Hospitals and Insurance Company Competing for Patients In Pittsburgh–Contracts In Question

In this case it’s Highmark and UPMC in the Pittsburg area.  It’s interesting to listen to the comments in the video and the “deals” are discussed here.  They bring up United Healthcare buying up physician’s groups and we have that big in the OC.  image

United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County


Health Insurance Contracts at the OC Corral–Lawsuits, an ACO and A Lot of Mixed Up and Confused Patients As Data Disruption and Patient Care Move Center Stage…


This is really getting tough for patients and again being here in the OC I am hearing a few issues and Blue Shield is suing the part of United that is part of the two big doctor groups.  It was just a couple months ago that Blue Cross and Highmark bought NaviNet which is used by several insurance companies so the insurers here have a joint effort.  Highmark also handles a lot of Medicare through contracts from CMS. 


Blue Cross/Blue Shield Insurers and Highmark Acquire NaviNet Transactional Portal And Medical Records Vendor–Subsidiary Watch


Blue Cross and Highmark back in 2009 tried to merge with each other which I believe was not allowed as they are both obviously different companies still.  I’m glad this is starting to get some national attention as again I see it here in the OC and it’s doing nothing for patients here either.  BD 

 

WSJ's Anna Mathews examines a battle being waged between Pittsburgh's UPMC hospital and insurer Highmark over patients and how consolidation in the health-care industry is spurring similar tensions.

 

http://online.wsj.com/video/a-supercomputer-to-rival-watson-from-jeopardy/C18EA6E2-E536-48E8-8A43-8774D80306A7.html

Orange County Oncology Doctor Who Couldn’t Stop Defrauding Medicare Will Get His License Back After He Serves Time & House Sold for Just Under $10 Million

This was the oncologist that couldn’t help himself and made millions and on top of this the government seems to have messed up with the auctioning of his big house.  The sale of his house was supposed to pay off damages and give the government some money back but the government liens were not filed against the Justices as individuals so the trustee says they will get zero.

The house by the way sold for just under $10 million so the defrauding business was good while it lasted and this was his second go around as he was slapped on the hands basically the firs time.  If there were big payments due on that house, no wonder he couldn’t help himself maybe?  BD

 

Orange County Oncologist Gets Sentenced to 18 months Prison – Diagnosed With “Co-Dependency”- Couldn’t Stop Fraudulently Billing Medicare

A technical glitch overlooked by federal prosecutors may impede the U.S. government from collecting nearly $7.6 million owed by an Orange County physician convicted of Medicare fraud.

The sale of Dr. Glen Justice’s beachfront Corona del Mar house was supposed to pay off damages and restitution he owes the government.

But a court-appointed trustee maintains that the government should get nothing from a sale now in the works because government liens were filed against the Justices as individuals and not against the trusts named on the deed.

Justice pleaded guilty in 2010 to five counts of fraud for billing the government and private insurers for expensive cancer drugs that were never given to patients.

http://lansner.ocregister.com/2012/03/23/did-feds-goof-in-convicted-doctor-case/160064/

The Wrath of Dr. Khan–ER Versus Medicine Video (Humor)

This is just too funny…only an ER doctor…and glad he has a sense of humor too.

 

Wrath of Dr. Khan

 

 

We certainly need a break now and then.  BD

BATS Stock Exchange IPO Rogue Algos–Attack of the Killer Algorithms Chapter 34–See How Other Killer Algorithms Occur in Every Day Life With Healthcare & Credit

If you haven’t figured this one out yet, it’s about computer code and “rogue” algorithms and this can happen at any time, any place and so forth.  Most all in tech know that even the best engineers cannot predict when and where but they do imagehappen and you can reflect back on the big Amazon cloud disruption that took place last year.  We don’t like it of course but it’s something we have to live with and the folks at BATS were smart in shutting it down immediately and not seeing a a self heal function would take place.  In addition, the circuit breaking “code” algorithms kicked in, which is a good thing.  Smart engineers made the right decisions at BATS and they will have to regroup and make their come back.

This is just one example on how we as consumers are all at the mercy of the Killer Algorithms at some point in time.  When you have servers running 24/7 making life impacting decisions about you that you can’t see, touch or talk to, it is frustrating for sure.  In healthcare, insurance companies live and die by their algorithms which analyze information and categorize almost everything about us. 

The big problem today is “flawed data” gets in there either by accident or by human error, or by a rogue algorithm.  Below is a digest of links and a great video that debunks a lot of the reports and methodologies used at times and how some of the marketing for profits created “designed” algorithms that specifically move money and you don’t even see it. Context is everything today and when we roll in some big data and we have some flaws in the integrity of what gets rolled in, then sometime we can’t see the bottom or the top.  Ever wonder why it takes so long to get errors fixed?  Some folks don’t update frequently enough too.  You just never know when the algos are going to bite. 

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 3-11-2012

This also looks like a good spot to repeat the TED video from Kevin Slavin who talks about how algorithms shape our world.  If you have not seen this video, take a look now at this mini crash and see how Nanex and other companies study these rogue algorithms to find out how the machines with no input do a lot of this.  It’s machine talking to machine and again when human is in there with potential flaws, time to pay a little attention here.

“It’s a bright future if you are an algorithm” but we can’t say the same for humans right now.

