Warren’s office reading it.  Case in point here is they all made a lot of money with and via United Healthcare so when you see a data selling proposal like this, one has to say hmmmmm. 

Anyway, in my opinion, the data selling here with this proposal is going way over the top on what’s needed for quality reporting on doctors and patient data.  Right now doctors are not happy and we sadly have quite a few that say “they can’t take it anymore” and quit.  400 doctors commit suicide every year.  We don’t need to make their lives even more miserable for the sake of selling data for stuffed reports, some out of context that will generate no ROI.  Actually I wrote a couple years ago about insurance companies driving themselves off a cliff with data.  They have so much of it today in trying to find some Pandora’s box of wisdom that they can’t even put out an accurate MD listing themselves as their quants keep changing the models of insurance policies based on cost numbers from doctors.

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..

In fact the complexities of insurers gets so bad with data, see the link below to where you have United Healthcare bidding and winning a contract to only find

out later the quants on the other side of United’s analytics bunch already knocked out all the doctors and there were none to go with this program.  See what I mean.

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

The Secret Scoring of Doctors has been going on for quite a while and this is why you can’t keep your doctor as Obama promised.  We can talk more intelligently now instead of hanging that one on Obama and look at it for what it is.  We do have enough other items that we can blame Obama for, but this the work of Quants, who insurers have hired by groves that create this misery.  Here’s more on the Secret Scoring of America’s physicians and there’s also a link there to the World Privacy Forum about their outstanding report on “The Secret Scoring of America” and that’s very much worth a read.  If you look at the top of this page, go to the link and see the Privacy Forum Testimony at the Senate on Data Selling and Scoring from a couple years ago.  You’ll get to hear what’s being sold and scored about you and the fact that Congress is doing nothing about it. 

“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..

In another industry, truck driving, the healthcare folks are spinning out of control over there too with wanting to get live real time readings on every driver’s blood pressure and sugar levels, etc.  That’s the work of some pilot the DOT is proposing and looking for drivers to volunteer.  Good luck as there’s a 100% turnover right now with long haul truck drivers not to mention a shortage, so let’s make their job even more miserable?  You can’t use technology in ways that don’t work the way that people do and that’s exactly what’s happening here.  I can’t think of any truck driver who would want to be hooked up real time monitoring of their vitals while driving a truck, the job is hard enough as it is. 

Remember how Bloomberg made everyone so miserable with thinking that his “Big Gulp” model was going to cut down kids drinking soft drinks with sugar?  It bombed as it was a bad model and “people don’t work that way” so with Andy Slavitt at CMS we have a lot of the same thought processes taking place, and he’ begins to become a liability rather than a help with healthcare numbers.  It’s all he knows, algos for profit and we have the extensive proof from the years of Ingenix, now called Optum Insights where he was the CEO. 

Selling doctors data is not the answer to providing better care.  Each hospital on their own has enough data to know what’s going on and reports such already to CMS.  Take ICD10, it has does nothing to improve patient care and only created a more complex billing system to where companies like Optum 360 stand to benefit and make more money.  It should have been delayed until ICD11 when SnoMed crosswalks are more mature. 

We issues too with some of the Silicon Valley technology perceptions and I wrote about that this week too.  You are being somewhat told that some of this technology is diagnostic when in fact it’s just another risk assessment, done to “score” you again, so again as consumers and doctors, we have this humongous ball and chain of risks tied to our ankles that not only denies access but also is a big contributing factor to accelerating inequality in the US as they are modeling it that way.  The folks with code or who pay for a lot of it have all the money.  By the way Optum Behavioral Health’s headquarters is right up there in Silicon Valley too. 

Silicon Valley Is At It Again Confusing the Public With Calling Risk Assessments a Form of A Diagnosis Tool…

So again maybe time to look at who’s running healthcare in this country?  In addition to Andy Slavitt and his Quant background we have HHS Burwell who was a former chief of staff for former US Secretary of the Treasury, Bob Rubin, so there’s the 6 degrees of Bob Rubin there, the person who succeeded in downing Glass Steagall during his tenure of office with the Clinton Administration.  Maybe this year at HIMSS as a keynote speaker we could hear about what her responsibilities were as Rubin’s chief of staff with the damage that was done.  He is by the way on the board of trustees of Mount Sinai-NYU Health as a side note. 

Again I see this as a total rip and a way to just sell more data for profit rather than providing any better care.  HHS and CMS have lost their way and are currently way off of where they should be in representing the government in healthcare.  Over the years United Healthcare has mentored many of the CMS models (a former CMS analyst told me that), and now they are beginning to break, just like the economic models in the US are doing.  This will do nothing except make money and not serve to improve the quality of healthcare.  As a matter of fact, myself and a banker had this conversation about 3 years ago and we both agreed that 50% of the analytics sold in the upcoming years would be totally useless and show zero ROI, so that’s exactly what this is, more data selling to make money and continue to trounce the dignity of the average US Consumer.  Here’s another area where HHS has poking their nose too, over at HUD, as they think they need your medical records before providing any help to you and have contracted with Lewis, another subsidiary of United Healthcare for this pilot. 

