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Kansas Sending Back $31.5 million Grant To Implement State Insurance Exchange–Maybe the Exchange Will Be At Your Local Dru

Posted Aug 09 2011 7:39pm

Earlier today there was an article on the web about Walgreens selling insurance and wanting to set up an exchange so this is where the title comes from.  Heck the retail drug stores such as Walgreens and CVS and many others have been selling your data to insurer underwriters for years.  Two of the big ones are Ingenix (now known as Optum-subsidiary of United) and Milleman. 

Walgreens Going to Sell Health Insurance? Data Information Connections Are Alive to Mine for Potential Premiums Rates & Chronic Conditions–Insurance Subsidiary Alert

Your prescription data has been sold to these 2 companies for years who then turn around and sell it elsewhere and I don’t know all destinations other than underwriters for sure, but it seems to be popping with pay for performance programs and in other places to analyze.  Here’s one example with United at the link below to “predict” who might get diabetes or I should say who is at risk.  These are all articles out of the Medical Quack archives here. 

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

In addition according to the article from Modern Healthcare, Oklahoma has already rejected $54 million to set up insurance exchanges.  I’m just here to connect the dots on the data and business of healthcare sometimes.  So it looks like exchanges are being discussed from selling at a retail level perhaps?   The financial folks are all over it saying a private exchange is great and their motive is money of course regardless of what type of insurance policy we as consumers may get, so let’s not forget that end of the deal here. 

Drug stores and insurance companies can fight the battle with the fact that they have the IT infrastructures to put this in place.  Even Medicare runs so heavily on outsourced health insurance IT system for processing claims.  Back in April I did a post about that fact that Medicare is the IT infrastructure that the government never got the chance to build, unlike Social Security that has one.  Sometimes carrier make extra money here too by holding Medicare funds for over 45 days before releasing payment to the government too. 

With all the recent acquisitions of Health IT companies by insurance carriers we are getting a little lopsided with some big Health IT company subsidiaries owned by them.  It’s all about the data, queries and selling that data.  By comparison we have a somewhat digitally illiterate Congress with the area of IT expenditures that sometimes think the cost grows on trees, like with putting MD Medicare claim information out there for the public. Believe me I do some billing and this is a mess and labor intensive project for IT consultants to do, and will not give any real ROI for both consumers and doctors to be publicly searched.  Dow Jones is suing to get the information out there but my sixth sense is thinking they want someone to get that huge big contract to do all of it, crazy. The good old boys don’t seem to see the cost versus value here and that’s why we end up with laws and a lot of wasted time here when there are bigger dragons to slay. 

Digital Illiteracy Is Killing Us With New Bill Wanting MD Medicare Compensation Put Online-No Clue on the Cost, Time and Truckloads of Errors to Audit and Correct

Congress would be smart to either get some IBMWatson support to search and query the information they need for making laws or at least go rent some space from the DOD, they have it. 

1.7 Billion Super Computer Hours Awarded by the DOE–Biomedical Research Projects Included for Parkinson’s and Cancer

So coming back around here if they have found a way to sell out data and keep the cost down for insurance exchanges, it looks like that could be the direction they are going here.  Remember though that when it’s all “for profit” the policy recommended may not be your best 1st choice but rather one that gives the insurers less exposure as that’s the way those algorithms work, so if it does evolve it will be a lot more “consumer beware”. 

It’s all about those algorithms and the government has not caught up to where the financial business is today and we are seeing that every day and regulators get stumped with 48 hour business models cranked out routinely and put into operation and it keeps the circle going without having the same artillery on the the other side.  So in essence more of our data will be sold to keep “the best healthcare system ever sold” going.  image

After what I read today about HHS and Facebook, we might all have to be living in a house that looks like this in the image at the right.  Again we come back around to needing executives with some Health IT hands on experience and participation to avoid some of this.  The FDA and FTC are doing their part on advertising as best they can but we still get those suckered into the algorithms that are marketed for “desired” rather than accurate results, all for making money only pretty much.  There are some wild claims out there today with analytics and many of them are great and help find cures, but then we come back to the ones that somewhat lurk out there to fleece and take advantages in ways they should not and knowing the difference is a big challenge today, especially with marketing in healthcare. 

FTC and FDA Tell Pom Wonderful To Change Their Advertising Claims or Submit for FDA Approval–Another Study Unrelated Claims Peaches and Plums Kill Breast Cancer Cells Too

How do agencies regulate math they know nothing about or don’t have the data capabilities to question?  This is a good question and a word of warning that they need to be questioned as everything in a report, a data set or a query is not gospel when it comes to formulas that are geared to make money.  BD

Kansas Gov. Sam Brownback and Lt. Gov. Jeff Colyer announced Tuesday that Kansas will return the early innovation grant it received in February from HHS to implement a state health insurance exchange.


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