If you don’t know what a Quant is, take time out and watch video #2 in the footer of this blog as they are not just limited to working at financial firms.  As a matter of fact, hedge funds and banks can’t hire enough of the and the same holds true for insurers and other healthcare entities.  These are the math wizards today that are working without a net of any “proof of concept” any more and are just tossing a lot of models out there to see if they stick.  I know that’s a crummy way of putting it, but that’s the reality of folks being soaked on models and numbersimage they don’t question, it’s the Dupes of Hazard society that exists everywhere today.  What the Quant do well, is to use math to create profits, no matter if it hurts individuals or not.  Look at what was recently done at Wells Fargo with the low level employees, as they didn’t just decide to sell fake accounts on their own, there was a pay for performance model created by quants with a number of carrots and probably some sticks attached.

If you have not heard of the Optum 360 subsidiary, the link below will explain how it works and how the subsidiary solicits hospitals and other healthcare entities (now Quest Labs) to hand over their billing, also know as revenue cycling with the big hopes of saving money and collecting more money.  Employees are usually let go by the healthcare entity and rehired as an Optum 360 employee with maybe less pay and worse benefits.  I read some of the reviews from Dignity Hospital reviews on GlassDoor and they said the benefits were a lot worse once they came under the Optum umbrella.  You could almost say it’s an internal US H1B process as the pay and benefit results seem to follow the same pattern. 

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…

The real deal here of course is the access to all the data as the data miners and sellers of the healthcare industry will take the data, score you and put the data into other “new” data bases and turn around and sell it.  This process is called repackaging and when this occurs, most of the time as consumers we have no idea where it goes or who originated the data.  As long as prescription data is not taken from a HIPAA covered entity such as a medical record, it’s out there for sale to who ever has the money.  Quest is also promoting their own “outsourcing” program with hospitals and just bought another hospital lab service, so that makes about 5 or more they have bought.  20-30% of the services performed for hospitals with this service end up going to their own Quest diagnostic centers to be worked. 

Subsidiaries of companies are something I have told all for years to pay attention to as that’s where all the data work is done andimage computer code is written to create big profits with running proprietary code that nobody ever gets to see or audit for accuracy. 

ScriptCheck, offered by ExamOne, a subsidiary of Quest Diagnostics is a big data mining firm, and so how many were not aware that Quest has been in the data mining and selling business for years?  Anyone buying a life insurance policy could very well be investigated and a full data pull created to get information for underwriting.  Sure we know some of this is necessary, but when do they cross the line?  Any more it’s all the time as the data gets repackaged and resold with data mining.  They take the list of meds and try to “guess” what medical conditions you have or “might” get.  That’s the scary part is the “might” or what is abused today and openly called predictive analytics.  In this article written in 2013, David Lazarius does a pretty job with explaining how this works. 

There is an update though as ExamOne bought a bunch of Ingenix (now called Optum Insights) algorithms in 2014.  We maybe all know that the former Ingenix subsidiary of United Healthcare is where current acting CMS administrator Andy Slavitt called home for a number of years and was taken to court over cheating on out of nextwork payment for MDs by using formulas beyond comprehension of most to inflate United Healthcare profits. I call it “Code Hosing” when I see this occur as you and I as a consumer have no access to either the math or the models used to create these profit centers and it ends up being a bunch of quantitated madness due to the fact that people are afraid to contest any form of math, good math or bad math.

Heres a few clips that tell you all about Quest Diagnostics ExamOne service and their purchase of the Ingenix MedPoint (OptumInsights) Algorithms in 2014 and what ScriptCheck is all about.   

“LENEXA, KS, October 27, 2014 / -- ExamOne, a Quest Diagnostics company and leader in helping insurers meet their underwriting needs, is pleased to announce the acquisition of certain proprietary assets from OptumInsight that support the ability to provide rapid responses to data inquiries for use in life and health risk assessments. The acquired assets will streamline and improve the ScriptCheck® service offered through ExamOne.”

Along with ExamOne’s expansive suite of insurance services (also known as Policy Express) the acquired technology is designed to accelerate the underwriting process, improve risk assessment, assess the accuracy of health statements and discover undisclosed doctors or medical conditions for underwriters.

