It appears this is another solution for physicians to look at cost as it is business intelligence.  Although the AMA had this to say on the topic:image

“Cohen also warns against paying for data from a source that isn't entirely transparent. Like many smaller health plans, some physician practices relied on data from the UnitedHealth Group subsidiary Ingenix.

Physicians paid Ingenix for the same data as a way to benchmark their own fee schedules. Unfortunately, as New York Attorney General Andrew Cuomo's office found in its investigation, the fees in the Ingenix database tended to be lower than the true "usual and customary" charges. Cuomo alleged that the insurers used a "closed loop" system to shortchange out-of-network physicians, feeding skewed charge data into the database to undercut what the same companies would turn around and cite as the basis for payments to out-of-network doctors.”

Would you trust them?  They are a subsidiary of United Healthcare and the related comments below contain some history on the data base that was determined to be not accurate and led to many issues with both physicians and patients as far as cost.  The lawsuits are still continuing with other states joining in.  As the AMA stated, there may be a lack of true transparency here.  Patients received balance billings and doctors were short changed on the fees. 

UnitedHealth Executive testified at the Senate – Rockefeller was not very satisfied

The Ingenix Inquisition – Hearing Requested by Senator Rockefeller

From the Senate hearings the reports are not all back yet.  Sutter signed a 5 year contract.  BD 

EDEN PRAIRIE, Minn., April 30, 2009 Ingenix, a leader in health information solutions, today announced that Sutter Connect, a Sutter Health affiliate and health care management and administrative services company, has signed a five-year contract for Ingenix Impact Intelligence™ and services from Ingenix Consulting. Through the agreement, Sutter Connect will offer physicians in the Sutter Medical Network access to performance metrics and services they can use to measure and improve medical care and delivery.

By selecting Ingenix, Sutter Connect will implement solutions and services that enable its physicians to:

  • Measure health care delivery against best practices and evidence-based medicine to understand key drivers of efficiency and effectiveness and to recognize high performance
  • Assess care delivery resources using a comprehensive, clinically-based approach to identify unique medical conditions for a patient and grouping all related services into episodes of care
  • Facilitate strategic planning efforts by identifying “total costs” and “total utilization” for different types of services (e.g., inpatient, outpatient, pharmacy, lab, radiology)
  • Improve quality of care by identifying high-risk patients and initiating condition management (including disease management) efforts accordingly
  • Identify disease categories that require additional management efforts

Ingenix and Sutter Connect Collaborate to Implement Performance and Quality Measures


Related Reading:

Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care
Texas Joining the Ingenix Inquisition with Introducing Bill for New Penal Codes – Fraud Against Practitioners
Doctors fight balance-billing ban on out-of-network costs to survive
Texas Joining the Ingenix Inquisition with Introducing Bill for New Penal Codes – Fraud Against Practitioners
The AMA and the California Medical Association file legal suit – WellPoint and Ingenix
The search for John Doe – Who’s running the queries (Algorithms) and wants to know
The Ingenix Inquisition – Hearing Requested by Senator Rockefeller
Andrew Cuomo – You Have to Like This Guy – Healthcare Reform
Prescriptions risk score used to deny health insurance

Consolidation in Health Insurance Carriers – Who will be the king of risk management?


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