This is a good time for me to repeat a link to a post I made 2 years ago and I think we are almost here in needing a Department of Algorithms or something like it very soon.  Business trumps government every time when it comes to algos for profit sadly.  BD

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?
How Algorithms Shape the World

Not only has BATS CEO Joe Ratterman released a letter to investors and clients, when you visit the Lenexa, Kansas firm's web page, you have the option of downloading a PDF explaining what caused the meltdown. If this self-inflected wound weren't damaging enough, the BATS meltdown also drove down Apple's stock price an estimated 9 percent with it before the circuit breakers kicked in.

The BATS IPO auction system glitch played a role in an issue resulting in the halting of Apple Inc.'s stock for five minutes. Three erroneous prints occurred that triggered a single stock circuit breaker for the AAPL ticker. Normal trading in AAPL resumed after the five minute trading pause and the three erroneous trades were later broken.

While it was unfortunate that our issues impacted another security, the industry's single stock circuit breaker system worked as planned and proved that recent improvements in U.S. equity market structure are working as intended.

http://www.advancedtrading.com/blogs/232700223?cid=twt_AT

Discussion on Supreme Court Hearing on Healthcare Reform–How Will This Play Out With Current Day Algorithms of Commerce And Unintended Consequences-Video

Do we think that they are immune from politics is one of the questions discussed here.  Granted there are changes to be made and amendments but to throw out Healthcare revision totally is not wise. When you stop and think of all the unintended consequences that will arise, it’s scary.  Again I go back to reviewing how it will play out with IT infrastructure as that’s what’s running the country anyway once it is put in place. 

You do have to admit as complicated as things are today you have to do your best to look at each portion and what changes would take place.  The business and banking areas are prepared as they always are to adjust their algorithms to maintain profit levels and THEY WILL RUN THEIR ANALYTICS and probably already have done some work in this area with projecting several different outcomes so they can move quickly in whatever direction they need.  It is what it is today with intelligence and formulas.  One health insurance company United recently hired the former US Assistant Attorney General from Minneapolis as a general counsel so that somewhat signals an area of preparedness on the part of big business here. 

Supreme Court Likely to Rule on Healthcare Law Early Next Year–This Gives The Justices Time to Rent Some Computing Space from the DOE As They Will Need It

With other attempted rulings we have had judges with potential conflicts of interest arise and this was mainly due to the fact that there seemed to be a huge neglect of mergers and acquisitions within the industry, which is pretty much still ignored to a degree and not discussed enough. 

3 Judges in Health-Care Lawsuits Caught Up In Potential Conflict of Interest-It’s Called Subsidiary Watch-Be Aware of Your Investments With Mergers and Acquisitions

Last year too I did raise the question of any judge being capable of a decision as it’s not easy and how will the language be interpreted.  Once the text goes into place, next stop is the IT infrastructure and I know many don’t like to hear this or talk about it much but again it’s the reality of world we live in today. 

Healthcare Reform Law– Is Any Judge Fully Capable of A Decision on a Law That is Challenged By Constantly Changing Algorithms?

If the ruling is not modeled correctly with looking at how each part would change and affect consumers and those in the industry, we are in for a huge roller coaster ride and perhaps more of a return to the Wild West.

The Good and the Killer Algorithms will move forward based on rulings and decisions made so again I hope the court is cognizant of this fact in what ever they choose. 

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 3-11-2012

How many laws come to think of it are “unworkable” today?  Intellectual arguments can be made but the ultimate answer here I think is to embrace a single pay system as the bandaids are not working and again economic times have changed since the law was put in place, so to strike it down completely would also be foolish at this point.  We don’t live in times any longer where laws last forever as passed.  BD 

Does Congress have the power to mandate that everyone in the U.S. have health insurance? The Manhattan Institute's Avik Roy and Columbia University's Gillian Metzger discuss the Supreme Court's hearing of the case with WSJ Legal reporter Ashby Jones.

http://online.wsj.com/video/the-constitutionality-of-health-insurance-mandate/5714E905-AFB2-4F72-91DB-51F40A352358.html

US Chamber of Commerce Working on Full Scale Mission With Seeking Life Sciences Opportunities in Israel

You can see some of the major companies included in this area and when you think imageof it a lot of the Intel technologies for chips has come from Israel for a long time; however in this instance the focus is Life Sciences.  Biotech conventions in Israel are also very hot and I do website that features interviews with many of the CEOs of Israeli companies and you can view a collection here.  

Another example is the Mayor of Akron who attended the ILSI BioMed Conference last year, getting educated and seeing what biotech interests he could bring back to hospitals in his city.  BD 

video platformvideo managementvideo solutionsvideo player

The U.S. Chamber of Commerce on Sunday embarked on its first full-scale mission to Israel, with the focus on the nation’s burgeoning life-sciences sector.

The U.S. Israel Business Initiative, a special section of the U.S. Chamber of Commerce launched in 2010, is meeting with key Israeli business and political leaders. A dozen high-ranking executives from major U.S. companies, including General Electric [GE 19.78  -0.07 (-0.35%) ], Boston Scientific [BSX 5.97  -0.03 (-0.5%) ], Oracle [ORCL 28.55  -0.08 (-0.28%) ], Merck [MRK 38.005  0.41 (+1.09%) ], and MedImmune, are on the tour. Myron Brilliant, senior vice president of the Chamber of Commerce’s international division, is leading the delegation.

