Pharmacy Benefit Managers Are Not Much More Than “Complex Well-Greased Algorithmic Human Scoring Machines” That Deny or Allow Access To Drugs To Create/Substantiate Big Corporate Profits
10Mar20180So let’s get down to what’s really happening here. Once upon a time the PBM models were a diff...
Optum/United Healthcare Quietly Sold Optum Hospice to Compassus in December of 2016-And Compassus Is Now Contracted Under Optum Services to Manage the Facilities, Services and Provide the OptumCare Doctors
Dec 27, 20170Optum certainly kept this very quiet when they sold their hospice facilities to Compassus and I don’...
Algorithms, Scoring Metrics, Privacy and more in today’s Healthcare business world–The Healthcare Algo Cartel
Nov 19, 20170This is a video of a recent presentation I did at the 74th Annual AAPS (American Association of Phys...
Pharmacy Benefit Managers Invade Medical Records and Electronically Connect Cash Patients to RX Discount Cards-OptimizeRX-to SingleCare to OptumRX
Jun 21, 20171This should not really come as a big surprise as what hasn’t the pharmacy benefit managment business...
DOJ Enters WhistleBlower Law Suit Against United Healthcare–Risk Fiddling for Profit, A Walk Back Down Ingenix Memory Lane AgainFeb 22, 20170Here we go again, back to those Ingenix algorithms and business models, getting a rerun of sorts of ...
Cigna & United Healthcare Face Class Action Suits-PBM Over Charging Customers for Prescriptions, OptumRX Pharmacy Benefit Management Software-“Front Running” Consumers With Killer Algorithms at the Drug StoreOct 16, 20161Here we go again. If you haven’t figured this out yet, when you buy a Cigna Health insurance p...
Quants of Optum Carve Out New Outsourced Billing Deal with Quest Labs, Will Also Serve to Enhance The Scoring & Data Selling Business Conducted by Both Companies via Powerful SubsidiariesSep 17, 20160If you don’t know what a Quant is, take time out and watch video #2 in the footer of this blog as th...
“Sully”, The Government’s Flawed Algorithms and Simulations Were Wrong, What Doctors Can Learn From Pilots…Sep 11, 20160I had to include the bit about the comparison here about doctors and pilots as this correlation over...
ICD-10 Conversion Allows Insurance Companies and Pharmacy Benefit Managers the Ability to Push More Drugs and Make Bigger Profits-The Illusion of Better Care Didn’t Happen-Cat Is Out of the BagAug 13, 20160Everyone now has made the big change to convert from ICD9 to ICD10 Coding for medical billing. ...
OptumCare Doctors to Get Allscripts Medical Records EHR–Optum Continues to Buy More Practices and Manage More Doctors Through Independent Physician Associations, Many of Which They OwnAug 07, 20160I’m starting to see more doctors in Orange County selling out their practices to United Healthcare’s...
The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!Jun 18, 20160One thing we all hate is the high prices we pay in the US today for our prescriptions. Sure we...
Cigna Launches New Company, CareAllies To Manage Patient Care, Doing Same Things as Does OptumJun 12, 20160By now we should all know the insurers are looking at ways to keep the cost of healthcare down and n...
Cigna Legal Case With Ingenix Flawed Formulas for Out of Network Payments Allowed to Proceed Under ERISA, Can’t Avoid the Claims…May 08, 20160How many companies used the Ingenix Data Base one has to question. While current Acting Direct...
Be Aware of Prescription “Claw Backs” as Pharmacy Benefit Management Profit Centers Continue to EvolveMay 07, 20160If you have watched the news of late, drug prices that we pay are a big item as the price of drugs k...
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 TrueMay 07, 20160I’ve been watching this for years with the way healthcare is changing in the US today and we certain...
United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance GroupsApr 19, 20160You can read the entire press release here as the report is broken down in several entities, but I f...
United Healthcare Hits the Bottom of the Barrel Linking Doctor Information to Healthgrades Flawed DataApr 06, 20160Ok if you have read here long enough, a few years, then you are accustomed to seeing outrageous flaw...