HHS and HUD Match Housing and Health Data - To Understand Needs of HUD Assisted Households-Study Contracted to Lewin Group - A Subsidiary of United Healthcare

Here’s one of the companies, Argus Analytics that buys all your credit card data and what a surprise to see the Consumer Financial Protection Bureau to be a customer of theirs as well.  See what I mean, it’s all about selling data for profit and this gets us no better care.  Be careful as well as the call centers of insurance companies are doing risk assessments on your voice to determine your current state of mind when you are on the phone with them as well. 

This is what the Algo Man, Slavitt running CMS sees as a future, a world of “scoring” consumers, using technology we have no access to and is pretty much just drunk on Algos, like the White House.  This is all Slavitt has ever known, so this data selling Senate Bill is just another extension of data for dollars and we lose again.  When it comes to privacy, we’re stuck there too as there’s a former United Healthcare lawyer that handles that at the ONC, she’s no help and has a long background of working to secure profits through her legal efforts as well.  Think the profit cards are stacked here, you might be right.  BD 

Privacy Duping of America-The Intangible Threat Model Has Changed Significantly-Companies Hide The Code On the Web, $180 Billion Dollar A Year Business, Welcome to The Duperville World of Inequality..

---

Some medical data miners may soon be allowed to share and sell Medicare and private-sector medical-claims data, as well as analyses of that data, under proposed regulations the CMS issued Friday.
Quality improvement organizations and other “qualified entities” would be granted permission to perform data analytics work and share it with, or sell it to others, under an 86-page proposed rule that carries out a provision of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value in Appleton, Wis., said the MACRA provision would allow organizations like the Wisconsin Health Information Organization to accept Medicare data and then publicly report the performance of physicians both on cost and quality. The information exchange, one of the original 13 qualified entities, is the all-payer claims database for the state.

http://www.modernhealthcare.com/article/20160129/NEWS/160129844?utm_campaign=socialflow&utm_source=twitter&utm_medium=social

United Healthcare Buys Helios Workman’s Comp PBM and Their Other Related Businesses

Here’s another purchase, Helios,  and the big focus here is the pharmacy benefit management.  It was just last year that United/OptumRX bought Catamaran.  What’s interesting about that purchase is that all the folks insured by Cigna now all have OptumRX as their pharmacy benefit manager.  Nothing like having a competitor for Cigna like United with their nose in a big part of your business, especially when Cigna just got sanctioned from CMS and can’t sell any more Medicare Advantage policies for a while. 

CMS Sanctions Cigna-No More Selling Any New Medicare Advantage Policies Until Algo Problems Denying Medical Coverage and Prescription Denials Are Fixed

Helios has some big contracts as well, such as the US Post Office and Southwest Airlines to name a couple.  As a claimant, you get set up with a credit card to get your prescriptions so all of that can be tracked and of course sold.  All pharmacy benefit managers work that way.  They offer you a MasterCard, the biggest data selling credit card service in the US and you have to put the money in, so it’s not like you are given money to charge against any settlement, one more way to get more data from you for the case and to sell.  The Preferred provider for scripts is Walgreens and they will want you on mail order too.  They have the same old predictive analytics they write about like all the others…they will predict your case, how long, the severity of the injury and so on.  If you want to read about what goes on if you pay cash on any prescriptions, almost anywhere, read this link below as you are now “scored” as an Outlier if they can’t find enough data about you and by default you score to a level of noncompliance.

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…

“Four years ago, we began our predictive analytics program by calculating an individual risk score to measure the potential of a claim becoming a high-cost pharmacy claim. Our clinical services team of pharmacists and nurses used these risk scores to prioritize claim intervention efforts following a needs-based triage approach that combined the numbers from the algorithms with the experience of the clinician.”

With owning more and more clinics, I could guess in time you will be referred to Optum owned urgent care centers as well.  Some states are blanketed with them already with the purchase of MedExpress, who’s buying up more private practices all the time. 

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…

In addition, if you need some infusion drugs, there’s probably another Optum subsidiary that will pay you a visit at home.

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…

Have you ever noticed the investments in low income housing from United?

