Algorithms Rule Us All--Automated Risk Scores…Tons of Error Bars, Bias and More-The US Digital Consumer Scoring System For Corporate Profit Keeps Raging On…VPRO documentary–2018

<p>This is a great watch and lot of information from Cathy O’Neil, author of “Weapons of Math Destruction” and computer scientist Jaron Lanier.   Nobody is minding the shop as you can’t ask a machine for an appeal or know how the machine computed<a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-HP3tYnrBzQE/XAs2rP220mI/AAAAAAABNQ0/ut3ZRjvmOlU_SaHOV_uJUr9HOPHJVaeYwCHMYCw/s1600-h/image=25255B4=25255D"><img width="383" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-BDj-Vc-1BKE/XAs2rnGUfbI/AAAAAAABNQ4/LLEhJ3c4pdIsFcrbJ1lgX9onj5uWez-jQCHMYCw/image_thumb=25255B2=25255D=3fimgmax=3d800" style="float: right; display: inline; background-image: none;" height="200" border="0" title="image"></a> the results. <strong>“Engagement is just a sanitized term for addiction”…says Lanier</strong>.  <strong>“So when you are giving over control to an algorithm, it’s giving control to a company and until you get clear on that, you’re going to be taken advantage of”.</strong>  That being said, give some serious thought to all these healthcare organizations promoting “engagement” as well as banks, credit cards and so forth.  </p><p>There’s a sector on a man being denied parole by an algorithm and nobody knows how it was computed.  There are cases where judges can’t overrule a decision for algorithms, and it frustrates all.  This is what I have to say about the big data business as relates to black boxes.  Also follow the plight of the “gig” delivery guy and watch for how that ends.  </p><p><strong><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2017/04/one-trick-algo-world-needs-to-be.html">“One Trick Algo World” Needs to be Licensed and Indexed–Spurious Correlations “For Profit” Are Out of Control</a></strong><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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><p><em>“The mathematicians and programmers begin to realize that the algorithms that are among all these automated decision systems are not neutral and may contain errors. Because the smart code may then decide more quickly than people, the results are not only sometimes defective, but sometimes downright dangerous. Should we be blindly guided by the decisions of the algorithm?</em></p><p><em>Where should they complain if something does not go as it should be? Legislatives are also emerging in<img width="170" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/encrypted-tbn1.gstatic.com/images=3fq=3dtbn:ANd9GcRp9TBlvWqtr16ku9oa-uGY_yLITLV9hYmtozmPi5XdbJ5RW7Sm" style="float: right; display: inline;" height="68"> the judiciary. For example, an American prisoner had to sit longer than comparable prisoners because the algorithm, which establishes a risk score, gave him an inexplicably high outcome. And unlike the decisions made by a judge, it turns out to be virtually impossible to challenge the assessment of an algorithm.”</em></p><p><em>“Algorithms don’t just predict the future they cause the future…and are causing winners and losers…built by companies looking to profit”…Algorithms are being used to “commoditize” us.” </em></p><p>Big Data and Artificial Intelligence is not going to save us, the perception of this has turned out to be wrong.  Again this is a good documentary that explains what’s going on out there and how you might want to wake somewhere along the line.  I’ve been writing about the “Attack of the Killer Algorithms” for years.  At one one point a few years back I was over 60 posts tagged as chapters with real life examples.  I issued a warning of this back in 2012.  </p><h6><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2012/11/big-dataanalytics-if-used-out-of.html"><font size="2">Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game</font></a></h6><p><iframe width="560" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000101A/https/www.youtube.com/embed/NFF_wj5jmiQ" height="315" allowfullscreen frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture"></iframe></p><p>Related posts:</p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2014/05/this-call-may-be-recorded-for-quality.html"><font face="Arial" size="1">“This Call May Be Recorded for Quality Purposes”..Heck Not, Millions of Algorithms Have Been Turned Loose to Listen To and Analyze Your Voice When You Talk To Your Insurance Company As Algorithms Continue To Take Over the World…</font><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2017/11/algorithms-scoring-metrics-privacy-and.html"><br><font face="Arial" size="1">Algorithms, Scoring Metrics, Privacy and more in today’s Healthcare business world–The Healthcare Algo Cartel</font></a></p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/03/its-time-to-look-at-some-of-proprietary.html"><font face="Arial" size="1">It’s Time To Look At Some of the Proprietary Code Running in the US–Too Many Companies and Banks Are Playing “Techno-God” Saying “Trust Me” With the Numbers and Stats…</font></a></p><h6><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2014/08/somebody-needs-to-start-calling-foul-on.html"><font face="Arial" size="1">Somebody Needs to Start Calling “Foul” On Proprietary Predictive Algorithms When They Cannot Be Replicated For Accuracy As This Accelerates Inequality and Promotes Even More Data Selling For Profit</font></a></h6><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2014/06/fico-medication-adherence-scoring.html"><font face="Arial" size="1">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</font></a></p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2013/12/quantitated-justification-for-believing.html"><font face="Arial" size="1">Quantitated Justification For Believing Things That Are Not True And Using Mathematical Processes To Fool Ourselves-The Journalistic Bot Functionality Debuts As Media Can’t Resist</font></a></p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/03/cybertopia-dreams-of-silicon-valley.html"><font face="Arial" size="1">“Cybertopia-Dreams of Silicon Valley”-Documentary About Politics, Economics and Debate on Where is the “Real” World Today? The Producers the Takers and the Dupers…</font></a></p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2014/11/computer-scientist-jaron-lanier.html"><font face="Arial" size="1">Computer Scientist, jaronLanier Explains How Big Data Is Used to Limit Our Freedom–The Value of Your Personal Data…</font></a><p>------------------------------------------------------------------------------------<p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/www.youtube.com/watch=3fv=3dNFF_wj5jmiQ" title="https://www.youtube.com/watch?v=NFF_wj5jmiQ">https://www.youtube.com/watch?v=NFF_wj5jmiQ</a></p>

Algorithms Rule Us All--Automated Risk Scores…Tons of Error Bars, Bias and More-The US Digital Consumer Scoring System For Corporate Profit Keeps Raging On…VPRO documentary–2018

This is a great watch and lot of information from Cathy O’Neil, author of “Weapons of Math Destruction” and computer scientist Jaron Lanier....