One of the main goals of the trip is to facilitate investment and cooperation between American companies and Israeli leaders in life-sciences industry, including companies that specialize in medical devices, bio-pharmaceutical firms, and genetic research. Over the next few days, executives on the Chamber's mission will meet with leaders in Israel’s life-sciences sector directly.

“There’s a real entrepreneurial spirit in Israel,” said Marc Perlman, global vice president, health care and life sciences, for Oracle. “It’s clear Prime Minister Netanyahu is very excited about Israeli innovation. When it comes to bringing investment into this country he gets it.”

http://www.cnbc.com/id/46850417

“Remote Area Medical–California” Begins Four Day Free Medical Clinic in Oakland–Volunteers Needed

Folks are traveling all the way from Napa to get care at the free medical clinic.  RAM does good work and thank goodness they are here and this is a reminder of the failing healthcare system in the US for sure.

The same problem exists in imageCalifornia as they have had at other free clinics and that is getting enough volunteers.  RAM was just in Sacramento and Oakland last year and has done a lot in California.  RAM has grown to have it’s own California branch so again what does that tell you about people needing medical care and having to go to the Coliseum to get it. 

Remote Area Medical Wraps Up Free Medical Care Clinic in Sacramento and Moves to Oakland For Another 4 Days of Free Care

For additional information you can visit the RAM California website to check on times and dates. Now notice one thing here again, we have a group that is dedicated to California which is part of the over all RAM group, so again the free clinics are growing as our healthcare system continues to fail.  When you watch the video they had to close early as they didn’t have enough volunteers.  BD

OAKLAND, Calif. (KGO) -- An amazing four-day program is underway in Oakland to provide free dental, medical, and vision care.

It is being offered by the Remote Area Medical Foundation (RAM) and imagethe program filled up quickly Thursday. The problem was not the turnout of patients. Instead, it was the lack of doctors that forced them to close down early.

At 3:30 Thursday morning, volunteers handed out 400 numbers to people looking for a free health exam. Some of them camped out for their spot in line. "It's a long wait. It's cold, but it's worth it," one man told ABC7. By 9:00, the clinic was full. "I'm shocked because I came all the way from Napa. I didn't expect it to be closed for the day," Kenneth Profit said.

The problem is not space or lack of equipment. There are plenty of empty dental chairs set up inside the Oakland Coliseum. The issue is finding enough dentists and eye doctors. "We don't have the number of volunteers today that we would hope to have," RAM founder Stan Brock said.

Ann Dukes, R.N., is a manager at Kaiser Hayward, but on Thursday, she was doing triage. "When I'm at Kaiser I'm supervising, not touching per se. Here is hands-on," Dukes said. When asked what kind of satisfaction did that give her, she said, "A lot more than supervising."

http://abclocal.go.com/kgo/story?section=news/local/east_bay&id=8591009

Wells Fargo Bank Files Suit Against Medical Development Intl Over Loan Defaults And Asked Judge to Appoint Receiver–Business Analytics Tactics and Algorithms Questioned

With $55.3 million in assets and $74.9 million in liabilities the money analytics are alive and running.  Medical Development according to the article here says that Well imageFargo became a “corporate raider” to divert company assets. 

Part of their business is in the Healthcare Analytics area with consulting for provider solutions.  The site states they have been a government contractor for years and has built healthcare networks and has a contract with the VA and also offers solutions for self funded employers. 

From the website below:

“MDI works along with healthcare payers to provide custom care networks, efficient administration and powerful analytics solutions. Our products and services allow administrators and healthcare professionals to:

  • Identify actionable items to reduce costs and manage risk
  • Create custom networks and plans for your clients
  • Eliminate overspending on duplicate or incorrect medical claims image
  • Evaluate complex health data in interactive, easy-to-use platforms
  • Create custom health programs for high-risk patients and disease groups
  • Predict future spending from the individual patient to the corporate level

All of our services are backed by dedicated cross-disciplinary support teams who provide IT assistance and personalized customer service, ensuring you'll always be equipped with the knowledge and ability to make practical, informed decisions.  This one appears to be one worth watching as perhaps their algorithms for analytics are either not making enough money or Wells Fargo perhaps was not providing adequate direction for them…who knows.  Now the company is also suing Wells Fargo too and is seeking $15 million in damages.

Banks and Health Insurance companies locking horns here and I bet the battles comes down to who’s business analytics algorithms caused the damage.  BD

Wells Fargo & Co. (WFC), the fourth- largest U.S. bank by assets, sued prison-service provider Medical Development International Ltd. in Delaware Chancery Court (1400L) seeking to recover $30 million in loans.

Wells Fargo said in complaint filed today in Wilmington that Medical Development, based in Ponte Vedra, Florida, has been in default on the loans “for quite some time” and asked a judge to appoint a receiver.

The company and affiliates have “also engaged in a series of self-dealing transactions including, among other things, so- called ‘loans’ to executives” for a “working farm,” a biographical screenplay and payments for “a Tesla Roadster,” lawyers for San Francisco-based Wells Fargo said in the complaint.

http://www.bloomberg.com/news/2012-03-23/wells-fargo-sues-medical-development-international-over-loans.html

FDA Considering Digitally Driven Kiosks for Self Diagnosis With Specific Conditions Via Algorithmic Processes

If you have heard or read the news of late it has been all over that the FDA is considering making certain drugs available over the counter that are now prescription only.  With that thought they are also investigating to see if a Kiosk imagewould be able to assist with helping patients find the correct medications along with doing a self diagnosis.  We have seen the kiosks that tele connect but these would be without the pharmacist and all done by the machine.  You can see what they have done in the UK with tele-pharmacists at the link below.

