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

<p>One thing we all hate is the high prices we pay in the US today for our prescriptions.  Sure we do get some discounts, but that too has become an effort in algorithmic shopping to click here and click there to get the best price.  It shouldn’t have to be that way,<a href="https://lh3.googleusercontent.com/-03KxuGam6CU/V2VweidWtYI/AAAAAAABMxA/bSF-WShHFqw/s1600-h/image%25255B3%25255D.png"><img align="right" alt="image" border="0" height="194" src="https://lh3.googleusercontent.com/-XeddxZrW3uQ/V2VwfOv-7PI/AAAAAAABMxI/QbtqtRipr-U/image_thumb%25255B1%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="285"></a> but it is as that’s how the systems have been built.  There are a ton of discount prescription cards floating around out there and they all vary in one way or another, but the big thing to remember about all of them is that they are a marketing firm that can and will sell your data to make money.  In addition, the discount cards act just like a pharmacy benefit manager with getting all your information when you use them to fill a prescription.  In addition, some of them offer referral fees so they can increase the size of their data base of patient information.  Data means money today and it can be repackaged and resold over and over, and yes, that’s us.</p> <p>I found a video on YouTube done by a pharmacist that very well in detail describes how the whole process takes place and how these discount cards work.  He tells you what to expect and how the pharmacist reacts and uses them for their required input when filling your prescription.  He uses some real life examples on a couple commonly prescribed drugs with a brand name and a generic drug.  Yes indeed some of this information makes its way to the big pharmacy benefit managers as well.  </p> <p>What is interesting too is that the pharmacist points out with one example, the patient is getting charged the normal “cash” price the pharmacy would have given anyway with an additional $4.00 as a fee added on, so before jumping into any of the discount cards, be sure and ask the pharmacist for the “cash” price first as you may not even need the card at all.  It all depends and you have to really check each time.  Again the pharmacist makes the point to where they have to send the discount card company information about you so you can get a discount when you use one of them to include the name of your doctor, medication name, etc. so the company now knows who you are, who your doctor is, date of birth, and more.  The data is resold to market you for something else, or to compile lists of people taking certain drugs (sold to pharma as an example) </p> <p><iframe height="315" src="https://www.youtube.com/embed/bUVbX3-gOWc" frameborder="0" width="560" allowfullscreen></iframe></p> <p>When it comes to privacy policies, you get stuck with the same old legal routine with a policy written by lawyers to be interpreted by lawyers basically that has a lot of “double talk” in the verbiage.  This is one big reason I have my campaign and have had it out there for a few years now to get Congress to pass a law to require all data sellers to be licensed-who are they and what are they selling!  This really comes in to play when the data about you being sold is flawed and frankly the data sellers don’t care as bad data gets the same price as good data as nobody looks at the data.  Why do you think t<img align="right" src="http://lh3.googleusercontent.com/-WTU_WavuGLg/VYjYaFce1MI/AAAAAAABMZA/DCNNtafnZm8/image%25255B8%25255D.png?imgmax=800" style="float: right; display: inline">here’s referrals promoting these cards-to get more data to sell!</p> <p>Again ask the pharmacist for the “cash” discount first as you may not need one of those cards, so find out first.  Some pharmacies will refuse to take the cards if the cost of the prescription causes them to lose money as well.  I read somewhere that Wal-Mart with their $4.00 generic drug plans being pretty large, no longer will accept the cards.  So again using the prescription cards, all comes back around to data for a discount and companies marketing such end up selling or giving the information back to pharma, other marketing companies or even companies like IMS, the largest data seller of health information in the country, making so much money they had an IPO last year and a lot of folks got wealthy from it.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/06/ims-health-buys-cegedim-information.html">IMS Health Buys Cegedim Information Systems to Include CRM and Intelligence Software - Data Selling Business Gets Healthier and Wealthier But Can’t Say the Same for the Health of US Citizens - It’s All About Making Money Selling Data, The Epidemic</a></h5> <p>So yes in short, the big pharmacy benefit managers work in one way or another with the big pharmacy benefit managers and can add to the their bases of prescriptions filled using these cards as the card folks sell it to them.  I wrote about how pharmacies and insurers are now doing what is called “medication prediction scores” on everyone, and be aware it’s a secret and you cannot get your score, but your insurer can. <strong>FICO does this and thinks that everyone should run around with a “score” on medication just like we do with credit, but the big problem is that the data is so flawed</strong> everywhere you turn for their prediction scores.  It’s a rip on consumers.  See what Express Scripts tells you about these scores, and worse yet, they “brag” about these scoring algorithms! <h5><a href="http://ducknetweb.blogspot.com/2014/06/fico-medication-adherence-scoring.html">FICO Medication Adherence Scoring Should Be Banned As It’s Quantitated Justifications for Profit That Hurts US Consumers Using Proprietary Algorithms That Cannot Be Replicated For Accuracy or Audited</a></h5> <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><a href="http://www.ejovi.net/goodrx-make-money/">I found a review on GoodRX,</a> who does provide a listing of current drug prices on their website and they too are “doing data”.  