Read more »

Pharmacy Benefit Managers Are Not Much More Than “Complex Well-Greased Algorithmic Human Scoring Machines” That Deny or Allow Access To Drugs To Create/Substantiate Big Corporate Profits

<p>So let’s get down to what’s really happening here.  Once upon a time the PBM models were a different type of creature but as time moved on they became less about a better and affordable price for prescriptions and more about and algorithmic machine to create profits, hidden for the most part as we can’t see the transactions written in computer code where every execution comes along and takes their<a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-cPuBknPJnJI/WqQR9-82JAI/AAAAAAABNMo/9BxoYmYEPDAeO2VeUBanKlAoH7tehHiYwCHMYCw/s1600-h/image=25255B3=25255D"><img width="395" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-xbwHhvTEeAo/WqQSDg_2GoI/AAAAAAABNMs/E_i8H8PUsT4fEPyQ_XZKR5otSvSnyMC4QCHMYCw/image_thumb=25255B1=25255D=3fimgmax=3d800" style="float: right; display: inline; background-image: none;" height="268" border="0" title="image"></a> chunk of money.  United Healthcare created the PBM model back in 1976 under the name of <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/en.wikipedia.org/wiki/Diversified_Pharmaceutical_Services">Diversified Pharmaceuticals</a>, which ended up ultimately being purchased by Express Scripts via SmithKline Beecham.  Express Scripts also purchased another PBM a few years back called <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/en.wikipedia.org/wiki/Medco_Health_Solutions">Medco</a>, so combine all the algorithms with both companies and you end up with a massive collection of algorithmic computer code, there to create profits.  </p><p>It was the feeling that too much corruption and price setting would occur if pharmaceutical companies owned pharmacy benefit managers so they divested themselves of the pharmacy benefit business and it got worse as the PBM businesses moved into the arena of the health insurance companies.  Initially the PBMs were supposed to work as a partner to help insurance companies control costs, but it’s far from that today.  Today all we see is a consumer “scoring” business that found out how to score you by mining and selling all your data to make big profits for the most part.  Sure there’s still drug pricing in the picture, but it’s more about what the market will bear than it is affordability.  What we have ended up with is more of a digital caste system with drugs that goes way beyond negotiating price and helps substantiate a digital caste system that is growing every year in the US.  We don’t have the algorithms and the formulas to fight back and thus as consumers and small businesses we are just mowed under by what’s taking place and we have a Congress that is flat out both too stupid to see it or has been sufficiently bought off by the big conglomerate, or both. </p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/09/excess-scoring-of-us-consumers-us.html"><strong>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..</strong></a></p><p>It’s hard today to even find really good journalism with the big media as they are all starving for revenue since Facebook came along with all their algorithms and functioned like a PBM to rob them of their advertising revenue so they are hanging on to what’s left on who pays for ads, and it circles right back to big pharma and health insurance companies, and nobody’s going to disturb what left of the golden goose that helps keep their doors open with new stories that give you the real picture today as they will not publish anything that will reduce what advertising revenue that they have left with anything detrimental reported about big pharma and health insurance companies.  As I wrote a while back, news rigging is here, and done with algorithmic models that write the news for them today as well.  It’s like your day trading software, you just plug in what you want and the software will write it up with a focus that you specify, or knock off news is also done this way, taking existing news and putting the bot to work t re-arrange an article (s) that’s already been written to create a new one with a bot that is smart enough to avoid any references that would create any plagiarism.  It’s the way it works, with 60% of what you read today being produced in this fashion.  </p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/04/news-rigging-has-arrived-astroturf-and.html"><strong>News rigging Has Arrived! Astroturf and Manipulation of Media Messages-TED Video About “The Fake Grass Roots” Of Big Pharma and Other Campaigns That Fool and Fool Again…</strong></a><p>Coming back around to the PBM machines, these are all automated processed and you can’t see what’s really going on and it’s hard to make changes as they keep adding more layers of hidden computer code and then create a story that will dupe you into thinking that some new algorithmic processes are going to save the day for consumers, and that’s not true, the machines are there to create more profits, not a better world for us with getting our medications we need, they have a captive audience and they know it.  If thing were really working the way they said they were, we wouldn’t have news stories and legal cases like this. You take the receipts, the cost as it’s been done many times on what you pay for your prescriptions, and you end up with the same thing, algorithms that lie to you and a big media service today that supports the algorithms that lie and cheat.  It’s in your face and you can choose to look at reality or go off into a little virtual world where you convince yourself that this is just not happening, which many people do and then wonder why things are not getting any better. <p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2016/10/cigna-united-healthcare-face-class_16.html"><strong>Cigna & United Healthcare Face Class Action Suits-PBM Over Charging Customers for Prescriptions, OptumRX Pharmacy Benefit Management Software-“Front Running” Consumers With Killer Algorithms at the Drug Store</strong></a><p>It’s what I call a “One Trick Algo” world out there for consumers and the PBM business clearly leads the way in all of this with trickery used with computer code to make you think this is not the case.  It’s all about selling, mining and scoring your data to rapidly increase the rate of inequality in the US and if you think that putting another layer top will fix things, you’re back in that virtual fantasy world as you can’t keep layering computer code and algorithms on top of bad models and expect anything to change, it will only get worse, more complex and that benefits corporate America when consumers have no clue about understanding the systems we are forced to deal with today, and you are told “just keep clicking” for those miracle fixes, which of course do not exist.<p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2017/04/one-trick-algo-world-needs-to-be.html"><strong>“One Trick Algo World” Needs to be Licensed and Indexed–Spurious Correlations “For Profit” Are Out of Control</strong></a><p>So there’s coupons out there for saving on your prescriptions, but did you know it’s just another pharmacy benefit manager financing the coupon?  Why do they do it?  They do it for money and data.  So as an example if your PBM is Express Scripts let’s say and you have a coupon from one of those discount card deals that will give you a better price, well it’s probably OptumRX (a wholly owned subsidiary of United Healthcare) that gives you the discount, so you’re still in the PBM game, just not the one that comes with your insurance plan to get your meds.  <p>These coupons too all have what is called a “bin” number on them just like your insurance plan has and you can easily do a “bin” number search on the internet to see who’s financing the discount of your prescription.  Drug stores have to pay a fee for the privilege of filling your prescription when a PBM card or discount is used and it’s called a DIR fee, and these get big as they do not all occur at the time of your transaction either.  When you ask for a “cash” discount from an independent pharmacy the drug store gets to avoid this fee and can keep more of the revenue and not have to give it to the PBM.  The DIR fees are yet another profit producing algorithmic machine of their own accord.  Recently it was discovered that Caremark was charging their own CVS drug stores a much smaller fee than what was being levied on other drug stores where Caremark is the patient’s PBM, so this gets very involved with quants and analysts figuring how much profit they can make with these fees.  Recently it was reported that the auditors at Publix Warehouse asked about the $25 Million<img width="182" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/lh3.googleusercontent.com/-XHSvyCC6Ly0/Vi7i2iz25hI/AAAAAAABMkY/pP9kI46N7qE/image=2525255B8=2525255D.png=3fimgmax=3d800" style="float: right; display: inline;" height="208"> Dollar DIR fees they had to pay, they didn’t know what they were and that’s a big charge so even the big corporations are getting screwed by the PBMs with these fees just to be able to fill your prescription.  What a big profit making algorithmic machine, is it not?<p>So if you have one of those cards, the one getting the big profits are the company names attached to that “bin” number folks.  