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What Is the Role of the Employer Today with Wellness and Health Insurance – Biometric Wireless?

Posted Oct 14 2009 10:01pm

The Wall Street Journal put out an article about a survey today, how far do employers go and what are the HR ramifications here?  Also, I question some of the privacy factors that enter the picture as well.  If you read this blog often enough you know I am a big fan of new technologies and image efficiencies, but I also understand and try to convey to all that implementation and privacy should not be overlooked, at any cost to the consumer.  We fight hard for those laws and privileges and don’t want to be ignorant and have technology sweep them away, simply due to the fact that it is new and there are no real laws that protect us, and seconding, consumes not being aware of this fact.  

Also worth mentioning is how does all this come together with the advice given for your health from your doctor, are we setting the stage for some potential collision courses here?   Could be as most physicians are not aware of the technology and devices that are emerging on the scene either, they don’t even know what a PHR is, take that first hand from someone who talks to many of them.  We have a big lack of training and education right on the forefront that nobody is adequately addressing, plus a lack of participation from Congress all the way down the ladder.   You can read the post below for some additional thoughts.

One Hell of a Training Program Needed – The Bottom Line to Success in Health IT

There are insurance companies who are entering into the area of remote biometric monitoring, Red Brick is one of them who I have written about a couple times on this blog, one mentioning their agreement with Target and secondly their agreement with Blue Cross or as some have called it remote management by behavior.   They offer the employer the option of wireless monitoring and incentives.  Where does this expertise come from, who is one of their partners, Ingenix, (a subsidiary of United Healthcare) which might just ring a bell of late when it comes to corrupt data bases and algorithms being used to throw back more cost to the consumer and pay a lower rate to MDs.  Are you ready to trust the partnership?  You can make your own decision.    So far, Red Brick has been very successful in getting funded with Venture Capital money so investors think there’s bucks to be made here too.  

So what are these devices that do this, well an iPhone with an accelerometer can do it, and there are others such as a Fitbit that is capable.  This is not an attack on the device manufacturers by any means, as I stated I like technology, but how and who does the implementing and where your data goes is the concern. If you buy a device on your own to use and improve your health and activity levels, hats off and great choice to take action in a positive direction.   With technology moving so rapidly today, there are other devices as well with these capabilities too.  Some of the devices enable you to sleep with it too to gather information.  These are data reporting devices with full analytical capabilities that can be viewed on your computer. 

Drug delivery methods are being changed and technology with research and development with drug companies is changing.  We see a lot more going towards the direction of being inhaled.  Certainly there’s some potential benefits here too with someone not having to inject themselves with a needle if they are a diabetic for a simple example.  One example I have used here several times is the Blue Tooth Inhaler, and yes folks, it reports data too.  So in essence here we have the patient taking their medication will a full analysis of when and how it was done, who gets that data? image

Compliance is what healthcare insurers want and what lengths will the business intelligence levels of information go?  Also keep in mind these “smart devices” will text you, email you and use other sorts of alerts to make sure you are on target.  Alerts are not a bad idea as long as you, the patient have some control over how, where and when they are sent, but if a monitoring wellness coach is in charge, well who knows exactly how this would take place, could you be hounded with an overload of alerts let’s say if you are using more than one device?   Here’s a new device that is sponsored by insurers, reminds you to take your pills, does your refills for you, and one other item, the pharmacy benefit managers now have access to all this data too, which is not covered by HIPAA.  Read the link below to find out more about how your medication records are sold by companies like Ingenix and Milliman to insurers to qualify you for insurance coverage and perhaps other business intelligence type “scoring” procedures. 

The Pill Bottle That Talks To Your Cell Phone, Creates Data ...

Secondly could this information be used as a compliance violation when it comes time to paying a claim?  Do we have any real privacy laws out there to protect us?  One insurer made the news today by shutting down when confronted.  Again, I emphasize with this type of battle ground for people just trying to get care, the devices and the data are coming and potentially force fed, so you may be required soon to be wearing a device and reporting data to enter the elite world of those “allowed” care. 