About ExamOne
ExamOne has provided a portfolio of services to the insurance industry since 1972. It has grown significantly through continuous innovation that meets the evolving needs of life, health and disability insurance providers and their customers. Laboratory testing was part of the company’s original services, which over time have expanded to include paramedical examinations, fraud detection, electronic data collection, and gathering attending physician statements and motor vehicle records. ExamOne also has expanded into helping individuals learn about their own health through its Inside Look™ product.

Part of the real scary part about this agreement is that now Optum also will be able to get any biometric screenings provided by Quest as well.  We have all seen the nighmare Orwelian companies like Red Brick (which was started by a one time United Healthcare young exec) that are intoEQUIPP monitoring every move we make and this looks like an open loop hole here for United Heatlhcare/Optum to get that data, what else can you say?  There’s nobody in their right mind that wants their insurance company to have all types of data and information that the insurer could easily miscontrue and take out of context to avoid paying a claim!  That’s what this does.  Actually it’s not just Quest and United Healthcare/Optum deal alone, we have a huge problem of “Excess Scoring” in the US taking place with consumer using flawed data, queries and proprietary code to where we do not have the ability to even correct it. 

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..

If you get a chance to talk candidly to pharmacists today, they’ll tell you all about what’s going on and how you are “scored” with every prescription you fill too.  There’s this EQUIPP program out there that tells them what to do and how to dig in and find outliers, some of which are diabetics who are not on statins.  The pharmacists who are forced to work this EQUIPP program model have to find their “outliers” or they could end up like the employees at Wells Fargo and be be out of a job if they don’t play the game.  In the drug industry, they couldn’t get doctors to push statins and other monitoring flawed data programs, so now the boom is lowered on your retail pharmacists who need their jobs.  Click on the image at the right and see what I’m talking about. 

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

So my guess here is that with United Healthcare/Optum having this new additional data of labs to query into the prescriptions, your lab tech could very well be the next person out there suggesting not only monitoring but also in a round about way, pushing more drugs. 

This really even gets more interesting with the Quants of Optum and their models for profit as United Healthcare has a contract with LabCorp as their exclusive Lab and has had that contract since 2007.  Optum and United Healthcare already get all that labimage information from LabCorp and the contract continues until 2018, so that’s what makes this Quest deal interesting and data rich with data selling.  If patients all over the country are already being directed to LabCorp facilities, how would Optum get a chunk of this money?  I suppose the answer is what just happened with the Optum 360 subsidiary now getting do most all of the billing for Quest Diagnositcs, right? 

Talk about quants working over time working both models of each lab to increase revenue, right?  Again watch video #2 in the footer and learn what a quant does as we have that same mentality running CMS with Andy Slavitt being both a former McKinsey consultant and a Goldman banker running everything.  All he is concerned about is numbers as he’s just an Algo Man who cares little about anything else.  Follow him on Twitter and it’s not hard to see at all.

The Rise of the Quants, Again! This Time In US Healthcare- Taming the MACRA Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not True

So what happens when you get a lab test done?  Depending on the result of course, you might get a prescription for a drug, we all know that by now (grin), so look at how this data mining is working today.  With Optum having all the lab information will this have a tendency to push more drugs, and the drugs that are covered by pharmacy benefit managers that make the most profit for them?  It is not far fetched in my book imageat all as I used to work with data, wrote software and it’s how the mentality works.  If you haven’t noticed by the way, the OptumRX is the largest revenue stream that United Healthcare has now, larger than each of their insurance groups when compared. 

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

So this is adding yet another element of behaviorial scoring and data mining for profit if you will and we’re not getting any breaks on cost.  As a matter of fact, this is a good link to look at that explains the coupons and discount cards at the pharmacy, as they tell you how it works.

The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!

Again, look at the subsidiaries of these big corporations and what are doing with data for your answers as it’s all there as the quants in healthcare keep modeling away to attain the best models for profit, not necessarily for better care, Moneyball as Optum calls it, which really only works well for baseball where everyone knows the rules, but with healthcare the rules change every day.  BD


UnitedHealth Group Inc.’s Optum health-services arm has struck a deal to oversee billing processes for lab giant Quest Diagnostics Inc., substantially expanding its growing business of handling such transactions for health-care companies. Under the 10-year pact, Optum will take over a number of key revenue-related services for Quest, including billing health insurers and consumers, and collecting and processing payments from both. About 2.400 employees who did such work for Quest will become Optum employees, but they will generally remain physically in their current locations.

http://www.wsj.com/articles/unitedhealths-optum-unit-to-oversee-quest-diagnostics-billing-processes-1473760800

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