Quants of Optum Carve Out New Outsourced Billing Deal with Quest Labs, Will Also Serve to Enhance The Scoring & Data Selling Business Conducted by Both Companies via Powerful Subsidiaries

<p>If you don’t know what a Quant is, take time out and watch video #2 in the footer of this blog as they are not just limited to working at financial firms.  As a matter of fact, hedge funds and banks can’t hire enough of the and the same holds true for insurers and other healthcare entities.  These are the math wizards today that are working without a net of any “proof of concept” any more and are just tossing a lot of models out there to see if they stick.  I know that’s a crummy way of putting it, but that’s the reality of folks being soaked on models and numbers<a href="https://lh3.googleusercontent.com/-QO1huLc4Ves/V92AEN8UY9I/AAAAAAABM0E/wF13WZgVGJU/s1600-h/image%25255B15%25255D.png"><img align="right" alt="image" border="0" height="78" src="https://lh3.googleusercontent.com/-CtZcwaQXId4/V92AE7cCDcI/AAAAAAABM0I/5rN3NG1tJRI/image_thumb%25255B9%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="244"></a> they don’t question, it’s the Dupes of Hazard society that exists everywhere today.  What the Quant do well, is to use math to create profits, no matter if it hurts individuals or not.  Look at what was recently done at Wells Fargo with the low level employees, as they didn’t just decide to sell fake accounts on their own, there was a pay for performance model created by quants with a number of carrots and probably some sticks attached.</p> <p>If you have not heard of the Optum 360 subsidiary, the link below will explain how it works and how the subsidiary solicits hospitals and other healthcare entities (now Quest Labs) to hand over their billing, also know as revenue cycling with the big hopes of saving money and collecting more money.  Employees are usually let go by the healthcare entity and rehired as an Optum 360 employee with maybe less pay and worse benefits.  I read some of the reviews from Dignity Hospital reviews on GlassDoor and they said the benefits were a lot worse once they came under the Optum umbrella.  You could almost say it’s an internal US H1B process as the pay and benefit results seem to follow the same pattern.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/04/mayo-clinic-is-latest-to-outsource.html">Mayo Clinic is the Latest to Outsource Revenue Cycling to Optum 360, A United Healthcare/Dignity Health Company Pursuing Hospital Contracts All Over the US For Profit…</a></h5> <p>The real deal here of course is the access to all the data as the data miners and sellers of the healthcare industry will take the data, score you and put the data into other “new” data bases and turn around and sell it.  This process is called repackaging and when this occurs, most of the time as consumers we have no idea where it goes or who originated the data.  As long as prescription data is not taken from a HIPAA covered entity such as a medical record, it’s out there for sale to who ever has the money.  Quest is also promoting their own “outsourcing” program with hospitals and <a href="www.prnewswire.com/news-releases/quest-diagnostics-completes-acquisition-of-clinical-laboratory-partners-outreach-laboratory-service-business-in-connecticut-300227605.html">just bought another hospital lab service,</a> so that makes about 5 or more they have bought.  20-30% of the services performed for hospitals with this service end up going to their own Quest diagnostic centers to be worked.  </p> <p>Subsidiaries of companies are something I have told all for years to pay attention to as that’s where all the data work is done and<a href="https://lh3.googleusercontent.com/-sUPaYPmhyqY/V92AFd84B4I/AAAAAAABM0M/LqEegYGImOk/s1600-h/image%25255B4%25255D.png"><img align="right" alt="image" border="0" height="138" src="https://lh3.googleusercontent.com/-DCiT1MZO3zc/V92AF8wyKTI/AAAAAAABM0Q/WM0FsT80Jtc/image_thumb%25255B2%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="288"></a> computer code is written to create big profits with running proprietary code that nobody ever gets to see or audit for accuracy.  </p> <p>ScriptCheck, offered by ExamOne, a subsidiary of Quest Diagnostics is a big data mining firm, and so how many were not aware that Quest has been in the data mining and selling business for years?  Anyone buying a life insurance policy could very well be investigated and a full data pull created to get information for underwriting.  Sure we know some of this is necessary, but when do they cross the line?  Any more it’s all the time as the data gets repackaged and resold with data mining.  They take the list of meds and try to “guess” what medical conditions you have or “might” get.  That’s the scary part is the “might” or what is abused today and openly called predictive analytics.  In this <a href="http://articles.latimes.com/2013/oct/21/business/la-fi-lazarus-20131022">article written in 2013, David Lazarius</a> does a pretty job with explaining how this works.  <p><strong>There is an update though as ExamOne bought a bunch of Ingenix (now called Optum Insights) algorithms in 2014</strong>.  We maybe all know that the former Ingenix subsidiary of United Healthcare is where current acting CMS administrator Andy Slavitt called home for a number of years and was taken to court over cheating on out of nextwork payment for MDs by using formulas beyond comprehension of most to inflate United Healthcare profits. <strong> I call it “Code Hosing”</strong> when I see this occur as you and I as a consumer have no access to either the math or the models used to create these profit centers and it ends up being a bunch of <a href="http://ducknetweb.blogspot.com/2016/05/the-rise-of-quants-again-this-time-in.html">quantitated madness due to the fact that people are afraid to contest any form of math,</a> good math or bad math. <p><a href="https://www.linkedin.com/pulse/20141027182707-39299902-examone-acquires-assets-from-optuminsight?forceNoSplash=true">Heres a few clips that tell you all about Quest Diagnostics ExamOne service</a> and their purchase of the Ingenix MedPoint (OptumInsights) Algorithms in 2014 and what ScriptCheck is all about.    <p><em>“LENEXA, KS, October 27, 2014 / -- ExamOne, a Quest Diagnostics company and leader in helping insurers meet their underwriting needs, is pleased to announce the acquisition of certain proprietary assets from OptumInsight that support the ability to provide rapid responses to data inquiries for use in life and health risk assessments. The acquired assets will streamline and improve the ScriptCheck® service offered through ExamOne.”</em> <p><em>Along with ExamOne’s expansive suite of insurance services (also known as Policy Express) the acquired technology is designed to accelerate the underwriting process, improve risk assessment, assess the accuracy of health statements and discover undisclosed doctors<img align="right" border="0" src="http://lh5.ggpht.com/_v3zjJigoAPE/SkL9GOgy_rI/AAAAAAAATec/4yxb2jf7CV8/image_thumb%5B5%5D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px"> or medical conditions for underwriters.</em> <p><em><strong>About ExamOne</strong><br>ExamOne has provided a portfolio of services to the insurance industry since 1972. It has grown significantly through continuous innovation that meets the evolving needs of life, health and disability insurance providers and their customers. Laboratory testing was part of the company’s original services, which over time have expanded to include paramedical examinations, fraud detection, electronic data collection, and gathering attending physician statements and motor vehicle records. ExamOne also has expanded into helping individuals learn about their own health through its Inside Look™ product.</em></p> <p>Part of the real scary part about this agreement is that now Optum also will be able to get any biometric screenings provided by Quest as well.  We have all seen the nighmare Orwelian companies like Red Brick (which was started by a one time United Healthcare young exec) that are into<a href="https://lh3.googleusercontent.com/-DRG5tPihlZE/V92AGSOr7MI/AAAAAAABM0U/O5NN6zkMnyk/s1600-h/EQUIPP%25255B5%25255D.png"><img align="right" alt="EQUIPP" border="0" height="457" src="https://lh3.googleusercontent.com/-rKZvRY4yzrk/V92AG2s461I/AAAAAAABM0Y/Rc7GljKudEM/EQUIPP_thumb%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="EQUIPP" width="449"></a> monitoring every move we make and this looks like an open loop hole here for United Heatlhcare/Optum to get that data, what else can you say?  There’s nobody in their right mind that wants their insurance company to have all types of data and information that the insurer could easily miscontrue and take out of context to avoid paying a claim!  That’s what this does.  Actually it’s not just Quest and United Healthcare/Optum deal alone, we have a huge problem of “Excess Scoring” in the US taking place with consumer using flawed data, queries and proprietary code to where we do not have the ability to even correct it.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/09/excess-scoring-of-us-consumers-us.html">Excess Scoring of US Consumers, US Citizens-Scored into Oblivion By Proprietary Algorithms and Formulas, Never Duplicated or Tested for Accuracy-Profits of Big Business And A White House Executive Command To Continue the Abuse..</a></h5> <p>If you get a chance to talk candidly to pharmacists today, they’ll tell you all about what’s going on and how you are “scored” with every prescription you fill too.  There’s this EQUIPP program out there that tells them what to do and how to dig in and find outliers, some of which are diabetics who are not on statins.  The pharmacists who are forced to work this EQUIPP program model have to find their “outliers” or they could end up like the employees at Wells Fargo and be be out of a job if they don’t play the game.  In the drug industry, they couldn’t get doctors to push statins and other monitoring flawed data programs, so now the boom is lowered on your retail pharmacists who need their jobs.  Click on the image at the right and see what I’m talking about.  <h5><a href="http://ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-enter.html">Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy</a></h5> <p>So my guess here is that with United Healthcare/Optum having this new additional data of labs to query into the prescriptions, your lab tech could very well be the next person out there suggesting not only monitoring but also in a round about way, pushing more drugs.  <p><strong>This really even gets more interesting with the Quants of Optum and their models for profit as United Healthcare has a contract with LabCorp as their exclusive Lab and has had that contract since 2007.</strong>  Optum and United Healthcare already get all that lab<a href="https://lh3.googleusercontent.com/-k-dnOpmw8Ow/V92AHa6pxII/AAAAAAABM0c/SxBgk_dHybQ/s1600-h/image%25255B19%25255D.png"><img align="right" alt="image" border="0" height="101" src="https://lh3.googleusercontent.com/-W_L3qRa38CQ/V92AH4GFwtI/AAAAAAABM0g/qfsi9ppy29s/image_thumb%25255B11%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="187"></a> information from LabCorp and the contract continues until 2018, so that’s what makes this Quest deal interesting and data rich with data selling.  If patients all over the country are already being directed to LabCorp facilities, how would Optum get a chunk of this money?  I suppose the answer is what just happened with the Optum 360 subsidiary now getting do most all of the billing for Quest Diagnositcs, right?  <p><strong>Talk about quants working over time working both models of each lab to increase revenue, right?</strong>  Again watch video #2 in the footer and learn what a quant does as we have that same mentality running CMS with Andy Slavitt being both a former McKinsey consultant and a Goldman banker running everything.  All he is concerned about is numbers as he’s just an Algo Man who cares little about anything else.  Follow him on Twitter and it’s not hard to see at all. <h5><a href="http://ducknetweb.blogspot.com/2016/05/the-rise-of-quants-again-this-time-in.html">The Rise of the Quants, Again! This Time In US Healthcare- Taming the MACRA Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not True</a></h5> <p>So what happens when you get a lab test done?  Depending on the result of course, you might get a prescription for a drug, we all know that by now (grin), so look at how this data mining is working today.  With Optum having all the lab information will this have a tendency to push more drugs, and the drugs that are covered by pharmacy benefit managers that make the most profit for them?  It is not far fetched in my book <a href="https://lh3.googleusercontent.com/-XgfibL-ArlQ/V92AIYYGhaI/AAAAAAABM0k/HXiYtXMIqGc/s1600-h/image%25255B9%25255D.png"><img align="right" alt="image" border="0" height="194" src="https://lh3.googleusercontent.com/-suvBkbofYL0/V92AI4FEAxI/AAAAAAABM0o/4R765Soth94/image_thumb%25255B5%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="265"></a>at all as I used to work with data, wrote software and it’s how the mentality works.  If you haven’t noticed by the way, the OptumRX is the largest revenue stream that United Healthcare has now, larger than each of their insurance groups when compared.  </p> <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p>So this is adding yet another element of behaviorial scoring and data mining for profit if you will and we’re not getting any breaks on cost.  As a matter of fact, this is a good link to look at that explains the coupons and discount cards at the pharmacy, as they tell you how it works. </p> <h5><a href="http://ducknetweb.blogspot.com/2016/06/the-truth-about-pharmacy-benefit.html">The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!</a></h5> <p>Again, look at the subsidiaries of these big corporations and what are doing with data for your answers as it’s all there as the<strong> quants in healthcare keep modeling away to attain the best models for profit,</strong> not necessarily for better care, Moneyball as Optum calls it, which really only works well for baseball where everyone knows the rules, but with healthcare the rules change every day.  BD <p> <hr> UnitedHealth Group Inc.’s Optum health-services arm has struck a deal to oversee billing processes for lab giant Quest Diagnostics Inc., substantially expanding its growing business of handling such transactions for health-care companies. Under the 10-year pact, Optum will take over a number of key revenue-related services for Quest, including billing health insurers and consumers, and collecting and processing payments from both. About 2.400 employees who did such work for Quest will become Optum employees, but they will generally remain physically in their current locations.</p> <p><a href="http://www.wsj.com/articles/unitedhealths-optum-unit-to-oversee-quest-diagnostics-billing-processes-1473760800" title="http://www.wsj.com/articles/unitedhealths-optum-unit-to-oversee-quest-diagnostics-billing-processes-1473760800">http://www.wsj.com/articles/unitedhealths-optum-unit-to-oversee-quest-diagnostics-billing-processes-1473760800</a></p>

