“Remote Area Medical–California” Begins Four Day Free Medical Clinic in Oakland–Volunteers Needed

Folks are traveling all the way from Napa to get care at the free medical clinic.  RAM does good work and thank goodness they are here and this is a reminder of the failing healthcare system in the US for sure.

The same problem exists in California as they have had at other free clinics and that is getting enough volunteers.  RAM was just in Sacramento and Oakland last year and has done a lot in California.  RAM has grown to have it’s own California branch so again what does that tell you about people needing medical care and having to go to the Coliseum to get it. 

Remote Area Medical Wraps Up Free Medical Care Clinic in Sacramento and Moves to Oakland For Another 4 Days of Free Care

For additional information you can visit the RAM California website to check on times and dates. Now notice one thing here again, we have a group that is dedicated to California which is part of the over all RAM group, so again the free clinics are growing as our healthcare system continues to fail.  When you watch the video they had to close early as they didn’t have enough volunteers.  BD

OAKLAND, Calif. (KGO) -- An amazing four-day program is underway in Oakland to provide free dental, medical, and vision care.

It is being offered by the Remote Area Medical Foundation (RAM) and the program filled up quickly Thursday. The problem was not the turnout of patients. Instead, it was the lack of doctors that forced them to close down early.

At 3:30 Thursday morning, volunteers handed out 400 numbers to people looking for a free health exam. Some of them camped out for their spot in line. "It's a long wait. It's cold, but it's worth it," one man told ABC7. By 9:00, the clinic was full. "I'm shocked because I came all the way from Napa. I didn't expect it to be closed for the day," Kenneth Profit said.

The problem is not space or lack of equipment. There are plenty of empty dental chairs set up inside the Oakland Coliseum. The issue is finding enough dentists and eye doctors. "We don't have the number of volunteers today that we would hope to have," RAM founder Stan Brock said.

Ann Dukes, R.N., is a manager at Kaiser Hayward, but on Thursday, she was doing triage. "When I'm at Kaiser I'm supervising, not touching per se. Here is hands-on," Dukes said. When asked what kind of satisfaction did that give her, she said, "A lot more than supervising."

http://abclocal.go.com/kgo/story?section=news/local/east_bay&id=8591009

Technorati Tags: Remote Area Medical,healthcare,healthcare reform,health insurance,charity,volunteers,medical care,Obama healthcare,RAM,RAM California,free clinic,Oakland

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Wells Fargo Bank Files Suit Against Medical Development Intl Over Loan Defaults And Asked Judge to Appoint Receiver–Business Analytics Tactics and Algorithms Questioned

With $55.3 million in assets and $74.9 million in liabilities the money analytics are alive and running.  Medical Development according to the article here says that Well Fargo became a “corporate raider” to divert company assets. 

Part of their business is in the Healthcare Analytics area with consulting for provider solutions.  The site states they have been a government contractor for years and has built healthcare networks and has a contract with the VA and also offers solutions for self funded employers. 

From the website below:

“MDI works along with healthcare payers to provide custom care networks, efficient administration and powerful analytics solutions. Our products and services allow administrators and healthcare professionals to:

• Identify actionable items to reduce costs and manage risk
• Create custom networks and plans for your clients
• Eliminate overspending on duplicate or incorrect medical claims
• Evaluate complex health data in interactive, easy-to-use platforms
• Create custom health programs for high-risk patients and disease groups
• Predict future spending from the individual patient to the corporate level “

All of our services are backed by dedicated cross-disciplinary support teams who provide IT assistance and personalized customer service, ensuring you'll always be equipped with the knowledge and ability to make practical, informed decisions.  This one appears to be one worth watching as perhaps their algorithms for analytics are either not making enough money or Wells Fargo perhaps was not providing adequate direction for them…who knows.  Now the company is also suing Wells Fargo too and is seeking $15 million in damages.

Banks and Health Insurance companies locking horns here and I bet the battles comes down to who’s business analytics algorithms caused the damage.  BD

Wells Fargo & Co. (WFC), the fourth- largest U.S. bank by assets, sued prison-service provider Medical Development International Ltd. in Delaware Chancery Court (1400L) seeking to recover $30 million in loans.

Wells Fargo said in complaint filed today in Wilmington that Medical Development, based in Ponte Vedra, Florida, has been in default on the loans “for quite some time” and asked a judge to appoint a receiver.

The company and affiliates have “also engaged in a series of self-dealing transactions including, among other things, so- called ‘loans’ to executives” for a “working farm,” a biographical screenplay and payments for “a Tesla Roadster,” lawyers for San Francisco-based Wells Fargo said in the complaint.

http://www.bloomberg.com/news/2012-03-23/wells-fargo-sues-medical-development-international-over-loans.html

Technorati Tags: Wells Fargo Insurance,Medical Development Intl,Florida,Analytics,lawsuit,money,management,insurance

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FDA Considering Digitally Driven Kiosks for Self Diagnosis With Specific Conditions Via Algorithmic Processes

If you have heard or read the news of late it has been all over that the FDA is considering making certain drugs available over the counter that are now prescription only.  With that thought they are also investigating to see if a Kiosk would be able to assist with helping patients find the correct medications along with doing a self diagnosis.  We have seen the kiosks that tele connect but these would be without the pharmacist and all done by the machine.  You can see what they have done in the UK with tele-pharmacists at the link below.