Walgreens Signs Agreement With PBM OptumRX (United Heatlhcare) and Anthem Then Sues Express ScriptsMar 21, 20160The long and short of the OptumRX agreement is to allow patients to be able to pick up and fil...
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 HarkenMar 13, 20160You read the title correctly as United adds yet one more subsidiary to their almost 400 subsidiary c...
United Healthcare Now Offering Employers Wearable Wellness Devices-UnitedHealthcareMotion–More Data To Mine And Sell With Related Risk Assessment Scoring Processes About You-Excess ScoringMar 01, 20160Here we go again, the Big Brother push and of course could all these “motion” scores be combined and...
And So It Starts With Funded Health Insurance Communities to Help the Poor and Obtain A Lot More Behavior Data to Mine and Sell For United Healthcare From the Participants…Feb 23, 20160If you have read here for a while there have been several posts about United Healthcare investments ...
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 AccessFeb 07, 20160It’s been a while since I hit this one but since last time, of course, things are getting worse out ...
United Files Lawsuit Against HHS/CMS–Doesn’t Want to Pay Their Portion of the Risk Fiddled $70 Billion Said Medicare Advantage Insurer FraudFeb 03, 20160This has been kicking around out there since Whistleblower lawsuits were filed. Initially Humana was...
United Healthcare Buys Helios Workman’s Comp PBM and Their Other Related BusinessesJan 29, 20160Here’s another purchase, Helios, and the big focus here is the pharmacy benefit management.&nb...
CMS Sanctions Cigna-No More Selling Any New Medicare Advantage Policies Until Algo Problems Denying Medical Coverage and Prescription Denials Are FixedJan 23, 20160As we may all know Cigna is working to be acquired by Anthem, which would be a huge acquisition.&nbs...
So What’s the Future With Guns and Healthcare? Will Doctors be Required to Do “Gun Risk Assessments” On Patients Next?Jan 07, 20160Of course we had to ask this question as with complexities, if a doctor should decide to turn inform...
Rite Aid Pharmacies are the Latest to Begin Used Flawed Data Provided by the EQuIPP Platform Relative to “Scoring” Patients for Predictive Medication Adherence–The “Outlier” Patients…Dec 16, 20151I have had some conversations with pharmacists who are on a pay for performance metric program based...
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…Nov 27, 20150We all know the home drug infusion business is growing as companies send out technicians and clinica...
HHS Joins Optum Labs as Research Partner–Back Peddles Support of FDA Sentinel Program That Does the Same Thing-More Impact from the Six Degrees of Bob Rubin Running Healthcare in the USNov 18, 20150We know Optum Labs is there to make money, selling slots to drug, device companies and others to hav...
Catholic Hospital Takes Horizon Blue Cross Insurance Company to Court-Tiered Hospitals With Additional Policy Discounts Unfair to Hospitals of Faith–Killer Algorithms At Work..Nov 08, 20150Well what’s not to say we’ll see more of this. Yes indeed it’s getting complicated to get heal...
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 YouOct 31, 20150How many people know that Optum has a bank? They don’t offer any retail services outside of an...
- If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United HealthcareOct 26, 20150
First question out of the barrel might be “how can that be”. It’s really not too difficult to ...
The End of “Consumer Common Sense” in the US-Fueled by Excess Scoring for Profit, Sustained By Media Publications Serving To Further The Inability For Simple Every Day Life Decisions…Oct 24, 20150This is topic that maybe does not get enough attention, simply due to the fact that today, consumers...
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..Sep 20, 20151If you read here often enough then you know I address this topic from time to time as companies and ...
Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…Sep 12, 20150This settlement was a long time coming and it appears now it’s on the way for over $9 million. ...
CMS Considering Fines for Inaccurate Doctor Listings, Not a Realistic Fix As Complex Doctor Scoring Algorithms Are Found At The Root of the Problem-Enter the Health Insurance Quants…Aug 15, 20150Stop and think a minute, if this was not such a big issue, don’t you think you would have better dir...