Quants of Optum Carve Out New Outsourced Billing Deal with Quest Labs, Will Also Serve to Enhance The Scoring & Data Selling Business Conducted by Both Companies via Powerful Subsidiaries

If you don’t know what a Quant is, take time out and watch video #2 in the footer of this blog as they are not just limited to working at fi...

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“Sully”, The Government’s Flawed Algorithms and Simulations Were Wrong, What Doctors Can Learn From Pilots…

<p>I had to include the bit about the comparison here about doctors and pilots as this correlation over the years has been used so many times and some very strange writings as doctor are not pilots, but some folks seem to think the two are more similar than they really are.  What is similar is how they are “scored” by algorithms though, which are proprietary for the most part and nobody gets to see the magic black box formulas.  Aviation though does have one advantage though as they do have a real “black box” that does record data and the conversations and actions of pilots.  They try to do something like this in healthcare, but it doesn’t work as pilots are dealing with an object, which is a jet, but doctors are dealing with humans, a person, not a jet.</p> <p>As a matter of fact the only real correlation between doctors and pilots was revealed a few years ago where a <a href="https://lh3.googleusercontent.com/-yUVXdZ6cAzo/V9WFyFxYJoI/AAAAAAABMzk/3tCAymVzC10/s1600-h/Sully%25255B3%25255D.png"><img align="right" alt="Sully" border="0" height="309" src="https://lh3.googleusercontent.com/-uDmgPHpT3-Y/V9WFy30eB3I/AAAAAAABMzo/o3sQqr9C6VQ/Sully_thumb%25255B1%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="Sully" width="205"></a>former United Airlines pilot duped even the AMA on the fact that he was a cardiologist and even had to <a href="http://retractionwatch.com/2011/04/13/remember-william-hamman-the-pilot-who-claimed-to-be-a-cardiologist-a-retraction-appears/">retract several papers he had written.</a>  William Hamman was a pilot for United Airlines who had started in med school years ago but never finished.  After he was exposed, <a href="http://abcnews.go.com/Health/MindMoodNews/fake-cardiologist-william-hamman-duped-real-doctors/story?id=12395288">his pilot job at United</a> soon disappeared.  So in my opinion only, this is really the correlation between doctors and pilots I ever found (grin).</p> <h5><a href="http://ducknetweb.blogspot.com/2014/02/what-can-healthcare-learn-from-aviation.html">What Can Healthcare Learn From Aviation? Watch Your Models As The Virtual World Can Be Far Different From the Real World When It Comes to Designing And Implementing Software & Hardware</a></h5> <p>I went to see the move “Sully” yesterday and that is the screaming value that I walked away with, <strong>don’t let flawed data and bad algorithms (flawed) produce inaccurate information that makes you begin to question who you are</strong> and use data to turn an individual who is hero into a zero.  The NTSB with their algorithms had it all wrong.  If you have read my blog for any amount of time, I preach this all the time on how folks get too wrapped up in stats and numbers and forget the “human” element and that’s what this move was all about.  Sure algorithms can be good as well and its more in the fact about how we use them for knowledge, and not about scoring people into data oblivion with flawed data and assumptions from Quants and Data Scientists who “think” they have the ultimate answers, especially in the area of predictive analytics.  </p> <p>Due to a lot of the over hype of the power of algorithms and how they are marketed, we have a real problem today in the fact that people can’t seem to tell the difference anymore on what’s a “real world” value and what’s a “virtual world” value.  I wrote about that initially in 2013 and it seems to be getting worse all the time, and so far I have not read any news stories of folks looking for Pokemon on a commercial airliner yet, but I have this feeling that the “dupes” who confuse both values will show up there soon as they have appeared everywhere else such as hospitals and police departments (grin). If you follow me on Twitter at all, I have a special name for this scenario, “The Dupes of Hazard Society”.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/virtual-world-values-and-real-world-we.html">Virtual World Values and The Real World, We Have A Big Problem: People Can’t Tell the Difference Anymore as Perceptual Madness Grows to Further Accelerate Inequality…</a></h5> <p>In the course of my life I have happened to run across and meet a couple other pilots who were in these types of life and death situations and there’s not a lot of time and in both of those instances, it too was the human element that saved the day, just like Sully did.  As a matter of fact, there is an airmanship award given every year by the Fraternal Order of Daedalians for the act of heroism by a commercial airline pilot. After seeing the movie and how the NTSB was stuck on their algorithms to turn the tide into discounting Sully, I feel he was left out of the award given in 2009.  <a href="http://www.daedalians.org/awards/george.htm">You can read about the award here</a> and see how no award was given in 2009.  Here’s a clip from the page that tells what the award is.  There are a number of awards and it’s mostly for the military but this is one award given to commercial airline crews.  If you look and see, in 2009, there’s no award for Sully on the Hudson river.  In 1998 you can see the award for <a href="http://www.memphisflyer.com/memphis/bruce-harris/Profile?oid=3704124">Bruce Harris from Delta,</a> who also “sucked in birds” and was able to save the day and all the passengers.  </p> <p><em><strong>“Lieutenant General Harold L. George Civilian Airmanship Award: A Daedalian trophy and award presented annually to the pilot, copilot and/or crew of a United States certified commercial airline selected by a Federal Aviation committee to have demonstrated ability, judgment and/or heroism above and beyond normal operational requirements. (First awarded in 1956.)”</strong></em></p> <p>Back on course, I couldn’t help  but notice how the movie created a “personal struggle” with Sully in the fact that after a while, you do have a tendency to doubt yourself and we all do it, so there’s nothing new about that, but when you have forces such at the NTSB pushing the envelope with flawed data and simulations, anyone would start to wonder if there was anything that could have been done differently.  The item they forgot which was brought out in the movie is the fact that this as a life or death panic situation and the flipping algorithms after the fact to try to show that the judgement on the part of Sully was purely wrong.  Sure continue the investigation to get to the truth, but to try and take away the heroism shown with this type of decision that had to be made with very little notice and the lives of 155 passengers, was obscene.  <strong>It’s like being in the “panic room” with a lot of company, the passengers.</strong>  </p> <p>Perceptions are a big part of our world and I liked the fact that the movie did address what I call Perception-Deception with the NTSB and their attitudes with their simulation algorithms.  I see this all the time where the Dupes of Hazard will fight with some math formulas and algorithms to death to defend their numbers which are usually based in an idea or thought that has no proof of concept.  Ok so now I get the chance to be tacky and take a dig as I see this every day with Andy Slavitt who runs Medicare in this country.  Everything he authors, talks about, etc. is all about numbers and he never goes to human side and we end up with a bunch of Quant models running healthcare with flawed data and methodologies.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/operation-perception-deception-into.html">Operation “perception-Deception” Into Full Swing in the US, With Killer Algorithms, Algo Fairies, Algo Duping, The Grays, and Of Course, Flags As Consumers Confuse Virtual World Values With the Real World…</a></h5> <p><strong>Indeed in the movie, Sully too had a bunch of “quantiated madness” and faulty simulations to deal with as well.</strong>  Doctors every day are getting ripped with flawed data and algorithms and scored into oblivion with things that are just not true as well.  You can read more about this at the link below at the quantitated madness dished out to their occupations by folks who bow to the all mighty algorithms without looking at the human side of care.</p> <h5><strong><a href="http://ducknetweb.blogspot.com/2016/05/the-rise-of-quants-again-this-time-in.html">The Rise of the Quants, Again! This Time In US Healthcare- Taming the MACRA Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not True</a></strong></h5> <p>So, sure Sully gets offered mental health counseling after the incident, and not being there, we have no <img align="right" src="http://lh3.ggpht.com/-6HDDm04lOwA/Ts0zq-EuFHI/AAAAAAAA4d8/nMT-KL0JEDY/image_thumb%25255B12%25255D.png?imgmax=172" style="float: right; display: inline">clue on what it could have entailed but again one could ask would such behavioral analytics serve a purpose to make one doubt themselves even further?  It could if the therapie were tweaked the wrong way.</p> <p><strong>Turns out I’m not the only one who writes about this topic</strong>.  I’ve writing about what I call <strong><a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">“The Attack of the Killer Algorithms”</a></strong> for a number of years.  I saw it come to surface with the Occupy Movement as that was a cause without a cause you could say as the perception of the general public seemed to view it.  Deep down it was not without a cause, but they couldn’t find the focus and that’s because it was hidden in proprietary algorithms they couldn’t see, talk or relate too, but they knew something was wrong and that was sufficient to make a statement.  There’s a new book out by <a href="https://mathbabe.org/">Cathy O’Neil, a former Wall Street Quant</a> during the financial crisis that’s worth a read.  I have to be honest and say I have not read the full book yet, although I feel like I almost have as I have read her blog for years on the same topic, the dark side of big data that she covers.  