All you have to do is take a look at their job listings, and you get the picture of what’s going on over there with looking for Channel marketing director, email marketing director and from the data side a python developer (python is the choice of computer languages for the financial firms), and a java script contractor.  With someone doing a review of the company it saves me the time of having to say a lot more about their card, and they focused on the same gray privacy policy you are starting to see templated on most web sites anymore.  <p>They make their money charging the pharmacy a fee for the referral, and do reserve the right to sell data.<a href="https://lh3.googleusercontent.com/-tfP_3JJPGgk/V2Vwf-tSsTI/AAAAAAABMxQ/ec0957ZOiGQ/s1600-h/image%25255B6%25255D.png"><img align="right" alt="image" border="0" height="162" src="https://lh3.googleusercontent.com/-fFREgbfEaNo/V2VwgWFBAMI/AAAAAAABMxY/t8tmC1OqJak/image_thumb%25255B2%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="244"></a>  It’s crazy that we have to jump through all kinds of hoops anymore with shopping for prescriptions, but that’s what the insurance and pharmacy business had created with their business models and contracts.  Here’s another post below on what pharmacists call “clawbacks” with using a pharmacy benefit price with either your PBM or even one of the discount cards.  <strong>You can end up paying more, so always ask for the “CASH” price first as pharmacy benefit managers are now telling the pharmacists they can’t volunteer this information, you have to ask.  The RX Bin number tells the pharmacist who to bill.  The discount card folks all have your data to do whatever they please with it as well as the pharmacy benefit managers and transaction records are accumulated. </strong> <h5><a href="http://ducknetweb.blogspot.com/2016/05/be-aware-of-prescription-claw-backs-as.html">Be Aware of Prescription “Claw Backs” as Pharmacy Benefit Management Profit Centers Continue to Evolve</a></h5> <p>Here’s another good video done with a taste of humor that explains the role of the Pharmacy Benefit Manager, the middleman cashing in big!  It’s done well and the Pharmacy Benefit Manager is jumping all over the counter during the video, getting in the middle. </p> <p><iframe height="315" src="https://www.youtube.com/embed/UXq2FetUu60" frameborder="0" width="560" allowfullscreen></iframe></p> <p>So in short, we are all getting ripped one way or another and have to “play this game” instead of just a simple process of filling a prescription.  The government has their hands in this till as well as now pharmacists are seeing patients with the use of another prescription monitoring program called EQUIPP to see your “star” rating if you are on Medicare as far as medication adherence goes.  Yes indeed, before you even show up data has already calculated a score about you that shows how they predict you will be with compliance.  It’s a real nasty game, and oh yes, those folks who use cash to pay for prescriptions, well they are now called Outliers as they can’t track enough data on you, so if you like and want privacy, pay cash.  Rite-Aid is the latest to announce using the data mining compliance software from EQUIPP.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/12/rite-aid-pharmacies-are-latest-to-begin.html">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…</a></h5> <p>The flawed prediction scores are indeed a dangerous business as they will end up denying you access at some point as well.  “Give old Jane the cheap stuff as our numbers predict she won’t take the expensive meds”…as a simple example.  <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 FixOutliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…</a></h5> <p>As a matter of fact, take a look at the first quarter revenue from United Healthcare, as their OptumRX revenue is exceeding that of the revenue produced by their insurance groups, more money made by United Healthcare with their OptumRX pharmacy benefit management company<a href="https://www.healthylife.optumhealthallies.com/ha/public/indexDtc.jhtml;sessionid=BR23TQVTSZWV0CW5GZIBQBY?_requestid=13686"><img align="right" alt="image" border="0" height="287" src="https://lh3.googleusercontent.com/-NK9BJ_g2_LA/V2Vwg4MvlNI/AAAAAAABMxg/rULTllfkSO4/image%25255B16%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="387"></a> than Medicare Part D policies..the world is changing and they are chasing the money.  Within the last few weeks, OptumRX has secured a few large contracts, like CalPers retirement system, Texas employee retirement system, etc. so they do want to control what drugs you can get and when.  Don’t forget the clawback video above as they are the pharmacy benefit manager featured in the news report, although they are all doing it.  <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p>Look what else gets involved with OptumRX pharmacy benefit management, infusion drugs so they may show up to provide that service for you as well.  The link below about OptumRX buying the infusion company has a<strong> side listing of a lot of government cronyism in healthcare</strong> too if you want to read about it.  </p> <p>There’s a company that’s a subsidiary of United Healthcare, <a href="https://www.healthylife.optumhealthallies.com/ha/public/indexDtc.jhtml;sessionid=BR23TQVTSZWV0CW5GZIBQBY?_requestid=13686">HealthAllies</a>  that was created by current CMS Adminsrator Slavit and Elizabeth Warren’s daughter (funded by Soros these days with her think tank) both former McKinsey consultants that will <strong><u>sell you a card to</u></strong> get both care and prescription discounts at the cost of $25.00 a month too.  It’s very dirty and corrupt these days in healthcare to say the least.  </p> <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>The discount card business has become very complex with just trying to get a prescription filled today and it’s done with complexities on purpose as everytime we don’t check something, we get fooled and pay more.  This is what I call the world of the <a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">Attack of the Killer Algorithms</a> as it is math models and computer codes that run everything so be aware, be very aware as it’s a game of being able to click for the right price anymore to the extremes and it shouldn’t be that way.  BD  </p>

