This is yet another expansion of the Medicare Advantage Killer Algorithms as the insurer business intelligence methodologies used are designating that these are additional areas that are having an impact on over all profit strategies.  This is a process that all companies do today; however when it comes down to the personal with health insurance it causes patients and doctors to have to make changes that can in fact have an impact on the care patients get and with doctors, where they get care. Patients again will have to shift and choose to make other arrangements.  Let’s go back to “you can keep your doctor” with Obamacare and shut out the fact that was created by the government as it was not, this is done with business analytics with insurers to keep profit margins and dividends flowing to investors.  United just raised their dividend if you missed it. 

The Boston Globe reports the situation in Massachusetts to where around 700 doctors will be fired from being Medicare Advantage in network participants.  This means again patients have to look into a couple alternatives which is changing doctors or moving on to straight Medicare coverage if they want to keep their doctor.  At least there’s little more warning this time with the change taking place on September 1st.  I love the stats quoted here as we are a nation of stat rats and if it’s you and your doctor affected, than stats mean absolutely nothing.  As the CEO of United said a few years ago at United “our shareholders will prosper”.  Doctors began getting  notices last week.   Here’s a back link again where I basically said the same thing. 

United Healthcare Firing Thousand of Doctors Caring For Medicare Advantage Plan Patients in Connecticut, Florida and Rhode Island-Attack of the Business Intelligence Killer Algorithms…

Now over here we have the same thing happening in Tennessee.  About 4 percent of the doctors will be cut from being Medicare Advantage providers here as well.  One little kind note is a small exception for Cancer patients being able to maintain their current doctors if they are under treatment so those folks may have to watch their claims as you might see items such as “what a treatment” questioned with claims or is this “an experimental treatment”, both very commonly used by insurers all the way around today with medical claims.  It’s interesting how the article goes the extra mile to say “doctors are not the bad guys here” in essence as I mentioned above it’s all about business intelligence algorithmic formulas that shuffle out to be “Killer Algorithms” with patients and doctors.  It’s strange as here in California United pulled out of the individual policy business but I see ads running like crazy on TV for their Secure Horizons Medicare plans here. 

When you have an insurer that is so large and has armies of subsidiary companies you have to think that even they can’t manage all their data and costing today as shown in contrast where there was no problem letting a $175,000 claim for a hammer to procedure for a banker’s wife in NYC just slide on through.    United makes 1/3 of their revenue today from Health IT efforts and 2/3 comes from the actual insurance side.  I have been posting about other states where United has also cut Medicare Advantage doctors and it’s even gone to a lawsuit in Connecticut.  This is an odd contrast to where United did bid and win for a Medicare Advantage plan in Maryland only to find their narrow networks too narrow and there were no providers to see the patients in the contract they had just won. 

Howard County School Board in Maryland Rescinds United Healthcare Contract As Retirees Didn’t Want the Medicare Advantage Plan, No Providers Available..

The Supreme Court last year did give doctors a small give in the fact that they are now allowed to group to litigate legal claims and they are using it.  The Supreme Court ruling went against the Oxford United Healthcare group which was tied up in courts for years over the use of not allowing doctors to group.  In the Connecticut case, medical associations have done a “me too” all the way from California, Texas and more as they are grouping to support the lawsuit.  A company the size of United though has a large team of lawyers on staff and a couple or three years ago hired the former US Assistant Attorney General for the State of Minnesota to come on board as general counsel.

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

I find it weird too in the northeast to where United bought a chunk of the Health Insurance business formerly owned by Health Net too as this all took place during the big Tri-Care bids when Health Net originally lost the northeast contract but got it back as Aetna cheated.  During the time before the re-award Health Net is  not that big and with potentially losing Tri-Care in the northeast money wise had to sell off some business.  Strange when you go to Health Net today you still see them represented as the insurer, but United owns it and I guess never switched clients over to Untied policies.  I just looked at it the other day on the Health Net page.  Just from the consumer end it makes is confusing to figure out where your actual bottom line dollars go.

As the Tri-Care bidding moved forward, for a little more history here we know that United sued the DOD to get the contract in the west. 

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?

I have seen a few articles like the one below too when United contests contract awards too and takes people to court as shown for the state of Georgia.

