This is a continuing story of the California Medical Association asking for a delay with starting the United Premium Designation Program and you can read more at the link below where they said no, algorithms have to run no matter what. You may not even know what the Premiums Designation is but it’s more analytics and scoring of doctors that they have to go through to maintain being in network with United.
The company says this program started in 2005 and that’s about right as I remember reading a brochure and information about it I said recently around 10 years back to my memory fits well here as at that time I was spending a lot of time around a primary practice office writing and programming an EMR which I sold for a very short time. You see a lot of stuff when you spend a lot of time at a doctor’s office. You can also visit the company’s site for MDs and see what all they have in store for MDs. Doctors can log in and see their Premium Assessment Results from there. There’s a pdf that will make your head swim as a patient that outlines all the grading formats. Here’s all the Optum/United software that is used for this complex evaluation from claim data.
“The Premium program uses different software programs to collect or "group" claims data into quality measures and episodes of care, including Symmetry Episode Treatment Groups® (ETG®), Symmetry Procedure Episode Groups® (PEG®), Symmetry Episode Risk Groups® (ERGs®), Symmetry EBM Connect® and 3MTM All Patient Refined Diagnosis Related Groups (APR DRG).”
The Practice Rewards page is left blank. So they have tools for the doctors to use with the symmetry software and the first is what they call EMB Connect which includes all the data from claims and is supposed to help doctor assess you, the patient to make you more compliant. Then it goes on to episode risk groups teaching doctors more on how to do a risk assessment on you and tools to predict your current and future healthcare usage.
There’s a couple others as well called Symmetry Episode Treatment groups and Pharmacy Risk and those dive into Population Health risks and assessments. So did you think population was a CMS invention, nope, it’s been here for around 10 years as I remembered seeing the beginning stages and all one has to do is pretty much just read the United Healthcare Annual Report and you can see where CMS gets their models and it’s been that way with a flurry of United people in government ever since Hillary Clinton rescued Lois Quam, who was a big executive at United, who was one of many who were named in the DOJ Criminal case the SEC brought forward in 2008-9 related to back dating stock to increase the value. I think it’s still the largest derivatives fine on record. The former CEO took the hit and the current CEO rushed to give his money back and moved into the current CEO job from being the former COO or CIO.
Anyway, as you can see here there’s a lot going on here with evaluating all the data on the doctors and when you add on that many of them in southern California via use of complex contracts are already getting paid at rates less than Medicare, this does not make them real happy to have a bunch of algorithmic figures and more analytics to jump through. This process has become more complex as all health insurers are hiring more quants to create models, although United I could guess has had their share for years since that’s where 1/3 of their revenue comes from these days, analytic, software, licensing and 2/3 from selling policies. You do have to wonder on top of their algorithms and models they are when you see the company just kick out a check for a $175,000 hammer toe procedure and then again hammer down many doctors to getting paid less than Medicare.
There’s also this example here too where the company goes out and bids and wins a Medicare Advantage contract and then has to give it back as they had no doctors in network to see the patients.
Here’s a couple more quotes on the system and see how your doctor has to be quantified by United Healthcare with stats, that may or may not lead to better care but this is the deal to be a Premium so remember that when you see the rankings. You’ll know that United has quantified him/her with numbers and is working to put you the patient into population health management and keep your doctor in the evidence based medicine area, so if he/she varies outside of what evidence shows with something new where there’s no evidence yet, they slip down a rank or so.
“EBM Connect helps you assess patient compliance with proven evidence-based treatment standards. EBM Connect compares the medical claim, pharmacy claim, lab result and enrollment data from your plan with evidence-based best practices for over 90 clinical conditions and almost 600 measures of care. These measures provide a quantifiable basis for actionable interventions by health plans, employers, disease managers and others.”
