Prescriptions risk score used to deny health insurance
Posted Nov 29 2008 12:06pm
Lawmakers are going to have a difficult time with this one as they are not technically up to date enough as a whole to comprehend how all of this works in my estimation. with understanding the algorithms of finance and the economy, Wall Street showed us that. Sad, but it is true and this is not the only area of privacy where nobody is minding the shop. If you don’t understand it or are not aware of it’s existence, how do you regulate and protect citizens? I’ve been asking this question for a long time as in some instances I can see some of this coming before it gets here, but for heaven sake, let’s worry about the PHRs out there, when risk management is much more of an invasion and is going on now at present.
What is funny is that I get marketing information wanting my participation from some of those exact same marketing groups (not EMR vendors) that feel they have all the answers on electronic medical records and their use, well maybe they do have part of it going here as it would appear to me that it has to benefit their interest, so in that area I’m not interested.
Insurance companies also exchange a ton of information on all of us through the MIB as well, the medical insurance bureau. Now all these organizations of course will offer you a copy of what they have on file, but is this doing anything to protect privacy, I think not. So now we have 2 sources to really nail down a ton of information, drugs and the MIB.
I find it extremely bizarre that we want better and affordable healthcare for all, but yet risk management stands up right in the way of progress here to head off any big human risk that might apply for coverage. The related reading below has additional information on this topic and several items on the MIB. Again, our Congress makes the laws and rules, and yet in so many areas they are not technically up to date enough and so risk management goes on behind the scenes to basically sell and market any part of our information with few or very little restrictions. The business is so profitable for Blue Cross that they have taken millions of dollars to build a Venture Capital company whereby they can invest money in other additional risk management ventures to keep the wheels rolling.
The companies get assessed fines, they pay them and just keep on going as there’s probably a few trillion sitting in the reserve funds if you were to put it all in one pot and yet folks wanting health care can’t get what they need and are scrutinized for eligibility and claim payment, when they need it the most. Somewhat sad when all those trillions of dollars in reserve just sit there, untouchable. BD
Did you know there's a market for your prescription data? Insurance companies are buying prescription data collected from companies like Milliman Intelliscript and Ingenix to help them make insurance coverage determinations.
Right now lawmakers are trying to figure out how to oversee a health-industry shift to computerized records and insurers have started testing systems that tap into prescription drug information.
Milliman Intelliscript, part of the Milliman Company, collects data from Pharmacy Benefit Managers (PBMs) that are not covered by the Health Insurance Portability and Accountability Act of 1996. Then insurance companies pay a small fee to obtain the data, which they use to deny or approve claim requests.