United Healthcare Expands Into More Low Income Housing Investments, This Time in Austin - They Want Your Rent Check Too-Subsidiary Watch

Notice this cozy arrangement with HHS and Optum Labs where HHS didn’t even use their own FDA agency Sentinel program that does the same thing.  Do read some of my links above and you might be surprised on what’s going on in plain sight around you.  United has just under 400 subsidiaries all involved in many types of business and is not just an insurance company.  BD 

---

UnitedHealth Group Inc.'s acquisition of workers compensation pharmacy benefit manager Helios will help the health insurer grow by expanding its offerings in the pharmaceutical space, an analyst says.

OptumRx Inc., UnitedHealth's PBM unit, acquired Helios on Jan. 15, spokespeople for the companies confirmed Wednesday.

While terms of the deal were not disclosed, Bloomberg reported it could be worth up to $1.7 billion.

Helios was established effective August 2014 following the merger of two workers comp PBMs, Progressive Medical Inc. and PMSI Inc.

http://www.businessinsurance.com/article/20160127/NEWS08/160129835/optumrx-acquires-workers-comp-specialist-pbm-helios

Silicon Valley Is At It Again Confusing the Public With Calling Risk Assessments a Form of A Diagnosis Tool…

This should be ruled trickery as that’s what it really is.  When you read the snip from the press release on Neurotrack, this is a “risk assessment” tool and not a diagnosis tool as they would like you to think.  This is software and there’ no genomic technology at all here in looking for markers.  A lot of software is getting called “cognitive” technology that somewhat grays the lines of the perception of the average consumer.  Look at the money raised here.

This is not a tool that will diagnose one for for Alzheimer's, it’s a software program that will make measurements on eye behaviors that will come up with a “risk” assessment value that can be scored and sold for money.  How risk assessments do we as consumers have tagged to our backs?  Probably more than you could ever imagine as many are secret as you don’t the score exists and maybe not even when you were scored and what data was used.

Guess what, this will be a money maker for selling your risk assessment for Alzheimer's and in time with incestuous marketing and convincing insurance companies that it will help them with underwriting policies, we’ll all have a “score” for this.  Read the clip below and you can see it’s yet one more assessment to get into monitoring diet, exercise and so forth. 

“Neurotrack’s cognitive health program is a multipart intervention, built on lifestyle recommendations in diet, exercise, cognitive training, sleep and stress management that have been shown to prevent decline and improve cognitive scores in people at risk for impairment.”

Again, this is not a diagnosis for Alzheimer's, but rather just a “risk assessment”.  All you have to do is watch the news and there’s lots of these so called cognitive programs out there for depression or whatever and they are the same thing, risk assessments.  Here’s an article in Venture Beat that is calling this product a “diagnosis” tool. 

If you don’t think there’s a ton of marketing here, read this statement and again I call this a “junk science” statement as nobody can predict such numbers and it’s like something you read published by the McKinsey company who always used the “T” word with relating to money.  If you have Alzheimer's, statements like this tend to allude to the fact that you could be a financial burden to the world if you will.  Another article that was in Wired Magazine said Alzheimer's was going to bankrupt the world..so come on with the marketing, ok? 

“The costs of Alzheimer's disease are enormous,” said Kaplan, “$200 billion today and projected to be in excess of $1 trillion by 2050.”

This product is for “risk assessment” and not a diagnosis.  Pharmacy benefit managers too would love to have this data as well as they look at all kinds of risk assessments on us today.  I’m not saying the software is useless but for goodness sakes, call it what it is and don’t mislead the public.  In addition, we have the company creating software for cognitive health that nobody will use either, as people don’t work this way and I’ve written about the world of broken software models that are pushed on consumers for the sake of making money and it goes beyond just healthcare.  This companion program is going to be nothing more than a digital wellness program, and gosh knows there’s jillions of those that don’t get used.

“Neurotrack is also developing a complementary computer-based cognitive health program, to support cognitive health through better nutrition, regular exercise, stress reduction, adequate sleep and “cognitive training tools” designed to preserve mental acuity.”

Actually there has to be a real good reason to administer this cognitive test and not just start “scoring” everyone to save the world from bankruptcy too.  We do have a real big problem with Silicon Valley thinking we want to walk around with a load of risk assessments, like a ball and chain and that’s about what they are doing and some of it is very Orwellian.  The developers and VCs would wish some of the technology they fund on their own mother.  At the link below I address this epidemic of Excess Scoring of US Consumers for Risk.  In addition, the World Privacy Forum a couple years ago put out a report called “The Secret Scoring of America” which is very good and goes into detail on Medication adherence predictions and how flawed and horrific those numbers are. 

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..

Many insurance companies now have what they call a “cognitive” evaluation for seniors that are insured and it’s a fair test and basically is question related, but the deal here, is this company working to ride on those coat tails and want to include even more risk assessments like this at that time?  I think the genomic research is a much better science and avenue to go after in this area when you want to look at Alzheimer’s risk, as you have some real science there and not just the action of your eyes compounded with a computer software program for wellness as this offers. 