I try to group together other like minds on the Killer Algorithms page of videos and links to help folks understand what’s going on out there.  For a preview of such, just scroll on down to the footer here and watch the 4 videos.  </p> <p><strong>“Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy”</strong> is the name of the new book and you can <a href="https://www.amazon.com/Weapons-Math-Destruction-Increases-Inequality/dp/0553418815/ref=cm_cr_arp_d_product_top?ie=UTF8">link here to Amazon</a> to find out more about it.  The book has been longer over due and she tells you how this insideous insidious “scoring” systems of algorithms works.  There’s some good examples on how teachers are “scored” and what happens to them when subjected to flawed data and flawed methodologies of “scoring”. <a href="https://lh3.googleusercontent.com/-1T-X0vt3giE/V9WFzQijODI/AAAAAAABMzs/yZI7oAgqSOg/s1600-h/image%25255B4%25255D.png"><img align="right" alt="image" border="0" height="193" src="https://lh3.googleusercontent.com/-KJ672vOBiEw/V9WFz-Y0qlI/AAAAAAABMzw/Tpnl68wFr3o/image_thumb%25255B2%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="133"></a> She’s a lot smarter than me and I used to develop software so I know as well as anyone does who writes or has written code on how dishonestly for profit can live in proprietary computer code.  </p> <p><strong>Cathy takes you to the next level up which are the mathematical models that are created before the computer code is created to automate “scoring” processes.</strong>  A model is written first and then comes the code that you can’t see, hear or touch.  It’s just there, gathering all kinds of data about you from God knows where and “scoring” you into some value system.  In her words, Cathy states we are all members of a cult without knowing we’re in one and that’s pretty much how it is.  To understand how this works, watch video #2 in the footer as the Quant documentary does a pretty good job for the layman to understand the basis of how these complicated formulas work.  <strong>In the words of Bill Gates “software is just a bunch of algorithms working together”.</strong>  </p> <p>As people we can’t be bias or are not supposed to to be, <strong>but what happens when the algorithms (that are created by humans) are bias?</strong>  Nobody’s doing anything about the <strong>“Code Hosing”</strong> that is taking place out there.  Again if you follow me on Twitter, I call <strong>it Code Hosing as that’s what it is, people being hosed with computer code they know nothing about other than how they are marketed to “trust it”.</strong>  People like Cathy have been urging the release of some of this proprietary “scoring” algorithms and code so we can see what makes it work, as how else can you validate models and code?  Want to see how you get scored every time you fill a prescription, something that all of us do?  Read the link below and see how these bias algorithms use all kinds of non scientific metrics to “score” you.  Pharmacy benefit managers get away with this garbage and soon the score may block you from access to some expensive drugs too.  This too is secret and you have no access to the score of methodology used to give you a prediction grade.</p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-enter.html">Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy</a></h5> <p>If you watch the Quant documentary in the footer, <strong>Mike Osinski who wrote the software for the mortgage scams</strong> that took place and crashed the economy, he’s has some real words of wisdom for his part.  He wrote the software the banks used and states is was never meant to be used the way it was to refinance loans.  His best quote from the video is <strong>“with software you can do something about anything, create all kinds of virtual worlds to function in, but what really matters is what happens in the real world”.</strong>  That’s a fact as again as I mentioned above people get involved in chasing all types of virtual values and forget about the “real” world and God knows he saw it first hand.  I like the part where he coudn’t even sleep at night for all the bankers and financial folks wanting more code and as he said “you have to right, you can’t be wrong”.  What those words really meant though during that time was<strong> “you have to be right and shove the money to the direction of the banks”.  </strong></p> <p><strong>Virtual worlds impact and affect all of us</strong>.  I like to use the world of <strong>Volkswagon who cheated with their computer code</strong> as a damning example as everyone knows about it by now that they cheated with their proprietary computer code.  Stop and think about this as the company created a perfect little “virtual” world of cars that did not pollute; however, in the real world they did pollute, so be a <a href="http://ducknetweb.blogspot.com/2013/10/on-being-data-skeptic-modelers-have.html">skeptic when you need to be.</a>  Sometimes the only way get “get on” to the cheaters is when we notice the output of the algorithms not putting out results that can be trusted.  The link below is also another of Cathy’s publications that is worth a read as well from a few years ago. </p> <h5><a href="http://ducknetweb.blogspot.com/2013/10/on-being-data-skeptic-modelers-have.html">“On Being a Data skeptic- Modelers Have A Bigger Responsibility Now Than Ever Before”–A Must Read Essay, Start “Sniffing the Data”…</a></h5> <p>Charlie Siefe, NYU, in video #1 in the footer also tells you about the Code Hosing taking place today and how we all take in numbers that are tossed at us with nobody questioning what is written, context is everything indeed.   It’s interesting as his talk is a Google’s NY headquarters telling their employees how they get duped.  Big people with money and somewhat good intentions get duped.<strong>  We all remember how Bloomberg and Frieden who now runs CDS were duped on Big Gulp.  I</strong>t was just another model created that was supposed to change behavior on what size of soft drinks people could buy and it failed miserably.  I’m sure both of them would maybe like to erase this chapter in their lives of the <strong>Big Gulp Dupe</strong>, as it was so much in the news as well as it’s failure.  They sucked in flawed data and a big failed model.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/11/how-many-more-bloomberg-big-gulp-failed.html">How Many More “Bloomberg Big Gulp” Failed “Proof of Concept” Models Can We Sustain Before Everyone Splits a Gasket?</a></h5> <p><strong>Bottom line is that all of us as citizens in the US are “scored” into oblivion</strong> and why even get out of bed every day (satire) as <strong>we have these huge, heavy ball and chains of what are called “risk assessments” that are tied to our ankles</strong>.  We get tired of walking around with that excess weight, which is exactly what it is.  Shoot we are so risk assessed that one wonders so any of us have the right to walk around this earth as we are a risk to everything!  Sure there is legit scoring and qualifications that need to exist and those models are not going anywhere soon but we’ve taken “scoring” to a new limit to where nobody has much worth except the algorithms and those who worship those virtual values!  This not how the world is supposed to work.  </p> <h5><a href="http://ducknetweb.blogspot.ca/2015/09/excess-scoring-of-us-consumers-us.html">Excess Scoring of US Consumers, US Citizens-Scored into Oblivion By Proprietary Algorithms and Formulas, Never Duplicated or Tested for Accuracy-Profits of Big Business And A White House Executive Command To Continue the Abuse</a></h5> <p>Anway, back on course here with <strong>Sully, my big take from this movie is the fact that it did put “scoring”, flawed data, and bad models flat in your face</strong> on how we are looking at value today and the NTS<strong>B was worshipping the Holy ground of some flipping algorithms </strong>and tried to denounce a real hero named Sully.  </p> <p>All algorithms are not bad and they do help us with knowledge and better managment and skills, <strong>but somewhere along the line we got off course and are somehow bowing down to the all mighty algorithms and functioning in virtual worlds instead of the real world</strong>.  Give that some thought next time before you go hook line and sinker into a set of numbers, statistics or scores that are presented to you, before you give the numbers more credit than deserved. BD</p> <p>Just for good measure, here’s a few related posts from the archives here…</p> <h5><a href="http://ducknetweb.blogspot.com/2014/01/movie-her-good-example-on-how-folks.html">Movie “HER”– Good Example On How Folks Can’t Separate And/Or Unite The Virtual With The Real World, Billionaires Are Made Out of Those Who Know How to Keep These Areas “Gray” With Creating and Maintaining The Addictive Code That Does It…</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2014/06/virtual-unreality-maybe-good-read-after.html">“Virtual Unreality” - Maybe A Good Read After the Fake Facebook “Science” Report To Help You Figure Out What’s A Virtual Value and What’s A Real Value Out There</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2016/01/silicon-valley-is-at-it-again-confusing.html">Silicon Valley Is At It Again Confusing the Public With Calling Risk Assessments a Form of A Diagnosis Tool…</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2015/10/citizen-score-in-china-huge-warning-for.html">“Citizen Score” in China, A Huge Warning For America About the Loss of Privacy, Lifestyle and Personal Worth As Noted by the ACLU With This Orwellian Nightmare</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2015/05/the-great-math-mysterysoftware.html">“The Great Math Mystery”–Software Engineering-Looking for Where It Does and Doesn’t Work-The Physics Connection…</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2014/06/when-models-are-too-complex-with-too.html">When The Models Are Too Complex With Too Many Bits of Data-Sometimes Quants, Data Scientists Just Guess and Assign a Number Value And “That’s Not Science At All “</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2014/03/obamacare-one-big-attack-of-killer.html">Obamacare - One Big “Attack of the Killer Algorithms” No Matter Which Direction You Turn, Compounded With a Lot of Government and Consumer “Algo Duping”….</a></h5>

