United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups

<p>You can read the <a href="http://www.businesswire.com/news/home/20160419005655/en/UnitedHealth-Group-Reports-Quarter-Results">entire press release here</a> as the report is broken down in several entities, but I found the most striking of all to be the “revenue” section, in other words where the money’s coming from to be of importance.  What are we starting to see as the insurer states they are withdrawing from around 8 states with Affordable Care Policies beginning in 2017?   The company did not participate in a large way with many of the ACA insurance exchanges and yes a decent number of folks will have to change their plans next year.  But what’s the deal with OptumRX revenue?  Here’s a screenshot of the revenue numbers and you can look for yourself.   The first column is this year and the second column is 2015 for a comparison.  </p> <p> </p> <p><a href="https://lh3.googleusercontent.com/-LLcWBXpVNcA/Vxb9Qd155kI/AAAAAAABMuU/ATpnQkODLOg/s1600-h/image%25255B4%25255D.png"><img alt="image" border="0" height="217" src="https://lh3.googleusercontent.com/-49g0-b4sJ7k/Vxb9RP9b1kI/AAAAAAABMuY/V3yDPAAbRjk/image_thumb%25255B2%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="613"></a></p> <p>We know that United had a $10 billion dollar bond sale to buy the pharmacy benefit management company, Catamaran that in essence helped get Cigna sanctioned with not being able to sell anymore Medicare Part D policies and I think that restriction is still there today, as the company was denying too many drugs to those insured by Cigna.  I had some sources tell me that in some exit interviews, etc. that the Catamaran folks working with referrals and approvals had no idea why they were denying requests other than the fact that the “screen said no” and that ‘s a little scary in itself.  In addition, Cigna was supposed to be denied their bonus payments from CMS for a lot of this activity but they gave in and allowed Cigna to get their money from the government.  So now all who are insured by Cigna have a pharmacy benefit manager, OptumRX, which is owned by United Healthcare.  </p> <h5><a href="http://ducknetweb.blogspot.com/2016/01/cms-sanctions-cigna-no-more-selling-any.html">CMS Sanctions Cigna-No More Selling Any New Medicare Advantage Policies Until Algo Problems Denying Medical Coverage and Prescription Denials Are Fixed</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2015/07/united-healthcare-having-big-bond-sale.html">United Healthcare Having a Big Bond Sale to Finance Purchase of Catamaran Pharmacy Benefit Management Company, Huge 10.5 Billion</a></h5> <p>United, under the Optum name also bought a Workers Compensation pharmacy benefit management company, who’s largest account just happens to be the US Post Office along with other very large corporations like Southwest Airlines and move…more money. <h5><a href="http://ducknetweb.blogspot.com/2016/01/united-healthcare-buys-helios-workmans.html">United Healthcare Buys Helios Workman’s Comp PBM and Their Other Related Businesses</a></h5> <p>There’s so much money made here on the high prices we pay for drugs that Anthem is suing Express Scripts to get a touch of that money, while at the same time OptumRX is inching its way into Walgreens with a 90 prescription.  </p> <h5><a href="http://ducknetweb.blogspot.com/2016/03/walgreens-signs-agreement-with-pbm.html">Walgreens Signs Agreement With PBM OptumRX (United Heatlhcare) and Anthem Then Sues Express Scripts</a></h5> <p>The pharmacy benefit management and making money model can be a little complex to understand indeed as the companies get what is called a kickback with sales of the drugs they distribute, and especially on generics, up to 80% can be handed back.  It can all add up to a lot of money.  So in essence, it may not always be the lowest price drug who gets the contract, it might be the pharma company that offers the biggest percentage kick back.  Being United owns OptumRX, this gets a bit tricky as they are there to negotiate drug prices; however, those kickbacks algo go to the United bottom line as profits so the very entity of an insurance company, United, they are there to work for and keep drug prices down, is also the same corporate umbrella that wants all the profit they can get from the pharmacy benefit management company as well.  