Aetna was named as one of the highest increases taking place with the number being 92% so how many that involves, it does not say.  When the federal law was passed it was not anticipated that insurers would be using sophisticated algorithmic formulas to query and score so extensively to keep profits high but if nothing is done, it will continue, they work the numbers.  What makes it a bit more complicated here is that we have two governing agencies, the insurance commissioner and the Department of Managed care.  What a nice 4th of July wish. 

Blue Cross Rate Increases Spread Between 2 Regulatory Agencies in California-Consumer Watchdog Calls on Governor to Merge Insurance Commissioner & Managed Care Office As HMO Side Rates Go up 16%

I say this all the time, get in to the math and technology as that’s how all of this is calculated and as a patient you are given a risk assessment score and some of these methodologies are far from being a correct match.  Here’s one example where one of the third party analytics company tweaked those algos a little to much so when a claim is denied, this is what you are battling, insurance company algorithmic formulas and they are not always right and get used for hard core decisions instead of intelligent guidance. 

Med Solutions and Blue Cross Caught On the Stress Test Denial Algorithm (video)

One example is using your credit scores to assess your behavior to give a number of whether or not you will take your medications'.  FICO is one agency that is selling this analytic services to insurers and pharmacy companies.  I declare it a mis match as you can skew data just about any way you want today and the other side that monitors is bringing a dull knife to gun battles without hi technology to verify. 

FICO Credit Score Company Develops New Medication Adherence Scoring Program–Risk Management Assessment Algorithms Created to Derive Profits For Corporations–Fail!

If you think you are being fleeced by some of the current day analytics, you are correct, you are and if you have not come to that conclusion do some reading as there’s a lot of it just on this site that will explain how the formulas are used and sometimes abused.  Read these two books for starters if you want to get a better understanding of how analytic are used today. 

Wendell Potter Tell All Book–Deadly Spin–One to Put On My List as “He Knows Algorithms and How they Create Profits”
“Proofiness–The Dark Side of Mathematical Deception”–Created by Those Algorithms–New Book Coming Out Soon

When it comes to the math with medical records a lot of effort and certification efforts have been put into place for safety and so forth, but we leave out the other side and certify medical record algorithms but the insurers run hog wild and very few question their algorithms and thus so we should certify them as well.  Ms. Sebelius doesn’t have a strong Health IT background in this specific area and thus I think they have to rely on so many outside companies to help them verify what in the world the carriers are doing.  They are just changing and adjusting those algorithms for profit and there’s a dark side. 

HHS Issues Final Rule for Health Insurers To Justify Increases–Need to Certify Insurance Algorithms For Calculation Just Like We Certify Electronic Record Algorithms

We certify software from medical record vendors, so why do we not certify that he algorithms run by insurers and their agents are also performing correctly?  Medical Loss Ratios, they get beat with the algorithms for business model profits and even those who sell health insurance are taking it in the shorts with compensation too.  Some are leaving the business while others cut back on services they used to do for free, so some of the hands that feed health insurers are getting cut too. 

Medical Loss Ratios Showing Devastating Effects With Health Insurance Agents and Consumers 

One of the absolute lowest blows here though is trying to create games online that get you to play and supposedly learn about living a healthier life and all Aetna and Humana here are doing is tying you down to a computer for even a longer amount of time and scraping some data to sell while they are at it.  To me this was absolutely one of the lowest blows to insult consumer intelligence.  They have money for grants for this absurdity and I would rather see claims paid as this will do little and probably won’t draw much of a crowd anyway. So when your premiums go up, remember they want your data and want you sit around and play games like those on Facebook.

Aetna To Offer Online Game Social Game For Personal Wellness- Joins Humana As They Have An Online Game Called FamScape

Consumers are smart enough to know that good health and eating habits are not a game, it’s real life so don’t be suckered in, it’s all in the math for profit.   Again as mentioned analytics will and are abused to get you to buy in with some of the marketing you see out there today too so do your best to make sure that you are getting some real analytic information and not being given numbers like referenced in the FICO story above, as credit agencies make money selling your data, so their rationalization of their data using credit scores is a mis match and put out there to market to see how many will sucker and buy it, plain and simple on their scoring. 

High Frequency Electronic Trading Methodologies And Algorithms Work Their Way Into Healthcare With Human Bodies Losing Liquidity With the “Data Game”

Coming back around here if you have not figured out it’s all about those algorithms read around the Quack and do some searches as there’s a lot more from where this came from.  I used to write all kinds of queries for analytics and you are not always getting the straight story with some of the “marketing analytics” being sold today.  Here in California one carrier was even going to have to refund some money to consumers as they charged too much. All Medicare claims are processed by contractors which are insurance companies so no big Medicare computer in Washington doing any of that work. 

Health Insurers Spending Millions to Update IT Infrastructure to Comply With Federal Laws–New Software, Algorithms and Other Health IT Systems To Provide Accurate Information

We need lawmakers who are digitally intelligent too otherwise this battle goes on and on with the wool pulled over their eyes too.  Congress could use some real algo men as well as other government entities to at least talk on the same algorithmic level as the insurers as they do have the most advanced IT infrastructures outside of the financial business and they use it.  BD 

More Congressional Testimonies About Health IT–Members of Congress Could Entertain Getting an “Algo Man” on Staff As Wall Street and Health Insurers Have Them–Don’t Leave Home Without One

If you read this far, what do you think about the math and use of computer formulas?  I’m just here explaining the process and what consumers need in order to not be fleeced with over worked and mismatched formulas when it happens.  Technology is not all bad and does great things but we have to be aware that just like a car can be used to drive to work it could also be used in robbery, so think about what the use of the algorithms are, just like the car.  BD 

Many plans are increasing their rates Friday, with no obligation to justify the increases. The latest rate hike by some of the state's largest health insurers affects 1.5 million Californians; mostly small business and individual policyholders.

The premium jump ranges from as small as 3 percent to a whopping 92 percent. For some customers, it's the third rate hike in less than a year.

"I have the authority right now to reject excessive rate hikes for auto insurance, homeowners insurance, property insurance, casualty insurance, but not health insurance," said California Insurance Commissioner Dave Jones

"I have the authority right now to reject excessive rate hikes for auto insurance, homeowners insurance, property insurance, casualty insurance, but not health insurance," said California Insurance Commissioner Dave Jones.

New bill to regulate California insurance hikes |


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