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

One thing we all hate is the high prices we pay in the US today for our prescriptions.  Sure we do get some discounts, but that too has beco...

Read more »

Cigna Launches New Company, CareAllies To Manage Patient Care, Doing Same Things as Does Optum

<p>By now we should all know the insurers are looking at ways to keep the cost of healthcare down and now it’s coming down to pretty much an “algorithm stick” for the doctors to deal with.  This new company, interestingly enough is being headed from a former White House Executive, <a href="https://www.whitehouse.gov/blog/2015/01/29/behind-budget-dr-julian-harris-omb-associate-director-health">Dr. Julian Harris</a>.  He’s the former OMB Associate Director for Health.  The revolving door between insurers and US Healthcare never stops.<a href="https://lh3.googleusercontent.com/-g94FEEyOHLQ/V14PcAKUSYI/AAAAAAABMwI/eH4hb4_XHoE/s1600-h/image%25255B11%25255D.png"><img align="right" alt="image" border="0" height="112" src="https://lh3.googleusercontent.com/-qmG7ce1zWS4/V14Pc9P6utI/AAAAAAABMwQ/EoEUz_bGlks/image_thumb%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" title="image" width="187"></a></p> <p>Seriously, now when you look at one insurers page you get the same rhetoric about empowering and motivating physicians, same text different insurance carrier and I bet the doctors are a bit tired of the quantitated madness they deal with today as it’s not doing much for them.  Just like Optum it’s a bunch of algorithmic formulas (and hey maybe they licensed some of those algos from Optum) to “score” and cut costs and access.  Here’s what happened one time a while back when Cigna and most all other health insurers licensed United Healthcare (Ingenix, now named Optum) algorithms, lawsuits.</p> <h5><a href="http://ducknetweb.blogspot.com/2016/05/cigna-legal-case-with-ingenix-flawed.html">Cigna Legal Case With Ingenix Flawed Formulas for Out of Network Payments Allowed to Proceed Under ERISA, Can’t Avoid the Claims…</a></h5> <p>Our CMS is being run today by Quant mind sets and there’s like no changing it as they “think” all this quantitation is going to save the day.  It will deny access and drugs at times though.  As a matter of fact, Cigna is still on the hot seat for quality issues and currently can’t sell any Medicare Part D plans as CMS has them sanctioned.</p> <p>I think there’s more that than the book cover myself as there’s this big merger with Anthem trying to take place as well and when you buy a Cigna plan now, you get another insurer, United Healthcare, under their OptumRX subsidiary to be your pharmacy benefit manager.  <a href="https://lh3.googleusercontent.com/-6wNyI_vR8R8/V14PdeAXiSI/AAAAAAABMwY/xPN-SZCJi7U/s1600-h/image%25255B10%25255D.png"><img align="right" alt="image" border="0" height="40" src="https://lh3.googleusercontent.com/-0z9Y6iu5g7Y/V14Pd_BDCoI/AAAAAAABMwg/laCU-htBzUs/image_thumb%25255B4%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" title="image" width="351"></a></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> <p>Cigna was one of the first companies that started using software to analyze and determine your current state of mind over the phone with their customer service centers and they just about do that now, so be aware when you use the call centers for customer service, that your state of mind is being actively scored and maybe that data gets sold to some behavioral business too.</p> <h5><a href="http://ducknetweb.blogspot.com/2013/08/insurers-certainly-like.html">Insurers Certainly Like Consumer/Business Healthcare Apps: Subsidiary of Blue Cross Rolls & Couple Others Out $20 Additional Million in Funding to Audax First Backed by Cigna & Cardinal Health</a></h5> <p>A few years ago Cigna increased their Medicare HMO business by purchasing another HMO called Spring. <h5><a href="http://ducknetweb.blogspot.com/2011/10/cigna-buys-healthspring-inc-for-38.html">Cigna Buys HealthSpring Inc For $3.8 Billion, Who Bought Bravo Medicare HMO Who Had Profits of a Billion in 2010-Subsidiary Watch</a></h5> <p>It’s going to be interesting to see how the insurance mergers and all these “managed care” algorithms all come into play and you can look forward to more flawed data as they have built massive data lakes and the bigger the lakes, the more errors you get. I addressed that a couple years ago.  <h5><a href="http://ducknetweb.blogspot.com/2014/09/health-insurance-business-is-driving.html">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..</a></h5> <p>It is also interesting to note that HHS Healthcare.Gov CEO is also touting Cigna as expanding their ACA insurance polices for sale, this of course since United Healthcare is pulling out of all but 3 states.  Keven Coulihan from Healthcare.Gov was also a former Cigna Healthcare executive, so more cronyism there as well.  I’ve kind of laughed at wondering when the co-marketing with Cigna and United Healthcare might begin on ACA and maybe even other policies as if Cigna gets the sale, then United Healthcare shares in the money as the pharmacy benefit manager.  By the way, you should look and see that United Healthcare/OptumRX revenue stream is making more money than their 3 insurance revenue streams and appears to be going back to their roots with making a lot of money with drug companies, how the company got started in the late 70s.  United sold the PBM a drug company who sold it to to Express Scripts (who I’m sure still uses Optum Algos today) a year later.  So co-marketing now so OptumRX can make even more money on pharmacy benefit management?  BD <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p> <hr> BLOOMFIELD, Conn.--(BUSINESS WIRE)--The nation’s health care system is moving from volume to value, yet it remains fragmented and complex. Health care providers are facing increased pressure to move from fee-for-service to value-based payment, yet current market solutions to accelerate this journey have been criticized as too rigid to meet complex provider needs. Cigna (NYSE: CI) has partnered with health care providers for many years to help them align their financial incentives with patient health outcomes, resulting in joint success through shared risk.</p> <p>The new company, CareAllies, Inc., will deliver the systems, capabilities and management services that providers need to be successful under a variety of value-based and risk-sharing models across the value-based reimbursement spectrum. CareAllies<a href="https://lh3.googleusercontent.com/-FRpRSWA7n34/V14PeeBC9lI/AAAAAAABMwo/isJXYN8nR78/s1600-h/image%25255B13%25255D.png"><img align="right" alt="image" border="0" height="72" src="https://lh3.googleusercontent.com/-Ib6rdDnnXCA/V14PezbPLiI/AAAAAAABMww/5BBggNTmxOM/image_thumb%25255B7%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" title="image" width="274"></a> will offer services to help ease providers’ administrative burden across payers and can even help providers launch and manage their own health plans. </p> <p>The new CareAllies will combine assets from Cigna, Cigna-HealthSpring’s management services division for independent physician associations (IPAs), and QualCare Alliance Networks, Inc. (QANI), which Cigna acquired in 2015. It will leverage these companies’ extensive histories of successful and innovative provider collaborations. Dr. Julian Harris has been named president of CareAllies, Inc., which will operate as a wholly-owned subsidiary of Cigna.</p> <p>CareAllies is similar to UnitedHealth Group Inc.'s health care services subsidiary, Optum Inc., said Vishnu Lekraj, senior equity analyst at Morningstar Inc. in Chicago.</p> <p><a href="http://www.businesswire.com/news/home/20160609005163/en/Cigna-Launches-Company-Deliver-Proven-Systems-Capabilities">http://www.businesswire.com/news/home/20160609005163/en/Cigna-Launches-Company-Deliver-Proven-Systems-Capabilities</a></p>

Cigna Launches New Company, CareAllies To Manage Patient Care, Doing Same Things as Does Optum

By now we should all know the insurers are looking at ways to keep the cost of healthcare down and now it’s coming down to pretty much an “a...

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Cigna Legal Case With Ingenix Flawed Formulas for Out of Network Payments Allowed to Proceed Under ERISA, Can’t Avoid the Claims…

