That’s about the size of it as today you have to look at the massive IT sides of business and if you don’t give that some thought, well you might be living under a rock as that’s pretty much what banks and insurance companies are today, huge software companies that manage a lot of money as well as your access to it.  We all know too that regulators have to approve not only this merger but Also the one with Aetna and Humana.  For years insurers have made money making things complex out there as that means profit and I’m not the first and won’t be the last to make that statement.

Designing business operations as well as insurance policies has changed.  I wrote a while back aboutimage the large number of “Quants” the insurance business has hired.  You could say these folks are a step above the actuaries as they work with different models and actually at some point they might even be auditing the work of an actuary.  Sometimes a Quant will use the same math model as an actuary as well, even though they may not openly admit it, but it happens.  I started noticing this years ago, especially with United Healthcare as so many of their subsidiaries are not insurance and work around the software, analytics, hearing aids, etc. that they sell, and oh yes, let’s not forget their hospice for profit subsidiary too.  If you don’t know what a Quant is or what they do, scroll on down to the footer and watch video #2, the Quant documentary and it tells about what they do in banking and just relate that to health insurance as what we get are financial models that have been somewhat modified to use in the health insurance business. 

Data Scientists/Quants in the Health Insurance Business–Modeling Beyond the Speed and Capabilities of Humans To Keep Up With The Affordable Care Act–Turning Into A World of Killer Algorithms That We All Hate..

The numbers, of course the real benefits of these mass mergers today as otherwise, they wouldn’t bother as it’s big IT mess and will require spending a lot of money with adding new software, analytics, etc. as well as getting rid of some.  In addition with subsidiary companies, it allows them to sell more of our personal data as well. Health insurers do that, again not right out with the arm that is insuring you, but rather a subsidiary imagethat contains a lot of “scores” about you, and in turn, they buy a lot of this data as well.  A while back I commented about this as I saw this coming for a few years…

Health Insurance Business Is Driving Itself Off a Cliff & Doesn’t Know When to Stop With Collecting, Analyzing and Processing Non Relevant Data With Little Or No Impact On Giving Good Care..

We all complain a lot about inaccurate MD “in network” listings, well that will get worse and I do have to somewhat chuckle a bit at the digital illiterates that get up and demand insurers provide accurate listings.  Think about it, don’t you think they would be doing that if they could?  Of course they would be they are buried in lake of data that involve constant change, again thank the Quants that model the profits and tie in stock prices daily, they have their fingers on this pulse all the time and shift the numbers and the models around to keep the profits rolling.  I think even Wall Street is wise to this as the insurance stocks went down on this announcement as well.  Wall Street works the same way with analyzing business models for investing.  In California, doctors can’t even keep up with Anthem on reimbursement policies.  It was less than 90 days from the last update when they rolled out yet another policy change.  Who can keep functioning like this and keep providing good medical care forever?  It’s a big part of the reason doctors are retiring and that the drop out rates in medical school are growing. 

Anthem Issues Yet Another Change to Physician Reimbursement Policies Less Than 90 Days After the Last Change–Here’s A Look at the Other Side of ICD 10 Complexities-Aetna Just Fired Some MDs Over This E/M Services Costing Factor

Well maybe by now you could be getting the picture here.  The only benefit that could occur is having a larger group to spread the expense over and when you talk about that, well now you are getting closer to looking at a single payer again.  This has been something I think United Healthcare has been positioning themselves for, if you look at the very close relationship they have had and currently have with HHS and CMS.  Those two agencies have depended for years on United Healthcare “mentored” business models and still do.  Where do you think population health came from?  I saw the beginnings of that years ago with brochures in doctors offices.  Like anything else with analytics, how far will they take it and invade privacy is a big question.  Using registries to get information is a good thing but with all the algorithmic formulas and proprietary code that United runs for profit, you can’t trust everything they put out by all means. 

While this is billed to create the largest insurance company,  it’s kind of a joke as United is much larger when you bring in all their entities that are not in the insurance business, everything from a bank to low income housing now and now they want to be in the urgent care business too.  So don’t just look at health insurers as that being their only business, as it’s not and you are fooling yourself if you do.  Actually I think Marylyn Tavenner is the CEO over at the big insurance lobby group right now that United left to further some of the efforts to make this a little bit more fair out there over at HHS and CMS with other insurers having a voice without United controlling everything.

Marylyn Tavenner Takes Over CEO Job of AHIP, Major Health Insurance Lobby Group in DC And United Healthcare Dropped Out a Few Weeks Ago…

So again, what do you as a consumer get out of this merger, pretty much nothing other than having to learn how to click on more websites and study what the new algorithms put out there for you to analyze so you can get some healthcare.  Again there may be the need to spread the cost over a larger group here and of course there’s the subsidies from the government in here too with Obamacare that have an impact.  So again, consumers benefit here?  Not a chance and there will be new algorithms rolled out and more work for you to just get some healthcare when you need it. 

Insurance companies are functioning pretty much like bank financial models and there’s a lot of flawed data out there and trickery you could call it as we are seeing this a lot today.  As a consumer you have to be aware of the constant changes and with Quant Modeled polices and business models, they are using tools and analytic way above and beyond the comprehension of the average consumer today, so the financially the battle is rigged, as well as some of the news you read today about such mergers, so be a skeptic when you need to be and try and swim as best you can in the world of “Algorithmic Health Insurance for Profit”…as I can’t think of any other way to describe what’s going on out there.  Check out the videos at the Killer Algorithms page to learn how this works as folks a lot smarter than me have taken time to create some good material that will give you a real good idea on how the math models and algorithms all work today and impact what care you do and don’t get.  BD 


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