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 upimage[4] 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

0 comments :

Post a Comment

 
Top