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HHS to Work With State Governors on Health Insurance Exchanges– Algorithms Beyond Comprehension And Functionality?

Posted Aug 02 2010 10:31am

We have indeed built ourselves one complicated system over the years and with today’s advances in business intelligence and having to support an insurance system that is largely “for profit” which has also invested heavily in data, where do the side come to an agreement.  As soon as you seem to put out one fire, one more erupts.  image

I said back when the position was filled it was going to require a lot of Health IT knowledge in the data area to work with complicated algorithms and budgets and indeed today we are at that fork in the road.  We have technology throwing us a new left curve every day of the week.  States are trying to figure out the appropriate algorithms to write grants to help fund their efforts.  This is indeed a disruptive process as corporate profits are in the picture and citizens are being required to support them through the purchase of health insurance.  It makes you wonder why and how healthcare needs to be tied to dividends at times, but that is the system we have that evolved over the years. 

We have so many laws and regulations on the books today that take an all out effort to understand and amend.  Technology though is reducing the costs of healthcare in many ways but along with that comes cost as well.  Doctors just want to treat patients and make them well again so the inherent frustration there is always alive and well.  We have everyone at different levels of health literacy and nobody really providing any role model examples. 

The current administration is trying to work with the complicated formats and as we see in the news every week, it gets more complicated.  A simpler system can’t help but be on the minds of everyone today but how do you go about it is the 800 pound gorilla? 

We are so far away from the principles of how health insurance was created, to spread the cost over large groups of individuals so affordable care was available for everyone and again today it’s all about profits and politics.  Running an efficient operation is by all means important, but with the status of affairs we have today, and providing care for all, it’s not going to get there. 

We have tons of software in the market place that is way overdone and way oversold and those processes all take their transaction fees. Automation is on the rise with technology doing the jobs that humans used to do and that portion is not going to change in healthcare or any other industry either, thus creating new jobs in the US is difficult.  image

Perhaps the idea of a single pay system could stand to be revived?  We all talk about using standards and there’s a lot of very intelligent people working on this but they have limits too.  Again, looking at where we are today, we are seeing corporate gains continue, loss of the middle class and those who are incoherent on why this is happening continuing to foster the old antics and games of politics and lobbying.  We do have some former insiders providing us some insight.

In the IT business when it comes time to update, we “migrate” all data over to a new system and then experience new conveniences and updates, but without that process you end up with huge systems and a lot of bandaids in place and those eventually with age start falling off and wounds never heal properly.  Are we getting closer to a point of migration?

I don’t know the answers but the path we are on today is not working well and the continued algorithmic processes of both “productive” and “dirty” algorithms continues as some are written to support special interests and are responsible for paying dividends on Wall Street.  The need is there today to dig below the surface and truly figure out which is which and find some of those “gray” areas that confuse all of us.  BD     

As governor of Kansas, Kathleen Sebelius once hopped on a plane to Washington to plead with federal officials for health funding.

Now the tables have turned. Ms. Sebelius, the secretary of health and human services, is trying to appease cash-strapped governors who will have big sway over the success of the health overhaul passed in March.

The law puts heavy demands on Ms. Sebelius—it has more than 1,000 references to actions that the "secretary shall" take. But much of the responsibility for actually implementing the changes falls to states, so the Obama administration's top health official has been working to guide them.

State officials say they are struggling to meet the law's deadline for getting the exchanges running by 2014. Strapped budgets have left states without the staff to handle basics such as writing grants to apply for implementation funding, officials say.

"I am very sensitive having been in that situation myself," Ms. Sebelius said. "It really helps to have been a governor."

Some governors say her department is underestimating the law's burden on states.

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