“Sully”, The Government’s Flawed Algorithms and Simulations Were Wrong, What Doctors Can Learn From Pilots…

I had to include the bit about the comparison here about doctors and pilots as this correlation over the years has been used so many times a...

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ICD-10 Conversion Allows Insurance Companies and Pharmacy Benefit Managers the Ability to Push More Drugs and Make Bigger Profits-The Illusion of Better Care Didn’t Happen-Cat Is Out of the Bag

<p>Everyone now has made the big change to convert from ICD9 to ICD10 Coding for medical billing.  When all of this was taking place, many said it would really not improve care and so far, that’s what we have seen.  The big coding change has not any impact in the “real” world; however when it comes to the “virtual” world the impact has been pretty big for analytics with insurance claim data.  It was an effort to where doctors and hospitals had to change their billing codes to add thousands of more specific codes.  Sure we all laughed at some of the codes and what they represented and some that would rarely be used if at all.</p> <p>The big sleeping monster on all of this is the use in behavior monitoring with all patients.  When fee for service items are billed by doctors and hospitals, this is the first code that is used to determine a diagnosis.  The second code is the CPT code which determines what the line item payment will be.  The two work together and the US is the only country that has this massive correction between the two for medical<a href="https://lh3.googleusercontent.com/-tWBotw6Xue8/V68k18unLrI/AAAAAAABMy8/j0A7lc_9qDE/s1600-h/image%25255B7%25255D.png"><img align="right" alt="image" border="0" height="143" src="https://lh3.googleusercontent.com/-KbTmiuOWJSM/V68k2kRMBdI/AAAAAAABMzA/W2ZsaJMws7E/image_thumb%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="240"></a> providers to get paid.  Sure in other countries is may be observed, but in the US, the coding is literally taken to heart everywhere as this is a linear function that doesn’t include the fact that with each patient you have variables, as no two people are the same, so it’s a bit of what I call Quantitated Madness.</p> <p>Most people have not a clue on how this works, but insurance companies are using “machine” learning technologies to further this linear process, which does become flawed as we do have “variables” with every patient.  Now when you visit your doctor and they submit a claim, those claims are being analyzed against machine learning technologies, which I prefer to call “trending” as that’s a much less concerting term if you will.  Sure we all learn and gain knowledge by following trends and patterns, but now it’s gone over the top and flawed data is being kicked out to your providers all the time, and in essence it is being used as a platform to push drugs.  </p> <p>Now insurers with their doldrums of “risk” assessing that doesn’t stop, doctors are being graded with these ICD10 numbers included on the claim.  If a doctor states that diabetes may not be managed perfectly by the patient with an ICD10 code, they get notes back from the insurance company about “compliance” with analytics that may not be true.  In other words, the information that is coming back to them is that they are missing an opportunity to prescribe more drugs, and of course all of this goes into the “magic” formulas they use to “score” our doctors today.  If you ever wonder why your doctor is in network today and then gone tomorrow, this analytical scoring of doctors from how they code a medical bill is part of the story.  I wrote about that a while back, “The Secret Scoring of America’s Doctors”.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/the-secret-scoring-of-americas.html">“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..</a></h5> <p>Ok, so you visit your doctor, discuss any chronic conditions and items you need to talk about related to better healthcare.  In order for the doctor or hospital to get paid for that service, they bill this information via an ICD10 code that describes the purpose of your visit.<a href="https://lh3.googleusercontent.com/-UUB5Z8eGbQY/V68k3d_DoyI/AAAAAAABMzE/fbJdGdO2TEM/s1600-h/image%25255B3%25255D.png"><img align="right" alt="image" border="0" height="142" src="https://lh3.googleusercontent.com/-fgOPxCW3l3M/V68k35A9qqI/AAAAAAABMzI/6o7nMdXN6Hg/image_thumb%25255B1%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="451"></a>  Insurance have spent billions of dollars to create system that will take this billing, analyze it and then come back with so called “opportunities” for the doctor to evaluated.  I have included a screenshot here from Dr. Wes, who was kind enough to put this on Twitter so you can see what they are bombed with by the time the insurance company does all their expensive analytic processes.  In this example, the insurer (United Healthcare) is telling the doctor that the numbers, when crunched say that the patient is not at 80% compliance on taking their medications.  Again, this can be totally false as it is all based on a code which can be totally taken out of context.  This happens a lot today, not only in healthcare but in other businesses as well and that is how we end up with all these bias analytics. <p>Pay attention is this is the type of analytics that is being created about all of us and in this example, you can see, it’s clearly promoting a pharma agenda and of course we know United Healthcare has a big interest in this as OptumRX is their number one dollar producting revenue stream, more than Medicare Part D and their two other reporting groups.  Here’s what I wrote about the United first quarter and the second quarter was the same story with where the big money was coming in for 2016. <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p>The company has clearly made a change in their operation to focus on partnering with big pharma to profit as a priority.  If you were not aware, that is how United Healthcare got started in business in the 70s as the first pharmacy benefit manager in healthcare.  They later sold the company to a drug company and used the sale profits to buy insurance companies and began as a healthcare insurance company. <img align="right" src="http://lh6.ggpht.com/-3szEXZPRIqQ/U7qv_R169gI/AAAAAAABKxc/evT7Y_hxGEc/image121.png?imgmax=800" style="float: right; display: inline"> A couple years later, Express Scripts bought the company from the pharmaceutical firm and so Express Scripts was able to get all the magical analytics code that runs today, with even more compleities added.  Outside of this blog, many times over United Healthcare has been covered by many other articles that talk about the millions or billions the company makes selling your data as well. <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p>So when you look back on this big push for ICD10 conversion, it has not done anything to provide better care for patients with doctors, but in reality added another level of complexity so you could be further “scored” and “risk assessed” by insurance and drug companies.  Again, with using linear measurement standards you end up somewhat being “scored” or “graded” on this so called curve of machine learning, which may not represent your entire health picture at all but ends up being more flawed data that doctors have to deal with and an analytics platform to push more drugs. From the consumer side, you are “scored” on what the Pharmacy Benefit Managers “predict” you adherence and compliance will be. Read the link below to find out about the 300 metrics used, that actually Express Scripts bragged about that are proprietary and hide the bias, all for the sake of creating these flawed scores relative to your behavior.</p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-enter.html">Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy</a></h5> <p>Here’s a link from the archives that tell about Express Scripts buying those “Ingenix” algorithms to score consumers on medication adherence and this was the root of it as PBMs went over the top with their “flawed prediction” software.</p> <h5><a href="http://ducknetweb.blogspot.com/2010/10/express-scripts-new-program-to-contact.html">Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On IngenixAlgorithms–We Want the Revenue Please Don’t Stop</a></h5> <p>This further graduates to the retail pharmacists who fill our prescriptions and how they are graded on their pay for performance levels on how you are predicted to take your meds.  Sure this is always a work in progress chore and pharmacists over all do a good job, and the patient may be well in compliance but they worry too about this flawed data that “scores” them.  You read the link below and watch the videos on the threatening letters they receive if they give you a cash price that is less than your insurance co-pay is.  In other words, they get penalized for helping the consumer with price if it is not what the insurance company supplies.  Why?  They can’t track the data as efficiently if you pay cash.  <h5><a href="http://ducknetweb.blogspot.com/2016/06/the-truth-about-pharmacy-benefit.html">The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!</a></h5> <p>By the way, you cannot even get this “medication adherence prediction” score that is calculated about you from your “data” behavior as it is secret.  So you have two sides of this flawed at work, from the doctor side and from the pharmacy side with insurers beating both over the head with wanting them to further control your behavior.  We all know that one person can’t control another person, but this is the perception-deception being sold out there.  Education is still the best method and to rate and grade patients on flawed data analytics is just wrong and fraudulent.  <p>So there you have it, the big ICD10 change was not to provide better care for patients and has not done one thing to improve that as you can read the news every day, we are all paying for additional flawed analytics that go nowhere except into the profits of insurers and pharmacy benefit managers with perceptions of the data taken out of context and skewed to make everyone look worse than they are.  <p>All of this analytics work with claim data about you of course is all sold and CMS Slavitt (an Algo man, former Goldman banker and McKinsey consultant) is all over it with wanting <img align="right" src="http://lh6.ggpht.com/_v3zjJigoAPE/TLZdsFwnFqI/AAAAAAAAiIY/NIhj9oaZrLo/image_thumb%5B4%5D.png?imgmax=800" style="float: right; display: inline">to sell all this claim data as well so more companies can create even more flawed analytic scores about you so more software companies can jump into the “Code Hosing” game. Read more about that at the links below.  <h5><a href="http://ducknetweb.blogspot.com/2015/06/cms-chasing-wild-virtual-horses-big.html">CMS Chasing Wild Virtual Horses-A Big Distraction on the Hope of Finding Some “Algo Fairies” By Giving Entrepreneurs Access to Medicare Claims and Other Data…Marketing & Astro Turfing “The Sebelius Syndrome”..</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2016/01/cms-medicare-proposing-more-data.html"><strong>CMS Medicare Proposing More Data Selling of Both Private and Medicare Patient Claim Data - A New Dignity And Privacy Attack on Both Consumers and Doctors</strong></a></h5> <p>So the cat is out of the bag, ICD10 was a new avenue for analytics in healthcare and does not one thing to produce better care, but was rather one more form of Health IT software that all were required by law to invest in.  So a little satire, here, why even as a consumer even get out of bed in the morning…you’re already risk assessed to the hilt!  We have no value when you look at all this nonsense and we all seem to be a risk to the world anymore.  What happens next on Infusion compliance?  As you can see insurers are buying those companies up as well.  Will each vein be risk assessed next?  There’s a ton of cronyism at the link below as well to include a discussion on Loretta Lynch as one example being a former lawyer who represented United Healthcare with anti trust lawsuits so you can see she’s in on the game or the dupe, one of the two.  BD  <h5><a href="http://ducknetweb.blogspot.com/2015/11/optumrx-united-healthcare-buys-home.html">OptumRX (United Healthcare) Buys Home Infusion Company AxelaCare-Using Algorithms To Determine Your Care With Being Financed By A “Too Big to Fail” US Health Insurance Company…</a></h5>

ICD-10 Conversion Allows Insurance Companies and Pharmacy Benefit Managers the Ability to Push More Drugs and Make Bigger Profits-The Illusion of Better Care Didn’t Happen-Cat Is Out of the Bag

Everyone now has made the big change to convert from ICD9 to ICD10 Coding for medical billing.  When all of this was taking place, many said...

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OptumCare Doctors to Get Allscripts Medical Records EHR–Optum Continues to Buy More Practices and Manage More Doctors Through Independent Physician Associations, Many of Which They Own