A lot of pharmacists if you give them the chance will match that price or even give you a better price with cash, as both you and the pharmacist win that way versus having the PBM monster algorithms charging in to get their cut.  Now we have Cigna wanting to buy Express Scripts so they can be liked United Healthcare and keep all that money, but there’s only one problem with Cigna being late to the dance here and that’s the fact that Cigna had a 10 year PBM agreement with PBM Catamaran which was bought by OptumRX (UNH) and there’s 5 years left, so no Express Scripts for those insured by Cigna, you have 5 more years of OptumRX unless they cut some kind of a deal and pay United Healthcare a boat load of money.  Right now Cigna needs a bond sale to be able to buy Express Scripts as they don’t have enough money, so when’s that going to take place?  I wrote this article back in 2015 when OptumRX bought Catamaran and few folks seem to be aware of this as they are too busy with their little virtual worlds of Facebook Follies and playing games I think. <p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/10/if-you-are-insured-by-cigna-guess-what.html"><strong>If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare</strong></a><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/03/united-healthcare-buys-catamaran.html"><strong>United Healthcare Buys Catamaran Pharmacy Benefit Manager Just As the PBM Gets Hit With A Class Action Lawsuit For Low Balling Pharmacy Reimbursements..And More Patient Data to Sell and Analyze For Profit</strong></a></p><p>Actually Express Scripts uses a lot of OptumRX algorithms already and has since 2010 with their bogus<img align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/lh3.googleusercontent.com/-WTU_WavuGLg/VYjYaFce1MI/AAAAAAABMZA/DCNNtafnZm8/image=2525255B8=2525255D.png=3fimgmax=3d800" style="float: right; display: inline;"> black box scoring metrics, so yeah they’re already connected at the algorithms you could say.  <p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2010/10/express-scripts-new-program-to-contact.html"><strong>Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On Ingenix Algorithms–We Want the Revenue Please Don’t Stop</strong></a></p><p>And here it is a few years later, revisited to see what kind of a bogus data selling/mining business Express Scripts created with those Ingenix (Optum) algorithms, quite the deal when you are scored on bogus metrics every time you fill a prescription.  Are you a man seeing a female MD, whoops that’s bad and do you have kids at home, that’s bad too as they will distract you from taking your meds.  These companies get away with this crap and sell those scores to insurers right and left.  So the choice is yours to start reading up and not being so stupid and speaking out and realize it’s an algorithmic computer code service that is running all of this. <p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-enter.html"><strong>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</strong></a></p><p>Did you know FICO buys all this scoring data from PBMs and sells it too?  Sure they want to cash in and mix t<img width="340" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/lh3.googleusercontent.com/-U0fHNHM3Vvo/VYjYc7peUgI/AAAAAAABMZI/N5v7HrnJd2c/image=2525255B3=2525255D.png=3fimgmax=3d800" style="float: right; display: inline;" height="282">his crap in with your credit scores!  Please get angry about this and start speaking up as the well greased algorithmic machines are taking over your meds every way they can.  Big pharma buys these scores too and if they can show that folks aren’t really taking their meds with a bunch of bogus stats, it helps them keep the prices high with their political campaigns for profit as they come back with arguments that patients are not taking their meds so why should they offer them for less!   Look at the image from Express Scripts, they want to make the patients the problem!  Non-adherence is not a disease to be cured, it’s the price of the drugs that adds to people not taking their drugs, wake up to the scam for bigger profits.  <p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2014/06/fico-medication-adherence-scoring.html"><strong>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</strong></a></p><p><strong>It’s pretty wild is it not that Express Scripts decided to turn medication adherence into a disease!  It’s not a disease at all.</strong>  They want you to think of it like you have cancer, diabetes, etc.  Beware of PBM marketing for profit.  <p>Be aware too of the next step of the PBM algorithms for profit, connecting coupons to your medical records.  This is promoted to doctors to provide you with an e-coupon that goes directly to the pharmacy in lieu of using your PBM discount.  When this is done electronically, you cannot ask for a cash discount from the drug store as the price is locked in and the drug store is electronically stuck with the DIR fee to pay that I discussed above.  If you are offered one of these, have the doctor print it out and give the drug store a chance to match it with a cash discount instead of sticking it to the drug store.  See how these algorithms for profit work and you had no idea at all.  It’s PBM wars you could say as if you don’t use your PBM for your script, or you don’t have one, by using a coupon, a DIR fee is created for the drug store to pay down the road and cha ching, cha ching they make some money. <img align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-3vUPXlYry8E/WUtNkuod6xI/AAAAAAABM5U/RBTZvIgihuwzV9mJkE-v1WQA66bHnFg4wCHMYCw/image_thumb=25255B5=25255D=3fimgmax=3d800" style="float: right; display: inline;"> <strong>PBMs  want no prescription filled without a PBM getting a DIR fee attached in the overall performance standards levied on the pharmacy. </strong><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2017/06/pharmacy-benefit-managers-invade.html"><strong>Pharmacy Benefit Managers Invade Medical Records and Electronically Connect Cash Patients to RX Discount Cards-OptimizeRX-to SingleCare to OptumRX</strong></a><p>Actually if you pay cash the PBMs come knocking at the door of the drug stores in time as well if they can’t track a credit card transaction or one of these coupon things, along with any other data supporting a purchase and you’ll be labeled a non compliant outlier if you use cash as well.  Get a load of that as the pharmacists at the drug stores get presented with lists of patients who are not compliant, only because they pay cash.  See how these black box analytics are really bogus!  PBMs are right in there pushing the war on cash.  Too many cash clients make the drug store look bad, which is ridiculous!  <p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html"><strong>Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…</strong></a><p>I have quite a few more posts in the archives of this blog that explain a lot of this as well, read them and learn up as when you hear laws and rules are being created to control the costs of medications today, just laugh like I do at those attempts as they are fruitless and Congress is way too stupid to understand how the well greased PBM algorithmic machines work, as you can’t change the machines with verbiage and expect any changed outcome, corporate America just codes around the verbiage and cheats if they want as the code and algorithms are all locked up in black boxes which nobody except the PBM has access to, so as long as they can tell a story that their code is complaint with verbiage, the nightmare lives on and nothing gets changed and they’ll keep telling you to go hang out in your little virtual worlds of the Facebook Follies and the likes to speak out.  Nobody listens to any of that anymore as well, it’s just a place to vent and you get trapped in their well greased algorithmic machines as well.  Here’s a big part of the problem. </p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/06/virtual-world-values-and-real-world-we.html"><strong>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…</strong></a></p><p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/05/privacy-duping-of-america-intangible.html"><strong>Privacy Duping of America-The Intangible Threat Model Has Changed Significantly-Companies Hide The Code On the Web, $180 Billion Dollar A Year Business, Welcome to The Duperville World of Inequality..</strong></a></p><p>So in closing I hope helped make the case and explained a bit more about the well greased PBM algorithmic machines that are in control out there, and the only way to do anything is to dump some of these black boxes and furthermore get to see their code that’s patented and running everything.  Until something is done is, no laws, rules, etc. will have much impact, they just call in their quants and code around it.  You can hear more of that from a presentation I did a few months ago where I spoke and spelled a lot of this out at a big doctor convention.  Here’s a spoiler screen to the right…how do you like that patent?  Time to wake up dupes and speak up. BD<p><strong><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2017/11/algorithms-scoring-metrics-privacy-and.html">Algorithms, Scoring Metrics, Privacy and more in today’s Healthcare business world–The Healthcare Algo Cartel</a></strong>