I would think this really becomes a balancing act and this would be where they call in the company quants with math to figure it out for them. <p>Who knows, a United Healthcare/Optum subsidiary AxelaCare, (bought by the OptumRX subsidiary) may show at your home to administer infusion drug some day as OptumRX bought this company as well.  The link below also contains a ton load of cronyism connections that I just felt like adding when I wrote the post.  I dug up the CMS director’s relationship to the Elizabeth Warren family and a few money ventures and you can also read how Lorretta Lynch used to handle anti-trust suits for United Healthcare.  She’s busy with another job right now and won’t be doing any of that for a while anyway.  <h5><a href="http://ducknetweb.blogspot.com/2015/11/optumrx-united-healthcare-buys-home.html">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…</a></h5> <p>For the time being it appears Harken Health, another creation of United Healthcare will stay around for a while with the ACA state insurance policies going away as they put their quants to work to create yet another model of insurance to throw against the wall to see if anything sticks. <h5><a href="http://ducknetweb.blogspot.com/2016/03/united-healthcare-puts-their-quants-to.html">United Healthcare Puts Their Quants To Work Again-Designs a Subsidiary to Compete Against Them and Sell Insurance With a New Set of Algorithms Named Harken</a></h5> <p>The pharmacy software algorithms that help make money selling our data and creating these flawed medication <img align="right" src="http://lh3.googleusercontent.com/-KDDBEc3i-I4/VaiE5CvPnTI/AAAAAAABMco/U9a02nrysU8/image%25255B3%25255D.png?imgmax=800" style="float: right; display: inline">adherence scores goes way back to 2010 when CMS director Slavitt was President of Ingenix (now renamed Optum) and sold Express Scripts sofware and systems on how to start collecting and selling data on consumers.  You do wonder with all of this if we do have the fox minding the hen house today at CMS as it seems ironic that the exact same models, some of which are failing keep working their way from United Healthcare to CMS, i.e. population health which was created by United around 15 years ago with the Ingenix folks.  The pharmacy benefit management business has a very profitable side business of selling and scoring all consumers when we pick up our prescriptions and you get secretly scored and sold all the time.  If there’s not enough credit card records for them to drag through of yours to see if you filled a presciption, then you default to being an outlier, and if you pay cash, same result.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html">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…</a></h5> <p>Here’s more detail on what’s going on with pharmacy data being sold and how you are secretly scored with proprietary metrics and algorithms that have never been proven for accuracy, but it makes for big money for pharmacy benefit management, sell that data and score those consumers, as pharma and insurance companies are the big buyers.  With OptumrX they can give all the scored data away to United as they own them and they’ll probably turn around and “score” you again with the data on some other correlated query.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-enter.html">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</a></h5> <p>The screenshot to the right shows how Express Scripts scores you and again this began in 2010 when Ingenix, now renamed Optum sold them the software needed to begin the scoring processes, when Andy Slavitt, who now runs CMS was the CEO of Ingenix.  Below is the back link on that story from 2010, so it revolves back again around one company and their algorithms and analytics, United or one of their subsidiaries.  <h5><a href="http://ducknetweb.blogspot.com/2010/10/express-scripts-new-program-to-contact.html">Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On Ingenix Algorithms–We Want the Revenue Please Don’t Stop</a></h5> <p>So the pharmacy benefit managers are all doing it in one shape of an algorithm or another and the data and scored are flawed as now the have started bringing in social network garbage and give you a score that may not accurately represent<img align="right" height="199" src="http://lh3.googleusercontent.com/-WTU_WavuGLg/VYjYaFce1MI/AAAAAAABMZA/DCNNtafnZm8/image%25255B8%25255D.png?imgmax=800" style="float: right; display: inline" width="312"> you at all, but again it’s big money and maybe helps explain the big push by United into pharmacy benefit management.  The last quarter revenue tells the story does it not? <p>So it’s very interesting is it not to see this huge shift of revenue from OptumRX to even outshadow their insurance group revenues?  It beat all of them on it’s own.  Of course though if you want information on your doctor or hospital, the last bone thrown at you by United is to link you to the most flawed site on the internet, Healthgrades to find flawed data, survey reviews and other information about them.  <p>By the way, don’t bother with a Healthgrades survey as they tie it to your phone number or email address so they can profile you for more e-commerce behavior analytics and who knows if they are selling that back to United?  It seems to be the way it works as we all know Healthgrades is not much more than clickbait for the site to generate ad revenue.  You can read below on that topic. <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-hits-bottom-of-barrel.html">United Healthcare Hits the Bottom of the Barrel Linking Doctor Information to Healthgrades Flawed Data</a></h5> <p>So what is the future here?  Big push into pharmacy benefit management and getting drug kick backs from pharma in the name of lower priced drugs?  When do we ever get to see that part of it?  Looks like the lost revenue claimed over the ACA insurance policies that are being dropped has been more than replaced, you think?  Of course in this process we can all look foward to a lot less privacy, as today’s it is already out of hand.  BD   

United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups

You can read the entire press release here as the report is broken down in several entities, but I found the most striking of all to be the “revenue” section, in other words where the money’s coming from to be of importance.  What are we starting to see as the insurer states they are withdrawing fro…

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United Healthcare Hits the Bottom of the Barrel Linking Doctor Information to Healthgrades Flawed Data

<p>Ok if you have read here long enough, a few years, then you are accustomed to seeing outrageous flawed data<img align="right" src="http://lh4.ggpht.com/-ilVu_kiGzrg/VGG8UIJGJFI/AAAAAAABLws/UnbU-RYyYc0/image%25255B20%25255D.png?imgmax=800" style="float: right; display: inline"> posts about Healthgrades and Vitals over the years and I’ll put a few of the links here if you want to look back as they are dandies.  When I say that I mean really big flaws about doctors and hospitals that were carried in major news coverage that both missed and still continued to publish.  </p> <p>It all started out years ago by accident when I found my former doctor who had been dead for 8 years on Healthgrades as still active and alive and seeing new patients and she still carried a 5 star rating in the after life, pretty amazing stuff you think? It even got the attention of the AMA, as how could data just flat out be this bad!  It is and was.  Here’s the post from 2010 that started it all.  This is what you get when a private equity firm doesn’t care about integrity and just wants to make money.  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/09/healthgrades-and-other-md-rating-and.html">Healthgrades And Other MD Rating and Referral Sites List “Dead Doctors” on Their MD Information Pages And Even Include the Insurance Plans the “Dead Doctors” Honor</a></h5> <p>Of particular notice too was this huge national case with Dr. Justice and he remained on there forever and might still be there.  