The data mining program was first announced back in April of 2010 with United and Walgreens and their partnership. I still feel there’s a lacking element here of the doctor in all of this. Certainly the goal is to bring about an awareness and help people get healthier, but again noting that pharmacists are offered pay for performance incentives is important, unless anything has changed since the original announcement.
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
“The prevention arm will use UnitedHealth claims data and other demographic information to flag people at risk of developing diabetes and invite them to a free, 16-session exercise and nutrition class at a local YMCA. They’ll have monthly follow-up after the class is over, and instructors will be paid bonuses if participants meet certain modest weight-loss goals.”
I’m not quite sure on how this all comes together but it sounds like a “make a buck save a buck” deal to me. Below are a couple recently filed lawsuits questioning the use of patient medication data for sale. Walgreens says this intangible business is worth over $749 million to them annually. All those neat gadgets also may have privacy issues you may want to check out too. The devices are pretty cool, but who’s getting the data and making a buck is something I want to know. It sounds like CDC is in approval of this process too, so United and others get to collect more data which again is used in all types of marketing, underwriting and more. LabCorp gets in here on some action too with providing a blood test and again the services are good, but the data brings money to the door of Untied at the same time. Can’t one just go to their doctor and get a test I ask? I don’t know but that’s who I trust.
Walgreens And CVS Accused of Selling Customer Prescription Data in 2 Separate Law Suits-Sales for Marketing Data Continues and the Data Bases Gets Larger with Technology
Under a separate press release you can read about the big kick off in New York for the YMCA, and again they seem to benefit some where in here too. How is the data analyzed, for better care or better profits as shareholders come first? I just connect the data dots here and try to explain how some of this occurs today with privacy and marketing, and there’s a lot of that going on behind the scenes in ways you may not be aware. With mergers and acquisitions, we are not dealing with the same old companies with the same old business models anymore.
My mother recently had her own experience as a senior with some of the marketing and sales efforts between her Part D carrier (which is not United) and Walgreens. One said checking her glucose twice a day was fine but the other, the drug store said no, you need to do that 3 times a day. She’s being checking her glucose for 20 years now and was told by the drug store it’s not often enough. It has to do with selling strips here, as 3 times a day will yield a bigger sale and thus so she is informed by the retail pharmacist that she’s doing it wrong, nice huh?
Both her doctor and health plan said twice a day is fine for her glucose readings. See what happens when the doctor gets left out!
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?
Maybe these are unintended circumstances, but hey they are happening so be aware of the driving business model just for your own good. With current business trends I would think that physicians would be brought into the groups since insurers seem to be buying up many of the IPAs (independent physician associations). Is it sorry doc your contract is getting cut to some lower rates as we have to ensure we have enough for P4P for the pharmacists?
OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch
Not too long ago some studies came out of Harvard that said pay for performance is not all it has cracked up to be too.
Pay For Performance Is Not All That It Has Cracked Up to Be-Time to Rethink As Money Is Not Creating Better Health Outcomes
"Governments and private insurers throughout the world are likely wasting many billions on policies that assume that all you have to do is pay doctors to improve quality of medical care," says senior author Stephen Soumerai, professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute. "Based on our study of almost 500,000 patients over seven years, that assumption is questionable at best."
At any rate the P4P drive continues to move forward and the algorithms for profit roll so whether or not CDC and Harvard agree, it will be interesting to see what other reports and studies surface as time moves on, as Harvard said it was wasting money paying doctors, so is this why the shift is going to pharmacists and others? Gotta get that valuable data that is worth millions for marketing and predictive behavior modeling business says <grin>. BD
Atlanta residents are among the first in the United States to have access to Diabetes Prevention and Control Alliance community-based programs that use proven approaches to help prevent and control diabetes.
The two Alliance programs – available at no cost to participants – are:
- The Diabetes Prevention Program with the Y helps people with prediabetes and who are at high risk for diabetes prevent the disease through healthy eating, increased physical activity and other lifestyle changes;
- The Diabetes Control Program with Walgreens provides education and support from trained pharmacists and nurse practitioners to help people with diabetes better control their condition and reduce the risk of developing complications from diabetes, such as nerve, kidney and eye disease.
The Diabetes Prevention and Control Alliance was launched in 2010 by founding partners UnitedHealth Group (NYSE: UNH), Walgreens (NYSE, NASDAQ: WAG), the Y and others.
There is substantial evidence that supports early and aggressive intervention to help people avoid the health and financial toll of diabetes. The programs at the Y and Walgreens have been tested in controlled clinical trials or pilot projects with the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Y, Indiana University, clinical centers, employers and retail pharmacies.
The Diabetes Prevention and Control Alliance is one of many UnitedHealth Group programs and services that fight diabetes, obesity and related health problems in creative, practical ways to help improve health care quality, expand support and coverage, and help bend the cost curve.
Home Healthcare Laboratory of America (HHLA), a subsidiary of Laboratory Corporation of America Holdings, another Alliance partner, provides screening tests to Control Program participants through the use of Lab-in-an-Envelope® services for use at home. HHLA mails HbA1c and lipid panel testing kits to participants every three months to provide a convenient method for them to regularly monitor blood glucose control and cholesterol levels.
Our teenage daughter just received a letter from UHC saying she had Diabetes! None of her healthcare providers have ever mentioned this!ReplyDelete
The United Healthcare letter has this at top:
"you have diabetes. You know it. And that means you can control it."
The letter then says Dear so and so, Our medical records indicate you may have diabetes, and that puts you in a perfect position to do something about it...".....Enroll in the Diabetes Control Program.
Can you imagine receiving a letter from your insurance company stating that you or a loved one has a disease that you have never worried about before?
Ironically, this will provoke me into getting my daughter a Doctor's appt and tested asap.
What a mean and inappropriate way to scare people. If there IS any evidence that my daughter has diabetes, why didn't UHC send us a personal note with the evidence? Why have none of the providers who have seen our daughter and that UHC reimbursed and paid never mentioned this to any of us? Never. Are they randomly sampling blood given for other tests? Our daughter had a Lyme disease test in March, not a glucose test.
It raises some serious questions, don't you think? How private is your blood? How safe is your insurance company regarding data mining and manipulation of unnecessary tests.
I hope our daughter doesn't have diabetes, but if God forbid she does, what a hell of a way to find out about it. If she's fine, then I have a lot more questions and comments about UHC sending us this letter.