Again as consumers we all don’t want to have to carry a unneeded risk assessment around needlessly if we don’t need it and the drive for profits for such a program like this will be there as the data scoring for profit continues to mature in the US.  I use the word “mature” as we all know there’s bit touch of Orwell in how cognitive assessments are both perceived and used today. IBMWatson is going after anything that moves to call it “cognitive” as they have had 13 quarters of lost sales and too many buy backs and thus their push goes beyond what some technologies are beneficial for as they want data scores to sell.  I often wonder what IBMWatson is doing with their install at Citibank, scoring consumers with behavior analytics to see who won’t notice a few extra fees, that’s cognitive too. 

So again, let’s focus on the proper perception and stop referring to “data risk assessment tools” as diagnostic tools.  It’s an awful disease but let’s not over risk assess and burden people with that worry that will never develop it. BD

---

PALO ALTO, Calif.--(BUSINESS WIRE)--Today, Neurotrack has announced the release of its first product, Neurotrack’s Imprint™, a digital cognitive assessment test that will enable earlier and more effective evaluation of patients who may be at risk for cognitive decline and help advance research and treatment of cognitive diseases like Alzheimer’s. The company has also revealed the private beta of Neurotrack’s cognitive health product, a personalized lifestyle program that brings together the best scientific research shown to reduce the risk of cognitive decline and improve overall cognitive health.

Also announced today, Neurotrack has raised $6.5 million in new funding led by Khosla Ventures and supported by Social Capital, Founders Fund, AME Cloud Ventures and iSeed Ventures. The funding will be used to accelerate research, product development, and recruiting and brings the total amount raised to $9.5 million.

Neurotrack’s Imprint™ Cognitive Assessment Test and Cognitive Health Program

Imprint™, the Neurotrack test, is a 5-minute web-based test that utilizes eye tracking technology to assess recognition memory and hippocampal impairment. The test is built on more than 30 years of research led by Neurotrack co-founder Dr. Stuart Zola, one of the country’s leading neuroscientists and researchers of cognitive decline. This research includes a five-year longitudinal study funded by the NIH, the results of which were published in the peer-reviewed American Journal of Alzheimer’s Disease and Other Dementias.

http://www.businesswire.com/news/home/20160127005908/en/Neurotrack-Secures-6.5-Million-Financing-Advance-Cognitive

Silicon Valley Venture Capitalists Funding Orwellian Software Apps For Medication Compliance-Obnoxious Pill Selfies–Time To Think About Boycotting Some VC Portfolio Companies Right Now…

I’ve complained about this here and there but this takes the hat.  When you dump out $12 million and on top of that get $7 Million from the NIH for software that is so Orwellian in nature, it’s time to speak up.  This is software you would not even wish on your mother to use, as people don’t work this way.

The creators of this AiCure software are not much more than “greedy”, stupid software architects that want to sell some virtual values that don’t work in the real world.  So as listed below, the bad guys are New Leaf, Pirtzker Group, Tribeca and Biomatics.  Go to each one of their home pages and view the portfolio pages and make a note of their portfolio companies and avoid them.

With an exception of developing devices or something that helps with treating disease or cures, the Silicon Valley Venture Capitalists need a hard reset and this Orwellian funding of software that uses facial ID and a video to substantiate a person taking their medicines is too much.  People don’t work this way and to force a broken Orwellian model on consumers that will push people into an unnatural way of living life is just wrong.  Picture yourself, being a prisoner of a phone and being treated like a child as not having the ability or brains to take your pills, and that’s exactly what these algo smurffs are tossing money at. 

See all the Venture Capitalists listed in the snip of the original below, boycott their portfolio companies is the best idea I can come up with.  The bright spot about this though is that so many start ups fail and we could give this one an anchor and toss it to the bottom of the ocean or the crap algo pit if you will.

How Many More “Bloomberg Big Gulp” Failed “Proof of Concept” Models Can We Sustain Before Everyone Splits a Gasket?

These jerks don’t even think the average consumer would like to have a little dignity in the world and because of apps and data mining and selling apps, it’s hard to find.  These are total jerks that duped old Francis Collins at the NIH as well.  Watch this video tat the link below to see some of the real demented perceptions that these folks get in their heads.  I’m not saying all is bad but there’s enough jerks that give no thought to humans to humans.  This is the type of garbage that pharma companies also fund so they can always come back and fault a patient for non compliance, whether it’s true or not.