<p>How many companies used the Ingenix Data Base one has to question.  While current<a href="https://lh3.googleusercontent.com/-4p0gQ9QGUG8/Vy9ff7ECsdI/AAAAAAABMvc/7hJroKXbycM/s1600-h/image%25255B8%25255D.png"><img align="right" alt="image" border="0" height="141" src="https://lh3.googleusercontent.com/-P6tj5WOrOJk/Vy9fgSL2qsI/AAAAAAABMvg/0wFz_OflLK8/image_thumb%25255B4%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="155"></a> <strong>Acting Director of Medicare, Andy Slavitt was the CEO of Ingenix it appears he was quite busy</strong>.  This case, as you can read below per a recent decsion is now allowing doctors to cotninue with their case for the use of the flawed Ingenix Data Base.  Upon taking the position to run Medicare, HHS Secretary Burwell was able to get an unprecedented pardons in place for Mr. Slavitt to avoid all these lawsuits.  Does that set well with you?  It happened.</p> <p>Connecticut General Life is the primary focus here with Cigna being the insurer providing the reimbursement.  This change probably hits Cigna at maybe not a good time when they are trying to merge with Anthem one could say, although there a lot more to the complex merge as well.  Cigna paid the claims, and thus the ruling is to now allow the case to proceed.  Last year, this Ingenix lawsuit was just settled as well with surgical centers also being short payed by Ingenix.  <a href="http://ducknetweb.blogspot.com/2011/04/unitedhealth-group-announced-re.html">Ingenix had a name change to Optum Insights</a> a couple years ago and I think all the lawsuits might have had something to do with that.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/09/another-united-healthcare-ingenix.html">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…</a></h5> <p>In addition, this case with Ingenix just settled last year as well.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/ingenix-optum-united-healthcare.html">Ingenix (Optum-United Healthcare) Lawsuits Still Bouncing Around Out There–One Recently Settled in New Jersey With Horizon Blue Cross Blue Shield That Was Still Using the Flawed and Corrupt Data Base for Out of Network Payment Calculations</a></h5> <p>In addition, this group of lawyers in New York appears to be investigating the potential of another lawsuit with United, relating back again to payment of claims. <h5><a href="http://ducknetweb.blogspot.com/2014/06/law-firm-investigating-unitedhealthcare.html">Law Firm Investigating UnitedHealthCare Claim Payments in New York Stating Under-Reimbursement By Manipulating Algorithmic Benefit Calculations…</a></h5> <p>A couple years ago, and it received very little publicity, the Supreme Court put out a ruling allowing doctors, <a href="https://lh3.googleusercontent.com/-xObDvflv5ec/Vy9fg87YoAI/AAAAAAABMvk/hn9IcfSuqa8/s1600-h/image%25255B9%25255D.png"><img align="right" alt="image" border="0" height="84" src="https://lh3.googleusercontent.com/-bmciTC_L-7Q/Vy9fhf90yrI/AAAAAAABMvo/jr9SXXVihbI/image_thumb%25255B5%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="240"></a>to be able to group to worth together on such cases of unfair business practices as well.  <h5><a href="http://ducknetweb.blogspot.com/2013/06/us-supreme-court-rules-physicians-can.html">US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts</a></h5> <p>Almost all the major insurers were hit with the under payment legal cases as they were all licensing the use of the Ingenix Data Base that allowed calculations to short pay doctors and patients for out of network claims.  Aetna ended up waiting long enough and in the end weaseled out of their payments with some quick work by the company that somehow showed a lack of interest had developed. <h5><a href="http://ducknetweb.blogspot.com/2013/01/aetna-payment-of-120-million-to-settle.html">Aetna Payment of $120 Million To Settle 15 Year Ingenix/United HealthCare Out of Network Erroneous Payment Algorithms Cuts Income for 4th Quarter</a></h5> <p>The big case of course that everyone may remember was the large class action suit that the AMA filed against Ingenix and won against United Healthcare Ingenix, and their CEO at the time, current CMS Acting Director Andy Slavitt.  The post was Chapter 19 of my old Killer Algorithms series to where I wrote about algorithms and formulas attacking consumers with either denying access or taking more money.  <h5><a href="http://ducknetweb.blogspot.com/2012/02/ama-announces-doctors-and-patients-can.html">AMA Announces Doctors And Patients Can Expect To See the UnitedHealthCare/IngenixClass Action Settlement Checks In the Mail Soon - Out of Network Short Payments–Attack of the Killer Algorithms Chapter 19</a></h5> <p>Ingenix itself was very busy as a subsidiary of United Healthcare securing Health IT contracts and buying up other companies as well.  As a matter of fact, all the <a href="http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html">bogus “medication prediction scoring” that we are all subject to when filling a prescription</a> was all started with Ingenix algorithms being licensed to Express Scripts in 2010.  I call it bogus as I am referring to the prediction portion of this and not the actual monitoring of hard data.  If you look at the 300 metrics used by Express Scripts and some of the other pharmacy benefit managers with their proprietary calculations, they have nothing to do with taking your prescriptions and predict with flawed calculations on whether or not you will be compliant.  As an example, if you have kids, that’s one bad ding for your score.  </p> <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 IngenixAlgorithms–We Want the Revenue Please Don’t Stop</a></h5> <p><strong>So back on track with Cigna here, they can’t seem to get out of being associated with United Healthcare either with some of their business.</strong>  United Healthcare is racking in big pharmacy benefit money as their acquistion of Catamaran turned United into the Cigna pharmacy benefit manager.  If I were Cigna running an insurance business I’m not sure I would be too happy with that with a competitor now running the pharmacy benefit end of the business?  It’s been stated that the Anthem/Cigna merge may not complete until 2017.  <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p>So this case is rolling along, and the judge did decide that individual doctors and medical associations can’t file additional claims, and <img align="right" height="160" src="http://lh5.ggpht.com/_v3zjJigoAPE/TAdpgWK8tcI/AAAAAAAAekk/rWgn0GxRDgk/image_thumb%5B9%5D.png?imgmax=800" style="float: right; display: inline" width="252">nor can it turn into a class action suit, but the<strong> current plaintiffs have the OK to collect from Cigna on the use, once of the flawed and corrupted Ingenix data calculations for paying doctors.  </strong>I sometimes wonder how much money Ingenix/United Healthcare really racked in from all of this as it went on for 15 years, had to be a bunch with all the licensing to so many other insurers as well.  </p> <p>Ingenix (Optum Insights) folks have been hanging around Washington DC for quite a while and you can kind of see this going back to HHS just gushing over their “Reach for The Top” model, link below from 2010.  It contains pretty much all the elements CMS is pushing and marketing today, Population Health, paying doctors less and so forth, so the influence and math models and algorithmic plan association here leaves no doubt and perhaps all these models is what maybe convinced Secretary Burwell that in addition to all the Ingenix lawsuits that Slavitt was the correct person to run Medicare?  Go figure I guess.  We all knew before Burwell we had the affliction of the <a href="http://ducknetweb.blogspot.com/2014/04/secretary-sebelius-at-hhs-resigns-wrong.html">Sebelius Syndrome</a> with her out of reality perceptions and chasing those Algo Faires too for perceived solutions.    BD  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/06/for-top-program-combines-prototype-from.html">"Reach for the Top" Program Combines Prototype from Ingenix (A Wholly Owned Subsidiary of United Healthcare) for Public/Private Community Health Data on HHS.Gov Site</a></h5> <p> <hr> May 2 — Out-of-network health-care providers have ERISA standing to continue with their lawsuit accusing Connecticut General Life Insurance Co. of using a manipulated database to determine their services fees, the U.S. Court of Appeals for the Third Circuit ruled. In the May 2 unpublished opinion, Judge Thomas I. Vanaskie reversed in part the district court decision that had seemingly put an end to a decadelong litigation. Vanaskie remanded the case to the district court, holding that the providers had sufficiently pleaded the existence of a valid assignment to support derivative standing under the Employee Retirement Income Security Act. <p>The proposed class action was originally brought by medical providers, individual subscribers and 14 medical associations, alleging that out-of-network services were underpaid because of flawed “usual, customary and reasonable” (UCR) rate data provided by Ingenix Inc.</p> <p>The providers' allegation that they received from CIGNA insureds an assignment of benefits or a claim assignment through which they were paid directly by CIGNA was sufficient to plead the existence of a valid assignment to support derivative standing, the court said.</p> <p><a href="http://www.bna.com/cigna-cant-avoid-n57982070578/">http://www.bna.com/cigna-cant-avoid-n57982070578/</a></p>

Cigna Legal Case With Ingenix Flawed Formulas for Out of Network Payments Allowed to Proceed Under ERISA, Can’t Avoid the Claims…

How many companies used the Ingenix Data Base one has to question.  While current Acting Director of Medicare, Andy Slavitt was the CEO of ...

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Be Aware of Prescription “Claw Backs” as Pharmacy Benefit Management Profit Centers Continue to Evolve