Pharmacy Benefit Managers Are Not Much More Than “Complex Well-Greased Algorithmic Human Scoring Machines” That Deny or Allow Access To Drugs To Create/Substantiate Big Corporate Profits

So let’s get down to what’s really happening here.  Once upon a time the PBM models were a different type of creature but as time moved on t...

Read more »

Algorithms, Scoring Metrics, Privacy and more in today’s Healthcare business world–The Healthcare Algo Cartel

<p>This is a video of a recent presentation I did at the 74th Annual AAPS (American Association of Physicians and Surgeons) meeting.  I don’t do too much blogging anymore as I don’t want to be confused with all the “junk” news out there but thought this is worth a look and listen for all.</p><p>The presentation was initially intended for a physician crowd, but after I thought about it, consumers can learn a lot from this as well.  We have too many folks today <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/06/virtual-world-values-and-real-world-we.html">choosing “virtual” values and getting lost in the real world and don’t realize</a> what goes on behind the scenes, and it’s a lot, things you can’t see rising from corporate America to gain control of us lesser valued serfs it seems.<a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-x9TT-P6Qjsc/WhHuVDVWncI/AAAAAAABM6k/xN1ufLdHrMM8gaJiMxDf4aNpcDKifKFoACHMYCw/s1600-h/Optum_moneyball=25255B4=25255D"><img width="207" alt="Optum_moneyball" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-NMTC07Amu2I/WhHuVoIroiI/AAAAAAABM6o/74SyRudsU7IGGN1PBCMVEbp4DoYGFY9sACHMYCw/Optum_moneyball_thumb=25255B2=25255D=3fimgmax=3d800" style="border: 0px currentcolor; border-image: none; float: right; display: inline; background-image: none;" height="149" border="0" title="Optum_moneyball"></a></p><p>Every direction you turn today, somebody is <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/09/excess-scoring-of-us-consumers-us.html">mining up some behavior data and scoring you today, so we have so many scores</a>, and many of them secret, who knows what value some big corporation or government is putting on our head today?  I’ve been writing about this for years and unfortunately we have gone beyond just good production software that helps us in life and in doing our jobs into a somewhat digital caste system.  I used to write software and this is my attempt here to let the average consumer know more about what’s really taking place out there.  I thought the Obama administration was getting way too virtual, but it seems the new Trump administration is just as bad with not seeing the real world and embracing virtual world values as well, so I guess it doesn’t matter which person or party is in control out there today, <strong>they don’t like the ugly real world </strong>and keep pushing virtual values on all of us to keep consumers in the dark.</p><p>I call it a <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2017/04/one-trick-algo-world-needs-to-be.html">“One Trick Algo” world</a> and that’s what you’re getting too often out there today, some algorithms and computer code, written by corporate America to profit that tricks you into things you would rather not do if you knew the whole story.  I call this <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/06/operation-perception-deception-into.html">“Operation Perception Deception”,</a> which was a post I wrote back in 2015 and sadly it’s getting bigger every day.  So take a look and see what’s going on behind the scenes in healthcare, and don’t deceive yourself too badly with virtual values as people can’t seem to be able to tell the difference anymore.  BD</p><p><iframe width="560" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000101A/https/www.youtube.com/embed/vKBMXQXWvvs=3frel=3d0" height="315" allowfullscreen frameborder="0"></iframe></p>

Algorithms, Scoring Metrics, Privacy and more in today’s Healthcare business world–The Healthcare Algo Cartel

This is a video of a recent presentation I did at the 74th Annual AAPS (American Association of Physicians and Surgeons) meeting.  I don’t d...

Read more »

DOJ Enters WhistleBlower Law Suit Against United Healthcare–Risk Fiddling for Profit, A Walk Back Down Ingenix Memory Lane Again