I think it was just about 3 years ago Rand Paul was finally removed from his listing as a doctor still<img align="right" src="http://lh4.ggpht.com/_v3zjJigoAPE/S8yqRB__HdI/AAAAAAAAdb4/ea4IfCEFW8s/image_thumb%5B2%5D.png?imgmax=800" style="float: right; display: inline"> taking new patients as well. <h5><a href="http://ducknetweb.blogspot.com/2010/04/prominent-orange-county-oncologist.html">Prominent Orange County Oncologist Pleads Guilty to Medicare/Insurance Fraud – Over $1 Million</a></h5> <p>This doctor here was on the FBI’s most wanted list and was captured living on an Iceberg in Italy and was listed on Healthgrades for years and still might be there with no sanctions or anything.</p> <h5><a href="http://ducknetweb.blogspot.com/2010/10/nose-doctor-on-run-found-living-in-tent.html">Nose Doctor on the Run Found Living in a Tent at the End of a Glacier in Italy, Admitted Fraud Still Listed on Some MD Referral Sites</a></h5> <p>Here was another site which couldn’t get this stuff right either, Dr. Justice again. <h5><a href="http://ducknetweb.blogspot.com/2010/11/avvo-physician-rating-service-cant-get.html">Avvo Physician Rating Service Can’t Get Accurate Information Listed on Doctors - One OC Oncologist Sitting in Jail for Fraud</a></h5> <p>The hospital reports were also disputed by some big names in the business as well a couple years ago.  <h5><a href="http://ducknetweb.blogspot.com/2011/05/healthgrades-hospital-list-algorithm.html">Healthgrades 'Best Hospital' List Algorithm Needs Work Again - Flawed Data<img align="right" border="0" src="http://lh4.ggpht.com/-obcJBMljkho/UDz9nzUYKoI/AAAAAAAA9O8/SPKSg3gvTB8/image%25255B5%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px"></a></h5> <p>So Healthgrades merges with a marketing group to fix this, better marketing but same flawed data showed up.</p> <h5><a href="http://ducknetweb.blogspot.com/2011/11/healthgrades-to-merge-with-cpm.html">Healthgrades to Merge with CPM Marketing–Will Their Data and Questionable Algorithms Will Be Improved For Consumers?</a></h5> <p>As a matter of fact the graphics changed on the site as well as adding some “flash” components, but when the queries ran, same old stuff, lip stick on a pig you could say. <h5><strong><a href="http://ducknetweb.blogspot.com/2012/03/healthgrades-hospital-report-is-out-and.html">Healthgrades Hospital Report is Out and Still Think Their Algorithms Needs Work…</a></strong></h5> <h5><a href="http://ducknetweb.blogspot.com/2012/06/healthgrades-puts-out-top-hospital.html">Healthgrades Puts Out Top Hospital List–Time to Drop All the Hospital Ratings Sites As Nobody Cares, Many Don’t Have Time To Read and Too Much “Flawed Data”</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2012/08/healthgrades-ceo-founder-joins-worldone.html">Healthgrades CEO Founder Joins WorldOne Board–Flawed Data And Broken Algorithms On the Move to Advise Market Research? Algo Duping Society?</a></h5> <p>We got used to seeing people like Dr. Gary Michelson on the list who retired years ago from practicing after winning a multi billion dollar law suit against Medtronic for stealing his patents.  <p>While working at the HHS ONC office, Dr. Reider never his practice and continued to see new patients for a number of years, which was not true of course, just laziness and not updating data for Healthgrades. <h5><a href="http://ducknetweb.blogspot.com/2013/09/jacob-reider-to-lead-onc-until-new.html">Jacob Reider To Lead the ONC Until New Leader Is Appointed–Visit His Page onHealthgrades Showing He’s Still Open For Business To See Patients, Along With Links to Dead Doctors, Some On Staff At Hospitals They Have Never Set Foot In And More…</a></h5> <p>This nose doctor was on the FBI most wanted list and continued to show as 5 stars on Healthgrades as he lived on an iceberg in Italy where the FBI finally captured him.  No sanctions, not a thing and this of course was pretty big news as well as a lot folks were looking for this doctor. </p> <h5><a href="http://ducknetweb.blogspot.com/2010/10/nose-doctor-on-run-found-living-in-tent.html">Nose Doctor on the Run Found Living in a Tent at the End of a Glacier in Italy, Admitted Fraud Still Listed on Some MD Referral Sites</a></h5> <p>Want to look up Michael Jackson’s old doctor, Dr. Arnie Klein who’s now dead?  This may have finally been updated after he died but even with all the news coverage he had, Healthgrades showed a lot of stars and his office in Beverly Hills that had been closed for years.  <img align="right" src="http://lh5.ggpht.com/-x3ApwLANug0/US6lvV15kuI/AAAAAAABGBc/9DMlsFSN_eE/image%25255B8%25255D.png?imgmax=800" style="float: right; display: inline">I figured they left Dr. Arnie Klein there to draw some clickbait visitors as he was in the news so much that people still looked him up and anyone on the Healthgrade page was exposed to ads and maybe clicked one or two, so the site made money with showing this dead doctor’s profile.  There’s quite a few dead doctors listed on the site practicing from the grave and this is just one example.  <h5><a href="http://ducknetweb.blogspot.com/2013/02/flawed-data-with-physician-and-hospital.html">Flawed Data With Physician and Hospital Rating Sites- Want To Go See Michael Jackson’s Former Dermatologist? Vitals andHealthgrades Says He’s Still There - Not…Flawed Data & Algorithms Persist…</a></h5> <p>I’ve never made it a habit of spending a lot of time on the site or looking up anyone unless there seemed to be a reason to hitting flawed data is very frequent and it only takes looking at one or two profiles and bingo, there it is.  Doctors are listed with admitting privileges they have never s<img align="right" height="355" src="http://lh6.ggpht.com/-vWYvCoo_0aI/U5TwyyuyhlI/AAAAAAABKi8/O227_HUD9oA/image%25255B20%25255D.png?imgmax=800" style="float: right; display: inline" width="414">tep foot in.  One doctor told me he liked “the fake awards” i.e. the “honor roll” stuff they put on there.  He thought it was pretty wild since half of what the site had on him was flawed. <p>When it comes to hospital ratings, this one takes the cake indeed.  Pacific Hospital who’s again even been in the news for fraud, putting fake screws in patients as well as bribing a state senator, ran with a 5 star rating even after the hospital was closed and the CEO was convicted.  The links even had a bunch of doctors listed on staff at the closed hospital. <h5><a href="http://ducknetweb.blogspot.com/2014/02/operation-spinal-cap-former-owner-of.html">Operation Spinal Cap-Former Owner of Orthopedic Hospital Admits He Bribed California State Senator Calderon-Hospital Closed And Sold But Still Listed onHealthgrades</a></h5> <p>The VA hired a doctor with a few serious sanctions in New York and I happened to look him up and he never left New York on Healthgrades and had a bunch of stars. <h5><a href="http://ducknetweb.blogspot.com/2014/06/top-doctor-for-miami-va-healthcare.html">Top Doctor For Miami VA Healthcare System Lost Medical License in New York, Had Issues With Florida Board of Medicine, But On the Internet He Still Works and Takes New Patients in New York With Plenty of Insurers…</a></h5> <p>Here’s another good example going back to the doctor that had ebola who was all over the national news, but on Healthgrades he never left Texas and of course was seeing new patients as the listing stated. <h5><a href="http://ducknetweb.blogspot.com/2014/07/texas-doctor-working-with-ebola.html">Texas Doctor Working With Ebola Patients in Africa Now Has the Disease Amidst All Precautions and Safeguards-Of Course Still Listed onHealthgrades As Taking New Appointments in Dallas</a></h5> <p>This was an oddity too with Healthgrades partnering with Athena Health and a few others on the web didn’t understand this either.  Did this make it easier to book an appointment with a dead doctor?  If the doctor profile is flawed, what good does this do?  There are other sites on the web that doctors do join to allow online appointments and they pay for it, so what was all this about?  <h5><a href="http://ducknetweb.blogspot.com/2014/07/healthgrades-partners-with-athena.html">Healthgrades Partners With Athena Health To Provide Easier Access to Book Appointments, Like Maybe Doing Better With Sorting Out Some of the “Dead Doctors” Seeing Patients in the After Life?</a></h5> <p>If you were looking to see if any doctors running clinical trials had any sanctions or disciplinary actions, well again<img align="right" height="327" src="http://lh5.ggpht.com/-hVvbNnT6Imw/VGG8V84InHI/AAAAAAABLxE/NZD9avZijuY/image%25255B16%25255D.png?imgmax=800" style="float: right; display: inline" width="391"> you were probably pretty much out of luck searching Healthgrades.  <h5><a href="http://ducknetweb.blogspot.com/2014/08/doctors-with-serious-sanctions-running.html">Doctors With Serious Sanctions Running Clinical Trials in the US And Sites Such As Healthgrades and Vitals Show No Sanctions at All So You Can Get Fooled Easily</a></h5> <p>I circled back almost a year later to see if Pacific Hospital, the one putting fake screws was still a 5 Star hospital, and sure enough there it was in all its glory with no mention of fake screws, the fact that the hospital has closed and the CEO was going to jail.  Healthgrades still showed that the hospital was taking Medicare and Medicaid patients.  <h5><a href="http://ducknetweb.blogspot.com/2014/11/why-does-hospital-that-was-closed-by.html">Why Does A Hospital That Was Closed By The Feds In 2013, that Put “Fake” Screws In Patients Backs, Has A CEO/Owner Who Admitted Fraud/Patient Endangerment And Is Waiting Sentencing And Who Bribed A State Senator, Still Show On Healthgrades With Five Star Ratings?</a></h5> <p>Those are just some examples I have covered since 2010 here on the quality of data you get when using the site to search out information.  By the way be sure to read the privacy statement as anything you do on the site is mined.  With their new survey program you have to use an email address or phone number to verify, well golly gee, guess what, that makes it easy for Healthgrades to match up who you are and get some survey behavior data to sell.  <p>So this is what you are getting now with United Healthcare making this flawed data site that’s there to make money off of ad revenue with what you see and click on for ads.  I don’t take any of their surveys or Hospital awards seriously at all.  Even if they change the metrics, they are still using a lot of flawed data to go into the metrics, so what good does that doo.  We have a problem in the US and it’s called <a href="http://ducknetweb.blogspot.com/2015/09/excess-scoring-of-us-consumers-us.html">“Excess Scoring”</a> and when folks are scored with data is flawed to begin with, it’s garbage in and garbage out as the old saying goes.  <img align="right" height="163" src="http://lh3.googleusercontent.com/-r3DyQ8OXX8U/VWNXE79B4_I/AAAAAAABMUQ/d7p1kWV6goc/image%25255B8%25255D.png?imgmax=800" style="float: right; display: inline" width="232"> <p>This is indeed why we need to index and license all data sellers and have a reference of what kind of data they sell.  United Healthcare sells a ton of data and if not under the main corporate umbrella, there’s just short of 400 subsidiaries that do so.  <h5><a href="http://ducknetweb.blogspot.com/2016/02/index-and-license-data-sellers-step-one.html">Index and License Data Sellers, Step One Needed for Any Consumer Privacy Efforts to Exist - Spurious Correlations and Flawed Data Risk Assessments Thrive To Erroneously Deny Access</a></h5> <p>So again, to me this is the absolute bottom of the barrel for getting accurate information to patients.  I guess nobody at United looked at the data either and that’s a big problem today as I chat with folks in markets and they say the same thing “nobody looks at the data”.  </p> <p>Be a skeptic when you need to be and again be aware of what you see on Healthgrades as it’s been years of flawed data and nobody seems to care about accuracy as long as something on the page gave you a desire to “click” so they could enhance their ad revenue. <p>I had email today from some doctors on this and they know exactly how bad the information has been from Healthgrades over the years.  Healthgrades wants to put the responsibility on the doctors for correcting their flawed data and that’s not right either.  <p>So here you are “duped again”…when it comes to quality information.  Ask other people about doctors and research elsewhere as Healthgrades and now United Healthcare surveys working in conjunction with Healthgrades is not giving you a straight story at all.  BD  </p>

United Healthcare Hits the Bottom of the Barrel Linking Doctor Information to Healthgrades Flawed Data

Ok if you have read here long enough, a few years, then you are accustomed to seeing outrageous flawed data posts about Healthgrades and Vitals over the years and I’ll put a few of the links here if you want to look back as they are dandies.  When I say that I mean really big flaws about doctors and…

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