“Cybertopia-Dreams of Silicon Valley”-Documentary About Politics, Economics and Debate on Where is the “Real” World Today? The Producers the Takers and the Dupers…

Just Because You Design It, Get Millions in Funding, Market and Promote It Doesn’t Mean We’re Going to Wear It and Find Value, The Wearables Business Where People Don’t Work That Way, Stifle Those Broken “Big Gulp” Models..Please..

Great picture off to the side, screen shot from their promo video show a pill ready to go down the hatch.  Just what you want to video.  Is this absolutely saying that everyone is dummied down now to where we need the Orwellian effect?  It’s bad enough with pharmacy benefit management too with “scoring” you to now “predict” if you will take your pill so flawed data scores you as non compliant, especially if you pay cash and then you get lowed down to a level of no dignity with this piece of crap.  People don’t work that way.  Nobody should be subjected to such insults as they promote in the video.  Stupid software engineers think apps like this are the cat’s meow.  So again my suggestion is to boycott the Venture Capitalists funding such nonsense.  Reminders are fine but this crap is over the top.

The video with doctors checking up on their patients…that is a laugh and a half as they don’t have time for that, give me a break and see how out of touch Silicon Valley is with doctor workflow.  They’re stupid with their visions.  Please do read the link below and I would like to see the evil algo guys bug their eyes out to find out they too are already being scored at the prescription counter on “their” predicted medication adherence”.  Yup folks, it’s a secret score and you can’t get it, but your insurance company can and buys them up regularly as one of the elements that goes into modeling narrow networks too.  None of these fat cat Orwellian VCs ever tried to get their secret score I can bet.

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…

In addition, this type of software will work it’s way into the Pharmacy Benefit Management and people will really hate it!!  We’re people and not babies but it’s data that can be sold and PBMs and insurers will get and sell it.  Shoot most folks don’t even have a clue on how the health insurer call centers let out millions of algorithms to determine your current state while you are on the phone with them, and yup, that get’s sold to for so called behavior research which is also  crock outside of clinical mental health areas. 

The “pissed off pharmacist” keeps me posted pretty well on how miserable it makes their jobs as well and they hate all this flawed data.  Last week, the pharmacists now are being put in a position to not only look at patients who are scored Outliers as there’s not enough credit card data to prove you filled your prescription, but now they want the pharmacists to predict who’s going to be an Outlier.  This is totally out of hand and falls into the abusive Excess Scoring of US Consumers.  Read the post below, been very popular and hope it makes more people angry the abuse. 

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..

Again, these VCs would not do this themselves and creating something like this is work of greedy data selling for profit Developers and the Venture Capitalists that fund garbage like this.  I spend more time helping people turn off Siri and Cortana on their phone too, we don’t want the noise and disruptions either.  So let’s boycott the portfolios of these VC jerks and the software will take care of itself as just reading this will pretty much turn the stomach of all, as again “PEOPLE DON’T WORK THIS WAY”.  

$12 Million dollars could have been used in much better fashion, not mention the $7 Million from the NIH that we as taxpayers had to pay for this garbage!  BD 

---

AiCure, a company that combines video facial recognition and artificial intelligence to confirm that patients have taken their medication has raised a $12.25 million Series A round, according to a company statement. The fundraise underscores the diverse landscape of medication adherence strategies by technology companies.

“Accurately understanding patient behavior through artificial intelligence defines a new category of medication adherence monitoring,” said Adam Hanina, AiCure CEO.

New Leaf Venture Partners led the Series A round. Other participants included Pritzker Group Venture Capital, Tribeca Venture Partners, and Biomatics Capital, established by Boris Nikolic, former Chief Adviser for Science and Technology to Bill Gates.

http://medcitynews.com/2016/01/aicure-fundraise/?utm_content=buffer64957&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

CMS Sanctions Cigna-No More Selling Any New Medicare Advantage Policies Until Algo Problems Denying Medical Coverage and Prescription Denials Are Fixed

As we may all know Cigna is working to be acquired by Anthem, which would be a huge acquisition.  As you may or may not know, Cigna’s pharmacy benefit manager now is OptumRX, the PBM subsidiary of United Healthcare.  This occurred when Optum purchased Catamaran PBM in 2015 and both have been merged in to OptumRX as the Catamaran name goes away.  There’s a lot of this taking place with the zillions of subsidiaries of United Healthcare too, so it making it harder to see the specific subsidiaries and what they do with United in putting money to the bottom line. 

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

In addition to make this purchase United had a $10 billion dollar bond sale and who the buyers are, we don’t know.

United Healthcare Having a Big bond Sale to Finance Purchase of Catamaran Pharmacy Benefit Management Company, Huge 10.5 Billion

In other news on the Pharmacy Benefit Manager purchase, Independent pharmacists filed a class action lawsuit against Catamaran.  Can you guess why?  The independent pharmacists are getting lowballed.  They might seem to fit the United Healthcare model of Ingenix, now called Optum Insights that lowballed MDs on payments for 15 years and had many law suits filed against them.  Just as a side note, Obama nominated Andy Slavitt to run CMS, and he was the CEO of Ingenix, the low balling company, do we want him at CMS? 