<p>Here we go again, back to those Ingenix algorithms and business models, getting a rerun of sorts of what occurred in 2011.  In 2011 there was one main lawsuit from the AMA along with many others that were filed (some being still settled) over using formulas that short changed doctors and patients on out of network chargees.  In addition, all other insurers who licensed and used the formulas were also drug<a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-8NzMOjjBagg/WK5g1-wSfAI/AAAAAAABM3s/AOVqANS-jQE/s1600-h/image=2525255B4=2525255D.png"><img width="309" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-biRchvnIWtQ/WK5g2ktWtlI/AAAAAAABM3w/TCmRA3P5nMY/image_thumb=2525255B2=2525255D.png=3fimgmax=3d800" 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" height="237" border="0" title="image"></a> into court for settlements.  This was a big deal and now we have another lawsuit with again, other insurers being named for using the formulas of Ingenix once again.  Here’s a case that has not settled yet as an example and one that just recently settled.</p> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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>A couple years ago Medicare said they were going to rerun the Medicare risk assessment scores, so there was no secret as to what was going to occur with an audit. <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2015/03/cms-to-rerun-medicare-advantage-risk.html">CMS to Rerun the Medicare Advantage Risk Scores–Dating Back to 2008 To Catch the Automated Risk Fiddlers of Said Insurer Fraud Amounting to Around $70 Billion–Be Ready For It…</a></h5> <p>There are other lawsuits on the books that have not settled yet in other areas, like this one with mental health that could go to a class action suit too. <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2013/03/class-action-lawsuit-filed-against.html">Class Action Lawsuit Filed Against UnitedHealthGroup and Their Various Subsidiaries There Of Relative to Mental Health Claim Denials & Violation of Parity Laws</a></h5> <p>Here’s a back link to the big settlement by the AMA.  Again this is only one of many and at the time I was writing a series of blog posts called “The Attack of the Killer Algorithms and this was chapter 19.  </p> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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 </a></h5> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2012/02/ama-announces-doctors-and-patients-can.html">the Killer Algorithms Chapter 19</a></h5> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2011/04/unitedhealthcare-erisa-class-action.html">UnitedHealthcare ERISA Class Action Lawsuit Expanded to Include DME and Ambulatory Surgical Center Providers</a></h5> <p>If you missed this along the way, things go so ugly with the Ingenix name, United Healthcare changed it to Optum, which you see all over the place today, as they are buying up broke doctor practices and urgent care centers like they are going out of style.  There’s 2 sides to United Healthcare, one that does insurance and the other Optum side that’s buying up and creating software was well as consuming and acquiring companies that have anything to do with doctors. <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2011/04/unitedhealth-group-announced-re.html">UnitedHealth Group Announced Re-Branding of Business Units-Focus on “Optum”–Changes IngenixName to OptumInsight</a></h5> <p>So again with this new lawsuit, which was created from the efforts of a high ranking former United Healthcare executive, not just an employee, we are seeing the same process again, Ingenix algorithms and models followed to fiddle with risk scores, make patients look sicker and get more money from the government this time instead of doctors. <p>Express Scripts ended up at one point in time a while back buying the old United Healthcare pharmacy benefit business and acquired some software and algorithms in the process and in 2010 was bragging how they are going to predict if you will take your medications.  This flawed scoring still goes on today. <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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>The entire <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/constantinecannon.com/whistleblower/wp-content/uploads/sites/2/2017/02/U.S.-v.-UnitedHealth-Group-First-Amended-Complaint.pdf">lawsuit can be read here</a> and there’s quite a few pages to the pdf to read.  Benjamin Poehling was the former high ranking executive that filed the whistle blower lawsuit.  It’s kind of uncanny that Poehling came from Arthur Andersen, where the current CEO of United Healthcare worked as Anderson’s CFO and all the Enron issues were on his watch.  Enron lead to the end of the Arthur Andersen auditing firm due to fraud.  Here’s a few quotes from the suit… <hr> <p><em>“United’s senior management push relentlessly to increase United’s revenue from risk adjustment. Tellingly, UHMR has assigned risk adjustment to its Finance Department, not one of its clinical departments. (Relator was assigned to his job despite having no clinical background.) In 2010 and 2011, UHMR has implemented projects referred to as “remediation plans”, “focus area projects,” or “affordability agendas” to increase IOI.</em> <p><em>UHG engages in an aggressive and extensive effort to find a justification or pretext to submit risk adjustment claims for additional diagnoses—regardless of whether the patient had or was actually treated for the diagnosis in the relevant period by a qualifying provider. United’s program has some components that are broad-based, and others that target specific high value HCCs. As an overall goal, UHG attempts to reach each of its members at least once every two years through one of its programs designed to find additional risk adjustment claims. </em> <p><em>Ingenix conducts chart reviews on behalf of UHMR, UHCS, and commercial clients. In the retrospective chart review process, Ingenix identifies provider charts to review and arranges for the charts to be collected. It uses both internal coders and also contracts with external vendors to review and code the charts. 129. These vendors review charts using a blind review. In a blind review, the reviewer codes every <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-f43KV0WYLek/WK5g3RYjExI/AAAAAAABM30/kiGdiLtsRK0/s1600-h/image=2525255B9=2525255D.png"><img width="469" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-fBbsaLzUH1s/WK5g4KJEweI/AAAAAAABM34/geIdBViAYIA/image_thumb=2525255B5=2525255D.png=3fimgmax=3d800" 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" height="123" border="0" title="image"></a>condition he or she identifies from the chart without knowing what codes the provider identified from the chart previously. Thus, the reviewer works from the raw chart material and reaches independent conclusions.</em> <p><em><strong>Under the COI program, United pays providers approximately $100 for each diabetes patient they assess for diabetes complications, submit a supporting diagnosis via a claim, and submit a medical record with matching documentation. In addition, it pays $200 for each doctor that receives training on the COI program and diagnosis coding. Recently, the COI program has expanded to other conditions that United suspects are frequently undercoded, such as chronic kidney disease (“CKD”), and chronic pulmonary disease (“COPD”).