<p>I’m starting to see more doctors in Orange County selling out their practices to United Healthcare’s Optum subsidiary.  Sometimes when patients go for their next appointment, in addition to see their doctor’s name on the door, it also now says OptumCare.  So now it appears at minimum <a href="https://www.optumcare.com/medical/locations/ca-orange-county/ocmg-huntington-beach.html"><img align="right" alt="WP_20160509_17_31_38_Pro" border="0" height="260" src="https://lh3.googleusercontent.com/-8J7WUJZ5Rz0/V6gUnXYM1OI/AAAAAAABMyg/p3uPnTCP6xc/WP_20160509_17_31_38_Pro%25255B7%25255D.jpg?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="WP_20160509_17_31_38_Pro" width="199"></a>that doctors practices that are owned outright by Optum will get Allscripts medical records and perhaps the affiliated doctors working for the Physicians Associations they own, such as Monarch Healthcare as an example.  The article was not explicit to explain enough about how this will work exactly.  If you click on the picture at the right, I did a snap shot of a new OptumCare Clinic in Orange County that was just opening and this is where a doctor recently sold his practice to Optum and they provided him with a physician’s assistant in his office and are running the operation.  Here’s a couple examples of the IPA affiliations at the links below. </p> <h5><a href="http://ducknetweb.blogspot.com/2011/08/united-healthcare-to-buy-huge-chunk-of.html">United Healthcare To Buy Huge Chunk of Orange County, California Managed Care Business with the Purchase of Monarch Healthcare–Subsidiary Watch</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2013/10/uc-irvine-affiliates-itself-with.html">UC Irvine Affiliates Itself With The Largely Managed And/Or Owned Orange County UnitedHealthCare Subsidiary Manifesto</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2014/05/memorial-healthcare-ipa-in-southern.html">Memorial Healthcare IPA In Southern California Has Been Merged Into MonarchHealthcare, a Wholly Owned Subsidiary of Optum Health, A United Health Company, “Lives and Providers Have Been Dropped From Inventory” At Memorial Healthcare IPA…</a></h5> <p>We all should probably know the squeeze is on the small practices to where the admistrative end of running a practice is under attack by the government with CMS and their new MACRA payment plan which is still up in the air as of this writing.  Practices of less than 24 doctors will pretty much be penalized and will not be able to sustain the cuts.  The new payment plan has no proof of concept and is just a model being put out there with a bunch of quantitated madness to again push more small practices out of business.  As an average, doctors who contract with United Healthcare get paid around 12% LESS THAN MEDICARE.  </p> <p>That will give you the idea of where all of this is headed.  In addition, the doctors who are affiliated via an IPA, Independent Physicians Association who are smaller practices no doubt will have to pay for the Allscripts EHR as wel.  I don’t know how it will work exactly for the “owned physicians” where Optum has bought them outright.  </p> <h5><a href="http://ducknetweb.blogspot.com/2016/05/the-rise-of-quants-again-this-time-in.html">The Rise of the Quants, Again! This Time In US Healthcare- Taming the MACRA Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not True</a></h5> <p>In addition, there’s a lot of other interesting items taking place with Optum and Urgent Care centers as they have opened up some of their own and they also bought Med-Express, who runs urgent care centers and is also soliciting doctors to sell their practices to their company. <h5><a href="http://ducknetweb.blogspot.com/2015/04/optum-united-healthcare-buys-medexpress.html">Optum (United Healthcare) Buys MedExpress Urgent Care Business- 141 Full Service Clinics In 11 States–Company Advertises They Are In the Market to Buy Your MD Practice, As A “Too Big To Fail Insurer” Moves Forward With More Acquisitions</a></h5> <p>Other insurers don’t have the “fox in the hen house” with the Feds either like United does and has for a number of years and here’s one more example.  <h5><a href="http://ducknetweb.blogspot.com/2015/11/hhs-joins-optum-labs-as-research.html">HHS Joins Optum Labs as Research Partner–Back Peddles Support of FDA Sentinel Program That Does the Same Thing-More Impact from the Six Degrees of Bob Rubin Running Healthcare in the US</a></h5> <p>Below are a couple of links that tell you more about the secret fudning of $36 Million that was created to finance <a href="https://www.optumcare.com/medical/about-optumcare/health-care-providers.html"><img align="right" alt="image" border="0" height="99" src="https://lh3.googleusercontent.com/-Q5pZlaR9W4c/V6gUnz-UwhI/AAAAAAABMyk/ggkMWp9ssdU/image%25255B4%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="240"></a>this entire subsidiary of Optum, Optum Clinics Holdings as well as the money raised, huge bond sale to by the Catamaran pharmacy benefit management company, which also increased their business as Catamaran had a 10 year contract with Cigna so under the OptumRX subsidiary, United Healthcare picked up a ton of revenue there.  I don’t know much about anti-trust but enrolling with one insurer and having a pharmacy benefit manager from another insurer seems to be cutting down competition in the prescription arena.  You can read more about the Clinic Care side of this in Southern California and link to what’s going on in other states <a href="https://www.optumcare.com/about-optumcare/health-care-providers/practice-models-locations/california.html">from here.</a>  This link appears to be additional practices in <a href="https://www.optumcare.com/medical/locations/ca-orange-county.html">Orange County that sold their practices to Optum.</a>  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/05/optum-clinics-holdings-new-subsidiary.html">Optum Clinics Holdings, New Subsidiary Incorporated In 2015 Raises Over 36 Million (Exchange of Shares) From Investors Unknown-Form D Used to Maintain Secrecy Of Who They Are For Now…</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2015/07/united-healthcare-having-big-bond-sale.html">United Healthcare Having a Big Bond Sale to Finance Purchase of Catamaran Pharmacy Benefit Management Company, Huge 10.5 Billion</a></h5> <p>Here’s what is being advertised to doctors…again probably at that 12% less than Medicare payment schedule.  Here’s a link to the “practice acquisition” page with one <a href="https://www.optumcare.com/about-optumcare/health-care-providers/howard-bland.html">doctor talking about how he sold out.</a>   I used to drive by that practice all the time on my way home a few years ago, and it’s not a new one.  </p> <p><a href="https://lh3.googleusercontent.com/-_1sgRxRunDo/V6gUoczPZbI/AAAAAAABMyo/fVn01w-QpsU/s1600-h/image%25255B9%25255D.png"><img alt="image" border="0" height="158" src="https://lh3.googleusercontent.com/-pe1wP13h0kI/V6gUoxeUBHI/AAAAAAABMys/0si9jM_5ID4/image_thumb%25255B4%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="715"></a> <p>So now with Allscripts Medical Records, there will be more access to your data from the big conglomerate, that’s for sure.  Optum used to sell their own EHR called Care Tracker and they sold it off about a year or so ago.  Optum has been advertising for a while that they also want to be your medical records integrator, for AllScrips and a few other big companies. <h5><a href="http://ducknetweb.blogspot.com/2014/02/allscripts-ends-up-with-loss-for-2013.html">Allscripts Ends Up With a Loss for 2013 of $104 Million-United Healthcare Subsidiary Ready To Step In To Be An allscripts Implementer And Beyond…</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2013/11/united-healthcare-optum-insight.html">United Healthcare (Optum Insight Subsidiary) Wants To Be Your Allscripts, Epic And GE Centricity EHR Consulting Service Starting With Implementation And Beyond</a></h5> <p>So if you are a patient, be aware that many small practices are being bought by United Heatlhcare, and there’s also a bunch being purchased by large hospital systems as well.  When I took the picture above, in a small strip mall you had the OptumCare office on one side and a new Tenet MedPost Urgent Care Clinic opening up a few doors down, again a small strip mall, large enough for both?  BD <p> <hr> </p> <p>Health services company OptumCare, part of UnitedHealthcare subsidiary Optum, announced on Friday that it has tapped Allscripts TouchWorks suite as its electronic health records (EHRs) platform for its physician practices. Implementation will begin later this year, the company said. OptumCare serves more than 8 million people in 49 geographic markets. </p> <p>Allscripts will integrate its EHR and practice management software with the technology OptumCare’s physicians currently use. The combined technology and single platform will facilitate the integration of patient’s care across the ambulatory continuum of care, the company said.</p> <p><a href="http://stateofreform.com/issues/healthit/2016/08/optumcare-selects-allscripts-health-provider/" title="http://stateofreform.com/issues/healthit/2016/08/optumcare-selects-allscripts-health-provider/">http://stateofreform.com/issues/healthit/2016/08/optumcare-selects-allscripts-health-provider/</a></p>

OptumCare Doctors to Get Allscripts Medical Records EHR–Optum Continues to Buy More Practices and Manage More Doctors Through Independent Physician Associations, Many of Which They Own

I’m starting to see more doctors in Orange County selling out their practices to United Healthcare’s Optum subsidiary.  Sometimes when patie...

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Hospital Mergers and Acquisitions-Providence and Southern California Based St. Joseph Get Regulator Approval to Begin the Process

<p>Irvine will be the home of a Providence St. Joseph system office once everything gets integrated.  The overall corporate office will remain in Washington.  This process began back in November of 2015 so the approval has now just been given for the merger to go forward.  The new company names combined both former company names.  </p> <p>This merger now creates the nation’s third-largest nonprofit health system.  There are five in Orange <a href="https://lh3.googleusercontent.com/-JxszddRzcE4/V2_pniB2DGI/AAAAAAABMx0/4MOOoyN4LP8/s1600-h/image%25255B7%25255D.png"><img align="right" alt="image" border="0" height="67" src="https://lh3.googleusercontent.com/-kGOx-tojEMI/V2_pobS1ZLI/AAAAAAABMx8/viFAxBREpSE/image_thumb%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="204"></a>county and six in Los Angeles county to come under the umbrella.  St. Josephs has a total of 16 hospitals and Providence has 34.  The hospitals in Orange County are St. Joseph in Orange, Mission in Mission Viejo and Laguna Beach, St. Jude Medical Center in Fullerton, and Hoag Hospital in Newport Beach and Irvine.  Hoag for many years has been Presbyterian affiliated and still is so this makes it interesting again as the facility is rolled up into Catholic healthcare ownership once again.  In case you missed it, Hoag already had their affiliation with St. Josephs a while back.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/02/st-josephs-and-hoag-hospital-in-oc-form.html">St. Josephs and Hoag Hospital In the OC Form New Healthcare Network Combining Hospitals</a></h5> <p>Also don’t forget you have St. Joseph rolling out this program with home healthcare too…so in time will we recognize some of the organizations caring for us?  It’s just an interesting question to ponder.  </p> <h5><a href="http://ducknetweb.blogspot.com/2016/02/st-joseph-healthcare-in-southern.html">St. Joseph Healthcare in Southern California Becoming a “Nurse Next Door” Franchisee-Acquiring 26 Locations With Option for Another 12–Their Current Private Home Care Business To Be Transitioned To This Model</a></h5> <p>As far as contracts, this may open things up again for physicians and insurers to do their thing so keep an open eye for such changes and rules that could be subject to change again.  In April, many patients received a check for $242.00 data breach that went back to issues with St. Jude and their medical records program at the time.  BD</p> <p> <hr> </p> <p>California Attorney General Kamala Harris has conditionally consented to Irvine-based St. Joseph Health’s proposed affiliation with Providence Health and Services. <p>St. Joseph will form a nonprofit corporation with Renton, Wash.-based Providence that’s referred<a href="https://lh3.googleusercontent.com/-rjGVCx0zsfA/V2_po1-KrXI/AAAAAAABMyA/CXcXYkst-ps/s1600-h/image%25255B3%25255D.png"><img align="right" alt="image" border="0" height="58" src="https://lh3.googleusercontent.com/-hh_lBa0iKwY/V2_ppDnaGrI/AAAAAAABMyI/J3cG-REHNm4/image_thumb%25255B1%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="240"></a> to in filings with Harris’ office as Providence St. Joseph Health. The new entity would be based in Renton and keep a regional office in Irvine. <p>It would oversee a health system with 43 hospitals and 13,544 licensed beds ranging from Washington state down to southern Orange County and east into Texas. Local facilities include St. Joseph Hospital-Orange; St. Jude Medical Center in Fullerton; and Mission Hospital, which has campuses in Mission Viejo and Laguna Beach. <p><a href="http://www.ocbj.com/news/2016/jun/22/ag-grants-conditional-consent-providence-st-joseph/" title="http://www.ocbj.com/news/2016/jun/22/ag-grants-conditional-consent-providence-st-joseph/">http://www.ocbj.com/news/2016/jun/22/ag-grants-conditional-consent-providence-st-joseph/</a>

Hospital Mergers and Acquisitions-Providence and Southern California Based St. Joseph Get Regulator Approval to Begin the Process

Irvine will be the home of a Providence St. Joseph system office once everything gets integrated.  The overall corporate office will remain ...

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The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!

