A couple months ago I lost my mother and if you read here often enough then you probably read about that, and the family had to make a decision about hospice care.  Luckily I have friends here so I was not in the dark and made a good choice of a good center.  I do look around and see what’s out there and what’s amazing is to now see health insurers owning palliative and hospice centers.  When one thinks of hospice you always seem to think of the service as being non profit but that’s not always the case anymore.  I try to keep folks updated on what I call my “subsidiary watch” posts as folks do find it interesting to know where their absolute bottom dollars go as far as contributing to big conglomerates today.

More so than just money, another important factor today to look at is the data as we all know data means money and if there’s a chance to create to make a buck they do it today, not matter what type of business it is.  So far nobody questions much of the math or models used, and it seems like with the exception of the NSA, we have a bunch of what could be called “digital duds” making laws.  This means folks that are not up to date or don’t take the time to study and see the big picture.  Anyway, back on course here I found one big hospice and palliative center owned by United Health Group, Evercare.  I went and looked up the SEC listing and it was there, in a few places, as a subsidiary of United Health group and as a subsidiary of a subsidiary of United called Ovations.  A quick search from Yahoo Finance told me this:

“A strong culture cares for and respects its elders; UnitedHealth gives them a standing ovation. Ovations, a subsidiary of UnitedHealth Group, serves the health needs of people age 50 and older byimage providing health insurance, medical information, disease management, and other health-related services. Ovations is one of the largest providers of Medicare supplemental insurance, serving nearly 4 million AARP members. The company also operates one of the nation's largest senior drug discount card programs and provides Medicare Advantage coverage. Health care for seniors and chronically ill patients in nursing homes and other long-term care facilities is coordinated by the company's Evercare subsidiary.”

Again as mentioned Evercare, the palliative and hospice care is also listed as a direct subsidiary of United Health Group as well.  Ovation if you read this is about “disease management” for people over 50 as well as insurance.  Ok so here’s a question here that comes to mind…where do folks with Ovation polices or other polices go for hospice and palliative care?  It it open under “covered contracts” to allow a choice or do they end up at Evercare either by contract or via marketing?  How does some of this work with Accountable Care Organizations today when one company has a range of varied holdings that all eventually are responsible for putting dollars down to the bottom profit line of the big conglomerate? 

Talk about complexities…good example right here and probably keeps a lot of lawyers pretty busy with interpretations.  In a previous post I somewhat look at some of this with a foundation owned by Optum the subsidiary of United having a foundation they own in the OC, forming yet another subsidiary under the foundation to get 51% control over a large surgical company with over 180 locations in the US.  This is getting very interesting with subsidiaries especially with ACOs always being front in the news and to what effect ownership and controlling interest is having. 

Health Insurance Business Under the Radar With Tiered Subsidiaries–Where All the Action Takes Place With Mergers, Acquisitions and Profit Centers-Subsidiary Watch

So l looked around the Evercare page a little more, and again I was happy in my case that I chose a highly recommended non profit for my mother’s care and wanted to see what kind of privacy statements it had.  They were long, confusing and you know your standard privacy statement with a lot of legal terminology that runs in circles.  I keyed in to look at the image“business associates” statement and here’s on paragraph of what was stated.  All kinds of areas were listed as far as sharing or providing data but anymore with breaches, etc. with so many business associates mentioned today I thought this was worth a look.

“We may use or disclose your health information for the following purposes under limited circumstances:

To Business Associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services.  Our business associates are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract”

Ok with all the talk about big data today, who are these “business associates” is the question that comes to mind..are they other subsidiaries?  How many of them are there?  Do they provide the data free or do they sell it and what kind of data and what kind of data does Evercare have access to as well from the other side.  I don’t know the answer and only the Query Masters know for sure when creating analytics and matching data bases but recently in the news it was reported that Blue Cross and United where buying up our Visa and Master Card purchases and when put on the spot, Blue Cross said they were using the information to monitor and see if their policy holders “were buying clothes a size larger” to watch for obesity and were not using it for underwriting, but we all know that underwriting is only a portion of the insurance business today. 

So to come around full circle here with the point to make one might ask what is a health insurance company anymore and what are all their objectives with subsidiaries?  At the time of death is palliative care and hospice also deemed to have to make a profit?  Does your data continue to be marketed and sold even after you are dead?  I thought about this after my mother passed and again I was glad I chose a non profit here as the last thing I would want would be profits paid to share holders based on her death. 

How does palliative and hospice care for profit fit with marketing and selling health insurance today and is the future of an ACO being successful dependent upon being a subsidiary of a health insurance company or being 51% in control of facilities like 180 surgical centers?  Everyone talks and worries about physician owned hospitals and treatment centers…will this may cause you to ask another question, what about those that are owned or governed by health insurance carriers that in essence tell us that shareholder profits mean everything?  Are we on the path of creating “health insurers” that are too big to fail?  Something to think about here as the government too with military contract and others is a huge customer as well.  It’s all about the models for profits and the math that makes these decisions today and the subsequent algorithms that run on servers 24/7 making life impacting decisions about all of us. 

“It’s Not the Data, It’s the Models Stupid”-Big Data Helps But It Is Not the Answer

Black Swan events are major events that take us by surprise, but afterwards yield clear explanations as to why they happened. Examples include the 9/11 attacks, the rise of the Internet and World War I.

But they can also apply to business, and so there is a temptation to apply Big Data to spot such Black Swans before they happen and to profit afterwards and at some point in time we might have to ask the question, were some of the current day models used a contributing factor to what is called a “black swan” or was it deep down in computer code layered that way and became a Black Swan when the math went bad?  Visit the Algo Duping 101 page for some videos created by people smarter than me that help explain how some of this works with data, math, models and then some.  BD


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