<p><script type="text/javascript" src="http://kfda.images.worldnow.com/interface/js/WNVideo.js?rnd=344707067;hostDomain=www.newschannel10.com;playerWidth=530;playerHeight=355;isShowIcon=true;clipId=12412460;flvUri=;partnerclipid=;adTag=News;advertisingZone=;enableAds=true;landingPage=;islandingPageoverride=;playerType=STANDARD_EMBEDDEDscript;controlsType=overlay"></script>If you have watched the news of late, drug prices that we pay are a big item as the price of drugs keeps<a href="https://lh3.googleusercontent.com/-B_ianRfzEgY/Vy6FmQlLxFI/AAAAAAABMvA/WM5j5vYFwO8/s1600-h/image%25255B2%25255D.png"><img align="right" alt="image" border="0" height="143" src="https://lh3.googleusercontent.com/-zgkJ-LQAdLg/Vy6FnKRc3SI/AAAAAAABMvE/G63cfrKoPig/image_thumb.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="244"></a> going up.  The pharmacy benefit management company is the middle man in between the pharmacy and you.  Their computers connect to the PBM and they are given the price to charge you according to your  agreement and insurance under which your prescriptions fall.</p> <p>Worth a mention here is that OptumRX last quarter became the biggest revenue producer of their 4 revenue categories.  That’s right they are making more here than any of their insurance groups when compared, more at the link below.  OptumRX gets a double whammy in revenue as their OptumRX, through the acquistion of Cigna is also the pharmacy benefit manager for those insured by Cigna.  Cigna is currently sanctioned by CMS though and and their former benefit manager, Catamaran, which was acquired and integrated into OptumRX was denying patients too many drugs and care. </p> <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>Of course in this video, which pharmacy benefit management company is heavily connected to claw backs?  United Healthcare, aka OptumRX. You may have wondered why we have the Walgreens and OptumRX agreement right?  There’s claw back money potential here as they state that patients can pay the same at Walgreens as they would getting a 90 day supply via the mail.  Well, when you watch the video, the computers talk to each other and the patient may receive a higher cost than what the Walgreens “no insurance-cash” rate would be.  So what do they do, split the difference with a profit?  More at the link below on how this happens.  Anthem is suing Express Scripts as well on the pharmacy kick backs that the pharmacy benefit management company Express Scripts receives on the sale of drugs.  That’s another avenue in which pharmacy benefit management companies make money,<a href="https://lh3.googleusercontent.com/-knR2byNEz5s/Vy6Fny6KkZI/AAAAAAABMvI/h1UiyX4ZnWM/s1600-h/image%25255B5%25255D.png"><img align="right" alt="image" border="0" height="172" src="https://lh3.googleusercontent.com/-ufxZJXQqv-Y/Vy6FoXrazRI/AAAAAAABMvM/3bkI2KAimvI/image_thumb%25255B1%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="244"></a> they get a kick back from the drug company on the dollar amount of the drugs that were sold.  </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>Some day if you need infusion drugs, there’s a good possibility a subsidiary of OptumRX, the subsidiary of United Healthcare might pay you a visit for that too as the company they bought operates in 38 states.</p> <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><strong>When you really want to throw off the entire pharmacy patient “scoring” system, just pay cash for your prescriptions</strong> and you’ll be scored by default as an outlier who doesn’t take their meds.  Before you walk in to most pharmacies today, the pharmacists already have you sized up with 300 metrics that have zero to do with taking your prescriptions on predicting whether or not you will.  I think it’s a big farce, costs a lot of money and they sell all of this data to insurers and other people who want to calculate any type of risk assessment on you.  The problem is, the numbers are flawed.  <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 Nonmedication Adherence Compliant With 5 Star Systems Full of Flawed Data…</a></h5> <p>Do always ask for the “cash” no insurance price is the moral of this story to avoid pharmacy benefit managers getting a claw back of your money and charging more when they find you could be asleep at the wheel if you will.  In the video they ask what kind of company is that which is supposed to negotiated cheaper prices for you and ends up charging you more?  That’s a good question and of course some of that probably goes to pay for all the software and algorithms that score you on predictions and risk, right? <p>Sometimes customers are paying more than the drug is worth as well.  Claw Backs don’t occur on every prescription but ask to avoid one happening with you is the best advice.  I had a person tell me they have a son who needs some expensive drugs due to some serious conditions he has and due to the pricing, he has to go to three pharmacies to get all the prescriptions for the best price.  That’s wild when that occurs but that shows how different the contracts are and how the pharmacy benefit management contracts work.  BD  <p><a href="http://www.newschannel10.com" title="KFDA - NewsChannel 10 / Amarillo News, Weather, Sports">KFDA - NewsChannel 10 / Amarillo News, Weather, Sports</a></p> <p> <hr> One source for our investigation, a New Orleans-area pharmacist, asked us to hide his identity.  Contracts with pharmacy benefit managers, or PBM's, prevent him from talking publicly. <p>But documents that multiple pharmacists provided to FOX 8 News show, in some cases, companies are charging copays that exceed the customers' costs for their drug.   <p>Pharmacists call it a clawback - the company is essentially clawing back money from you and, our source tells us, you probably don't even realize it's happening. <p>“They have no idea,” the pharmacist says.</p> <p>“Whatever the insurance company/PBM tells us to charge as a copay, we have to charge the patient for that,” our source says.  “We cannot discount it, we cannot forgive it. Our computer calls their computer. They tell us charge the patient this much money.”</p> <p>But many pharmacists, who asked that we not reveal their identities, gave us dozens of examples. They include <a href="http://ftpcontent.worldnow.com/wvue/documents/HOPCpg24.jpg">a $22 clawback</a> on a nasal steroid, fluticasone; <a href="http://ftpcontent.worldnow.com/wvue/documents/HOPCpg6.jpg">$7.85 for a diabetes treatment</a>, invokamet; <a href="http://ftpcontent.worldnow.com/wvue/documents/HOPCpg11.jpg">$12.39 for diazepam</a>, a drug that treats anxiety, muscle spasms and seizures.</p> <p><a href="http://www.newschannel10.com/story/31891070/zurik-copay-or-you-pay-prescription-drug-clawbacks-draw-fire">http://www.newschannel10.com/story/31891070/zurik-copay-or-you-pay-prescription-drug-clawbacks-draw-fire</a></p>

Be Aware of Prescription “Claw Backs” as Pharmacy Benefit Management Profit Centers Continue to Evolve

If you have watched the news of late, drug prices that we pay are a big item as the price of drugs keeps going up.  The pharmacy benefit ma...

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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