United Protesting Yet Another Contract Award–State of Georgia Where They Claim “It Was Rigged”…

In addition insurers are now beginning to compete with hospitals too and here’s a little bit about that where United is now setting up their own urgency care clinics with a couple Texas for starters.  It’s a weird situation here as they have to work together on some levels of healthcare but in other areas there’s competition. 

United Healthcare Now Entering the Urgent Care Clinic Business To Help Keep Patients Out of the ER, Two More Opening In Houston–Subsidiary Watch

These processes are all business analytics and they just cut and chop and doctors and patients are being left to fend for themselves as the systematic process to keep profits for shareholders prevails.  The old saying of follow the money still holds true but you also have to follow the data today and somewhat think like a jerk to project how data burns a hole in the pocket of a business that has some to sell, as it’s an epidemic in the US and your real articles all over the web, besides this blog about United and the money they make selling data, they’ve been doing it for years and years. 

I was worried back in 2009 when Kathleen Sebelius was nominated as I feared she was no contest for the extreme analytics used by health insurers and sadly it turns out I was correct as I don’t have to tell you what happened there as it played out over and over on main stream media, one foot in mouth or weird perception after another, and it was nothing personal but just myself notice clean hard fact that you can’t have non data mechanic logic folks running agencies that have to deal with very complex technologies and business intelligence algorithms that make profit for insurers.  She’s not alone though as we have Mary Jo White at the SEC White at the SEC and Richard Cordray at the Consumer Protection Agency suffering from the Sebelius Syndrome as well, not personal at all. 

I recently had a doctor tell me here, who is not happy with his complex contract with Untied that now pays him less than Medicare, that he actually bought some of their stock as he was just so overly impressed with how brazen the company is and just ram rods everything through that they want and later said he would probably sell his United stock as he realized he was kind of betting against himself in the end.  He was tired of the fact that claims were not getting paid on bought a few share of stock to get even in essence for the low pay contracts and all his office’s administrative time spent.  We had a merger of a couple big doctor’s groups here recently in California and it’s kind of worth a note that the doctors and patients being moved to the other group in verbiage were just called “inventory” if you will.  What really galls doctors though  and here’s an example is that they do a lot of chasing around to find out that United doesn’t have claims people familiar enough with their own policies, i.e. tell us it’s not covered now instead of reams of paper and faxes later. 

A few years ago it was all over the papers in the OC when United shut down a division and the method used to terminate people with getting an instant message on their computer, asking them to report to the lobby where a bunch of busses were waiting that took them to a hotel and gave them their walking papers.

I tell people all the time and have for years to look at health insurance companies as whole to include all the subsidiary companies they own and what they do as it too is very complex as you also have a lot of different interests that are not direct health insurers operating entities or you may find 51% controlling interests by the insurer or by one of their subsidiaries.  I had a hospital CEO a while back who read some of my archives and he said he was floored to find out how many different subsidiaries his hospital had with portions of United Healthcare, as again he had never looked at the entire company as a whole and of course he approved contacts and payments to those subsidiaries or companies that are 51% controlled by the insurer.  Also it’s interesting to note where folks from HHS end up going who were responsible for writing part of the healthcare law, link below. 

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

A couple years ago I wrote a post about agreeing with a banker that banks are pretty much just software companies anymore and noted the same can be said for health insurers too, so are you getting this message yet?  If not you might give it some thought. 

Banks Are Actually Just Software Companies and the Same Can Pretty Much Be Said for Health Insurance Companies As Well-5 Unspoken Reasons Tech Projects Fail

Here’s a post I did a while back (link below) with a partial listing of some of the United Healthcare subsidiaries and where they function and you could be come aware of the fact that they own a bank, sell electronic medical records, own clearinghouses, invest in low income properties, sell Chinese made hearing aids, consult with device and drug companies for FDA submissions, run hospice services, a lot of military contracts and more.  I did this as information as I like to know where my bottom line dollars go to the ultimate corporate till. 

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

We do have a big case of “The Grays” as I feel with folks not coming to the reality of all the complexities we have out there today and you see things like this where people have had enough with the bliss perceptions we read about with government.  We do have Killer Algorithms out there operating on servers 24/7 that make life impacting decisions about all of us and in this case it’s Medicare Advantage doctors and patients. We have virtual values that are analytics, etc. that come out of virtual world and have impact and affect “the real” world, so important that virtual and real world models work together today as we are beginning to see a big failure of all types of models and it’s not only in software. 