So as you can see there’s a lot here and why the CMA was asking for some changes and delays and their concern on you’re the patient being confused when you see the “Premiums” rankings. It means your doctor has been quantified and that’s a model and all models have flaws as well. I think where the CMA is concerned as this article says is in the fact that relying on such quantification heavily will hurt the doctor and patients, and we all know how flawed data is all over the place today. You will be steered to a layer of tiers, to select a doctor. Actually if you wait long enough the internet with all the flawed data out there today will end up in time giving you some kind of diagnosis:)
So if it were me, I’d still ask others about doctors as that’s still the best and you’re going to get a “data presentation” of your intended selected doctor and not the whole picture. There’s a video at the footer of my blog, #1, called “Context is Everything” and I advise everyone to watch it and see how you get duped on data and numbers and make choices with too much virtual world value and not enough real world value. When you ask another person about a doctor, you’re getting “real” world value and when you look at a doctor’s “data” this is all virtual stuff here with quantitated mass data using criteria that an insurance company decides is what counts, not you. This is a real problem today with way too many confusing virtual and real world values and insurance companies are not immune to that either.
I’m sure this is part of what the CMA is trying to address here is that stats and numbers don’t tell the whole story and boy do we remember that with the VA in Phoenix as they could not get into the real world when interviewed by Anderson Cooper and he too walked away scratching his head saying the same thing, “all they could talk about were their numbers”. Some of United’s models now are starting to fail anyway in some other areas as just like hedge funds their models fail after an amount of time and don’t make money anymore and the same with models like this, they get dated and either need an update or be dumped as they may no longer work with current economic times. BD
"In its current form, the program will not only confuse patients but will also fail to provide them with meaningful information that could actually assist them in making important health care decisions,” wrote CMA President Richard Thorp, M.D., in an August 13, 2014, letter to the insurer.
The program uses clinical information from health care claims to evaluate physicians against various quality and cost-efficiency benchmarks. CMA believes that the program as currently planned will only lead to confusion among patients and physicians and fails to achieve a central stated goal of UHC –to modify physician practice patterns to improve both quality and cost-effectiveness.
UHC has regrettably chosen to avoid making any substantive changes to the Premium Designation program. The serious flaws that were ignored by UHC and remain in the program, CMA continues to believe, can cause real damage to physicians and patients, especially as UHC begins to use the inaccurate designations as a basis of steering patients into various tiers.
This article calls it “data repackaging” and I have had another name for it, “data flipping” but it’s all the same thing. Referenced here is Senator Rockefeller and he’s on I have hounded for a couple of years to get on this and pass a law requiring an index of all data sellers, which would require licensing and disclosure of what kind of data they sell and to who. You need an index #1 before anything else can happen and I’ve been writing about that fact for 3 years but non data mechanics logic folks can’t get that “fact” through their heads and thus it goes on and on and on. What if we had stock brokers running around with no licenses and heck I even have to get a license to catch a little fish that has virtually no risk involved for me.
Fast of the matter here is they are getting sloppy with their mailing lists and data and let me tell you, flawed data gets the same price as accurate data so there’s nothing to create any reason for them to be responsible at all as that’s just over head. It’s truly a sad state of affairs that these bottom feeders can’t even a bit of integrity to the data they sell, as again they don’t care. Want to get into wearables, well think again until this is resolved if you like privacy as the FTC found 7 of them selling your data and they have not named who they are.
I have had my issues with flawed data and if you read the link above Acxiom on day tried to tweet with me and I tweeted back politely with facts. I have been on my own time working on this for 3 years and my readers here know it and get beat over the head about it. Three years ago when proclaimed this an epidemic folks thought I was crazy but I use data mechanics logic and I’m ahead of everyone, not a talent per se, I just visualize using my former development coding writing and sales ability combined and I figure it out almost every time.
So here’s the campaign for privacy and transparency if you can kick in a few bucks, that would be great as I’m a couple years into this already and I do update what I’m doing, did one one today. Nothing will work until we do step one and that is to identify who we want to regulate. At the campaign link there are links that tell you both about insurers buying your credit card data and some real details about how they record and analyze your voice at their call centers, which becomes yet one more item about you that they could potentially sell.