United Healthcare Buys Catamaran Pharmacy Benefit Manager Just As the PBM Gets Hit With A Class Action Lawsuit For Low Balling Pharmacy Reimbursements..And More Patient Data to Sell and Analyze For Profit

So with this situation occurring and as I understand it, Cigna signed a 10 year agreement to be the Cigna PBM and it’s about 2 years into the contract.  This could make Cigna even more anxious to get the Anthem acquisition take place.  When you have a giant insurance competitor now running your pharmacy benefits (OptumRX who also likes to make money with drugs) you have one huge company getting a strangle hold here.  If the acquisition of Cigna by Anthem could take place, then the underwriting could change the policies to be at least on paper, underwritten by Anthem and then Cigna could ditch the United Healthcare owned OptumRX.  United Healthcare did that a few years ago with buying out the Health Net northeast business, underwrote the policies and let Health Net manage and keep the name, so folks may not have been aware that for a few years, their Health Net policy was underwritten by United Healthcare.  The link below is from the archives and explains how this came about over the Tri-Care contract bidding, which is coming up again soon. 

UnitedHealthCare Buys a Portion of Health Net in the Northeast

Health Net and Humana File Protests over Military Healthcare Awards to UnitedHealthcare and Aetna

So the real story here is we have the work of expensive quants working on policies today, sometimes stomping all over the actuaries as the quant models are directed at profit as a priority.  The machines run the healthcare business anymore.  BD 

---

Cigna Corp. announced Friday that it is temporarily banned from enrolling new customers in its Medicare Advantage and standalone prescription-drug plans following an October audit from the US Centers for Medicare and Medicaid Services (CMS).

In a letter dated January 21, the CMS reported that “widespread and systemic failures” at the insurer resulted in customers being denied medical coverage and prescriptions they rightly had access to. After customers filed grievances about being inappropriately denied services, Cigna failed to properly address those complaints, the CMS said.

http://arstechnica.com/science/2016/01/feds-sanction-health-insurance-company-for-erroneously-denying-coverage/

Zeke Emanuel Joins Venture Capital Group–Will He Still Be Writing US Healthcare Policy at the CAP Think Tank?

I think all may remember Dr. Zeke Emanuel writing the famous post on the New York Times that basically said he wants to die at age 75 and further insinuated that all of us have served out our usefulness at that age.  A little bit more about Zeke is he also has been writing US Healthcare policy at the CAP (Center for American Progress) think tank for a number of years.  The think tank was started by John Podesta who is a big promoter of Obama and just happens to be Hillary Clinton’s campaign manager as well.  That’s enough to make anyone almost choke at this point. 

The CAP has had a lot of people venturing in and out of the think tank and one in particular is Lois Quam, another big Hillary buddy who has been given all types of positions at the State Department while Hillary held that office.  Lois Quam was a big executive at United Healthcare prior, actually the person who set up the AARP contract and PacifiCare acquisition.  She escaped getting prosecuted when the former CEO of United Healthcare was prosecuted by the Department of Justice for back dating stock certificates. 

In addition, we may all remember the economist from MIT, Jonathon Gruber, who said the US consumers are stupid.  In a way he was correct as he works with financial models that consumers do not have access too, so that makes us stupid. 

If you have read any of Dr. Emanuel’s writings over the years, it’s almost a front page commercial for United Healthcare and their Optum division.  It’s been on the web for a few years in his own words.  Again being at the CAP with Lois Quam and various other members that are either current or former employees of United Healthcare could have some impressions there. 

As a matter of fact here’s a CAP article telling Secretary Burwell basically what she should do, written by Zeke and published at the CAP.  You should read it and in today’s world of complex data and math models, you can realize what Zeke is recommending and what Burwell came out with and set as a goal are impossible to reach, the model is already broken as people can’t physically adapt and be algorithms to enter all the data these 2 dreamers think is possible with some pixie dust.  This is what’s been writing our healthcare policy, a bunch of dreamers who have never written code. 

Payment Reform Action Plan: Meeting the New Medicare Payment Reform Target

Now I guess it’s Money ball time for Dr. Emanuel in advising this Venture Capital firm on how they can make money and again reference the “dreamer” notations above and they all become dreamers as again they are creating models that are physically impossible to do.  We’re humans needing care and we can’t sacrifice quality of care to meet these impossible goals, not matter what the data says.  Scroll on down to the bottom of this page and watch video #1 about quantitated justifications for things that are just not true and you’ll get the idea from Professor Siefe, mathematician at NYU, who by the way has sued HHS a couple times over not releasing public information.

