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HHS to California Blue Cross – Bring Your Algorithms to Washington And Explain

Posted Feb 08 2010 1:01pm

One of the companies they rely on for business intelligence is SAS Business Analytics.

Health insurance carriers have suggested additional algorithms to provide solutionsbut as I always say with software it’s the implementation that countsso maybe the letters and public awareness of how this has been handled has an impact?  We have seen the carriers reinvent themselves as banks too and we all know that’s a terribly sore subject today all over the place. 

Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

I started suggesting a “Department of Algorithms” over a year ago and maybe we are getting closer to this reality as our government is working hard to bring data systems for all the department up to par.

When you stop and think about itwe go to the full extent to certify software from EHR/EMR vendors and they pay for that too; howeverthe other side of the coin leaves us up in the airwe have no clue on how they are calculating riskprofitsand much less what claims will be paid.  In the out of network data base schemeBlue Cross was also an active participant in the Ingenix (there they are again) program that has been disbanded thanks to the efforts of NY Attorney General Cuomo. 

Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!

Even after the exposure of the algorithms used for out of network chargesthe process continues with Anthem and Ingenix with pursuing biometric data informatics.  I like technology and all that it doeswe we are not ready for all of this to be dumped on consumers and doctors without proper implementation and privacy issues not addressed.  We can’t even handle cell phones as they are now without huge levels of distractionbut they don’t seem to realize this and it’s all bottom line dollars and us humans will have to figure it outright?  I fully understand the need for business intelligence and projectingbut the scale is a little lopsided hereor maybe a lot. 

I believe this is why we had the “Behavioral State of the Union Address” from President Obamait is time.  It’s not just “for those guys over there” any longer.  BD

The Obama administration on Monday asked California's largest for-profit health insurer to justify plans to hike customers' premiums by as much as 39 percenta move that could affect some 800,000 customers.

In a letter to the president of Anthem Blue CrossHealth and Human Services Secretary Kathleen Sebelius said she was very disturbed to learn of the planned increasescalling them "extraordinary." She said they were hard to understand in light of the profitability of Anthem's parent companyWellPoint Inc.

"I believe Anthem Blue Cross has a responsibility to provide a detailed justification for these rate increases to the public," Sebelius wrote. She said the company should also make public what percentage of customers' premiums go to medical care versus administrative costs.

Peggy Hinza spokeswoman for Anthemsaid she would check whether the letter had been received.

The company has declined to provide details on the rate increases such as how many people would be affected or how much the new rates would be. It's also not clear whether customers in other states are being affected. In a statement last week the company blamed the increases on rising costs of medical care.

WellPoint earned $536 million in the final three months of 2009not counting roughly $2.2 billion it gained in the fourth quarter for the sale of a pharmacy benefit management subsidiary. The Indianapolis company is the largest commercial health insurer based on membership. It operates Blue Cross Blue Shield plans in 14 states and Unicare plans in several others.

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