</strong></em> <p><em>Relator knows that at least the following United executives know about some or all of the problems discussed herein, and have participated in the scheme to continue submitting fraudulent claims and to refuse to correct previously submitted false claims: Stephen Hemsley, UHG Chief Executive Officer; Gail Boudreaux, UHG Executive Vice President and CEO of United Healthcare; Larry Renfro, Optum CEO; Tom Paul, UHMR Chief Executive Officer; Cindy Polich, UHMR President; Lee Valenta, Ingenix’s former Chief Operating Officer (and current President of Ingenix’s Life Sciences Division); Jack Larsen, former CFO of PSMG (and current CEO of UHCS); Scott Theisen, UHMR Senior Vice President of Finance; Jeff Dumcum, Senior Vice President of Ingenix; and David Orbuch, PSMG Chief Compliance Officer.</em> <p><strong><u>And this….</u></strong> <p><em>“United’s refusal to correct errors in its risk adjustment claims is so extreme that it submits risk adjustment claims to CMS for diagnoses taken from claims that it itself refuses to pay as being fraudulent and/or abusive.</em> <p><em><strong>United developed “playbooks” containing ideas for increasing its risk scores.</strong> These playbooks are garnering top-level attention at the company while the myriad problems with United’s risk adjustment programs and processes go unresolved. 195. United conceals the one-way nature of its risk adjustment programs from CMS and even its investors. For example, United’s remediation plan for 2010 that sought to increase IOI by $800 million allocated $100 million to “Project 7.” Project 7 was United’s codeword for initiatives to increase risk adjustment payments. The company used a codeword (as opposed to “growth,” “enrollment,” or “claims”) because it did not want CMS or other investigatory government agencies to know it had a campaign to claim an additional $100 million through risk score increases.</em> <p><em>United customizes its kickbacks depending on the nature of its overall reimbursement arrangement with the provider group. The providers United chooses to pay additional amounts for increased risk scores are those that do not already have an incentive to upcode diagnoses. United uses three basic payment structures for its providers: (1) percent of premium capitated providers, which receive a percent of United’s CMS premiums for its patients; (2) “fixed” capitated providers, which receive PMPM payments from United that are not tied to United’s CMS premiums; and (3) feefor-service providers, which are paid based on the claims they submit to United.”</em> <hr> <p>If you made it through those paragraphs you can easily see how complex insurers have made medical billing for sure.  Once again we come back to the business models of Ingenix and some of the automation in the IRAD data base to work these claims.  Here’s another billing subsidiary United bought, again we’re talking coding and billing here. <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2010/09/ingenix-wholly-owned-technology.html">Ingenix (Wholly Owned Technology Subsidiary of UnitedHealth to Acquire A-Life Coding Software/Services–Tons of Money and Profit With Coding Transactions and Algorithms - Subsidiary Watch</a></h5> <p>I talk too about the United/Optum incest at times too with HHS and CMS and here’s a blast from a few years ago…this was the beginning of pushing “population health” that all know the term and nobody really knows what it does half the time to even include vendors of the algorithmic processes.  This is where the government bought yet another United Healthcare model. </p> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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><strong>Simon Stevens, who is now running the NHS and worked at United Healthcare</strong> a few years ago had this to say…</p> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2009/05/united-health-care-says-cheaper.html">United Health Care Says Cheaper Efficient Doctors and Reducing Hospital Visits by the Elderly Would Help Reduce the Cost of Healthcare</a></h5> <p><strong>Former Acting director of CMS, Andy Slavitt claims Simon is a good friend of his and let’s not forget that Andy Slavitt was the CEO of Ingenix when a lot of this was going on.  Larry Renfro came in later from his executive position at AARP to run the Ingenix show.</strong>  </p> <p>United Healthcare sure seems to be lining up some big executives as well with last year hiring the former CEO of Stanford University Healthcare to work for United as a VP and recently in the UK, Optum hired Nick Seddon, who worked for David Cameron as his special healthcare adviser.  There’s a group in the UK that is also bringing attention to the fact that one company, United/Optum has been taking over way too much ground and is not leaving enough competition out there with other countries.  </p> <p>The entire suit takes a while to read but there’s a ton of detailed explanations as to what United and other insurers taking advantage of their consulting and billing services are accused of.  Again, do leopards change their spots?  Here’s another suit you might want to read about…it just does not stop when you have complex built algorithms that can spin around faster than you can take a deep breath to score and stick you with more risks than you ever dreamed of, all for the sake of making money from the government.  </p> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/2016/10/cigna-united-healthcare-face-class_16.html">Cigna & United Healthcare Face Class Action Suits-PBM Over Charging Customers for Prescriptions, OptumRX Pharmacy Benefit Management Software-“Front Running” Consumers With Killer Algorithms at the Drug Store</a></h5> <p>Feel free to search this blog, there’s plenty of information like this written since 2008 on how companies cheat with computer code and algorithms…BD  </p> <p> <hr> </p> <p>United Healthcare, the largest provider of Medicare Advantage (MA plans) services, is being sued by the Department of Justice (DOJ) for fraud. To give you a sense of United Healthcare’s size consider that just their third quarter revenue was $46.3 billion, up 11.6 per cent from the same period a year earlier, and the bulk of the growth was billing services and data analysis for healthcare groups, which ws up 34 percent since the beginning of 2016.</p> <p>Medical charts, the primary source of diagnostic data were reviewed looking for incremental increases but not for errors that would decrease the risk adjustment.  New diagnostic codes were submitted, but an erroneous diagnosis was not deleted. On a two-way street, “they do not look both ways.” And these reviews were profitable, a $30 cost for chart review resulted in an average of $450 in additional payments. Ingenix sought to find additional diagnosis by using data analytics to identify practices, where chronic conditions were underreported based on population prevalences or where a new diagnosis was suggested by medications patients were receiving. Here the physician was contacted with patient assessment forms (PAFs) to consider these diagnoses for the patient. Physicians receive a small fee for reviewing these PAFs. Ingenix also developed initiatives designed to get patients to visit their doctors each year. But wait a minute, these programs encourage physicians to screen patient’s more carefully and to encourage annual checkups.</p> <p><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/www.acsh.org/news/2017/02/21/department-justice-believes-united-healthcare-defrauding-medicare-10885" title="http://www.acsh.org/news/2017/02/21/department-justice-believes-united-healthcare-defrauding-medicare-10885">http://www.acsh.org/news/2017/02/21/department-justice-believes-united-healthcare-defrauding-medicare-10885</a></p>

