If you read around the web you have heard about the California efforts and several other states and this article talks about Maryland and their progress, but I keep seeing the same comments about the somewhat mysterious “Federal Data Hub” that QSSI, a subsidiary of United received a contract to build.  QSSI is also still a topic of conversation on their contract award with HHS as well so that adds some heat to the fire of inquisitions.  Colorado is asking some of the same questions but United Healthcare has their Colorado CEO sitting on the board of members to manage their exchange.  Colorado has spent over $66 million haired CGI group to set it up. 

If you go back in time a few months, the award to build the federal hub to QSSI has been the topic of conflicts of interest as well.  What is also interesting is that we keep hearing that United themselves are not committing to participate as one of the insurers in most states, do they know something we don’t:)

It is difficult to know QSSI’s role because its contract is not publicly available and HHS did not provide a copy. A draft statement of work issued by HHS and used for the bidding process offers a glimpse of what the contract entails. 

The contract was awarded to QSSI in September and then also in September, United bought them.  In July, Steve Larsen left HHS and went to work for Optum as a VP, a big United Healthcare company…so does something sound fishy here?  When HHS became aware of the acquisition, it was too late to cancel the contract because all was moving too far behind so HHS set up a firewall to block United Health Group from gaining access to QSSI’s data.  Then the work stopped on the firewall and the acquisition was reported to the SEC and this was done after the election. 

US Health Insurance Regulator Leaving to Take a Job at UnitedHealth Care As Vice President of the Optum Division – Moving to the “For Profit Side” With Business Intelligence Algorithm Dollars To Review

If you read here often enough then you have seen the “subsidiary watch” posts I have here related to healthcare mergers and acquisitions and about 70% of them are about Untied Healthcare and companies they buy or create. You can read more about their LHI division here which I rolled into a Tri-Care post, and I’ll bet you didn’t even know this division existed.  They have contracts with the DOD, VA and other military entities and do occupational health, VA disability exams and more so in addition to Tri-Care one more way they make big money.  So it appears while HHS was working on the exchanges, United was working on DOD, VA and other entities. 

Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?

If you read the post, (link below)  Untied created a separate subsidiary just to go after Tri-Care business, that’s it.  When you look at the LHI it might make a little more sense on why they sued the DOD for the western contract as they would want to collaborate on the two subsidiaries both being military related and providing outsourced services.  Just do a search on this blog using the words subsidiary watch and you will find truckloads of Untied subsidiaries and what they do.  United also lost a case in the Supreme Court this week with not allowing doctors to assemble in groups to settle unfair insurance practices. 

United Healthcare Referral Algorithms Not Working Well With Tri-Care, Company Moving Their Subsidiary Execs Around, DOD Could Fine The Company Later–Subsidiary Watch

There will also be a user’s fee so I guess this could be attributed to absorbing some of the cost for the federal hub?   It will be interesting but with all the acquisitions and created subsidiaries is United too big to fail?  Here’s one more example of making money selling data and of course they have been doing that via subsidiaries for years with prescription data. 

More Data For Sale Soon With Shared Clarity With United Healthcare Labs and Dignity Health–Crunching Numbers on Medical Devices With Shared Clarity
United Healthcare Buys Humedica and Gets More Data to Analyze and Sell To Medical Device and Drug Companies–More Big Profits From Health Data

It certainly looks like United is out with their formulas and math getting what they want, more government business, enough to where they maybe don’t need the policies to be created by exchanges?

United Healthcare Wants a Bigger Portion of the Government Health Insurance–More Model Complexities–It’s a Wait and See To Determine How the Algorithms Will Play Together

It looks like all the way around United with the work of their subsidiaries has just flat out modeled HHS and I keep saying hire some modeling quants to work for the government to keep up.   Back in 2009 I said technology was going to eat up Sebelius and HHS and with all the business United controls, I think they did. 

I like technology and what it can do but at this point even I have to say what in the heck has been built here and where’s the value!!   This is a mess and it’s not going to flow well at all. 

Hats off to all who have poured hours of time and dedication from the IT end of all of this as it’s a lot of work, but gee can we get someone running HHS with some technology in their background?  There’s no thinking on one’s feet here and everything depends on staff sadly.  The Consumer Watchdog warned her about insurance companies back in 2010.    These tech breakthroughs to save the day or just not there, but the time and expense is so the wish to “hurry up technology”…well you know that tune…”the short order code kitchen burned down a few years ago and there was no fire sale”.  Perhaps a little Algo Duping going on here and there are others in the cabinet with that issue as well. 

HHS Secretary Sebelius Still Looking for Tech Breakthroughs To Save the Day


Second, apparently the Federal Data Hub is up and running. While that is what the Obama administration has been telling us, it has been hard to find anyone who has actually seen it or used it.

Third, Maryland has its system ready to exchange eligibility and premium information with the health insurance plans - - perhaps the biggest challenge the new exchanges, state or federal, face.

We don't know any details on just where they are and if they are on track. They continue to tell us they will be ready on October 1 to begin enrollment and on January 1 to exchange billing and eligibility information with the health plans - - by far the toughest challenge.

But why all of the secrecy? Why aren't we getting the same reports from the Obama administration we are getting from Maryland? Why isn't the GAO doing a report on just where the administration is in the 35 states' exchanges they will now manage?


Post a Comment

Google Analytics Alternative