It’s not just insurance that keeps you from retaining your doctor, look at this at how competing Health Systems just capture you, your medical records and express you on over to where they want you to go.  You have to go where it’s “financially advantageous”image not to where the care could be better.  Look at this story and listen to how the doctor communicates what happened. 

The patient had full confidence in their long time cardiologist and the data just ripped this option right out from underneath the patient here and they had to go where they were told to go.  So you want to keep your doctor, well you have a couple elements working against you and it’s all about money.  First of all when you buy your insurance policy with a list of who’s in network, you could get surprised later as the Secret Scoring and Firing of Doctors continues to keep things non fluent here as insurers are using more Quants, some who probably worked for high frequency trading firms and banks, to keep the profits rolling down to the bottom line penny.  Here’s a good archived article from the past that describes how United did a lot of this with Medicare patients with using algorithms only to just fire the doctors, no explanation given as again we had some Killer Algorithms at work here to disrupt your medical care.  Read the other links here as the company themselves could not and still cannot keep up with what their own Quants are designing on these models and it keeps everyone disrupted and maybe not such a good fashion. 

“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..

I would also guess here too along this path that the medical records were de-identified and dumped into some research firm as well.  You can see what Optum Labs with their partners Mayo, Dignity and more do with all that data to charge researchers and drug companies a fee to dig through all of it.  As a matter of fact anyone, even if you do not go to the Mayo clinic can sign up and put your medical records on line..ummmm….yeah more data for Optum Labs, you think?  It’s all about money and IBM is trying to do the same thing so just be aware. 

Optum Labs Add Four Additional Data Miners To the Collaboration Looking for Data…

Nobody wants to use the almost free FDA data base, the Sentinel program to do the same thing, right?  Gotta make money with patient data too.  Sure there’s information to be mined from medical records but it’s not going to save the world and those drug companies that mine data from Optum, well they have marketers too so you have that angle working on what gets mined out of there for some more pharma marketing campaigns.  As a matter of fact with all the steroid marketing going on and little clinical stuff from all this research at Optum, maybe marketing mining is the real objective here, you think? 

“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..

Basically what this doctor has written about here is money talks and referrals are sometimes uttered useless when it gets in the way of big money.  Sometimes United themselves can’t even keep up with who’s in network as they went out and bid and won a contract and found they fired all the doctors already.  The left quant at United doesn’t know what the right quant is doing here:)

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

Anyway good input from this doctor as this is trending as he says, your healthcare is controlled by cost algorithms, not referrals anymore as the Quants with health insurers who probably used to create high frequency trading algos are at the controls. 

The complex business of medicine is continuously evolving. As insurance companies, doctors and patients align themselves with different health care systems, the competition to keep patients has heightened to a disturbing level. This is not necessarily best for the patient. Here is my story illustrating this new phenomenon.

A female patient came to see me last month complaining of chest discomfort.  Her stress test results suggested a major cardiac issue. Further diagnostics, specifically a cardiac catheterization, were needed. I called a colleague who specializes in this procedure, and set it up for the following week. Together, my patient of 15 years and I discussed her concerns and expectations. Then off she went to the next part of her journey. Her voyage through the health care system turned out more complicated than anticipated.

As it turns out; my well-respected colleague would not perform the procedure because this patient was an employee of a competing heath system. Thus, it was financially advantageous for her to have the procedure in that health system by their doctor, in their hospital.

This action ignored the fact that I had a long-standing clinical relationship with the patient and many of her family members. More importantly, it disregarded the patient’s request that I remain her cardiologist.


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