The big solution comes together with both government and private entities working together and the the insurance industry coming to terms that the big fat profits that have been attained for years are going to get smaller, fact of life.  This article worries so much about fraud, well that’s why we have business intelligence to fix and stop some of what has happened in the past, big challenge now is to get people educated and to use it.  It will get better. 

Business intelligence rules and science and the pharmaceutical business are already facing this return, so it’s going to move right along in to the next portion of healthcare, insurance.  Better business plans and knowledge, also known as business intelligence lead us to many answers and greed and big profits do not.  Part D was a failure as there were too many politics involved that created too many huge profits and healthcare was not the focus. 

Here’s a presentation from Mike Milken that basically outlines the same plan and might offer a little more information about some goals for reaching imagethe ultimate destination. 

Institute for Health Priorities – A Game Plan for Life from the Milken Institution

The National Institute of Health is already working in this direction, early stages, but working, so what’s up with the insurance business taking a hint and becoming part of team instead of an industry of that everyone fears and dislikes.  It is hard  as there’s so much information going around and earlier this year members of the Senate had not even seen a personal health record thus had no clue on how business intelligence works in health care and PHRs are a big part of it, so how would the full circle be able to come around with the full comprehension of a better insurance coverage plan for the citizens of the US.  Can’t have one without the other, so again time we get smart and get out intelligence together here for a full understanding of the entire situation.  Health insurance companies and Wall Street use business intelligence to the highest degree for all their decision making algorithms.  Those decisions affect life for you and me and whether or not we will get healthcare. 

The Gates Foundation gets it, paying money for Viacom to run educational ads, where normally a foundation has to wait until a form of media donates time, but they are paying for it.  This will help reach and educate those who read very little and spend so much time in front of the television.  Mr. Gates has also made a numerous presentations to Congress on the point of education as well, gets a round of applause and then everyone goes back to business as usual with little or no change. 

Gates Foundation and Viacom Team Up for “Get Schooled”

So eventually when the health insurance business comes to terms that profit levels are going to fall, and again they are still entitled to make money by all means, but not at the rate of what has been seen for the last few years, and realize that science and clinical evidence is coming together as well, the old time algorithms set strictly for profiteering will need to change.  It will involve coming to the table as a true partner to work with government as a whole without secret or untold agendas based solely for profit.  BD 

Congress is currently away on a two-week recess, but weighty work is occurring in its absence. Staff negotiators are trying to come to agreement on a budget framework for 2010 and beyond. Although this is happening behind closed doors, it appears likely that the budget deal will eventually include a government-run health-insurance option, or "public plan," to compete with private health insurance under the comprehensive health-care reform called for by President Barack Obama.

Some lawmakers support or oppose a government-run health-insurance option for purely ideological reasons. Others are open to it because they are pragmatic and -- laudably -- want to be persuaded by data and facts. These moderates have been much influenced by the supposed fact that a public plan such as Medicare is more efficient than commercial insurance. Advocates of the public option routinely ask, "Aren't Medicare's administrative costs a fraction of those of private insurers?"

But the comparison between public and private plans is a false comparison. Private insurance and public benefits are not the same business. For all its warts, private insurance tries to manage care. Medicare is mostly about paying the bills presented to it.

In fact, the total amount of Medicare fraud is unknown. The government does not measure or estimate fraud in its programs; instead, it measures payments made "in error." According to Medicare's own most recent data, payments made in error amount to over $10 billion annually. (Medicaid's payment errors in 2007 equaled a whopping $32.7 billion, according to a report by the Department of Health and Human Services.) Others have claimed Medicare's payments made in error are much higher. Even with the inclusion of the budget of the inspector general for the Department of Health and Human Services, Medicare spends less than one-fifth of 1% on antifraud measures -- a small fraction of what private plans invest in their efforts to build a network of honest providers.

Kerry Weems and Benjamin Sasse Say Fraud Is a Hidden Cost in Public Medical Plans -

Related Reading:

The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers
A.I.G. To Get 30 Billion more in Bail Out Money from the Government
Concerned over Wall Street CEO Pay – How About Health Insurance CEOs?

Will Greed lead to Meltdown of the Health System?

Health Insurers Pondering Some New Business Models
Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

Former US NIH Director Joins the Bill and Melinda Gates Foundation


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