Shoot three years ago I suggested devaluating some algorithms for the purpose of balance but as you can see it has not worked that way and the imbalance and folks being too far stuck in virtual values is killing us as they can’t tell the difference anymore half the time, the VA is right there and staring us in the face with this unwanted scenario.  By the way too a subsidiary of United, LHI contracts to do disability exams for Vets all the across the country and does a lot of work for DOD as well as United has a specific “government” subsidiary they created for that purpose. 

Complexities Are Winning - Medicare Principal; Deputy Administrator Calling It Quits - Time For Folks To Come Out of “The Grays” And Look at the Reality of the Complex Systems We Built - Beyond Humans And Even the Machines To Handle At Times-IT on Overload

In short, every time  new risk analytics come out with cost associations, both doctors and patients have to disrupt their current medical care, their relationships with doctors and go scramble so they can be assured of care. How long is this going to keep happening one might wonder?  Which comes first the human or the algorithms? 

The machines will never have ethics as that’s purely human and there’s a great abstract that addresses this so as smart as machines can get, you will never get ethics input unless you ask a human, which you do hope has ethics.  Nurses too are worried and concerned about the over reach of algorithmic medicine and who better to ask than those folks on the front line.  Doctors and nurses deal with the “real world” every day and there’s a name for that: patients.  Analytics and costs numbers are virtual values that help us make decision and we need them; however the balance is off and only the dollars and share holders call, we have problems. 

Limitations And Risks Of Machine Ethics (That Really Don’t Exist) - Abstract Basically Substantiating the Existence of What I Coined As “The Attacks of the Killer Algorithms”…

At this point we have all pretty much figured out that “pre-existing risk” has now been replaced by “narrow networks” and they are showing up everywhere.  This again is a model being used to risk assessments along with gosh only knows what else gets in there as insurers now buy up our MasterCard and Vista records along with some stealth voice analytics to get every tiny stick of data they can to allow or deny care or service.  Of course insurers are at the top of the list as pointed out by the World Privacy Forum on the “Scoring of America’, which in itself outside of healthcare is impacting inequality. 

Pre-Existing Conditions With Health Insurance May Be Gone But Narrow Networks Are Providing The Same End Result For Many Ill Patients With Not Being Able To Get Care - Extreme Cases Of New Killer Algorithms Popping Up With Insurance Business Models…

Again we are a nation of “Stat Rats” and they are failing in many areas.  A few years ago I was getting tired already of the the Levin Reports (another subsidiary of United) that talked about billions and trillions in healthcare with technology and those as we have seen were untrue as we have today and were more or less there for marketing purposes. So again look at where your information comes from and where the bottom line dollars go as every subsidiary is expected to put money to the bottom line, unless it’s one in the Caymans that doesn’t have any key executives named and yes that have one of those too I found right off their SEC listing.  So many of those Lewin reports seemed to end up as Quantitated Justifications for things that were not true.  If you read the link below and watch video you can see the automation that is being used today with “data news” and again we really have to look at what is addressed with reports out there today, especially with healthcare. 

Quantitated Justification For Believing Things That Are Not True And Using Mathematical Processes To Fool Ourselves-The Journalistic Bot Functionality Debuts As Media Can’t Resist the Formulas…

I understand companies are in business to make a profit but how large does that profit need to be?  How about when it impacts care for patients and the doctors income that take care of the patients?  You can keep “scoring” and running risk assessments and use segmentation and inequality and access for the average consumer gets impacted and I might add too we have no way of seeing what data and where.  We don’t see the data here with these Medicare Advantage doctors being fired by United, do we?  It’s proprietary models and coding that we are just expected to assume they are correct, but again there’s that shareholder side that wants money too. 

The company has a huge amount of power and control and I do have to say it sure looks like we are headed down the same path as we did with banks with “too big to fail” or “too big to jail”..take your choice of which ever one you prefer.  Take in some educational videos at the Killer Algorithm page when you have time or just scroll down and watch the 4 videos in the footer of this blog for starters,  created by folks much smarter than me, but you will get the idea of the models and algorithmic controls used today to allow or deny access and ask “who’s algorithms are they” and “will I benefit”.   A local Arizona TV news station seems to be keeping pretty busy with helping consumers settle their claim differences with United too.   The Medicare Advantage folks in Massachusetts and in Tennessee might be asking this question today as the doctors continue to be fired by Untied Healthcare.  BD 


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