Insurance Company Ends Health Plan Rather Than Pay Out

Back on the topic of education here, this week the American Academy of Family Physicians put out an article “Consumers Lack Critical Information About Value of Health IT”.   Well how about those family practice doctors that lack the same knowledge?  I’m not attacking here but rather asking if this is an example of the pot calling the kettle black if you will, in what are they doing to educate their members?  Are they aware of the “Engaged Patient” movement that is trying to work on this and engage others?   The 2 groups could really find some good common ground I think and both could image grow with some additional information on technology instead of one more announcement with one group picking on another. 

This week, another website, MassDevice was speaking about the same and I must say good to hear it so I don’t feel like a lone ranger out here.  They have some real interesting input here on comparing transparency with Medicare and Private Insurers.  Medicare is transparent and Private Insurers are not and the public sector plays the game better with transparency.  They also mention the abuse of data as seen with Ingenix and the fact that we have no recourse here and pose the question about are these the types of business models we need to protect for better healthcare.

Is Data Integrity the Achilles Heal of Healthcare reform?

“Healthcare is increasingly a data-driven enterprise. The accelerating adoption of evidence-based medicine, the coming revolution in personalized medicine, the advent of the electronic health record and the dedication of stimulus funds and reformers' political capital to the institutionalization of comparative effectiveness research all speak to the growing centrality of empirical data in medical practice.

But it is not the case. Indeed, the proposition is laughable and the opposite is true, at least in the healthcare arena. The Medicare program, for example, is characterized by extraordinarydata transparencyin reimbursement rate-setting, coverage determination processes, quantification of services provided and annual financial accounting. Any citizen can see the formulas used to establish rates; can provide comments (which are available for public inspection on the Internet) on payment methodology proposals, payment determinations, coverage analyses and other critical decisions; and can expect to have decision-makers respond in some detail to those comments.

Private insurers, in contrast, make all of these decisions in secret and with no transparency. They typically hold information about their payment rates and financial performance as proprietary and confidential and generally do everything they can to prevent enrollees from gaining access to the kinds of data Medicare disseminates freely as a matter of course . When it comes to data symmetry, cost and transparency in health insurance, the public sector is a better market player than the private.

Not so with private insurers, who provide no equivalent recourse. Where there have been data management abuses, they have been in the private sector. Take, as a case in point, the example ofIngenix.

"Getting insurance companies to keep their promises and cover medical costs can be hard enough as it is," Cuomo said. "But when insurers create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need."

Also in the news we had an economist from MIT rebutting the threat of premiums going up, they are going to do that anyway, everyone just received their new rates with open enrollment so what else is new.

In closing here I’ll ask you are you not a bit tired of everyone that is dumb calling you dumb?   Think about it, I see a lot of that and non participation leads to people being dumb, Congress all the way down.  I like new technology and what it does, but participation and implementation with privacy is everything 

Technology and algorithms are moving fast and less you read the further in the hole you get.  For matters of privacy, I believe all these data reporting devices should go through a personal health record first with the data as that puts you in control and if you decide to share the information you can after you research and fully understand what permissions you are granting to who.  HealthVault already is doing this with a number of data reporting devices and I’m sure Google Health is also hot on that trail.  The smart data reporting devices are here and this is no longer Star Wars so prepare yourself and get educated before technology is used against your ignorance.  Again, we are already seeing this today with how we are scored with image claim processing, etc. and as I have said many times before, it’s in the algorithms, Wendell Potter knows and has told us all about these.  If we choose to not take a few minutes away from entertaining ourselves, those that do take time out will and do have the upper hand and it’s a hard battle for all of us with very few participants and credible mentors out there.  BD

Is Distraction Getting in the Way of HealthCare Reform - Can we take a break from entertaining ourselves

An annual survey from consulting firm Towers Perrin shows that 4% of companies are working with remote biometric monitoring (getting basic readings on patients’ health from home, in an effort to better manage disease) today, and 20% expect to be doing so in 2012. For personal health records, those figures are 31% and 60%. Fifty-four percent are now using ongoing reviews of medical claims to identify gaps in care, and 69% say they will be doing so in 2012. The consulting firm also says employers are beginning to show an appetite for “using provider incentives or penalties as a means of encouraging new health care practices with the potential to improve outcomes and reduce costs.”

How Far Should Companies Go to Help Workers Be Healthy? - Health Blog - WSJ

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