MedCentre Prescription Kiosk ATM-Like Machines May Give Pharmacies Some Competition in the UK – Installed at 5 Hospitals in the UK

The concern though is the usual error factor and mis interpretations and patients getting the wrong medication.  In essence though when you think about it this is not much different than today and buying the wrong thing when we self diagnose for the flu and other ailments we may have, except this is offering more knowledge available and if some of the current prescription drugs become OTC this is a concern as we are talking new drugs out there.  The targeted conditions/drugs presently being looked at are asthma, diabetes, high blood pressure, high cholesterol and migraines so there’s plenty of room for discussion here as well as development of an algorithm that could do the job without risking safety. 

I’m not sure we may see this anytime soon for some of the conditions as there’s a lot of work involved here with writing the code, testing and so forth.  I could see it initially available to perhaps do refills as a starting point.  The FDA has a way to go here with this project, but nothing will occur until decisions are made about which drugs come off the prescription list I would guess and there’s still the question of enough engineers at the FDA.  BD 

FDA and Medical Devices-Who Doesn’t Get This, They Are Looking for Engineers Just Like Technology Companies Are Doing- Get Some Congressional Digital Literacy in Place

Certain prescription drugs may soon be available to consumers through digital kiosks, rather than a doctor's diagnosis, underscoring the methods technology is transforming healthcare.

The Food and Drug Administration is mulling digitally-driven patient kiosks where people can self-diagnose for specific conditions through an algorithm-based survey. The process would drop the prescription requirement for certain treatments and common ailments.

Self-diagnosis would let users get medical care in a more convenient way. The kiosk concept under FDA consideration indicates the regulatory agency is taking a serious step towards using digital technology to deliver healthcare, moving away from relying on third-party app developers.

As the FDA hashes out its plans to eliminate the need for prescriptions, relying on modern technology is one way to streamline a process to help save medical professionals valuable resources in an overburdened system. But to make sure patient care remains a top priority, the FDA and industry professionals are sure to carefully determine how to make the process work without compromising a potentially life-changing diagnosis.

http://www.mobiledia.com/news/134007.html

CVS/Caremark Sends Letters to Tufts Members Containing Personal Information Like Medical Conditions/Meds Info to Wrong Patients–Attack of the Killer Algorithms Chapter 24

This is chapter 24 addressing flawed data this time.  The article said that CVS would not discuss this, well if you are in technology you know what happened, it was a rogue algorithm, in other words a programming error and this is what “The Attack of the Killer Algorithms” is all about.  This time it was private information sent to the wrong people but what’s it going to be next time.  If you read my series on the “Attacks” there’s tons more like this.  This why we need not rush the programming that takes place with developers.  Companies who put rushed deadlines on developers of software and push for releases before their time are fools, but it happens.

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 3-11-2012

There’s one story above about people who don’t get jobs because data is flawed or mismatched and this is becoming more frequent and let’s not forget the huge profits made here with CVS selling data too.  There’s a few lawsuits floating around out there on this subject and the data sellers should be taxed as they make billions selling data they get for free.  How times do rogue algorithms like this attack the data they sell?  That’s a good question to ponder and it does and is getting to be more frequent. 

Consumers Lose More Privacy With New CoreLogic Credit Reporting–”Score” Marketed For Insurers and Employers To Gain Information-California Prohibits Potential Employers – From Using As Jan 1 - Killer Algorithms Part 8
Independent Pharmacies Not Able to Compete with Big Chains and Fear Going Out of Business–They Don’t Have Same High Levels of Data To Sell to Profit- Attack of the Killer Algorithms Chapter 23

So the patients at Tuffs were screwed with privacy and they get an “I’m sorry” for the mistakes the CVS algorithms made, but let’s don’t talk about the maybe billion dollars they made “selling’ your data too..don’t forget that happens.  The lawsuits below implicate the SEC 2010 statement from Walgreens on their intangible data profits. 

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

This case fits the “Killer Algorithms” because what to do the recipients do?  They can’t talk to that algorithm and it made decisions and sent out flawed information, matched to the wrong person.  If you haven’t figured it out yet, this is why the entire Occupy movement got started as it’s not what you see but it’s rather the intelligence that runs in the background you DON’T see.  That’s the problem and issue as we base too much of the economy today on algorithms and making money selling data rather than investing in manufacturing and using more technology there. 

Occupying Wall Street–It’s All About the “Attack of the Killer Algorithms”–The Unfair and Marketing Exploit of Ethics Using Math–This Could be a Subject for Michael Moore to Explore and Document In a Movie

So there you have it, Chapter 24 of the Killer Algorithms and stay tuned for Chapter 25 when I find it..sadly the chapters will keep coming.  BD 

CVS Caremark Corp. said Friday that it mistakenly sent letters to about 3,500 Tufts Health Plan members, giving them personal information about the medical conditions and medications of other members enrolled in a supplemental Medicare plan managed by Tufts.

The mistake was due to an unspecified “programming error,” CVS Caremark, pharmacy benefits manager for the Tufts Medicare Preferred Plan, said in a statement.