<p>I’ve been watching this for years with the way healthcare is changing in the US today and we certainly need and do use constructive and good measurements in what the industry does, but just like in the financial world, we’re starting to cross some borders here into madness where mathematical models with “no” proof of concept even are producing numbers that don’t compute and host environments that are hostile to the future of providing good care.  In other words, it’s time to take to take a step back and look at where we are and it’s not pretty nor productive in a lot of business areas today. </p> <p>It was back in 2009 I started noticing the correlations of what was happening in the financial world and compared it to what is taking place and healthcare and when you do a bit of research and reading on this topic, it’s not hard to figure out that some of the healthcare models are not much more than some of the financial models that have been tweaked a bit to try and perform the same linear methodologies that are either flawed from the start, or that contain proprietary computer code that developers have been <b>selling with the tag line “trust me”. </b> “<b>Trust me” is becoming a huge problem</b> as proprietary software and algorithms are all locked up in what is called a “compiler”, in other words nobody without proper credentials can see what the magic sauce is.  <p>There are good reasons to have some “magic sauce” around though and folks patent a lot of it.  Back in the early days of the mid 90s, when all were working to create tools that actually helped us with business this was not really an issue, but the world has evolved today and that’s not always the case.  We can look at Volkswagen as an example, which we all should know by now; they cheated with their computer code and built a<b> “virtual world of cars that did not pollute”.</b> <p>With software you can do something about anything, and the methodologies can be true and they can be false as we learned.   I borrowed that line from the video documentary about the Quants of Wall Street, the Alchemists and if you have not seen it, scroll down to the bottom of this page and watch it, as we have tons of Quants in Healthcare today, just like we do in finance.  <h5><a href="http://ducknetweb.blogspot.com/2014/10/data-scientistsquants-in-health.html">Data Scientists/Quants in the Health Insurance Business–Modeling Beyond the Speed and Capabilities of Humans To Keep Up With The Affordable Care Act–Turning Into A World of Killer Algorithms That We All Hate..</a></h5> <p>I read every day with the frustrations of the average consumer trying to make sense out of what’s going on and they can’t.  This is a world controlled and ruled by individuals who are both responsible and irresponsible in what they design and create out there and both exist.  All one has to do is look at Wall Street and know there’s a lot of folks up there who cheat with computer code, an issue that even those who are elected to make laws in this country can’t understand, and that’s scary as that’s their job.  <a href="http://ducknetweb.blogspot.com/2014/09/eric-holder-resigns-as-head-of.html">Former Head of the Department of Justice, Eric Holder, determined he didn’t want to explore this avenue of crime</a> either and turned his head away from having to deal with crimes that are committed with cheating with computer code and math models.  We saw that plain and clear in the PBS documentary called <a href="http://ducknetweb.blogspot.com/2013/01/the-untouchables-too-big-to-jail.html">“The Untouchables”.</a> <p>I used to write software and I look at what some of the journalists put out there today and truly I ask myself “where in the hell did they get that interpretation” with some of the news articles?  Again just like the average consumers, they don’t understand or make an effort and we get “junk” news and interpretations.  There are some good exceptions out there though, with real journalists, and not jounobots that do dig in and create some good articles, so this not an attack on the entire industry, just the ones who are blinded with Perception-Deception and produce a lot of just with quantitated madness statistics on things that are not true.  We all know at this point that a lot of the news we read today is “rigged” and the complaints are numerous.  <p>Media newspapers are running out of money to put out the news as Facebook and a few others have taken a lot of their ad revenue which is used to support them and wrapped it into their news feeds which also use algorithms to tell you “what you should read”.  God help us with the dupes that are totally sucked in there as well.  I call it the Dupes of Hazard society today.  Take a look and see how easy it is to produce fake news today with a bot that does all the writing.  One bot is so good that the creator used it to create 10,000 books and put them on sale at Amazon.  These jounobots are not just restricted to writing content either; you’ll find them writing content to verbally justify a lot of quantitated madness we deal with today.  <h5><a href="http://ducknetweb.blogspot.com/2015/04/news-rigging-has-arrived-astroturf-and.html">News Rigging Has Arrived! Astroturf and Manipulation of Media Messages-TED Video About “The Fake Grass Roots” Of Big Pharma and Other Campaigns That Fool and Fool Again…</a></h5> <p>So now we move to the next level of quantitated madness out there with the new CMS MACRA rules for grading doctors.  We all know that the Meaningful Use model has bit the dust and logically, all models are not created to run forever, as some might think.  If you talk to a good Quant though, they will pretty much tell you that you can’t take another model, load it on top of a model that’s already broken and expect a good “fix”, and that’s what I see happening here.  There’s almost a 1000 pages of quantitated madness that is going to reward doctors for better care?  We do need some reporting and that’s the point of this post, the point is that with putting a new model on top of one that is already broken, well guess what, this one will be broken too.  <p>Broken models are not fixed by created yet another model on top and lead us into very complex areas of math to where nobody will understand what’s going on.  With that in mind, health insurers have done this for years and I’m not the first to state that they make money based on complexities and keeping consumers “off balanced”.  Insurers have a captive audience and they know it and have been modeling like this for years! <p>Others know this as well so I’m no genius with this conclusion at all.  As a matter of fact way back in 2009 when Sebelius was nominated to run HHS, before she ever stepped foot in that office, I said exactly this would occur, that insurers would reduce her to mincemeat as she’s out of the same mold at Eric Holder was with not wanting to deal with reality and how those smarter than her would use their quantitated skills to model all over her and get what they want, the insurers. <h5><a href="http://ducknetweb.blogspot.com/2009/02/kathleen-sebelius-kansas-governor-for.html">Kathleen Sebelius, Kansas Governor for HHS – Please not! Put the “Smart” People in these key positions</a></h5> <p>So not much has really changed in essence from that day and we are still continuing on the same path.  I call it STAT RAT FEVER as my own coin when I talk about the government’s activity in healthcare as that’s all they do.  <strong>Currently we have two folks running HHS and CMS that were former McKinsey consultants.</strong>  If you have not read some of the books out about the brain washing institute, do it and you’ll understand what goes on.  <p>I call it the “Scientology effect” of the business world as you find their consultants everywhere and some have even gone to jail.  Recently we had Mckinsey written all over Valeant, who again before he was the CEO of that company, was a long time McKinsey consultant.  Almost anymore when I see any study from McKinsey using the “T” word, “trillion” that could be saved, you have to laugh as they use quantitated madness reports to get you upset and motivated to believe whatever kind of numbers they want to sell that day.  Of course if you go back in time and look up some of their old studies and compare them to what has really occurred, you do find a lot of fictional marketing in some of what they have published. <p>We do have one doctor at the ONC who is no longer the chair person, DeSalvo who for about a year bit on the perception-deception tall tale that medical record developers were deviously writing code not to interoperate.  That was a marketing ploy of a big EMR company that was planted out there as “marketing” to make people think that medical record vendors were “on purpose” writing code that would “block information”.  Of course anyone whose’ been in the business long enough knows that’s a farce as it takes time and money to write code and no vendor is going to do that, and maybe they just didn’t have the time, money and resources to write enough code yet to match her perception of what interoperable code should be (grin).  