<p>One thing we all hate is the high prices we pay in the US today for our prescriptions.  Sure we do get some discounts, but that too has become an effort in algorithmic shopping to click here and click there to get the best price.  It shouldn’t have to be that way,<a href="https://lh3.googleusercontent.com/-03KxuGam6CU/V2VweidWtYI/AAAAAAABMxA/bSF-WShHFqw/s1600-h/image%25255B3%25255D.png"><img align="right" alt="image" border="0" height="194" src="https://lh3.googleusercontent.com/-XeddxZrW3uQ/V2VwfOv-7PI/AAAAAAABMxI/QbtqtRipr-U/image_thumb%25255B1%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="285"></a> but it is as that’s how the systems have been built.  There are a ton of discount prescription cards floating around out there and they all vary in one way or another, but the big thing to remember about all of them is that they are a marketing firm that can and will sell your data to make money.  In addition, the discount cards act just like a pharmacy benefit manager with getting all your information when you use them to fill a prescription.  In addition, some of them offer referral fees so they can increase the size of their data base of patient information.  Data means money today and it can be repackaged and resold over and over, and yes, that’s us.</p> <p>I found a video on YouTube done by a pharmacist that very well in detail describes how the whole process takes place and how these discount cards work.  He tells you what to expect and how the pharmacist reacts and uses them for their required input when filling your prescription.  He uses some real life examples on a couple commonly prescribed drugs with a brand name and a generic drug.  Yes indeed some of this information makes its way to the big pharmacy benefit managers as well.  </p> <p>What is interesting too is that the pharmacist points out with one example, the patient is getting charged the normal “cash” price the pharmacy would have given anyway with an additional $4.00 as a fee added on, so before jumping into any of the discount cards, be sure and ask the pharmacist for the “cash” price first as you may not even need the card at all.  It all depends and you have to really check each time.  Again the pharmacist makes the point to where they have to send the discount card company information about you so you can get a discount when you use one of them to include the name of your doctor, medication name, etc. so the company now knows who you are, who your doctor is, date of birth, and more.  The data is resold to market you for something else, or to compile lists of people taking certain drugs (sold to pharma as an example) </p> <p><iframe height="315" src="https://www.youtube.com/embed/bUVbX3-gOWc" frameborder="0" width="560" allowfullscreen></iframe></p> <p>When it comes to privacy policies, you get stuck with the same old legal routine with a policy written by lawyers to be interpreted by lawyers basically that has a lot of “double talk” in the verbiage.  This is one big reason I have my campaign and have had it out there for a few years now to get Congress to pass a law to require all data sellers to be licensed-who are they and what are they selling!  This really comes in to play when the data about you being sold is flawed and frankly the data sellers don’t care as bad data gets the same price as good data as nobody looks at the data.  Why do you think t<img align="right" src="http://lh3.googleusercontent.com/-WTU_WavuGLg/VYjYaFce1MI/AAAAAAABMZA/DCNNtafnZm8/image%25255B8%25255D.png?imgmax=800" style="float: right; display: inline">here’s referrals promoting these cards-to get more data to sell!</p> <p>Again ask the pharmacist for the “cash” discount first as you may not need one of those cards, so find out first.  Some pharmacies will refuse to take the cards if the cost of the prescription causes them to lose money as well.  I read somewhere that Wal-Mart with their $4.00 generic drug plans being pretty large, no longer will accept the cards.  So again using the prescription cards, all comes back around to data for a discount and companies marketing such end up selling or giving the information back to pharma, other marketing companies or even companies like IMS, the largest data seller of health information in the country, making so much money they had an IPO last year and a lot of folks got wealthy from it.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/06/ims-health-buys-cegedim-information.html">IMS Health Buys Cegedim Information Systems to Include CRM and Intelligence Software - Data Selling Business Gets Healthier and Wealthier But Can’t Say the Same for the Health of US Citizens - It’s All About Making Money Selling Data, The Epidemic</a></h5> <p>So yes in short, the big pharmacy benefit managers work in one way or another with the big pharmacy benefit managers and can add to the their bases of prescriptions filled using these cards as the card folks sell it to them.  I wrote about how pharmacies and insurers are now doing what is called “medication prediction scores” on everyone, and be aware it’s a secret and you cannot get your score, but your insurer can. <strong>FICO does this and thinks that everyone should run around with a “score” on medication just like we do with credit, but the big problem is that the data is so flawed</strong> everywhere you turn for their prediction scores.  It’s a rip on consumers.  See what Express Scripts tells you about these scores, and worse yet, they “brag” about these scoring algorithms! <h5><a href="http://ducknetweb.blogspot.com/2014/06/fico-medication-adherence-scoring.html">FICO Medication Adherence Scoring Should Be Banned As It’s Quantitated Justifications for Profit That Hurts US Consumers Using Proprietary Algorithms That Cannot Be Replicated For Accuracy or Audited</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-enter.html">Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy</a></h5> <p><a href="http://www.ejovi.net/goodrx-make-money/">I found a review on GoodRX,</a> who does provide a listing of current drug prices on their website and they too are “doing data”.  All you have to do is take a look at their job listings, and you get the picture of what’s going on over there with looking for Channel marketing director, email marketing director and from the data side a python developer (python is the choice of computer languages for the financial firms), and a java script contractor.  With someone doing a review of the company it saves me the time of having to say a lot more about their card, and they focused on the same gray privacy policy you are starting to see templated on most web sites anymore.  <p>They make their money charging the pharmacy a fee for the referral, and do reserve the right to sell data.<a href="https://lh3.googleusercontent.com/-tfP_3JJPGgk/V2Vwf-tSsTI/AAAAAAABMxQ/ec0957ZOiGQ/s1600-h/image%25255B6%25255D.png"><img align="right" alt="image" border="0" height="162" src="https://lh3.googleusercontent.com/-fFREgbfEaNo/V2VwgWFBAMI/AAAAAAABMxY/t8tmC1OqJak/image_thumb%25255B2%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="244"></a>  It’s crazy that we have to jump through all kinds of hoops anymore with shopping for prescriptions, but that’s what the insurance and pharmacy business had created with their business models and contracts.  Here’s another post below on what pharmacists call “clawbacks” with using a pharmacy benefit price with either your PBM or even one of the discount cards.  <strong>You can end up paying more, so always ask for the “CASH” price first as pharmacy benefit managers are now telling the pharmacists they can’t volunteer this information, you have to ask.  The RX Bin number tells the pharmacist who to bill.  The discount card folks all have your data to do whatever they please with it as well as the pharmacy benefit managers and transaction records are accumulated. </strong> <h5><a href="http://ducknetweb.blogspot.com/2016/05/be-aware-of-prescription-claw-backs-as.html">Be Aware of Prescription “Claw Backs” as Pharmacy Benefit Management Profit Centers Continue to Evolve</a></h5> <p>Here’s another good video done with a taste of humor that explains the role of the Pharmacy Benefit Manager, the middleman cashing in big!  It’s done well and the Pharmacy Benefit Manager is jumping all over the counter during the video, getting in the middle. </p> <p><iframe height="315" src="https://www.youtube.com/embed/UXq2FetUu60" frameborder="0" width="560" allowfullscreen></iframe></p> <p>So in short, we are all getting ripped one way or another and have to “play this game” instead of just a simple process of filling a prescription.  The government has their hands in this till as well as now pharmacists are seeing patients with the use of another prescription monitoring program called EQUIPP to see your “star” rating if you are on Medicare as far as medication adherence goes.  Yes indeed, before you even show up data has already calculated a score about you that shows how they predict you will be with compliance.  It’s a real nasty game, and oh yes, those folks who use cash to pay for prescriptions, well they are now called Outliers as they can’t track enough data on you, so if you like and want privacy, pay cash.  Rite-Aid is the latest to announce using the data mining compliance software from EQUIPP.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/12/rite-aid-pharmacies-are-latest-to-begin.html">Rite Aid Pharmacies are the Latest to Begin Used Flawed Data Provided by the EQuIPP Platform Relative to “Scoring” Patients for Predictive Medication Adherence–The “Outlier” Patients…</a></h5> <p>The flawed prediction scores are indeed a dangerous business as they will end up denying you access at some point as well.  “Give old Jane the cheap stuff as our numbers predict she won’t take the expensive meds”…as a simple example.  <h5><a href="http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html">Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to FixOutliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…</a></h5> <p>As a matter of fact, take a look at the first quarter revenue from United Healthcare, as their OptumRX revenue is exceeding that of the revenue produced by their insurance groups, more money made by United Healthcare with their OptumRX pharmacy benefit management company<a href="https://www.healthylife.optumhealthallies.com/ha/public/indexDtc.jhtml;sessionid=BR23TQVTSZWV0CW5GZIBQBY?_requestid=13686"><img align="right" alt="image" border="0" height="287" src="https://lh3.googleusercontent.com/-NK9BJ_g2_LA/V2Vwg4MvlNI/AAAAAAABMxg/rULTllfkSO4/image%25255B16%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="387"></a> than Medicare Part D policies..the world is changing and they are chasing the money.  Within the last few weeks, OptumRX has secured a few large contracts, like CalPers retirement system, Texas employee retirement system, etc. so they do want to control what drugs you can get and when.  Don’t forget the clawback video above as they are the pharmacy benefit manager featured in the news report, although they are all doing it.  <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p>Look what else gets involved with OptumRX pharmacy benefit management, infusion drugs so they may show up to provide that service for you as well.  The link below about OptumRX buying the infusion company has a<strong> side listing of a lot of government cronyism in healthcare</strong> too if you want to read about it.  </p> <p>There’s a company that’s a subsidiary of United Healthcare, <a href="https://www.healthylife.optumhealthallies.com/ha/public/indexDtc.jhtml;sessionid=BR23TQVTSZWV0CW5GZIBQBY?_requestid=13686">HealthAllies</a>  that was created by current CMS Adminsrator Slavit and Elizabeth Warren’s daughter (funded by Soros these days with her think tank) both former McKinsey consultants that will <strong><u>sell you a card to</u></strong> get both care and prescription discounts at the cost of $25.00 a month too.  It’s very dirty and corrupt these days in healthcare to say the least.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/11/optumrx-united-healthcare-buys-home.html">OptumRX (United Healthcare) Buys Home Infusion Company AxelaCare-Using Algorithms To Determine Your Care With Being Financed By A “Too Big to Fail” US Health Insurance Company…</a></h5> <p>The discount card business has become very complex with just trying to get a prescription filled today and it’s done with complexities on purpose as everytime we don’t check something, we get fooled and pay more.  This is what I call the world of the <a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">Attack of the Killer Algorithms</a> as it is math models and computer codes that run everything so be aware, be very aware as it’s a game of being able to click for the right price anymore to the extremes and it shouldn’t be that way.  BD  </p>

The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!

One thing we all hate is the high prices we pay in the US today for our prescriptions.  Sure we do get some discounts, but that too has beco...

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Cigna Launches New Company, CareAllies To Manage Patient Care, Doing Same Things as Does Optum