Guess what, insurers love this data too and I have heard from friends they get letters and do not have diabetes that begin with “now that you have been diagnosed with diabetes” …and that’s not right. Granted we need the awareness and it’s out there but we don’t need flawed data doing a diagnosis. You’ll get scored and denied something based on this flawed data, happens all the time and it’s on your dime to fix the data that the sellers made millions distributing.
This is the biggest racket around as they all want to make their millions and billions and then it comes back to us, the consumer to prove our innocence of whatever nonsense their data for profit lists. Again all these non data mechanic logic folks have been just swimming in this with goofy perceptions on how take action and I’m tired of it as they do nothing except wish for some Algo Fairies to come along and save the day..duh? Here’s a little example of one of my posts being read by Senator Warren’s office.
Not only that but the data brokers get off easy if they can’t pay their fine, like this one who was fined $1 million but had it cut back to $60,000.00 as the fine would put him out of business and he couldn’t afford it, well I say fine to the second option by all means. One less out there selling flawed data is great for consumers.
60 Minutes videos will fill you in as well about this nasty business that hurts consumers.
So what, forget going to the doctor and let the internet diagnose you now with all these so called predictive analytics, no thanks! Time to license and index all data sellers so we know who they are! Once you’re done here, take a visit over to Healthgrades and Vitals and see if you can find a “dead doctor” or one with flawed data over there to make an appointment with. Three links below will give you some good insight there on how flawed their data is. BD
The 42-year-old information technology worker's name recently showed up in a database of millions of people with "diabetes interest" sold by Acxiom Corp., one of the world's biggest data brokers. One buyer, data reseller Exact Data, posted Abate's name and address online, along with 100 others, under the header Sample Diabetes Mailing List. It's just one of hundreds of medical databases up for sale to marketers.
In a year when former National Security Agency contractor Edward Snowden's revelations about the collection of United States phone data have sparked privacy fears, data miners have been quietly using their tools to peek into America's medicine cabinets. Tapping social media, health-related phone apps and medical websites, data aggregators are scooping up bits and pieces of tens of millions of Americans' medical histories. Even a purchase at the pharmacy can land a shopper on a health list.
"People would be shocked if they knew they were on some of these lists," said Pam Dixon, president of the non-profit advocacy group World Privacy Forum, who has testified before Congress on the data broker industry. "Yet millions are."
They're showing up in directories with names like "Suffering Seniors" or "Aching and Ailing," according to a Bloomberg review of this little known corner of the data mining industry. Other lists are categorized by diagnosis, including groupings of 2.3 million cancer patients, 14 million depression sufferers and 600,000 homes where a child or other member of the household has autism or attention deficit disorder.
"It is outrageous and unfair to consumers that companies profiting off the collection and sale of individuals' health information operate behind a veil of secrecy," said Sen. Jay Rockefeller, D-W.Va. "Consumers deserve to know who is profiting."
Exact Data's Chief Executive Officer Larry Organ said the list posted on its website shouldn't have included last names and street addresses, and the company has since deleted any identifiable information. He said the data came from Acxiom and Exact Data was reselling it.
Here’s that topic again that nobody liked to talk about “hospital inequality” or in this case we have “no hospital” in a poor county in Virginia. Remote Area Medical is there this weekend to provide free healthcare in a community that has only 3 dentists and where the doctors are struggling. In Texas last week, people showed up to the ER room of hospital to find a “sorry we’re closed” sign on the door and we’ll tell you more later, they ran out of money is the long and short of it.
You can go here to watch the video as I can’t embed it and it links to Facebook, one of those media stations still running news through Facebook, and I see more are changing to fix that, thank goodness. I wish the TV station would change their parameters on the Kaltura player to allow embedding:) It can be done as I’ve worked with their platform.
Some people have been waiting a year for care and even the football team is out unloading the trucks and planes. East Tennessee and Southwest Virginia are two place where the need is great and where Ram has had many free clinics. As a matter of fact, there’s a big free clinic going on in Los Angeles this weekend too, so it’s not just rural areas where healthcare is needed. BD
Lee County's airport is being converted into a temporary medical facility by Remote Area Medical and their team of volunteers to provide free services that are much needed. "It's a poor county. We need to be there, Remote Area Medical needs to be there. Their hospital closed, their doctors are struggling. In the entire county they have three working dentists. This is an area of great need," says Health Wagon medical director Dr. Joe Smiddy.