“We are monitoring this situation and CVS Caremark’s response and outreach to Tufts Health Plan’s Medicare Preferred Plan members,” said Sonya Hagopian, vice president at Tufts Health Plan, which is based in Watertown and operates in Massachusetts and Rhode Island.

CVS Caremark spokeswoman Christine Cramer said the company would not discuss the incident beyond what it said in the statement.

http://www.boston.com/Boston/businessupdates/2012/03/cvs-caremark-mistakenly-sends-personal-information-about-drugs-and-medical-conditions-wrong-members-medicare-prescription-plan/yuPzeD7N7uwbJkLSbWrJnO/index.html?p1=News_links

Small Businesses Question Health Insurance Tax Being Affordable–Economics Have Changed Since Law Was Written-Tax “Millionaire Data Sellers” Instead - Much Bigger Pot To Make Up for Lost Budget Funds

If you read here often enough you may have stumbled across my little campaign to tax the profits that banks, corporations, high frequency traders, drugs store chains and so on make getting “data for nothing and the profits for free”.  The potential is huge if Walgreens made just under $800 million on their SEC statement in 2010 and I would almost guess they could have broke a billion in 2011. 

Why should the big conglomerates profit so heavily and the “algorithmically generated profits” be so high?  There’s no incentive to set up factories and hire people when a company can grab a couple programmers, write the web mining algos and start running a few queries and reports and sell the data which they get for free.  We try and base too much of our economy today on algorithms and while we need them, we all need balance with manufacturing too.  You know the best part of this idea is that insurance companies make millions selling data too so maybe a nice little revenue/tax bonus here and they still make enough to keep shareholders happy to boot. 

Here’s my thoughts on this topic and the average consumer has no clue that all this is made as you can’t see, touch, feel or talk to those algorithms but they have teeth and take your money and your data behind scenes if written to “maximize financial dollar profits” whether they are accurate or not.

Start Licensing and Taxing the Data Sellers of the Internet Making Billions of Profit Dollars Mining “Free Taxpayer Data”–Attack of the Killer Algorithms Chapter 17 - “Occupy Algorithms”– Help Stop Inequality in the US

Small businesses are being pinched and this is no exception.  It’s not that the Healthcare Law was bad but the economy evolved and a few modifications are needed, and especially in the math areas.  Nobody is accountable there and with some of the big data capabilities coming in it’s hard to get to the bottom with multiple layers of code running.  By the way thanks to all who are now searching for “The Attack of the Killer Algorithms” on search engines as it looks like that’s becoming a keeper. 


There are many very good provisions of the Healthcare law and who’s the fool that thinks this doesn’t need to be revisited and adjusted all the time, it’s the world we live in so a total repeal like some folks talk just shows a lot digital illiteracy with politicians and lawmakers. 

I said a while back that our new consumer protection chief better have some good understanding of math and algorithms as big business is using all of it for profit. I have no problem with companies making profits but when technological formulas are widening the inequality someone needs to dig in here and get with the math and algos.  The link below has about 20 chapters on the Attack of the Killer Algorithm examples if you want to dive in further and see how formulas that run on servers 24/7 make life impacting decisions about out with a bunch of flawed data in the works.  BD 

President Appoints Richard Cordray as New Consumer Financial Protection Chief - Hope He Knows And Understands Correcting Flawed Math and Formulas To Battle the “Financial Attack of Killer Algorithms” On Consumers With Banks and Corporate USA

Small businesses are very mindful of their spending especially when it comes to healthcare. The Health Insurance Tax that's included in the Patient Protection and Affordable Care Act is raising eyebrows among business owners.

He's talking about the Health Insurance Tax that's included in the Patient Protection and Affordable Care Act.

http://www.khastv.com/news/local/Tax-143727746.html

Roche Cutting the Price of 2 Cancer Drugs in India To Potentially Avoid Compulsory Law Provisions That Allows Generic Drugs When Cost Is Not Affordable

It was just last week that India took the very first step to make cancer drugs more affordable with Bayer and it looks like Roche might see some writing on the wall.  We all know how expensive cancer drugs are and how unaffordable they can be for the patients who need them most.image

India Authorizes Local Drug Manufacturer to Make and Sell Generic Copy of Patented Bayer Cancer Drug To Make It Affordable

By jumping ahead of the game and making the drugs affordable up front they could stand to remain outside of the laws in India and again hopefully they will be affordable.  The two drugs Herceptin and Mabthera will also be renamed to market under a different name.  After last week I wondered if some flood gates would begin to open and it looks like pharmaceutical companies, at least Roche took notice.  BD 

Roche Holding AG is cutting the price of two expensive cancer drugs in India—and giving them new names—in an effort to gain market share and avoid competition from generic drugs in the fast-growing economy.

The move marks a shift for the Swiss drug maker, which long has argued that consumers everywhere should pay the same price for its medications. By giving the drugs new names in India, Roche hopes to avoid losing pricing power elsewhere, though it isn't clear the company will succeed on that score.

The arrangement involves Herceptin and Mabthera, the wholesale costs of which are about $3,000 to $4,500 a month per patient. Tuygan Goeker, head of Middle East and Asian markets at Roche, said the prices would be cut in India starting next year, though he declined to say by how much. By offering lower-priced versions, Roche also aims to avoid being compelled under Indian law to allow generic-drug makers to produce less-expensive copies.