Doctors In Network Leave United Healthcare–Tired of Getting Paid At Rates 12% Less Than Medicare…Jul 30, 20150This problem is expanding into Kentucky now. I have heard it for years in California with diff...
CVS and IBM Watson Project–Please Make It Stop-13 Quarters of Declining Profits for IBM, Is This Is What We Get, More Algorithms Biting Us Constantly So More Data Can Be Mined and Sold Resulting In Excess “Scoring” of US Consumers..Jul 29, 20150When IBMWatson first came out I thought it was great and still do for cancer research and other area...
United Healthcare Finds Yet Another Way to Track You At the Grocery Store–Healthy Savings Card That Will Give You Discounts and Track What You Buy..Jul 29, 20150It doesn’t stop does it? We all know by now that the savings and rewards cards are trackers an...
Anthem and Cigna Merge, What’s In It For Consumers, Nothing Really, But There Will Be a Massive Data Mess of Analytics, Budgets, and You’ll Never Get An Accurate Listing of MDs in Network…Jul 25, 20150That’s about the size of it as today you have to look at the massive IT sides of business and if you...
United Healthcare Having a Big Bond Sale to Finance Purchase of Catamaran Pharmacy Benefit Management Company, Huge 10.5 BillionJul 23, 20150Here we go again, more leveraging and the healthcare we get depends on the financials of such. ...
Anthem Issues Yet Another Change to Physician Reimbursement Policies Less Than 90 Days After the Last Change–Here’s A Look at the Other Side of ICD 10 Complexities-Aetna Just Fired Some MDs Over This E/M Services Costing FactorJul 03, 20150I guess the question is anymore is “how bad do you want to be a doctor”. The red tape and what...
Aetna Ends Up Buying Humana for $37 Billion-More Medicare Advantage Plans Under One Roof, Stock Buy Backs And the Never Ending Puzzle of Healthcare Profits by the Algorithm….Jul 03, 20150So we are all watching to see how insurance merger mania goes and here’s the next after Centene boug...
Health Net Gets Sold-Centene Managed Care Is the Buyer-Conglomerate of Companies Involved in Medicaid, Medicare and Other Care Managing Business UnitsJul 02, 20150Centene is yet another managed care organization which you could say was a competitor of Health Net ...
Covered California Insurance Participants to be Risk Assessed With Individual Scores To Be Sent to CMS By Anthem–Appears To Be No Opt Out For Privacy, Payback Time For the ACA Subsidies As Feds Get Your Scored DataJun 29, 20150When you read this article entirely, it’s like what in the heck is this now? Seriously read th...
Hospital News Rigging Now? UPMC and Local Paper In a Dispute Over What’s Covered in the News, Takes Paper Out of Hospital Gift Shops…Jun 28, 20150Here we go again, and advertising from the Pittsburgh newspaper has also been cut, but the article s...
Operation “Perception-Deception” Into Full Swing in the US, With Killer Algorithms, Algo Fairies, Algo Duping, The Grays, and Of Course, Flags As Consumers Confuse Virtual World Values With the Real World…Jun 24, 20150What a week it has been so far as well as last week as well. It is worrisome as to what the Am...
CMS Chasing Wild Virtual Horses-A Big Distraction on the Hope of Finding Some “Algo Fairies” By Giving Entrepreneurs Access to Medicare Claims and Other Data…Marketing & Astro Turfing “The Sebelius Syndrome”..Jun 17, 20150One thing I think that can safely be said is Andy Slavitt, a one time Goldman Sachs banker and Unite...
Walgreens, No Time For Charity, Moves Truckloads of Closed Store Inventory to Landfill, Mayor of Wyoming Town Upset As New Products Perfectly Usable Were TrashedJun 06, 20150We all know how big business has to focus on stock buy backs, acquisitions, etc. today so donating p...
With Humana Up For Sale, What’s the Impact of the Medicare Risk Assessment Re-Run for Said Medicare Fraud? It’s a Big Potential Monetary Exposure For Humana and Other Insurers…Jun 04, 20150If you are not aware of the Medicare Advantage Re-Run of the Risk Assessment model, I’ll give you a ...
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