Here’s a couple paragraphs from a prior post I’ll add here as it has relevance with cronyism in government healthcare today…

“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 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.”

Anyway, you might want to read the other article as there’s a lot more but this is the group that has influenced healthcare in the US for a number of years, again lead by the John Podesta Think Tank, the CAP.  So again, now it appears there’s more of a money grab here for the doctor going to work for a VC firm to advise on “what sells” and what Healthcare policies he’s been able to write for the US Government at the CAP?  When Andy Slavitt was nominated, the CAP wrote article after article praising the President on his selection as well, ignoring the tons of lawsuits filed against his former Untied Healthcare subsidiary, Ingenix. 

Is this a good thing having the doctor on board at a VC firm and still writing HHS Healthcare Policy?  BD 

---

GREENWICH, Conn.--(BUSINESS WIRE)--Oak HC/FT, a leading venture growth-equity fund investing in healthcare information and financial technology companies, announced today the appointment of Ezekiel “Zeke” J. Emanuel as Venture Partner. Emanuel will put forth his unique expertise around the American healthcare system to advise the firm as well as current and potential partners, including entrepreneurs and portfolio company executives.

“Zeke’s passion for transitioning the healthcare system to higher quality and lower costs is completely aligned with our firm’s mission and purpose,” said Annie Lamont, managing partner at Oak HC/FT. “We are thrilled that Zeke has joined our growing team to provide deep expertise on each aspect of the American healthcare system. Together we will work towards enhancing the impact of our companies and entrepreneurs to fix the system for patients of all ages.”

http://www.businesswire.com/news/home/20160111005748/en/Zeke-Emanuel-Joins-Oak-HCFT-Venture-Partner

AMA Decides to Buddy Up with the Silicon Valley Data Sellers–Investing In A Healthcare Innovation Company, Yeah It’s Just More Flipping Code To Be Blunt…

What a difference a President makes.  Last president of the AMA seemed much more interested in doctors and their work and now we have a shift back to data selling and analytics again.  AMA makes money licensing CPT codes that are used throughout the healthcare industry as well as distributing data bout doctors so maybe put things together and some folks in the Silicon Valley want some of that doctor data, you think?

Well former Goldman Quant and now Columbia Professor Emanuel Derman this week pretty well summed the state of affairs up in a few words:

“the economy is drunk on math”…brilliant and that pretty much describes what’s probably going on here.  I read this stuff and have written about it for years and honest to God it’s like sickening with all these analytics announcements.  The ones we have now are not saving any money to speak of so, give it up.   Besides Pfizer just said they were raising prices on 100 drugs, so now the analytics folks are going to score it off our fannies. Scoring of course denies access and somehow saves money.

With every bank and other financial institution, I guess the AMA didn’t want to be left out of the data game, it’s makes money, but doesn’t really save any is the issue.  A few years ago the AMA dabbled in their portal they developed and sold it to AT&T as I think it was becoming a bit of a conflict or maybe just wasn’t doing enough.

AMA Selling Online Physician Portal to AT&T–The AMAgine Project, There’s Money in Selling And Aggregating Those Algorithms

AMA sells software too…

One Pioneer ACO Saved Money Using Software From AMA Subsidiary Who Provides Software From a United Healthcare Subsidiary

About 3 years ago a banker and I had a conversation and I’ll be darned if this is not the state of affairs today with software and algorithms, half will be useless.

Half of Analytics Investments By Companies and Banks Will Be a Waste–What Do We Analyze with Big Data and Does It Have Value–Some Algo Fairies Would Do Better at Disneyland…

Not only that but also predicted this and all thought I was crazy but we’re right in the thick of it today…consumers being abused with data sellers!!  That was almost 4 years ago I wrote the post below and the AMA now is jumping on the data for profit band wagon as well.  I sure hope more consumers wake up as I’m doing my best to tell you what’s going on.  It’s not hard with having some former coding skills and what I call the use of data mechanics logic.  The Code Hosers live amongst us and take your money and your digital rights away all the time.  BD 

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

---

SAN FRANCISCO – Building on its historic commitment to advance the practice of medicine and improve public health, the American Medical Association (AMA) today announced that it is investing $15M to become founding partner of a health care innovation company - Health2047, Inc. – that will conduct rapid exploration of innovative solutions to the biggest challenges facing the nation’s 1.1 million physicians and the patients they serve.

“Improving the health of the nation is at the core of the AMA's work and Health2047 will build partnerships to create new solutions for physicians and their patients that improve health care delivery and health outcomes,” said AMA Chief Executive Officer and Executive Vice President James L. Madara, M.D., who serves as board chair of Health2047. “Health2047’s product orientation and entrepreneurial DNA will help forge new paths and bring commercial solutions to market faster.”