<p>By now we should all know the insurers are looking at ways to keep the cost of healthcare down and now it’s coming down to pretty much an “algorithm stick” for the doctors to deal with.  This new company, interestingly enough is being headed from a former White House Executive, <a href="https://www.whitehouse.gov/blog/2015/01/29/behind-budget-dr-julian-harris-omb-associate-director-health">Dr. Julian Harris</a>.  He’s the former OMB Associate Director for Health.  The revolving door between insurers and US Healthcare never stops.<a href="https://lh3.googleusercontent.com/-g94FEEyOHLQ/V14PcAKUSYI/AAAAAAABMwI/eH4hb4_XHoE/s1600-h/image%25255B11%25255D.png"><img align="right" alt="image" border="0" height="112" src="https://lh3.googleusercontent.com/-qmG7ce1zWS4/V14Pc9P6utI/AAAAAAABMwQ/EoEUz_bGlks/image_thumb%25255B5%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="187"></a></p> <p>Seriously, now when you look at one insurers page you get the same rhetoric about empowering and motivating physicians, same text different insurance carrier and I bet the doctors are a bit tired of the quantitated madness they deal with today as it’s not doing much for them.  Just like Optum it’s a bunch of algorithmic formulas (and hey maybe they licensed some of those algos from Optum) to “score” and cut costs and access.  Here’s what happened one time a while back when Cigna and most all other health insurers licensed United Healthcare (Ingenix, now named Optum) algorithms, lawsuits.</p> <h5><a href="http://ducknetweb.blogspot.com/2016/05/cigna-legal-case-with-ingenix-flawed.html">Cigna Legal Case With Ingenix Flawed Formulas for Out of Network Payments Allowed to Proceed Under ERISA, Can’t Avoid the Claims…</a></h5> <p>Our CMS is being run today by Quant mind sets and there’s like no changing it as they “think” all this quantitation is going to save the day.  It will deny access and drugs at times though.  As a matter of fact, Cigna is still on the hot seat for quality issues and currently can’t sell any Medicare Part D plans as CMS has them sanctioned.</p> <p>I think there’s more that than the book cover myself as there’s this big merger with Anthem trying to take place as well and when you buy a Cigna plan now, you get another insurer, United Healthcare, under their OptumRX subsidiary to be your pharmacy benefit manager.  <a href="https://lh3.googleusercontent.com/-6wNyI_vR8R8/V14PdeAXiSI/AAAAAAABMwY/xPN-SZCJi7U/s1600-h/image%25255B10%25255D.png"><img align="right" alt="image" border="0" height="40" src="https://lh3.googleusercontent.com/-0z9Y6iu5g7Y/V14Pd_BDCoI/AAAAAAABMwg/laCU-htBzUs/image_thumb%25255B4%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="351"></a></p> <h5><a href="http://ducknetweb.blogspot.com/2016/01/cms-sanctions-cigna-no-more-selling-any.html">CMS Sanctions Cigna-No More Selling Any New Medicare Advantage Policies Until Algo Problems Denying Medical Coverage and Prescription Denials Are Fixed</a></h5> <p>Cigna was one of the first companies that started using software to analyze and determine your current state of mind over the phone with their customer service centers and they just about do that now, so be aware when you use the call centers for customer service, that your state of mind is being actively scored and maybe that data gets sold to some behavioral business too.</p> <h5><a href="http://ducknetweb.blogspot.com/2013/08/insurers-certainly-like.html">Insurers Certainly Like Consumer/Business Healthcare Apps: Subsidiary of Blue Cross Rolls & Couple Others Out $20 Additional Million in Funding to Audax First Backed by Cigna & Cardinal Health</a></h5> <p>A few years ago Cigna increased their Medicare HMO business by purchasing another HMO called Spring. <h5><a href="http://ducknetweb.blogspot.com/2011/10/cigna-buys-healthspring-inc-for-38.html">Cigna Buys HealthSpring Inc For $3.8 Billion, Who Bought Bravo Medicare HMO Who Had Profits of a Billion in 2010-Subsidiary Watch</a></h5> <p>It’s going to be interesting to see how the insurance mergers and all these “managed care” algorithms all come into play and you can look forward to more flawed data as they have built massive data lakes and the bigger the lakes, the more errors you get. I addressed that a couple years ago.  <h5><a href="http://ducknetweb.blogspot.com/2014/09/health-insurance-business-is-driving.html">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..</a></h5> <p>It is also interesting to note that HHS Healthcare.Gov CEO is also touting Cigna as expanding their ACA insurance polices for sale, this of course since United Healthcare is pulling out of all but 3 states.  Keven Coulihan from Healthcare.Gov was also a former Cigna Healthcare executive, so more cronyism there as well.  I’ve kind of laughed at wondering when the co-marketing with Cigna and United Healthcare might begin on ACA and maybe even other policies as if Cigna gets the sale, then United Healthcare shares in the money as the pharmacy benefit manager.  By the way, you should look and see that United Healthcare/OptumRX revenue stream is making more money than their 3 insurance revenue streams and appears to be going back to their roots with making a lot of money with drug companies, how the company got started in the late 70s.  United sold the PBM a drug company who sold it to to Express Scripts (who I’m sure still uses Optum Algos today) a year later.  So co-marketing now so OptumRX can make even more money on pharmacy benefit management?  BD <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p> <hr> BLOOMFIELD, Conn.--(BUSINESS WIRE)--The nation’s health care system is moving from volume to value, yet it remains fragmented and complex. Health care providers are facing increased pressure to move from fee-for-service to value-based payment, yet current market solutions to accelerate this journey have been criticized as too rigid to meet complex provider needs. Cigna (NYSE: CI) has partnered with health care providers for many years to help them align their financial incentives with patient health outcomes, resulting in joint success through shared risk.</p> <p>The new company, CareAllies, Inc., will deliver the systems, capabilities and management services that providers need to be successful under a variety of value-based and risk-sharing models across the value-based reimbursement spectrum. CareAllies<a href="https://lh3.googleusercontent.com/-FRpRSWA7n34/V14PeeBC9lI/AAAAAAABMwo/isJXYN8nR78/s1600-h/image%25255B13%25255D.png"><img align="right" alt="image" border="0" height="72" src="https://lh3.googleusercontent.com/-Ib6rdDnnXCA/V14PezbPLiI/AAAAAAABMww/5BBggNTmxOM/image_thumb%25255B7%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="274"></a> will offer services to help ease providers’ administrative burden across payers and can even help providers launch and manage their own health plans. </p> <p>The new CareAllies will combine assets from Cigna, Cigna-HealthSpring’s management services division for independent physician associations (IPAs), and QualCare Alliance Networks, Inc. (QANI), which Cigna acquired in 2015. It will leverage these companies’ extensive histories of successful and innovative provider collaborations. Dr. Julian Harris has been named president of CareAllies, Inc., which will operate as a wholly-owned subsidiary of Cigna.</p> <p>CareAllies is similar to UnitedHealth Group Inc.'s health care services subsidiary, Optum Inc., said Vishnu Lekraj, senior equity analyst at Morningstar Inc. in Chicago.</p> <p><a href="http://www.businesswire.com/news/home/20160609005163/en/Cigna-Launches-Company-Deliver-Proven-Systems-Capabilities">http://www.businesswire.com/news/home/20160609005163/en/Cigna-Launches-Company-Deliver-Proven-Systems-Capabilities</a></p>

Cigna Launches New Company, CareAllies To Manage Patient Care, Doing Same Things as Does Optum

By now we should all know the insurers are looking at ways to keep the cost of healthcare down and now it’s coming down to pretty much an “a...

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Cigna Legal Case With Ingenix Flawed Formulas for Out of Network Payments Allowed to Proceed Under ERISA, Can’t Avoid the Claims…

<p>How many companies used the Ingenix Data Base one has to question.  While current<a href="https://lh3.googleusercontent.com/-4p0gQ9QGUG8/Vy9ff7ECsdI/AAAAAAABMvc/7hJroKXbycM/s1600-h/image%25255B8%25255D.png"><img align="right" alt="image" border="0" height="141" src="https://lh3.googleusercontent.com/-P6tj5WOrOJk/Vy9fgSL2qsI/AAAAAAABMvg/0wFz_OflLK8/image_thumb%25255B4%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="155"></a> <strong>Acting Director of Medicare, Andy Slavitt was the CEO of Ingenix it appears he was quite busy</strong>.  This case, as you can read below per a recent decsion is now allowing doctors to cotninue with their case for the use of the flawed Ingenix Data Base.  Upon taking the position to run Medicare, HHS Secretary Burwell was able to get an unprecedented pardons in place for Mr. Slavitt to avoid all these lawsuits.  Does that set well with you?  It happened.</p> <p>Connecticut General Life is the primary focus here with Cigna being the insurer providing the reimbursement.  This change probably hits Cigna at maybe not a good time when they are trying to merge with Anthem one could say, although there a lot more to the complex merge as well.  Cigna paid the claims, and thus the ruling is to now allow the case to proceed.  Last year, this Ingenix lawsuit was just settled as well with surgical centers also being short payed by Ingenix.  <a href="http://ducknetweb.blogspot.com/2011/04/unitedhealth-group-announced-re.html">Ingenix had a name change to Optum Insights</a> a couple years ago and I think all the lawsuits might have had something to do with that.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/09/another-united-healthcare-ingenix.html">Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…</a></h5> <p>In addition, this case with Ingenix just settled last year as well.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/ingenix-optum-united-healthcare.html">Ingenix (Optum-United Healthcare) Lawsuits Still Bouncing Around Out There–One Recently Settled in New Jersey With Horizon Blue Cross Blue Shield That Was Still Using the Flawed and Corrupt Data Base for Out of Network Payment Calculations</a></h5> <p>In addition, this group of lawyers in New York appears to be investigating the potential of another lawsuit with United, relating back again to payment of claims. <h5><a href="http://ducknetweb.blogspot.com/2014/06/law-firm-investigating-unitedhealthcare.html">Law Firm Investigating UnitedHealthCare Claim Payments in New York Stating Under-Reimbursement By Manipulating Algorithmic Benefit Calculations…</a></h5> <p>A couple years ago, and it received very little publicity, the Supreme Court put out a ruling allowing doctors, <a href="https://lh3.googleusercontent.com/-xObDvflv5ec/Vy9fg87YoAI/AAAAAAABMvk/hn9IcfSuqa8/s1600-h/image%25255B9%25255D.png"><img align="right" alt="image" border="0" height="84" src="https://lh3.googleusercontent.com/-bmciTC_L-7Q/Vy9fhf90yrI/AAAAAAABMvo/jr9SXXVihbI/image_thumb%25255B5%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="240"></a>to be able to group to worth together on such cases of unfair business practices as well.  <h5><a href="http://ducknetweb.blogspot.com/2013/06/us-supreme-court-rules-physicians-can.html">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</a></h5> <p>Almost all the major insurers were hit with the under payment legal cases as they were all licensing the use of the Ingenix Data Base that allowed calculations to short pay doctors and patients for out of network claims.  Aetna ended up waiting long enough and in the end weaseled out of their payments with some quick work by the company that somehow showed a lack of interest had developed. <h5><a href="http://ducknetweb.blogspot.com/2013/01/aetna-payment-of-120-million-to-settle.html">Aetna Payment of $120 Million To Settle 15 Year Ingenix/United HealthCare Out of Network Erroneous Payment Algorithms Cuts Income for 4th Quarter</a></h5> <p>The big case of course that everyone may remember was the large class action suit that the AMA filed against Ingenix and won against United Healthcare Ingenix, and their CEO at the time, current CMS Acting Director Andy Slavitt.  The post was Chapter 19 of my old Killer Algorithms series to where I wrote about algorithms and formulas attacking consumers with either denying access or taking more money.  <h5><a href="http://ducknetweb.blogspot.com/2012/02/ama-announces-doctors-and-patients-can.html">AMA Announces Doctors And Patients Can Expect To See the UnitedHealthCare/IngenixClass Action Settlement Checks In the Mail Soon - Out of Network Short Payments–Attack of the Killer Algorithms Chapter 19</a></h5> <p>Ingenix itself was very busy as a subsidiary of United Healthcare securing Health IT contracts and buying up other companies as well.  As a matter of fact, all the <a href="http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html">bogus “medication prediction scoring” that we are all subject to when filling a prescription</a> was all started with Ingenix algorithms being licensed to Express Scripts in 2010.  I call it bogus as I am referring to the prediction portion of this and not the actual monitoring of hard data.  If you look at the 300 metrics used by Express Scripts and some of the other pharmacy benefit managers with their proprietary calculations, they have nothing to do with taking your prescriptions and predict with flawed calculations on whether or not you will be compliant.  As an example, if you have kids, that’s one bad ding for your score.  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/10/express-scripts-new-program-to-contact.html">Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On IngenixAlgorithms–We Want the Revenue Please Don’t Stop</a></h5> <p><strong>So back on track with Cigna here, they can’t seem to get out of being associated with United Healthcare either with some of their business.</strong>  United Healthcare is racking in big pharmacy benefit money as their acquistion of Catamaran turned United into the Cigna pharmacy benefit manager.  If I were Cigna running an insurance business I’m not sure I would be too happy with that with a competitor now running the pharmacy benefit end of the business?  It’s been stated that the Anthem/Cigna merge may not complete until 2017.  <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-reports-1st-quarter.html">United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups</a></h5> <p>So this case is rolling along, and the judge did decide that individual doctors and medical associations can’t file additional claims, and <img align="right" height="160" src="http://lh5.ggpht.com/_v3zjJigoAPE/TAdpgWK8tcI/AAAAAAAAekk/rWgn0GxRDgk/image_thumb%5B9%5D.png?imgmax=800" style="float: right; display: inline" width="252">nor can it turn into a class action suit, but the<strong> current plaintiffs have the OK to collect from Cigna on the use, once of the flawed and corrupted Ingenix data calculations for paying doctors.  </strong>I sometimes wonder how much money Ingenix/United Healthcare really racked in from all of this as it went on for 15 years, had to be a bunch with all the licensing to so many other insurers as well.  </p> <p>Ingenix (Optum Insights) folks have been hanging around Washington DC for quite a while and you can kind of see this going back to HHS just gushing over their “Reach for The Top” model, link below from 2010.  It contains pretty much all the elements CMS is pushing and marketing today, Population Health, paying doctors less and so forth, so the influence and math models and algorithmic plan association here leaves no doubt and perhaps all these models is what maybe convinced Secretary Burwell that in addition to all the Ingenix lawsuits that Slavitt was the correct person to run Medicare?  Go figure I guess.  We all knew before Burwell we had the affliction of the <a href="http://ducknetweb.blogspot.com/2014/04/secretary-sebelius-at-hhs-resigns-wrong.html">Sebelius Syndrome</a> with her out of reality perceptions and chasing those Algo Faires too for perceived solutions.    BD  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/06/for-top-program-combines-prototype-from.html">"Reach for the Top" Program Combines Prototype from Ingenix (A Wholly Owned Subsidiary of United Healthcare) for Public/Private Community Health Data on HHS.Gov Site</a></h5> <p> <hr> May 2 — Out-of-network health-care providers have ERISA standing to continue with their lawsuit accusing Connecticut General Life Insurance Co. of using a manipulated database to determine their services fees, the U.S. Court of Appeals for the Third Circuit ruled. In the May 2 unpublished opinion, Judge Thomas I. Vanaskie reversed in part the district court decision that had seemingly put an end to a decadelong litigation. Vanaskie remanded the case to the district court, holding that the providers had sufficiently pleaded the existence of a valid assignment to support derivative standing under the Employee Retirement Income Security Act. <p>The proposed class action was originally brought by medical providers, individual subscribers and 14 medical associations, alleging that out-of-network services were underpaid because of flawed “usual, customary and reasonable” (UCR) rate data provided by Ingenix Inc.</p> <p>The providers' allegation that they received from CIGNA insureds an assignment of benefits or a claim assignment through which they were paid directly by CIGNA was sufficient to plead the existence of a valid assignment to support derivative standing, the court said.</p> <p><a href="http://www.bna.com/cigna-cant-avoid-n57982070578/">http://www.bna.com/cigna-cant-avoid-n57982070578/</a></p>