Neuroscientists who initially supported the HBP feel that they have been taken advantage of with this project and can’t determine if there’s going to be any value found here. You can read a portion of the report in Nature below or use the link and read the entire article. One option to save the project would be to eliminate neuroscience from the Brain project and just focus on technological objectives.
Secondly they could split the focuses of neuroscience and technology into separate sections. Their last option mentioned here would be to attempt to put the entire project back on track which means funding again and to try to revive trust in the project and involve additional neuroscience entities.
This project gave birth to the US Brain Project which focuses on techniques development, only one element so if the European project is having this kind of difficulty what does that say for what the US is doing here? The Neuroscientists feel this took advantage of them and again it became bad model with a bunch of data on servers to maintain.
Are these folks not well enough attached to reality here? The European Board announced plans to dissolve the cognitive-neuroscience program. 18 principal investigators left as well as the director. All they are left with is again a massive data base limited to numerical simulations and by themselves yield no understanding. So I think we need to keep a close eye on the US Brain Project at this point and not saying there won’t be any value at all, but rather to watch and see if “value” can be created and if they can get the models right. If the European project is not restructured it looks like they have a waste of money on hand. BD
Contrary to public assumptions that the HBP would generate knowledge about how the brain works, the project is turning into an expensive database-management project with a hunt for new computing architectures. In recent months, the HBP executive board revealed plans to drastically reduce its experimental and cognitive neuroscience arm, provoking wrath in the European neuroscience community.
The crisis culminated with an open letter from neuroscientists (including one of us, G.L.) to the European Commission on 7 July 2014 (see www.neurofuture.eu), which has now gathered more than 750 signatures. Many signatories are scientists in experimental and theoretical fields, and the list includes former HBP participants. The letter incorporates a pledge of non-participation in a planned call for 'partnering projects' that must raise about half of the HBP's total funding. This pledge could seriously lower the quality of the project's final output and leave the planned databases empty.
The HBP blends two styles. One comes from a history of successful interdisciplinary collaborations in the European Union in brain- and neuron-inspired computation1. The second originates from a computational research programme, the Blue Brain Project2, initiated by Markram in 2005 (see 'Brain activity'). This collaboration between the Swiss Federal Institute of Technology in Lausanne (EPFL) and the IBM computing corporation aimed to build large-scale 'bottom up' numerical simulations of a rat's neocortical column, a set of about 100,000 neurons considered to be a functional unit within the brain.
The crisis results mainly from ambiguities concerning the place of neuroscience in the HBP. From the beginning, neuroscientists pointed out that large-scale simulations make little sense unless constrained by data, and used to test precise hypotheses. In fact, we lack, among other resources, a detailed 'connectome', a map of connections between neurons within and across brain areas3 that could guide simulations. There is no unified format for building functional databases or for annotating data sets that encompass data collected under varying conditions. Most importantly, there are no formulated biological hypotheses for these simulations to test4.
Many scientists also feared that the HBP would siphon funds from fundamental research. The European Commission's investment in a large 'brain project' would influence what other research areas it chooses to fund. Nonetheless, such an opportunity seemed unlikely to arise again, and neuroscientists (ourselves included) joined up, even if they did not agree with all aspects of the HBP proposal or with certain promises used to sell it. We put our faith in open and interdisciplinary collaboration, trusting that intellectual and operational details would take shape gradually and collectively.
Neuroscience in the HBP is now limited mainly to simulations and to building a massive infrastructure to process mostly existing data. The revised plan advances a concept in which in silico experimentation becomes a “foundational methodology for understanding the brain”5. Numerical simulations and 'big data'6 are essential in modern science, but they do not alone yield understanding. Building a massive database to feed simulations without corrective loops between hypotheses and experimental tests seems, at best, a waste of time and money. The HBP's goals now look like a costly expansion of the Blue Brain Project, without any further evidence that it can produce fundamental insights.