A stand-alone, for-profit entity, Health2047 is an integrated innovation company that combines strategy, design and venture disciplines, working in partnership with leading companies, physicians and entrepreneurs to improve health care. Its new Silicon Valley-based innovation studio will draw upon the AMA’s deep subject matter expertise and the organization’s unique relationship with physicians nationwide to develop new products, tools and resources that improve the practice of medicine and the delivery of health care to patients. Health2047 will collaborate with AMA content experts across a wide range of medical, health policy, and pragmatic practice areas. It will also integrate health care companies, technology companies and entrepreneurs to co-develop, create and spin out offerings that can have large scale, systemic impact on health care and medical practice.

http://www.ama-assn.org/ama/pub/news/news/2016/2016-01-11-ama-launches-health2047.page

So What’s the Future With Guns and Healthcare? Will Doctors be Required to Do “Gun Risk Assessments” On Patients Next?

Of course we had to ask this question as with complexities, if a doctor should decide to turn information over to the FBI on a patient, there will be a need to substantiate reasons of course.  What even makes this even more interesting is the fact that none of the medical records can be used.  That’s pretty much how things operate in the US with the current quantitated justification system that the White House, HHS and CMS subscribes to.  Take a look around and see all the other “scoring” mechanisms in place that are using data and math scores to predict what you will do.  The problem is, they are not accurate.  I’ve spent a bit of time talking with doctors and pharmacists that time and and time again that struggle with the “scoring” flaws all the time. 

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 even if a patient doesn’t talk about guns, want a gun, etc. will they be given a “gun risk assessment” now.  This is how everything works as there’s big money to be made and some Heatlh IT company will jump on this one to have a software as a service

“gun assessment” for doctors to use.  Just wait and see.  I’m saying this as it’s a pattern and I used to write software and once you know some of the data mechanics logic, it’s not hard to figure out. 

It’s not like there’s “no” avenue for doctors to report a patient they have real questions about now.  What’s the deal with going direct to the FBI?  FBI going to have some questions on why the doctor is telling them about a specific patient as well, you think?  I have no problem with background checks for ownership of guns, and sure they can be a bit more elaborate than what we have now.  It’s just that I have watched this White House Adminstration and all they do is capture numbers and the President seems to be sold on this 100% anymore.  You also have United Healthcare that wants to grab up any mental health management areas they can.  Kaiser out here in California when they were fined for not providing enough help, signed a contract with the Optum division of United Healthcare so don’t forget their involvement in view of the almost 400 subsidiaries they have, and all are not involved with insurance, but rather management of your care. 

United would love to add a “gun assessment” software application that someone would have to pay for to make this work and rake in all the money. They also have their mental health issues.  If you want to read about some cronyism in government healthcare you might not be aware of, check out this link. 

Class Action Lawsuit Filed Against UnitedHealthGroup and Their Various Subsidiaries There Of Relative to Mental Health Claim Denials & Violation of Parity Laws

So this is what we have forming here, yet one more “risk assessment” some software and/or insurance companies can now make money peddling.  We already have the 6 degrees of Bob Rubin, with Secretary Burwell running HHS and Andy Slavitt, a one time Goldman Sachs banker and more running CMS. 

The US government loves risk assessments and publishing numbers, and they don’t really care about the health and care of US citizens.  All you have to do is read a few of Secretary Burwell’s tweets on Twitter and that’s about all she states is that she believes number will cure everything, and that’s in between the multiple selfies posted so we don’t forget who she is and what she looks like I think. 

Then we come down to the ONC division of HHS who’s responsible for HIPAA policy and what do we have there?  A former United Heatlhcare lawyer writing HIPAA healthcare policy, so we lose again.  We all know by now probably that Loretta Lynch used to represent United Healthcare with their anti trust lawsuits and so it’s probably not on her agenda to even look at what’s impacting the consumer with health insurance. 

ONC Hires New Privacy Head, A California Corporate Lawyer From United Healthcare, One of The Biggest Operating Data Selling Companies In the US

So again, being I used to write software and have written on this for quite a while now, watch out for “gun risk assessments” to show up and companies to profit from it, while the data is flawed and of course we will lose access based on how the context plays out.  Actually go down to the bottom of this page and watch the first video from Mathematician Charles Siefe at NYU and he’ll tell you all about how you are duped over and over and over with numbers.  It’s a real eye opener and helps you become a skeptic when you need to be one, or use the link below.   BD 

Context is Everything–More About the Dark Arts of Mathematical Deception–Professor Siefe Lecture Given at Google’s New York Office–Big Healthcare Focus