Cigna Legal Case With Ingenix Flawed Formulas for Out of Network Payments Allowed to Proceed Under ERISA, Can’t Avoid the Claims…

How many companies used the Ingenix Data Base one has to question.  While current Acting Director of Medicare, Andy Slavitt was the CEO of ...

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Be Aware of Prescription “Claw Backs” as Pharmacy Benefit Management Profit Centers Continue to Evolve

<p><script type="text/javascript" src="http://kfda.images.worldnow.com/interface/js/WNVideo.js?rnd=344707067;hostDomain=www.newschannel10.com;playerWidth=530;playerHeight=355;isShowIcon=true;clipId=12412460;flvUri=;partnerclipid=;adTag=News;advertisingZone=;enableAds=true;landingPage=;islandingPageoverride=;playerType=STANDARD_EMBEDDEDscript;controlsType=overlay"></script>If you have watched the news of late, drug prices that we pay are a big item as the price of drugs keeps<a href="https://lh3.googleusercontent.com/-B_ianRfzEgY/Vy6FmQlLxFI/AAAAAAABMvA/WM5j5vYFwO8/s1600-h/image%25255B2%25255D.png"><img align="right" alt="image" border="0" height="143" src="https://lh3.googleusercontent.com/-zgkJ-LQAdLg/Vy6FnKRc3SI/AAAAAAABMvE/G63cfrKoPig/image_thumb.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="244"></a> going up.  The pharmacy benefit management company is the middle man in between the pharmacy and you.  Their computers connect to the PBM and they are given the price to charge you according to your  agreement and insurance under which your prescriptions fall.</p> <p>Worth a mention here is that OptumRX last quarter became the biggest revenue producer of their 4 revenue categories.  That’s right they are making more here than any of their insurance groups when compared, more at the link below.  OptumRX gets a double whammy in revenue as their OptumRX, through the acquistion of Cigna is also the pharmacy benefit manager for those insured by Cigna.  Cigna is currently sanctioned by CMS though and and their former benefit manager, Catamaran, which was acquired and integrated into OptumRX was denying patients too many drugs and care. </p> <h5><a href="http://ducknetweb.blogspot.com/2016/04/united-healthcare-hits-bottom-of-barrel.html">United Healthcare Hits the Bottom of the Barrel Linking Doctor Information to Healthgrades Flawed Data</a></h5> <p>Of course in this video, which pharmacy benefit management company is heavily connected to claw backs?  United Healthcare, aka OptumRX. You may have wondered why we have the Walgreens and OptumRX agreement right?  There’s claw back money potential here as they state that patients can pay the same at Walgreens as they would getting a 90 day supply via the mail.  Well, when you watch the video, the computers talk to each other and the patient may receive a higher cost than what the Walgreens “no insurance-cash” rate would be.  So what do they do, split the difference with a profit?  More at the link below on how this happens.  Anthem is suing Express Scripts as well on the pharmacy kick backs that the pharmacy benefit management company Express Scripts receives on the sale of drugs.  That’s another avenue in which pharmacy benefit management companies make money,<a href="https://lh3.googleusercontent.com/-knR2byNEz5s/Vy6Fny6KkZI/AAAAAAABMvI/h1UiyX4ZnWM/s1600-h/image%25255B5%25255D.png"><img align="right" alt="image" border="0" height="172" src="https://lh3.googleusercontent.com/-ufxZJXQqv-Y/Vy6FoXrazRI/AAAAAAABMvM/3bkI2KAimvI/image_thumb%25255B1%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="244"></a> they get a kick back from the drug company on the dollar amount of the drugs that were sold.  </p> <h5><a href="http://ducknetweb.blogspot.com/2016/03/walgreens-signs-agreement-with-pbm.html">Walgreens Signs Agreement With PBM OptumRX (United Heatlhcare) and Anthem Then Sues Express Scripts</a></h5> <p>Some day if you need infusion drugs, there’s a good possibility a subsidiary of OptumRX, the subsidiary of United Healthcare might pay you a visit for that too as the company they bought operates in 38 states.</p> <h5><a href="http://ducknetweb.blogspot.com/2015/11/optumrx-united-healthcare-buys-home.html">OptumRX (United Healthcare) Buys Home Infusion Company AxelaCare-Using Algorithms To Determine Your Care With Being Financed By A “Too Big to Fail” US Health Insurance Company…</a></h5> <p><strong>When you really want to throw off the entire pharmacy patient “scoring” system, just pay cash for your prescriptions</strong> and you’ll be scored by default as an outlier who doesn’t take their meds.  Before you walk in to most pharmacies today, the pharmacists already have you sized up with 300 metrics that have zero to do with taking your prescriptions on predicting whether or not you will.  I think it’s a big farce, costs a lot of money and they sell all of this data to insurers and other people who want to calculate any type of risk assessment on you.  The problem is, the numbers are flawed.  <h5><a href="http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html">Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Nonmedication Adherence Compliant With 5 Star Systems Full of Flawed Data…</a></h5> <p>Do always ask for the “cash” no insurance price is the moral of this story to avoid pharmacy benefit managers getting a claw back of your money and charging more when they find you could be asleep at the wheel if you will.  In the video they ask what kind of company is that which is supposed to negotiated cheaper prices for you and ends up charging you more?  That’s a good question and of course some of that probably goes to pay for all the software and algorithms that score you on predictions and risk, right? <p>Sometimes customers are paying more than the drug is worth as well.  Claw Backs don’t occur on every prescription but ask to avoid one happening with you is the best advice.  I had a person tell me they have a son who needs some expensive drugs due to some serious conditions he has and due to the pricing, he has to go to three pharmacies to get all the prescriptions for the best price.  That’s wild when that occurs but that shows how different the contracts are and how the pharmacy benefit management contracts work.  BD  <p><a href="http://www.newschannel10.com" title="KFDA - NewsChannel 10 / Amarillo News, Weather, Sports">KFDA - NewsChannel 10 / Amarillo News, Weather, Sports</a></p> <p> <hr> One source for our investigation, a New Orleans-area pharmacist, asked us to hide his identity.  Contracts with pharmacy benefit managers, or PBM's, prevent him from talking publicly. <p>But documents that multiple pharmacists provided to FOX 8 News show, in some cases, companies are charging copays that exceed the customers' costs for their drug.   <p>Pharmacists call it a clawback - the company is essentially clawing back money from you and, our source tells us, you probably don't even realize it's happening. <p>“They have no idea,” the pharmacist says.</p> <p>“Whatever the insurance company/PBM tells us to charge as a copay, we have to charge the patient for that,” our source says.  “We cannot discount it, we cannot forgive it. Our computer calls their computer. They tell us charge the patient this much money.”</p> <p>But many pharmacists, who asked that we not reveal their identities, gave us dozens of examples. They include <a href="http://ftpcontent.worldnow.com/wvue/documents/HOPCpg24.jpg">a $22 clawback</a> on a nasal steroid, fluticasone; <a href="http://ftpcontent.worldnow.com/wvue/documents/HOPCpg6.jpg">$7.85 for a diabetes treatment</a>, invokamet; <a href="http://ftpcontent.worldnow.com/wvue/documents/HOPCpg11.jpg">$12.39 for diazepam</a>, a drug that treats anxiety, muscle spasms and seizures.</p> <p><a href="http://www.newschannel10.com/story/31891070/zurik-copay-or-you-pay-prescription-drug-clawbacks-draw-fire">http://www.newschannel10.com/story/31891070/zurik-copay-or-you-pay-prescription-drug-clawbacks-draw-fire</a></p>

Be Aware of Prescription “Claw Backs” as Pharmacy Benefit Management Profit Centers Continue to Evolve

If you have watched the news of late, drug prices that we pay are a big item as the price of drugs keeps going up.  The pharmacy benefit ma...

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