Are you tired of analytical software yet? Here’s one more software tool aimed at the employer to help manage their employee benefits as relates to health insurance and what the employees are opting for or what services they could using that are cheaper, like encouraging employees to use generic drugs. In addition, the press release states there are some modules built in here that go into preventive care. When we get all done reading this post, let’s have some fruitful “meaningful use” chat (grin).
It states there’s a 90 day time to go live which is less than normal data integration. The product is web based, thus all the data connections to various plans and insurers with employee information, carrier information, etc. has to be connected. Ingenix industry benchmark information will be provided for full algorithmic comparisons. The “what if” scenario is there to create to measure risk management and cost assessments. This is one big aggregation of data program and perhaps in time they may be adding other information in as far as what device companies make cheaper devices too. Having worked with data it’s just the path that data aggregation takes and with the news yesterday of the acquisition below, I might not be off base here.
A couple months ago there was the purchase of QualityMetric so you can explain to your employee what their care is economically a risk for you.
QualityMetrics also wants the patient to understand the economic benefit of your score too. Did I say that correctly, is this about healthcare or the economics of your care? Granted like every survey and information gathering system there’s good information attained, but how it is used and analyzed for profits is where the problem lies. Along with all of this there’s a section whereby the algorithmic processes are used to “ predict” medical expenses, we don’t want any more surprises here, right? Don’t forget the company has other areas whereby they make money selling your medication records for underwriting or other purposes.
With all your medication records for sale, perhaps they are being purchased by clinical trial companies as in the link below, with the connection of the I3 division.
Almost a year ago Ingenix bought this company that collects overpaid medical claims from providers and returns them to insurers.
This week their analytics folks determined there’s a risk for seniors who are prescribed some antipsychotics for developing diabetes. This was their own in house study but in time could there be restrictions on what will be covered in this area for seniors as I have seen things like that happen with using a published report of algorithms to justify decision processes, like what was done on the Oncology study.
Come to think of it, will these be some of the patients identified on the claim mining project to identify those patients where United has Pay for Performance Benefits available for the Walgreens pharmacies and the YMCA that was announced a couple weeks ago for identifying patients who have the “potential” of developing diabetes?
UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools
If you have read this far, it might be enough to make your head spin with analytics and it appears just to inquire within their own benefit structure you are somewhat cornered into buying something that analyzes all the data they analyze. Remember those pharmacists will be working the employee end of this with the list of those patients who appear to have a “risk” of developing diabetes and probably in time the employers will know who they are too. If that doesn’t work then they will “sick” the wellness coach out there to “drive” you to better health too “as all the statistics will show” that you are in fact the “evil twin” here with issues.
I still somewhat like the atmospheres of a nice friendly doctor’s office myself without being analyzed to death and not having to worry about a pharmacist trying to “tackle me” with information every time I visit the pharmacy, but all the statistics and pay for performance will lead in that direction as folks will obsess with analytical data as most in every day positions don’t have enough common sense on how to handle some of the decision making processes in front of them on the screen.
Decisions will be made though if there is a dollar savings, whether or not this may or may not be the right decision it will be the one made as human nature has taught us to “use those numbers and algorithms” on the screen and you are validated as you have saved money.
When I see analytics to this degree it makes me think of the need to certify payers with a copy of their algorithms, file them and store a working digital copy so we can see up front what is being done.
We take the time to certify EHR medical record software to be accurate and ethical, so why not start certifying the algorithms and software used by the payers, a missing link with “machine gun” business intelligence with the payers while the rest of us run around with swords and daggers, so what’s up with that?
There are also 3rd parties using the same software provided by Ingenix for claim and business intelligence payment processing. Trizetto is owned by a private equity firm in the UK so all the profits go over there. CareMore a Medicare Part D company is a good example here in southern California that works with Trizetto and some of the intelligence supplied by Ingenix.
A couple months ago United bought another wellness company that specializes in using biometric monitoring.
In addition Ingenix provides analytical services to Red Brick who provides employee incentive health care benefits for employees with or without biometric monitoring and Target stores was one of their first contracts. Biometrics depending on how a system is implemented can have you answering text messages and jumping around perhaps at times where it may not be possible or just flat out a good time while on the job, but your statistics will show how much moving around you have done with those accelerators and devices that report data and you may be called to answer to that as an employee.
That is just a short summary of some of what I have recently posted here so no wonder they want you to buy one more software program to incorporate all of this and chances are that some of the prior company purchases may have technology incorporated into the TrendView software. If nothing else this post may have presented a summary of some of the many entities the company is entrenched with and an idea of where the money comes from, and I didn’t by any means get them all.
One final item worth mentioning here too is don’t forget to file for your 15 years of underpayments that occurred by the use of a skewed data base from who else, Ingenix and now employers can further drill down on their healthcare expenses that many are having a hard time paying for today with yet even more analytics. BD