Roche's plan also partly is aimed at preventing India from demanding a so-called "compulsory license" for Roche drugs, which would allow a generic-drug maker to make less-expensive copies. Indian law gives the country's patent regulator such authority if a medicine is priced beyond patients' reach.

http://online.wsj.com/article/SB10001424052702303812904577297673910205972.html?mod=googlenews_wsj

Worried If your ACO Is Going to Be Too Costly? HCP Offering Accountable Care Reinsurance–Once You Figure Out What Your ACO Model Is…

It didn’t take long for this to pop up especially with so many unknown factors that are out there today as even the best laid plans with analytics are in a model, technology can show up tomorrow and throw a left hook at any time.  We have a lot of created and non-created disruptions in healthcare and some good and some not so good.image

ACO Stop Loss Reinsurance is the actual name and there premiums paid and it can be spread over a number of payments.  Many managed care organizations have purchased re-insurance policies as well and sells malpractice insurance to doctors as a primary business. 

Last year in the Cayman Islands, Aetna took out a reinsurance policy in case their medical operating loss numbers went over 104%.  BD 

Aetna Takes Out Reinsurance Deal In The Cayman Islands- $150 Million to Kick When Medical Loss Ratio Hits 104%

HCP National Insurance Services, Aliso Viejo, Calif., is now offering accountable care organization reinsurance for participants in the Medicare Shared Savings Program.

The company, which also specializes in providing medical malpractice insurance, described reinsurance for ACOs as “a big growth area” for the company in a news release.

http://www.modernhealthcare.com/article/20120322/NEWS/303229960/

IBM Watson Going to Work at Memorial Sloan-Kettering Cancer Center–Data Loading and Training To Begin

This is actually very good to compile cancer data and we can certainly learn from it.  The process will take a while as the data has to be fed in.  When used for diagnosis knowledge, patient input, drugs, and so forth this is great.  Even big data has the same issues though as what we have used for years and that is being assured of what data you load as it’s still a machine.  At the end of 2011 it was also announced that on the west coast that Cedar Sinai was going to explore the system for the same or similar purposes. 

Wellpoint to Bankroll Use of IBM Watson at Cedar Sinai Medical Center to Research Cancer Data/Information To Provide Guidance for Physiciansimage

For research this is great but hold your breath before bringing in the coding and billing portions of all of this as that’s where caution is needed.  If you read the news today how many stories, and there are tons of them with coding, billing and reimbursement thus if one leaves the work of Watson to research and clinical areas without that mess, we might have some good intellectual break throughs.  I commented on that a while back as when you have multiple layers of new code running through the machine does what it learns and is taught and you run close of getting to a bottomless pit at times, but again for research and clinical use this is a good deal. 

Machine Learning Software Working Behind the Scenes Should Move With Caution in Healthcare-Writing the Unreadable With Rogue Algorithms With No Human Intervention

As the article states it’s going to be a while before the Watson processes are going to be available for use and data integrity along with credibility is going to be key in the preparation.  On the other side of the coin though in the financial areas, something for consumers to be aware of with big data as nobody checks the math of banks and a lot of the big investment firms so more place to hide code to enable desired results more so than accurate results as we know what happens when money is involved.  The SEC certainly is going to need some “big data” capabilities soon or as consumers we are sunk.     

IBM Watson Going to Work At Citigroup on Wall Street–Congress Didn’t See Big Data As A Tool (Hadoop Framework) When They Had Their Chance…For Consumers The Attack of the Killer Algorithms–Chapter 22

When left to it’s own, and not regulated and audited, we get what I have written about below with formulas running a muck and hurting consumers.  BD

Attack of the Killer Algorithms–Digest & Links for All Chapters–See How the Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You

WHITE PLAINS, N.Y. — The medical training of IBM’s speedy Watson computer will continue with a residency at a renowned Manhattan cancer hospital.

IBM and Memorial Sloan-Kettering Cancer Center said Thursday that they will add the latest in oncology research — and the hospital’s accumulated experience — to Watson’s vast knowledge base, and keep updating it.

Watson will be fed textbooks, medical journals and — with permission — individual medical records. Then it will be tested with more and more complicated cancer scenarios and assessed with the help of an advisory panel, Kohn said. It’s expected to speedily suggest diagnoses and recommend treatments, ranking several alternatives.

Watson can even be instructed about individual patient preferences, Kohn said. When evaluating treatments, for example, it could take into account that a patient feels strongly about not losing her hair.

http://www.washingtonpost.com/national/health-science/ibms-famed-watson-computer-to-be-trained-in-cancer-to-diagnose-treat-patients-at-ny-hospital/2012/03/22/gIQA2RPtSS_story.html

Rite Aid Stores Hosts RV Tour From the Skin Cancer Foundation Coming To A Store Near You For a Free Skin Cancer Screen

This is pretty cool as a big RV comes around and had 2 private exam rooms so each person has privacy while being screened.  All locations in each state have not been posted yet but it looks like Florida is right at the top of the tour. 

The tour is accredited with finding over 5,000 cases of pre-cancer and 239 cases of melanoma as well.  There’s also a page where dermatologists can sign up to volunteer.  Most states have laws to where MDs can’t cross state lines to assist so they need local doctors to make it work.  BD 

Rite Aid Road to Healthy Skin

Press Release:

CAMP HILL, PA (March 22, 2012) – Thousands of Americans can receive free full-body skin cancer screenings this spring and summer thanks to The Skin Cancer Foundation's annual Road to Healthy Skin Tour presented by AVEENO® and Rite Aid. Starting this week, the Tour’s 38-foot customized RV is stopping at more than 50 Rite Aid stores as it zig-zags across the country.

