Ingenix started selling its diabetes-prediction service in February to insurers and imageemployers, one more way they make money.  I would think information this vital and helps with compliance could be open source or at least free so further analysis studies could be made.  This is part of the profit area of United Health Group.

Express Scripts appears to have some new information they may have paid for through out this process and now wants an ROI.  If the patients are not refilling their prescriptions, it has an effect on the income of pharmacy benefit managers so they are on the case here to call patients and they think patients will like this…maybe…and maybe not.  Here’s a good post with information from my 87 year old mother who was not part of Express Scripts but had something similar from Walgreens to where the pharmacists told her she should be taking her glucose 3 times a day instead of 2. 

This became an issue for Mom, a 15 year diabetic who knows the routine as the reality of all of this was the fact that she was using fewer strips and Mom just didn’t want them to expire.  The call didn’t do much for her as her Medicare Part D carrier said twice a day was fine…so what gives this better care or marketing for sales?  This is a good read of a real marketing phone call and situation so proof of concept may need some more work. 

Compliance Police Out In Force for Seniors–Health Plans and Drug Stores Making Phone Calls-Business Models & Caller Behavior Sucks -A Result of Pay for Performance Efforts?

You may also want to be aware of the fact that United Healthcare pays Walgreen pharmacists pay for performance money for those who get patients to sign up for various programs using Ingenix data, so here you go with Ingenix making a sale on predictive data to Express Scripts. 

UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools

Express Scripts is closing its dispensing pharmacy in Bensalem, Pa., in December and will be laying off 500 employees, so again the question, do they need money and thus the push for compliance?  In the second quarter this year they spent $410,000 on lobbying.

The company also said they were moving some fulfillment locations where they have non union employees, and I would guess this is a money and benefits situation here at hand and much of their call center activity is said to be moving to the Philippines so there could be more than 500 laid off in time.  I don’t know if they received a tax break or not but if so, this would not be a warm welcome. 

Pharmacy benefit managers are the holders of a lot of medication data and this is probably why we had the lawsuit initiated in Texas against CVS.  Express Scripts competes with CVS Caremark pharmacy benefit manager.  We have not heard the particulars on how CVS plans to work with compliance and is under investigation in 20 states by the Federal Trade Commission. 

Texas Pharmacies Files Lawsuit Against CVS–Privacy Misuse Cited With Patient Information Relating to Marketing Via RX Review Plan

You can read more about Ingenix MedPoint here.There’s also a flash presentation where you can view the process here.


“By increasing understanding of potential disease conditions and relative risk, MedPoint enables underwriters to more accurately project future claims costs on a case-by-case basis.”

There was a law on the books at the Senate and I have not heard the outcome but it seems to be lacking some teeth with regulating patient data as the do not fall under the auspice of HIPAA.  As you can see from the headline they could be required to watch their marketing, but nothing about buying and selling us so companies like Ingenix and Milleman keep profiting from selling our information.

Data Mining Marketing Amendment on Senate Health Bill – So Our Medication Records Can Still Be Sold Just not Marketed, Huh?

You know it seems to be that compliance for profit is pretty sick and when consumers find out that it’s all about money with compliance, well that takes away from the education process and attraction for better health.  Speaking of algorithms and their use, Ingenix recently had another lawsuit filed for underpayments on outpatient surgery centers, similar to the one the AMA settled for 15 years of short payments to doctors and patients.

Outpatient Surgery Centers File Class Action Lawsuit Against UnitedHealth and Ingenix for Underpayments

Pharmacy companies are in possession of a lot more data these days too and we are seeing some partnerships in marketing that we have not seen before.  One thing to keep in mind too is all the mergers and acquisitions we are seeing today and this means sharing and analyzing data together as one company could be violating laws or rules with certain activities but another subsidiary in a related business could without violating laws. BD

Pharmacy-benefit manager Express Scripts Inc. is unveiling a new program that aims to contact people who fail to take their prescription drugs—before they actually stop.

The company Monday will announce an initiative intended to predict in advance who's most likely to discontinue a medication regimen, and keep those people on their drugs with interventions such as letters or phone calls. This is an effort to encourage compliance and offer help such as mail-order prescriptions.

It's one of a growing number of efforts to forecast and prevent costly health problems. New initiatives from UnitedHealth Group Inc.'s Ingenix unit and WellPoint Inc. seek to pinpoint those expected to develop medical conditions such as diabetes. CVS Caremark Corp., the big drug store and pharmacy-benefit management company, has researched how to predict drug compliance, and next year plans to start using the results to target certain customers with strategies to encourage adherence.

The predictive initiatives are one part of a far broader category of programs by insurers and pharmacy-benefit managers, or PBMs, that delve into enrollees' medical information to identify gaps in existing care, such as recommended medical tests that aren't being performed. The companies then typically inform patients and their doctors.

Adding Predictability to Benefits -


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