Maryland State Insurance Exchange Brings In United Healthcare Subsidiary QSSI To Help Repair The System, Their Main Contractor I
Posted Dec 28 2013 11:50pm
For about the last 4 years I have written many, many posts about the subsidiaries of health insurance companies and where they fit in. As this article states the operations are said to operate separately but one thing they all have in common is that each subsidiary is responsible for putting profit dollars to the corporate conglomerate bottom line. Some subsidiaries are related in business functions. Some subsidiaries are in fact investors that put money into low income housing projects and partner with banks. If the name QSSI sounds familiar it should as they were one of the contractors, who later became the lead contractor with Healthcare.Gov. QSSI is a government contracting company that was purchased by United Healthcare about 2 weeks or so after they were awarded the contract to work on portions of the Healthcare.Gov project.
As you can see in the article below, the main contractor for the state of Maryland is also owned by an insurance company. Come to think of it, most Medicare contractors are owned by insurance companies, subsidiaries, so you will find subsidiaries in places you have never thought of before. Most insurance companies today also own their own VC companies as well where they invest money in start ups and other projects. As a matter of fact if you visit the SEC listings for United Healthcare, you will about 15 pages listing all their subsidiaries with everything from Chinese Hearing Aids, low income housing investments, software consulting, medical records software companies and so on. About 1/3 of the revenue for United comes in from subsidiaries that are not directly in the insurance business, mostly software and software consultants.
A few years ago the company integrated their revenue cycling with Cerner medical records as part of the system so there’s some licensing revenue that comes in to a subsidiary of United when a Cerner system is sold, as of course United is not giving away the software for free and that integration was announced before the name change from Ingenix to Optum. Also of interest the CEO of Optum Insights (United sub)spent a number of years at Cerner before going to work there. The Optum LYNX ED Charging application from Picis (another subsidiary) algorithm does the ER visit calculations with CernerFirstNet, their ER tracking and triage. In addition we have this new company that United formed, speaking of revenue cycling to work with Dignity Healthcare (link below) and they are busy hiring more folks to work on premise at the hospitals in this area. You will find Picis at many VA hospitals as they were already there before United bought them.
Optum and/or Optum Insights subsidiaries of United Health also make a lot of money selling data and they have for years as being one of the original companies selling prescription data, which does not full under HIPAA and has been used for underwriting assessments among other things. I watch what happens in the OC and in addition to being a subsidiary or a subsidiary of a subsidiary (aka tiered subsidiaries) they also own 51% or controlling interest of other physician’s groups and formed a new company with their Memorial Foundation to tier some additional interest, such as “Wave Imaging” and “SimonMed”.
Here’s a past post with a ton of links relative to United from my archives over the last four or so years…even some on here beyond what you see at the SEC, as again some of these are 51% controlling interest ownerships, kind of how they under the radar. LHI is another United owned government contractor that does disability work for the VA and is always looking to hire doctors to see military patients and use “their” software to add such medical records created to the VA VistA record system, big operation that also does healthcare deployment for the DOD as well such as group inoculations and physicals too. United by the way does have a “military” subsidiary that handles that end of their business and the Tri-Care agreement figures in there too and you may or may not remember that United sued DOD to get the Tri-Care West contract and there’s been almost nothing in public records to tell us what exactly was the case here and in getting the contract through a lawsuit as such, they put a Blue Cross subsidiary that had the contract out of business.
There’s also the Optum Practice Management medical records system sold under subsidiaries and yet one more subsidiary CanReg consults with companies trying to get their medical devices or drug introduced and approved by the FDA. In addition United/Optum also announced that it was ready to be the integrator for hospital systems purchasing Epic, Allscripts and GE Centricity, and since we have had issues with insurance exchanges I know more of you are now much more familiar with the job the integrator does with aligning all the proper technologies to work together and integrator or not the big complex systems today have issues so you can’ always say failures are due to the lack of having an integrator as look at Deloitte, CGI, and a few others that are having issues outside of the Federal government with state and other government entities with contract and performance failures. The company also created yet another subsidiary, a Medical Claims Clearinghouse to integrate with Epic.
So I would say that if the government is looking for potential conflicts of interest, the best place to start looking as at the 15 page SEC listing for one or they can search my archives here as I have a ton of posts about insurance company subsidiaries and it’s not just United but being they are the biggest there’s more of them.
New York though who has had some of the best success with their exchange went a completely different route with their selection of a contract, SCC or Computer Science Corporation who was not there to sit around and write open source code from the bottom up like many tried to do, but rather they are Gold partners for Oracle, Microsoft and many more and have the expertise to meet deadlines and know which technologies can work together. California chose an Oracle Gold partner for their design. I still feel bad for Oregon as that whole situation was not fair and as much as everyone is dogging on them, few seem to mention that when other contractors saw the scope of the work to do with at the same time as creating an insurance exchange…they walked (to include an IBM subsidiary company) and said “it’s yours Oracle”..again the legislature created that mess with wanting a rewrite of most of their social service in addition to the exchange with checking 1700 sources for eligibility where most exchanges were at 250 to 400, so an additional 9 months of custom code there.
Anyway, here’s a couple SEC listing links for UnitedHealthGroup aka United Healthcare and Optum.
We have no clue on what big conglomerates may or may not do with “data” though and if subsidiaries exchange and pool data, only the Query Masters know for sure but it’s a good question to ask today with everyone and talking about their big data as the big corporate conglomerate over all of them has the control to take care of business as they desire. So when it comes to involvement with exchanges, the data and the algorithms are the big items to question of course.
So it will be interesting to see what route Congress takes to investigate all of this with QSSI and the other truckloads of subsidiaries United owns or owns 51% controlling interest in. BD
When state leaders brought in a new company to help repair their troubled health care exchange, they went to one whose owner has a lot to gain from the sales of insurance plans under the Affordable Care Act.
The Columbia-based health care technology company Optum/QSSI is a subsidiary of UnitedHealth Group, which also owns one of the four insurers selling policies on Marylandhealthconnection.gov.
QSSI will help the state's main contractor on the exchange, Noridian Healthcare Solutions, which also is owned by an insurance interest — BlueCross BlueShield of North Dakota, which is independent of CareFirst BlueCross BlueShield , another of the companies selling policies on Maryland's exchange.