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Healthcare Reform Laws Stand–Time For More Work On Health IT Business Models/Software/Algorithms For Insurers And Time For

Posted Jun 28 2012 1:21pm

Ok this is not the same type of response you are seeing everywhere else but if you read here often enough you wouldn’t expect a “magpie” type of editorial either, so we continue on with the opinion of another bird, a duck:)image  I do have to say I found the ruling interesting and overall good as when you look at a repeal, gosh think of the mess of “unknowns” it would have created if repealed.  We live in the world of the unknown today and when you stop and think about this, why do you think predictive algorithms are so popular..inquiring minds want to know so they can adjust their business models, but some of these models are flawed too, but that’s a story for a different day as the science of predictions will probably never be perfected in my lifetime.  Insurers know the money involved in changing IT infrastructures to be law compliant and as in the example below, they can also use this to publish something that would be popular with the American pubic as United and others did.  Do you see this as a negative, of course not. 

As a matter of fact United might be situated pretty well right now with all of this as they have been doing predictive algorithms and business models long before most others caught wind of it and the person credited with creating much of the healthcare reform laws at HHS is now sitting on their payroll.  In addition, don’t lose sight of the fact that insurers are bidding on the administration of both Medicare and Medicaid contracts, so they make money there if a state or other entity awards them a contract.

We ended up with the law in it’s current state as the “public option” was removed and thus it has lead us down a different path, as when it was removed, other options and provisions had to be included to compensate so now the task might be to again review this and see if that was truly a portion of the law that could have lead to a smoother transition and allow options for consumers who can’t afford commercial policies.

When you revisit the fact that insurers want the administrative contracts with Medicaid and Medicare, I would guess they would again be interested in participation here versus the government running a full on public option
, but if a public option were truly in fact initiated, it should be run by the government and not outsourced as we run into the same political battle again if we do.  Is there a better way to do this with upholding the requirement that consumers all by law pay for health insurance?  I don’t think so but others could have some different opinions.  Carriers are duking it out over these contracts all across the country.  If the money was not substantial and related to bottom life profits it kind of lends light as to why we things like this happening.



Now with having a “tax” penalty of sorts, it may not be that bad as the penalty could be cheaper than acquiring insurance and again this is where the states come to task with this situation with folks just opting out.  Nobody likes taxes but again until more is written here and the IT business models put into place to run it, we don’t know yet.  It’s almost like a judgment of sorts as getting it is one thing, but collecting it is yet another issue.  This means new IT infrastructure to put the “algorithms” in place to handle this on a large scale as well, so more “algo men” are definitely needed to pursue this tax business model and structure it so it works and we have “accurate” results rather than “desired” results for profit only.  The carriers have already modeled accepting pre-existing conditions and looked for other areas to make up the difference in what is lost in one area to look for gains in other areas of business.

Hopefully we have maybe finally surpassed the use of algorithmic formulas to deny care and we all remember stories like this that were in the news before reform took place and we want these business models to run with “non flawed and biased” data and hope this does not become another battle like what is occurring with bank on Wall Street to where analysts are told “find loopholes” and there will be some of that activity anyway, but let’s hope it doesn’t float out there like it has in years past. 



In the area of Health IT there are many challenges and software and algorithms that function accurately are getting much more difficult to produce and this is not to say that the companies doing the programming are inferior, its just the world we live in today and Health IT will continue to evolve and it will get better as we are now coming to the age of accepting the fact that “flawed data” is creating havoc in some circles as you read about clinical trial reports and so forth.  We to deal with that too. 

Here’s an example of something that happened last year, bad algorithms, and nobody at fault here, but the GE Centricity EHR system had to fix their software.  Software in the words of Bill Gates is nothing more than a bunch of algorithms working together so think of that when you see the word algorithms used so much here it’s the same stuff:)  The financial business has this issue coming out their ears and they have CEOs that have no clue on how formulas and algorithms work, check out Jamie Dimon for more on that topic.   Fact of the matter is that today it is a lot more difficult to develop software and algorithms as the integration processes sometimes take their tolls when running across many platforms and transactions take place. 

GE Centricity EHRs Need To Fix Their Algorithms (Math)-Some Customers May Not Be Able to Attest Until The End of November After the Software Update


I think if the Supreme Court had not ruled this way, they may have never been able to leave this ruling, in other words the Court could have had a full lifetime on reviewing and dissecting this law:)  Again this is over all a good thing but the IT Infrastructures of how we do business today need to be in the forefront as nothing is perfect but the importance of protecting “ethic values” big.  We will still have “algorithms for profit” to deal with and the need to check for accuracy of math and code and that battle will continue with the “Attack of the Killer Algorithms” to where the middle class will continue to have to battle back against the most profitable business times we have ever experienced as a nation and the formulas do it for them, not for us for the most part. 

You can see some every day examples of what we have and what’s ahead.  One item though that I found disappointing though is the tax on medical device companies being singled out and you can read more of my thoughts on that as the “Data Sellers” of the world should be taxed as they have the big profits, so just look at Walgreens making short of $800 million in 2010 doing this and imagine the profits they make and there’s a “Killer Algorithm” chapter dedicated to my thoughts on that one for sure. 

In summary, I really don’t think there was any other way to go as the IT Infrastructure costs to change some of this is huge!  I have said this many times before and maybe those members of Congress who are not aware of this, as some are not real techie, time to include this and model it before rushing out with an “emotional” statement or press releaseActually I would like to see our lawmakers come up to speed and use some big data capabilities when making laws, it would help them.  Perhaps instead of generating laws in committees as it is done now, reverse it. Have a full open floor of both and have everyone query and get their information first, and the go off to committees as we would at least have everyone starting with the same figures and  information.  Anybody need a wake up call in this area..read the link below:


More on that thought…please budget the SEC as this impacts the healthcare laws as eventually we will be needing to purchase insurance from those who are traded on the open market.  If investments are now being made on “emotions” certainly the “emotions and ethics” of healthcare need to be addressed as well and we are all still humans last I looked.  Somebody made a great statement yesterday on Twitter and said “why are we regulating humans when the machines are doing the trading” which in part is pretty much true and “the machines are also making more decision in healthcare as well, so think about that those similarities.  Overall all the Supreme Court kind of did what they had to do I think and not a bad deal, but the business of healthcare legislation is far from being over.  BD 
 


WASHINGTON — The Supreme Court on Thursday left standing the basic provisions of the health care overhaul, ruling that the government may use its taxation powers to push people to buy health insurance.

Chief Justice Roberts, the author of the majority opinion, surprised observers by joining the court's four more liberal members in the key finding and becoming the swing vote. Justices Anthony Kennedy, frequently the swing vote, joined three more conservative members in a dissent and read a statement in court that the minority viewed the law as “invalid in its entirety.”

The decision did significantly restrict one major portion of the law: the expansion of Medicaid, the government health-insurance program for low-income and sick people. The ruling gives states some flexibility not to expand their Medicaid programs, without paying the same financial penalties that the law called for.

http://www.nytimes.com/2012/06/29/us/supreme-court-lets-health-law-largely-stand.html?pagewanted=1&_r=1&hp


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