DOJ Enters WhistleBlower Law Suit Against United Healthcare–Risk Fiddling for Profit, A Walk Back Down Ingenix Memory Lane Again

Here we go again, back to those Ingenix algorithms and business models, getting a rerun of sorts of what occurred in 2011.  In 2011 there wa...

Read more »

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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-QO1huLc4Ves/V92AEN8UY9I/AAAAAAABM0E/wF13WZgVGJU/s1600-h/image=2525255B15=2525255D.png"><img width="244" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-CtZcwaQXId4/V92AE7cCDcI/AAAAAAABM0I/5rN3NG1tJRI/image_thumb=2525255B9=2525255D.png=3fimgmax=3d800" 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" height="78" border="0" title="image"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/ducknetweb.blogspot.com/search/label/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-sUPaYPmhyqY/V92AFd84B4I/AAAAAAABM0M/LqEegYGImOk/s1600-h/image=2525255B4=2525255D.png"><img width="288" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-DCiT1MZO3zc/V92AF8wyKTI/AAAAAAABM0Q/WM0FsT80Jtc/image_thumb=2525255B2=2525255D.png=3fimgmax=3d800" 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" height="138" border="0" title="image"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/www.linkedin.com/pulse/20141027182707-39299902-examone-acquires-assets-from-optuminsight=3fforceNoSplash=3dtrue">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" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/lh5.ggpht.com/_v3zjJigoAPE/SkL9GOgy_rI/AAAAAAAATec/4yxb2jf7CV8/image_thumb=255B5=255D.png=3fimgmax=3d800" 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" border="0"> 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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-DRG5tPihlZE/V92AGSOr7MI/AAAAAAABM0U/O5NN6zkMnyk/s1600-h/EQUIPP=2525255B5=2525255D.png"><img width="449" alt="EQUIPP" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-rKZvRY4yzrk/V92AG2s461I/AAAAAAABM0Y/Rc7GljKudEM/EQUIPP_thumb=2525255B3=2525255D.png=3fimgmax=3d800" 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" height="457" border="0" title="EQUIPP"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-k-dnOpmw8Ow/V92AHa6pxII/AAAAAAABM0c/SxBgk_dHybQ/s1600-h/image=2525255B19=2525255D.png"><img width="187" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-W_L3qRa38CQ/V92AH4GFwtI/AAAAAAABM0g/qfsi9ppy29s/image_thumb=2525255B11=2525255D.png=3fimgmax=3d800" 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" height="101" border="0" title="image"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-XgfibL-ArlQ/V92AIYYGhaI/AAAAAAABM0k/HXiYtXMIqGc/s1600-h/image=2525255B9=2525255D.png"><img width="265" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-suvBkbofYL0/V92AI4FEAxI/AAAAAAABM0o/4R765Soth94/image_thumb=2525255B5=2525255D.png=3fimgmax=3d800" 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" height="194" border="0" title="image"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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...

