If you don’t know what a Quant is, take time out and watch video #2 in the footer of this blog as they are not just limited to working at financial firms. As a matter of fact, hedge funds and banks can’t hire enough of the and the same holds true for insurers and other healthcare entities. These are the math wizards today that are working without a net of any “proof of concept” any more and are just tossing a lot of models out there to see if they stick. I know that’s a crummy way of putting it, but that’s the reality of folks being soaked on models and numbersMayo Clinic is the Latest to Outsource Revenue Cycling to Optum 360, A United Healthcare/Dignity Health Company Pursuing Hospital Contracts All Over the US For Profit…
The real deal here of course is the access to all the data as the data miners and sellers of the healthcare industry will take the data, score you and put the data into other “new” data bases and turn around and sell it. This process is called repackaging and when this occurs, most of the time as consumers we have no idea where it goes or who originated the data. As long as prescription data is not taken from a HIPAA covered entity such as a medical record, it’s out there for sale to who ever has the money. Quest is also promoting their own “outsourcing” program with hospitals and just bought another hospital lab service, so that makes about 5 or more they have bought. 20-30% of the services performed for hospitals with this service end up going to their own Quest diagnostic centers to be worked.
Subsidiaries of companies are something I have told all for years to pay attention to as that’s where all the data work is done andquantitated madness due to the fact that people are afraid to contest any form of math, good math or bad math.
If you get a chance to talk candidly to pharmacists today, they’ll tell you all about what’s going on and how you are “scored” with every prescription you fill too. There’s this EQUIPP program out there that tells them what to do and how to dig in and find outliers, some of which are diabetics who are not on statins. The pharmacists who are forced to work this EQUIPP program model have to find their “outliers” or they could end up like the employees at Wells Fargo and be be out of a job if they don’t play the game. In the drug industry, they couldn’t get doctors to push statins and other monitoring flawed data programs, so now the boom is lowered on your retail pharmacists who need their jobs. Click on the image at the right and see what I’m talking about.
Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy
So my guess here is that with United Healthcare/Optum having this new additional data of labs to query into the prescriptions, your lab tech could very well be the next person out there suggesting not only monitoring but also in a round about way, pushing more drugs.
This really even gets more interesting with the Quants of Optum and their models for profit as United Healthcare has a contract with LabCorp as their exclusive Lab and has had that contract since 2007. Optum and United Healthcare already get all that labThe Rise of the Quants, Again! This Time In US Healthcare- Taming the MACRA Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not True
So what happens when you get a lab test done? Depending on the result of course, you might get a prescription for a drug, we all know that by now (grin), so look at how this data mining is working today. With Optum having all the lab information will this have a tendency to push more drugs, and the drugs that are covered by pharmacy benefit managers that make the most profit for them? It is not far fetched in my book United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance Groups
So this is adding yet another element of behaviorial scoring and data mining for profit if you will and we’re not getting any breaks on cost. As a matter of fact, this is a good link to look at that explains the coupons and discount cards at the pharmacy, as they tell you how it works.
The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!
Again, look at the subsidiaries of these big corporations and what are doing with data for your answers as it’s all there as the quants in healthcare keep modeling away to attain the best models for profit, not necessarily for better care, Moneyball as Optum calls it, which really only works well for baseball where everyone knows the rules, but with healthcare the rules change every day. BD
UnitedHealth Group Inc.’s Optum health-services arm has struck a deal to oversee billing processes for lab giant Quest Diagnostics Inc., substantially expanding its growing business of handling such transactions for health-care companies. Under the 10-year pact, Optum will take over a number of key revenue-related services for Quest, including billing health insurers and consumers, and collecting and processing payments from both. About 2.400 employees who did such work for Quest will become Optum employees, but they will generally remain physically in their current locations.