I thought it was great when Dr. Halamka addressed it for what it really is, and he’s a doctor and a computer scientist at Harvard Medical and if anyone knows what the correct perception is, he does. <h5><a href="http://ducknetweb.blogspot.com/2015/05/information-blocking-finally-revealed.html">“Information Blocking” Finally Revealed for the Hoax and Make Believe Story That It Is With Medical Records Sharing and Interoperating…</a></h5> <p>So hold on to your hats with MACRA as both Burwell and Slavitt are both former McKinsey consultants, where some basic training was attained, if you will.  Neither have any backgrounds in the clinical side of healthcare so at some point, one has to ask, why don’t we have some folks with clinical backgrounds at the top of the helm in government healthcare?  I think it’s a good question.  We can all go back and see the <a href="http://ducknetweb.blogspot.com/2016/01/cms-medicare-proposing-more-data.html">long extensive background of Andy Slavitt</a> with his former position at CEO of Ingenix, which was renamed to Optum Insights and how when thing got really hot over there with all the lawsuits, United Healthcare folks just moved him over to run QSSI when United purchased that company to get in on some of the Healthcare.Gov action with more algorithms and software. <p>In addition the “do not disturb”  <a href="http://ducknetweb.blogspot.com/2015/09/another-united-healthcare-ingenix.html">sanctions given to Slavitt at CMS</a> were unheard of.  All those lawsuits would distract him from doing his job?  Well why don’t we look at how and why all those lawsuits came to be?  He’s a Quant and also spent some time at Goldman Sachs, and the banks really heavily on their Quants to model their financial models.  If you happened to see “The Big Short”, they offer an explanation there as to “what a quant does” in a humorous way.  You hear “listen to my quant”, and that indeed was a good portion of the movie that tells you right there what the quants are hired to do to ensure profits.  It was funny in the way that the quant was presented as an Asian individual who didn’t speak English, but could<b> write good code and then there was the insert of him blowing that perception into the dirt as he explained “what he really does”.  </b> <p>There’s a lot of models out there that don’t work.  One of the most well known examples is the Bloomberg Big Gulp.  The developer of that process actually ended up leaving Bloomberg and went to work at the <a href="http://ducknetweb.blogspot.com/2014/11/cdc-shuts-down-obesity-for-work-place.html">CDC and created yet another model that didn’t work</a> called Obesity for the Workplace.  Again these are theories and some kind of numbers that may or may not work.  It’s hard sometimes not to get caught up in the perceptions at times too as we are presented with a ton of mathematics that say it will work.  As we all know by now, the <a href="http://ducknetweb.blogspot.com/2014/11/how-many-more-bloomberg-big-gulp-failed.html">Bloomberg Big Gulp mathematics failed</a> as “people don’t work that way”.  I see it time after time when quants and developers think they have “the answer” with a vision in their heads on how people will work with their code and models and it flops.  There’s no easy answer to a lot of it as well and you need at least some proof of concept developed, but we don’t even get that anymore.  I speak of this as I got fooled too in this game and saw it a long time ago.  You think you have the answer only to find out you don’t.  <p>When the financial stakes get high though, you do get marketing folks called in to write all kinds of quantitated<img align="right" alt="Image result for stat rat fever" src="data:image/jpeg;base64,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" style="float: right; display: inline"> justification stories as to why it has to be the cat’s meow and the peanut galleries on the web, toss out all their potential skeptic feelings and simply just buy in to the madness.  I wrote about this a while back and called it<b> <a href="http://ducknetweb.blogspot.com/2015/06/operation-perception-deception-into.html">“Operation Perception-Deception”</a></b> in the US before everyone else started jumping on the same band wagon.  You implement enough failed models and people eventually stop drinking the Kool-aid.  In addition, some of the skewed quantitated madness has people just flat out doing strange things with attacking symbols like flags and so forth, as again they are wrapped up in a world of technology that they can’t see or understand, with a very small number of Quants and developers creating algorithms that are denying access and eventually taking away a lot of our freedoms in the US.  <h5><a href="http://ducknetweb.blogspot.com/2015/06/operation-perception-deception-into.html">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…</a></h5> <p>If I were a doctor today being subjected to this new grading system, which is basically a re-write of a lot of what United Healthcare has been developing with a lot of their models, I would be a skeptic indeed.  When you look at the fact that CMS sanctioned Cigna health insurance for not providing quality care, and then took away their penalty (nullified the rules of the game) and then come back with this to grade doctors and think it’s going to create better value for care?  We have some folks out there not looking at big picture.  Admittedly the health insurance models for grading has failed so what makes you think this MACRA model is going to be an accurate representation?  Think about that.  <p>I’ve learned some of what I know from mathematicians that work for universities that have written and put out<a href="https://lh3.googleusercontent.com/-nt6n15gqwhY/Vy4VaxyIwhI/AAAAAAABMus/PdEfb4ZYFWo/s1600-h/image%25255B3%25255D.png"><img align="right" alt="image" border="0" height="185" src="https://lh3.googleusercontent.com/-VuYtl44zCO8/Vy4VbQqkO-I/AAAAAAABMuw/BNV9SSlJ7Uk/image_thumb%25255B1%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" title="image" width="124"></a> some extensive work in this area.  Charlie Siefe at NYU in Mathematics has been very outspoken and if you watch video #1 in the footer, you can learn a lot from just one video.  He also wrote the book called <a href="http://ducknetweb.blogspot.com/2012/01/context-is-everythingmore-about-dark.html">“Proofiness, the Dark Arts of Mathematical Deception”.</a>   I’ve also had some chats with Ed Frenkel, mathematician at Berkeley and we all seem to be on the same page.  A quant is both a mathematician and one who writes code.  Watch video #2 in the footer to understand how they function in the financial world and you can easily see how their work slides right over into healthcare, especially when there are profits to be made.  This is the real deal out there today.  <p>How do we know that MACRA is not going to turn out to be another Bloomberg Big Gulp type of model?  There’s no proof of concept, no pilot, it’s just a matter of tossing a bunch of quantitated madness out there that they “think” will be able to create value in healthcare.  At this point with all the complexities of this 962 page model of mathematical complexities I think it’s a good idea to read the <a href="http://geekdoctor.blogspot.com/2016/05/a-deep-dive-on-macra-nprm.html">post from Dr. Halamka, CIO of Harvard Medical,</a> who for years sat on the committee to help guide the ONC and HHS on their models…basically it’s a monster that provokes one to think about leaving the practice of medicine.  He’s smarter than anyone in government who’s responsible for creating this model of madness that has no proof of concept what so ever. <p><strong>Again as I mentioned early, you can’t put a new model on top of a broken model that’s already failing and hope to have a good fix,</strong> it just won’t work and you need a model that doctors can work with and not a ton of quantitated madness for things that just maybe not be true.  When it comes to models, I think we all know or should know by now that United Healthcare has been the mentor in place at HHS for a long time and there’s tons of documentation all over the web that substantiates this.  I still think about the New York Times article from 2009 when Senator Rockefeller asked both Slavitt and the CEO, Hemsley of United “how do you folks sleep at night”, link to the post below.   <h5><a href="http://ducknetweb.blogspot.com/2009/04/is-this-case-for-new-law-illegal.html">Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care</a></h5> <p>Here’s another comment from a doctor on the entire MACRA process…and I’ll close with this.  BD  <p><i>“When Blumenthal was at ONC , he understood doctors needed to see patients, and the EHR was one of many tools to help doctors care for patients. Farzad got us off track with insane busy work in stage 2, on now we are completely off the rails.”</i>