Read more »

“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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-yUVXdZ6cAzo/V9WFyFxYJoI/AAAAAAABMzk/3tCAymVzC10/s1600-h/Sully=2525255B3=2525255D.png"><img width="205" alt="Sully" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-uDmgPHpT3-Y/V9WFy30eB3I/AAAAAAABMzo/o3sQqr9C6VQ/Sully_thumb=2525255B1=2525255D.png=3fimgmax=3d800" 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" height="309" border="0" title="Sully"></a>former United Airlines pilot duped even the AMA on the fact that he was a cardiologist and even had to <a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/abcnews.go.com/Health/MindMoodNews/fake-cardiologist-william-hamman-duped-real-doctors/story=3fid=3d12395288">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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/www.memphisflyer.com/memphis/bruce-harris/Profile=3foid=3d3704124">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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/lh3.ggpht.com/-6HDDm04lOwA/Ts0zq-EuFHI/AAAAAAAA4d8/nMT-KL0JEDY/image_thumb=2525255B12=2525255D.png=3fimgmax=3d172" 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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/www.amazon.com/Weapons-Math-Destruction-Increases-Inequality/dp/0553418815/ref=3dcm_cr_arp_d_product_top=3fie=3dUTF8">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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-1T-X0vt3giE/V9WFzQijODI/AAAAAAABMzs/yZI7oAgqSOg/s1600-h/image=2525255B4=2525255D.png"><img width="133" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-KJ672vOBiEw/V9WFz-Y0qlI/AAAAAAABMzw/Tpnl68wFr3o/image_thumb=2525255B2=2525255D.png=3fimgmax=3d800" 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" height="193" border="0" title="image"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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...

Read more »

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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-tWBotw6Xue8/V68k18unLrI/AAAAAAABMy8/j0A7lc_9qDE/s1600-h/image=2525255B7=2525255D.png"><img width="240" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-KbTmiuOWJSM/V68k2kRMBdI/AAAAAAABMzA/W2ZsaJMws7E/image_thumb=2525255B3=2525255D.png=3fimgmax=3d800" 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" height="143" border="0" title="image"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-UUB5Z8eGbQY/V68k3d_DoyI/AAAAAAABMzE/fbJdGdO2TEM/s1600-h/image=2525255B3=2525255D.png"><img width="451" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-fgOPxCW3l3M/V68k35A9qqI/AAAAAAABMzI/6o7nMdXN6Hg/image_thumb=2525255B1=2525255D.png=3fimgmax=3d800" 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" height="142" border="0" title="image"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/lh6.ggpht.com/-3szEXZPRIqQ/U7qv_R169gI/AAAAAAABKxc/evT7Y_hxGEc/image121.png=3fimgmax=3d800" 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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/http/lh6.ggpht.com/_v3zjJigoAPE/TLZdsFwnFqI/AAAAAAAAiIY/NIhj9oaZrLo/image_thumb=255B4=255D.png=3fimgmax=3d800" 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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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...

Read more »

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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/www.optumcare.com/medical/locations/ca-orange-county/ocmg-huntington-beach.html"><img width="199" alt="WP_20160509_17_31_38_Pro" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-8J7WUJZ5Rz0/V6gUnXYM1OI/AAAAAAABMyg/p3uPnTCP6xc/WP_20160509_17_31_38_Pro=2525255B7=2525255D.jpg=3fimgmax=3d800" 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" height="260" border="0" title="WP_20160509_17_31_38_Pro"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/www.optumcare.com/medical/about-optumcare/health-care-providers.html"><img width="240" alt="image" align="right" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-Q5pZlaR9W4c/V6gUnz-UwhI/AAAAAAABMyk/ggkMWp9ssdU/image=2525255B4=2525255D.png=3fimgmax=3d800" 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" height="99" border="0" title="image"></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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/www.optumcare.com/medical/locations/ca-orange-county.html">Orange County that sold their practices to Optum.</a>  </p> <h5><a href="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-_1sgRxRunDo/V6gUoczPZbI/AAAAAAABMyo/fVn01w-QpsU/s1600-h/image=2525255B9=2525255D.png"><img width="715" alt="image" src="http://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/https/lh3.googleusercontent.com/-pe1wP13h0kI/V6gUoxeUBHI/AAAAAAABMys/0si9jM_5ID4/image_thumb=2525255B4=2525255D.png=3fimgmax=3d800" 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" height="158" border="0" title="image"></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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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://library.vu.edu.pk/cgi-bin/nph-proxy.cgi/000100A/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...

Read more »