Data breaches, Congressional meetings and testimonies over rate hikes, increased pressure from HHS and they are accredited for conducting imagebusiness in a manner consistent with national standards?  This kind of reminds me of the Martin Luther King hospital getting accredited and we all know what happened there so what does this really mean with agencies that do accrediting?   It means they can lever more policies and power regarding utilization and the article says it represents a status of excellence? 

Somebody needs to get realistic today with wording on press releases today.  Everyone I read today tells me how happy they are with announcements or decisions and they are all starting to sound the same. 

From the URAC Accreditation Website:

“Accreditation is a process by which an impartial organization (URAC) will review a company's operations to ensure that the company is conducting business in a manner consistent with national standards.”

I think one of the biggest outrages was the request from the carrier to ask doctors to “rat” on their patients.image

Docs Outraged across the US at Blue Cross Request

Here’s a few more past articles:

Anthem Blue Cross Security Breach Occurred During System Upgrade – Information Accessed by Attorneys Looking for Information Relative to Lawsuits With Carrier

Health Insurance Company Ran an “HIV” Algorithm To Cancel Consumer’s Policy –An Automatic Fraud Investigation Revealing “False Positives” Or “Unhealthy Patients”

HHS to California Blue Cross – Bring Your Algorithms to Washington And Explain

Class Action Lawsuit Filed Against Blue Cross Blue Shield in Florida – Out of Network Ingenix Algorithms

Risk Adjusted Cost Index – Blue Cross in Texas Agrees to not terminate physician contract for referring to physicians outside network

When questioned though we get something like this:

My Algorithm Didn’t Do That, Did It? Is There a “Department of Algorithms” in Our Future?

For own personal opinion, accreditation doesn’t seem to hold a lot of value today as we have seen those who were accredited both with insurers and hospitals exhibit many items that don’t seem to fit.  BD 

WOODLAND HILLS, Calif., July 27 /PRNewswire/ -- Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company announced today that they have been awarded full accreditation status for Health Utilization Management (HUM) standards from URAC, a Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry. URAC HUM Standards ensure that all types of organizations conducting utilization review follow a process that is clinically sound and respects patients' and providers' rights.

"Anthem's staff of nurses, physicians and other key associates are very proud of the recognition that this full accreditation status represents. URAC is a highly respected national leader in promoting health care quality through its accreditation and certification programs. It symbolizes a level of excellence for our organization and validates our commitment to quality and accountability, and reflects our overall strategy of delivering increased healthcare value to our members" expressed Julie Theodore, R.N., Regional Vice President, Medical Management Operations.

Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company... -- WOODLAND HILLS, Calif., July 27 /PRNewswire/ --


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