The Tour draws on the expertise of local dermatologists who volunteer  imageto perform free, full-body skin cancer screenings, which The Skin Cancer Foundation recommends receiving annually. In its fifth year, the Tour is reaching out to new communities and adding new stops in Georgia, Virginia, Pennsylvania, upstate New York and Ohio. Many of the Tour stops are at Rite Aid Wellness Stores, which are Rite Aid's latest store prototype and feature expanded pharmacy services, an enhanced selection of wellness products, and regular health events and screenings such as these.

“We're proud to have sponsored the Road to Healthy Skin Tour every year since its inaugural journey," said Robert Thompson, Rite Aid executive vice president, pharmacy. "These screenings are a great example of the kind of proactive health and wellness resources that Rite Aid is committed to providing. Rite Aid pharmacists can help customers select the right sunscreen and counsel on possible medication interactions, such as the increased sun sensitivity that accompanies many common prescriptions."

The four past Tours have caught nearly 5,300 potential skin cancers and pre-cancers including more than 200 suspected cases of potentially deadly melanoma. Visitors are screened in one of two private exam rooms on the RV on a first-come, first-served basis. They also can sample sun protection products and learn about skin cancer prevention and early detection.

Visit www.skincancer.org/tour to view an interactive map of the Tour.

The Skin Cancer Foundation is the only global organization solely devoted to the prevention, early detection and treatment of skin cancer.  The mission of the Foundation is to decrease the incidence of skin imagecancer through public and professional education and research.  For more information, visit www.SkinCancer.org.

Rite Aid Corporation (NYSE: RAD) is one of the nation’s leading drugstore chains with approximately 4,700 stores in 31 states and the District of Columbia and fiscal 2011 annual revenues of $25.2 billion. Information about Rite Aid, including corporate background and press releases, is available through the company’s website at www.riteaid.com.

United HealthCare Awards Contract to One Blue Cross/Blue Shield Subsidiary to Process Tri-Care Claims While The Other BlueCross BlueShield Company Lost the Over All Tri-Care Bid To United In the West

This is getting interesting as the entire Tri-Care situation has drug on forever and we don’t know if the lawsuit United filed against DOD had any influence on this recent award.  There’s some history from a couple days ago at the link below. 

United Healthcare Secures Tri-Care Military Defense Contract for Western USA Presently Handled by Blue Cross Contractor TriWest

Palmetto (PGBA) has been around in the west for quite a while as the contractor as I have sent claims through them when doing medical billing.  I found this one page at Palmetto kind of interesting as it has all the billing and EDI information and questions, except right in the middle they will tell you how to tweet on Twitter:)  I have never seen a compilation like this before. 

image

TriWest is owned by 11 Blue Cross and Blue Shield plans and two University Hospital systems so this gets even more interesting and do they use software that was created by United’s Optum division?  They could as it’s been around for a long time so integration would be easier.  So through subsidiaries and ownership Blue Cross/Blue Shield has been all over the Tri-Care processing portion of the business for a long time.  Ok so what’s next?  We can speculate maybe and wonder if Untied will be offering Blue Cross some money for the Palmetto subsidiary some day?  I say that as they kind of come in and buy all types of technology companies and if they are integrating with their own systems…well..hmmmm…

Back in 2009 the Tri-Care contracts all began and United was originally awarded the north from HealthNet, they protested and got it back.  Right after this, Health Net sold  its Northeast insurance and HMO units in Connecticut, New York and New Jersey to UnitedHealthcare.  BD

HealthNet Will Keep the Tri-Care North Contract – GOA Investigated the Original Award to Aetna

FLORENCE, SC – PGBA, a BlueCross BlueShield of South Carolina subsidiary company has been awarded a new contract by UnitedHealth Military and Veterans Services (UMVS) to help process TRICARE claims.

TRICARE is the U.S. military's health care program for active-duty and retired service members and their families.
PGBA, based in Florence, S.C., announced March 16, it would process TRICARE claims and provide claims-related customer service and sophisticated systems platforms, integrated with UnitedHealth Group systems, on behalf of beneficiaries, physicians and hospitals as a subcontractor to UMVS.

http://www.healthcareitnews.com/news/bcbs-south-carolina-company-process-tricare-claims?topic=04,28

Healthgrades Hospital Report is Out and Still Think Their Algorithms Needs Work…

This time they appeared not to even touch Massachusetts is appears as last time MDs from some great hospitals were upset they were either not on the list or not ranked properly.  Healthgrades said themselves a while back that their algorithm needs work and now they merged with a marketing company but I wonder how long the rankings here will continue to be of public interest.  I know it’s sure slowed down a lot with consumers I talk to. 

HealthGrades to Merge with CPM Marketing–Will Their Data and Questionable Algorithms Will Be Improved For Consumers?