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

I’ve been watching this for years with the way healthcare is changing in the US today and we certainly need and do use constructive and good...

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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...

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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 Vi...

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Walgreens Signs Agreement With PBM OptumRX (United Heatlhcare) and Anthem Then Sues Express Scripts

<p>The long and short of the OptumRX agreement is  to allow patients to be able to pick up and fill a prescription in a retail store versus mail order.  That in inself tells me that there’s folks who don’t care for mail order services?  In addition, Walgreens will be able to pick up<img align="right" src="http://lh3.googleusercontent.com/-U0fHNHM3Vvo/VYjYc7peUgI/AAAAAAABMZI/N5v7HrnJd2c/image%25255B3%25255D.png?imgmax=800" style="float: right; display: inline"> more data to sell as well.  OptumRX does it’s share of prescription data selling as well.  We might see other types of arrangements surface as remember there are two Hedge Fund executives sitting on the board at Walgreens.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/09/two-hedge-fund-executives-gain-board.html">Two Hedge Fund Executives Gain Board Seat Walgreens, Stock Buy Backs To Continue And Increase, As Well Cost Cutting With Products And Maybe Employees</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2013/10/walgreens-cashing-in-big-in-data.html">Walgreens Cashing in Big In the Data Selling Epidemic Arena–Incentives Connected to Apps and Devices That Sell, Re-Query and Re-Sell Our Data And Data Profiles</a></h5> <p>Walgreens and United Healthcare have also ventured together on other projects, as in some areas pharmacists gain some P4P money with getting a customer to sign up for the YMCA.  I think there are some matching funds from CDC that come into play here too.  A short while back a pharmacist told me that they were told to only sign up patients with United Healthcare with the YMCA and that would make sense based on this agreement at the link below. <h5><a href="http://ducknetweb.blogspot.com/2011/08/unitedhealth-ymca-expand-diabetes.html">UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P forWalgreens</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2010/04/unitedhealthcare-to-use-data-mining.html">UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreensand the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools</a></h5> <p>Moving forward Anthem who’s suing Express Scripts wants a judgment that it could terminate its deal with Express Scripts, which goes to 2019, but the Anthem is not sure it would officially end the contract?  Below is where Walgreens was charged wtih over charging customers.  They all want one thing, money.  A couple years ago United and Anthem had a pretty big dispute going and Walgreens is at a disadvantage in the fact that they don’t own a pharmacy benefit manager so are they too going to put more United Healthcare eggs in the basket with OptumRX? <h5><a href="http://ducknetweb.blogspot.com/2013/08/walgreens-accused-of-overcharging.html">Walgreens Accused of Overcharging Customers-Algorithms-Drug Stores Have to Pay Penalties on Their Issues, Why Does Wall Street Skate When Their Killer Algorithms Attack?</a></h5> <p>If you have watched the news of late, then you may have noticed that United/Optum RX has figured out there’s big money in distributing drugs and pharmacy benefit managers of course make money with so called kick backs from the drug companies and their distributors.  You may not always get the lowest price but rather the drug that pays the PBM the best.  Here’s where OptumRX is now in the workman’s comp pharmacy benefit management business with this acquisition of a couple months ago.  Pay attention folks as the bigger conglomerates keep getting bigger and bigger and the more say they have, the less say we have. <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>You can see here where OptumRX has already hurt some of the business in Florida with a big move to take some of their business. </p> <h5><a href="http://ducknetweb.blogspot.com/2014/05/express-scripts-to-lay-off-400-people.html">Express Scripts To Lay Off 400 People Tampa As United Healthcare Moves Patients To Their Own Pharmacy Benefit Management Company-Subsidiary Watch</a></h5> <p>By the way, look at how Express Scripts “scores” you with predictive behavior algorithms with 300 metrics that mostly have nothing to do with taking prescriptions.  They all do this and I just happend to cover the Express Scripts portion as they brag about it on their website for anyone to see. <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>It was back in 2010 that Express Scripts started running medication adherence predictions with the use of<img align="right" border="0" src="http://lh3.googleusercontent.com/-WTU_WavuGLg/VYjYaFce1MI/AAAAAAABMZA/DCNNtafnZm8/image%25255B8%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px"> Ingenix (United Healthcare) algorithms, so the scoring algorithms get intertwined all over the place for the sake of making money selling “scores” about all of us and with flawed data to boot.  The archived post on that one is below.  <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>Now with Walgreens working to buy Rite-Aid, they too are using the EQIPP Platform to “score” and take in a bunch of data on predictions.  The only problem with this program is that it searches out all kinds of financial data to check on you to find a credit card, or some other transaction to see if you filled a prescription, when, and a lot more.  Below are a couple links that goes into detail on why you should pay cash for prescriptions if you want to preserve “some” of your privacy. <h5><a href="http://ducknetweb.blogspot.com/2015/12/rite-aid-pharmacies-are-latest-to-begin.html">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…</a></h5> <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>Are you starting to see a pattern here, maybe?  If you don’t better dig in a look again as this is all about making money distributing drugs and not so much on saving costs as it’s always billed.  Why else would Anthem be suing Express Scripts?  In addition you also have FICO doing medication prediction scoress, so easy they say to do with mining data about you is all they need is your name and address and they can score anyone on with what they also call medication adherence scores…la te dah…tons more data about you to sell along with these “scores”. <h5><a href="http://ducknetweb.blogspot.com/2014/06/fico-medication-adherence-scoring.html">FICO Medication Adherence Scoring Should Be Banned As It’s Quantitated Justifications for Profit That Hurts US Consumers Using Proprietary Algorithms That Cannot Be Replicated For Accuracy or Audited</a></h5> <p>Also as a side note, be aware that your voice is being scored for your behavior at the insurance call centers, most of them have these algos to score you and yes these behavior scores get sold too! </p> <h5><a href="http://ducknetweb.blogspot.com/2014/05/this-call-may-be-recorded-for-quality.html">“This Call May Be Recorded for Quality Purposes”..Heck Not, Millions of Algorithms Have Been Turned Loose to Listen To and Analyze Your Voice When You Talk To Your Insurance Company As Algorithms Continue To Take Over the World…</a></h5> <p>So out of this deal with OptumRX, as a patient you get convenience of going to a Walgreens store and both Walgreens and OptumRX benefit on getting more data and scores to sell about you, and those scores are top secret, just try and ask a pharmacist for your medication prediction adherence score sometimes?  BD <p> <hr> Unlike CVS, Walgreens doesn’t operate its own drug-benefits business. The deal with OptumRx will probably draw more customers into Walgreens stores, along with boosting drug sales, according to Ann Hynes, an analyst at Mizuho Securities. Express Scripts probably has the most to lose during the employer-benefits selling season, which begins next month, according to Hynes. The company has a similar arrangement with Walgreens, but still tends to push customers to get their drugs by mail. <p>UnitedHealth’s partnership with Walgreens starts on Jan. 1. Some members with drug coverage from OptumRx may lose the option of filling their prescriptions at pharmacies other than Walgreens under the deal, though that’s up to the employer or other entity that’s making the benefits decision. The deal will also give Walgreens pharmacists more access to information that will help them counsel patients who are on multiple drugs, aren’t getting refills or taking pills that shouldn’t be taken together, said Mark Thierer, chief executive officer of OptumRx.</p> <p><a href="http://www.bloomberg.com/news/articles/2016-03-17/unitedhealth-takes-on-cvs-express-scripts-with-walgreens-deal" title="http://www.bloomberg.com/news/articles/2016-03-17/unitedhealth-takes-on-cvs-express-scripts-with-walgreens-deal">http://www.bloomberg.com/news/articles/2016-03-17/unitedhealth-takes-on-cvs-express-scripts-with-walgreens-deal</a></p>

Walgreens Signs Agreement With PBM OptumRX (United Heatlhcare) and Anthem Then Sues Express Scripts

The long and short of the OptumRX agreement is  to allow patients to be able to pick up and fill a prescription in a retail store versus mai...

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