First of all let me clarify where I am coming from with a short bit of background as to where some of my viewpoints come from.  I spent 25 years in marketing and sales and then learned to code and wrote medical software, so I am a bit of hybrid here who first of all analyzes how software will be used, and then that hat off and look at aspect #2-the marketing and sales efforts.  To be truthful, it makes my brain hurt at times but further resolves the fact that we need and should value the advice of good healthcare CIOs today that can see the bottom line and get past the marketing phase of all of this. Unfortunately marketing and profits sometimes seem to trump these efforts as everyone is a marketer today.  image

If you are speaking to a marketer/sales individual, you are trying to evaluate the value of a software purchase and it is easy to get mislead in this area as the software sold today is good for the most part and will do exactly what it says it will do.  As  a consumer you can see some visuals and pretty much for the most part see that, yes, it’ will work and produce results, but the secondary question that comes to mind, is what is the value and cost of such services. Do you really need it and will investment show savings and ROI.  If you are not involved in healthcare IT today and are trying to make those decisions on your own, big mistake as you may be missing one big piece of the puzzle. 

The healthcare transaction business feeds upon itself to a large degree and yes we need those services but to what level and cost?  You may have one medical claim with several 3rd party vendors taking a chunk of the money, it has been designed in part to function this way as all those “chunks” add up to profits and shareholder dividends.  image

Anti-fraud efforts also with their algorithmic formulas actually deny good claims too as the queries run and “compartmentize” the results for an end result decision that you run to your computer screen to see.  Health insurance companies also create 3rd party subsidiaries to perform these functions too and they make money.  You can look at UnitedHealthGroup for one example and all the products from their data base management company Ingenix  for one example – subsidiary watch here.  Sometimes those algorithms have problem too as we are seeing with the AMA lawsuit with the efforts of NY Attorney General Andrew Cuomo finding them.  To further identify the investments here United has made 5 similar purchases so far this year. 

Ingenix (Subsidiary of UnitedHealthGroup) Buys Picis Hospital Software Analytics Company – Algorithms of Healthcare Continue To Grow

With mergers and acquisitions out there today on fire, it’s hard to keep up with who owns who and who’s data base is going to integrate with who’s.  The rules and laws of Medical Cost Ratios just had a big gray could emerge overhead.

HHS National Plan to Improve Health Literacy – Not Going To Happen Until We Focus on Using Technology (The Tool for Literacy) Which Includes Role Models at HHS And Other Places in Government

We do not certify these functions as we do with the creation of medical record software and thus we have this roller coaster of a ride taking place.  Maybe we should fully entertain this process? 

Venture Capital Investments Continue in Over Crowded Healthcare Transaction Software Companies – the Ones you Don’t See That Drive Up the Cost of What We Pay – Those Algorithms

This article mentions how critical these services are and I do agree we need a certain level of anti fraud software and services, but when do we cross the line with these algorithms for profit? I believe this is the area where Mr. Gingrich is confused as he’s like everyone else in looking at the face value of seeing the software producing results, but are we getting our money’s worth, and further more are we getting “accurate” or “desired” results, stop and give that some thought.  Profits are linked with the word desired.  Accurate is linked with transparency.  Our government is looking at the situation with our US CIO doing an extensive evaluation to ensure taxpayer money is not over spent in the same scenarios. 

VA Cans $500 Million Financial System Overhaul – Financial Transactions - The Business That Keeps Feeding Itself

Thus in his defense in here I would say we are perhaps lacking in the full on comprehension of how the system works.  We have a glut of competition in this area and they all want to “market” value to you and the hard part is determining where that value is and do you need it, and how much are you currently using.

It is already a proven fact that technology alone can’t enforce anti fraud efforts alone, you still need to have human interactions and investigations as they may look wonderful with data transactions, but when you pay a physical visit, you get a whole new picture.  Again we have no shortage of anti fraud software out there and it is a cost of doing business, other industries have it and it takes a chunk of the revenue from a claim and does add to profits of publicly traded companies, why do you think all the investors are jumping on this bandwagon

Ask TJ Maxx about anti fraud efforts for an example in another industry.  Technology is a cost of doing business anywhere today and to say this is part of providing medical care to me doesn’t fit.  It’s a profit machine to a degree with algorithms constructed to do so and it’s up to the end buyer to figure out which is effective and not producing over exaggerated profits, it’s a balance.

I question at time how much IT knowledge is being used from valuable CIOs who know what this is all about.  When I read articles about members of Congress not using a password to lock down their own personal networks at home, well, where do these statements have their base?  This is stuff that is all over the news today and I didn't have to go very far to find it as it’s on Twitter and in my RSS feeds every day.   image

So what gives here?  Is this article factual or political?  We all that same question a lot today as technology throws us a new left curve every day and those who are “participants” see it and to go further with that is stresses some of us out too.  If you don’t acknowledge the existence of Health IT, I don’t know, does one not have these same concerns? 

In my little tiny opinion, I think that perhaps the expertise of a Healthcare IT expert would be very beneficial to have as an ally before we see more articles of such talking about “value” today as again “it is all about those algorithms” and you can ask any broker on Wall Street too how they use “those algos” and they all have at least one “algo man” that sits on their boards too.  it’s part of every day business with investors and it’s part of healthcare today as Health IT is reshaping everything around us every day. 

Google wouldn’t exist today were it not for their algorithms and they build really good ones too that we all depend upon every day for valued information and some of their algorithms are healthcare related, so once we can get past the political arena here and see where the decision making processes are coming from rather than just an over all political statement, maybe we can get somewhere. 

One more small comment on my part here too, I would like to see the term “circuit breaker” on Wall Street renamed to possibly indicate that this is an algorithm of code that runs to as it would help for consumer education purposes as most think of a piece of hardware on their house that stops electricity and this is not the case as it’s an algorithm and mathematical process.  BD 

What would you think if bureaucrats confiscated your iPhone because they decided it didn't provide enough value? State regulators may help the federal government do just that to the health-care benefits of millions of Americans.

The most important element in implementing ObamaCare will be the requirement for health insurers to meet what is called a medical loss ratio. This requires health-insurance plans to split the dollars they receive from insurance premiums into two buckets.

Another example is fraud prevention. According to the National Health Care Anti-Fraud Association, up to 10% of all health-care spending is stolen by criminals preying on the system, from kickback payments and billing for services never provided, to medical identity theft and phantom medical equipment providers. Some crimes harm patient safety by exposing patients to drugs and treatments they don't need or, in the case of medical identity theft, creating inaccurate health records that could result in improper treatment during emergencies.

Newt Gingrich and David Merritt: Who Decides on Health Care Value? -


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