They have their share of flawed data out there like many who report on healthcare and they were just ahead of the rest when I found my former doctor who has been deceased for 8 years still on their listings.  I know she’s no longer on there but it brought attention to what we get out on the web as far as aggregated data sometimes.  I didn’t see any of the Kaiser Permanente hospital on there either for that matter.  BD 

HealthGrades 'Best Hospital' List Algorithm Needs Work Again - Flawed Data

DENVER, CO – HealthGrades, a provider of consumer healthcare information, named America’s best 50 and 100 hospitals for 2012 in a report issued today.

These hospitals demonstrated superior and sustained clinical quality, ranking them in the top five percent of all hospitals in the nation, according to a press release issued by the company.

Key report findings include:

  • America's 50 and 100 best hospitals are located in 88 cities in 25 states.
  • The majority of America's 50 and 100 best hospitals are nonprofit (87 percent), 7 percent are for profit, and 6 percent are government owned.
  • America's 50 and 100 best hospitals range from 100 beds to more than 500 with 45 percent having less than 350 beds and 55 percent having more than 350 beds.

"As our nation seeks to elevate the quality of care at all hospitals, these elite facilities provide a roadmap for success," said Arshad Rahim, MD, HealthGrades director of accelerated clinical excellence, in a written statement. "Consumers increasingly are demanding greater transparency and quality when selecting healthcare providers. These hospitals are delivering. We commend them for their dedication to excellence in patient care."

http://www.healthcarefinancenews.com/news/healthgrades-names-americas-top-hospitals?page=0,0&topic=19

J and J Sold Vaginal Mesh Implant Without FDA Approval for 3 Years

J and J also has a part in the vaginal mesh mess with their product and lawsuits are starting here too.  The questions here are the fast track approval for the Prolift mesh imagedue to the fact that it is similar to Gynemesh a product made by another company.

The product was put on the market in 2005 and was not given approval by the FDA until 2008.  The FDA asked in 2007 for a 501k submission and again after it has been out there for a couple of years already.  All companies now who make the mesh product were ordered by the FDA to study organ damage and other complications from the mesh.  In 3 years the FDA accumulated over 100 complaints on the Prolift product.  This is yet one more issue for J and J to work with and settle.  BD  

Johnson & Johnson sold a vaginal mesh implant for three years before U.S. regulators approved the device, now the subject of more than 550 lawsuits by women who claim it injured them.

J&J introduced the Gynecare Prolift device in March 2005, touting it in an annual report as an “innovative and effective surgical option” for weakened pelvic muscles. The U.S. Food and Drug Administration said it learned of the Prolift in 2007, when J&J sought approval for a related product. The FDA cleared both devices in May 2008.

The company, the world’s second-biggest health-care products maker, said it could market the Prolift without approval because it was so similar to an approved device, the Gynecare Gynemesh, said Morgan Liscinsky, an FDA spokeswoman, in a March 16 e-mail. “FDA disagreed with this assertion,” concluding distribution began “without appropriate” clearance, she said.

J&J’s unauthorized sales might cost it more to resolve lawsuits over the product. J&J already has endured recalls of artificial hip implants and over-the-counter drugs. Three J&J units have pleaded guilty in the past two years to bribery or illegal marketing of drugs. A fourth agreed to plead guilty in a marketing case.

Andrew Sokol, an associate professor of obstetrics/ gynecology and urology at the Georgetown University School of Medicine, said he was “absolutely concerned” after hearing that J&J marketed the Prolift without FDA approval.

“That information would have been important for most surgeons,” Sokol said. “Most surgeons probably would have not used a completely new product if there was no oversight.

http://www.bloomberg.com/news/2012-03-21/j-j-sold-vaginal-mesh-implant-without-u-s-regulatory-approval.html?

Robotic Tek Mobilization Device Could Someday Make Wheelchairs Obsolete–The Device Moves Like A Segway and Supports and Uplifts User to Standing Position

The device was created in Turkey and they are looking to market in the US and the price in the article here said around $15k would the cost and so I don’t think the imageScooter Store has to worry too soon about immediate competition.  This would be nice if insurance and Medicare get in the act here with considering the device.

The man in the video has no use of his legs and the chair does it all as far as moving him from a sitting to a standing position. It has controls so you can call it to your bedside or where ever you need to it respond.  This is great watching him get around and go up and down as needed.   It has been through a full set of clinical trials so it’s just about ready to go and will be sold in Turkey this week.  BD 

Wheel Chair substitute

The young man in this video looks like he's riding a Segway. But Yusuf Akturkoglu was paralized after falling from a horse five years ago, and he's being mobilized by an amazing device invented by Turkish scientists. It's going to change lives.image

It's called the Tek Robotic Mobilization Device, and it not only allows people who can't walk get around more independently than any device has before, but it also helps them stand up on their own, which is crucial for maintaining basic health functions in people who have spinal cord injuries.

Instead of entering from the front like a normal wheelchair, people using the Tek RMD enter from the back of the device. That way they don't have to hoist themselves with a momentum that can be dangerous and is next to impossible to do alone. By attaching a thick padded strap around the hips, Yusuf maneuvers himself into the Tek RMD on his own.

The makers of Tek RMD says it's the most compact device of its kind, which allows Yusuf to navigate crowded grocery aisles, libraries, and who knows, Coachella, maybe? All without knocking into the people and things around him. Users still need ramps in place of stairs, but the device eliminates the need for special bathroom stalls and other facilities that allow space for bulky wheelchairs.

http://gizmodo.com/5894489/segway+style-device-for-paraplegics-puts-wheelchairs-to-shame