MedCentre Prescription Kiosk ATM-Like Machines May Give Pharmacies Some Competition in the UK – Installed at 5 Hospitals in the UK

The concern though is the usual error factor and mis interpretations and patients getting the wrong medication.  In essence though when you think about it this is not much different than today and buying the wrong thing when we self diagnose for the flu and other ailments we may have, except this is offering more knowledge available and if some of the current prescription drugs become OTC this is a concern as we are talking new drugs out there.  The targeted conditions/drugs presently being looked at are asthma, diabetes, high blood pressure, high cholesterol and migraines so there’s plenty of room for discussion here as well as development of an algorithm that could do the job without risking safety. 

I’m not sure we may see this anytime soon for some of the conditions as there’s a lot of work involved here with writing the code, testing and so forth.  I could see it initially available to perhaps do refills as a starting point.  The FDA has a way to go here with this project, but nothing will occur until decisions are made about which drugs come off the prescription list I would guess and there’s still the question of enough engineers at the FDA.  BD 

FDA and Medical Devices-Who Doesn’t Get This, They Are Looking for Engineers Just Like Technology Companies Are Doing- Get Some Congressional Digital Literacy in Place

Certain prescription drugs may soon be available to consumers through digital kiosks, rather than a doctor's diagnosis, underscoring the methods technology is transforming healthcare.

The Food and Drug Administration is mulling digitally-driven patient kiosks where people can self-diagnose for specific conditions through an algorithm-based survey. The process would drop the prescription requirement for certain treatments and common ailments.

Self-diagnosis would let users get medical care in a more convenient way. The kiosk concept under FDA consideration indicates the regulatory agency is taking a serious step towards using digital technology to deliver healthcare, moving away from relying on third-party app developers.

As the FDA hashes out its plans to eliminate the need for prescriptions, relying on modern technology is one way to streamline a process to help save medical professionals valuable resources in an overburdened system. But to make sure patient care remains a top priority, the FDA and industry professionals are sure to carefully determine how to make the process work without compromising a potentially life-changing diagnosis.

http://www.mobiledia.com/news/134007.html

Technorati Tags: Kiosk,prescriptions,e-prescribing,e-prescriptions,technology,drugs,pharmacy,pharmacists,FDA,self diagnose,patients pharmacists

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CVS/Caremark Sends Letters to Tufts Members Containing Personal Information Like Medical Conditions/Meds Info to Wrong Patients–Attack of the Killer Algorithms Chapter 24

This is chapter 24 addressing flawed data this time.  The article said that CVS would not discuss this, well if you are in technology you know what happened, it was a rogue algorithm, in other words a programming error and this is what “The Attack of the Killer Algorithms” is all about.  This time it was private information sent to the wrong people but what’s it going to be next time.  If you read my series on the “Attacks” there’s tons more like this.  This why we need not rush the programming that takes place with developers.  Companies who put rushed deadlines on developers of software and push for releases before their time are fools, but it happens.

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 3-11-2012

There’s one story above about people who don’t get jobs because data is flawed or mismatched and this is becoming more frequent and let’s not forget the huge profits made here with CVS selling data too.  There’s a few lawsuits floating around out there on this subject and the data sellers should be taxed as they make billions selling data they get for free.  How times do rogue algorithms like this attack the data they sell?  That’s a good question to ponder and it does and is getting to be more frequent. 

Consumers Lose More Privacy With New CoreLogic Credit Reporting–”Score” Marketed For Insurers and Employers To Gain Information-California Prohibits Potential Employers – From Using As Jan 1 - Killer Algorithms Part 8

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Independent Pharmacies Not Able to Compete with Big Chains and Fear Going Out of Business–They Don’t Have Same High Levels of Data To Sell to Profit- Attack of the Killer Algorithms Chapter 23

So the patients at Tuffs were screwed with privacy and they get an “I’m sorry” for the mistakes the CVS algorithms made, but let’s don’t talk about the maybe billion dollars they made “selling’ your data too..don’t forget that happens.  The lawsuits below implicate the SEC 2010 statement from Walgreens on their intangible data profits. 

Walgreens And CVS Accused of Selling Customer Prescription Data in 2 Separate Law Suits-Sales for Marketing Data Continues and the Data Bases Gets Larger with Technology

This case fits the “Killer Algorithms” because what to do the recipients do?  They can’t talk to that algorithm and it made decisions and sent out flawed information, matched to the wrong person.  If you haven’t figured it out yet, this is why the entire Occupy movement got started as it’s not what you see but it’s rather the intelligence that runs in the background you DON’T see.  That’s the problem and issue as we base too much of the economy today on algorithms and making money selling data rather than investing in manufacturing and using more technology there. 

Occupying Wall Street–It’s All About the “Attack of the Killer Algorithms”–The Unfair and Marketing Exploit of Ethics Using Math–This Could be a Subject for Michael Moore to Explore and Document In a Movie

So there you have it, Chapter 24 of the Killer Algorithms and stay tuned for Chapter 25 when I find it..sadly the chapters will keep coming.  BD 

CVS Caremark Corp. said Friday that it mistakenly sent letters to about 3,500 Tufts Health Plan members, giving them personal information about the medical conditions and medications of other members enrolled in a supplemental Medicare plan managed by Tufts.

The mistake was due to an unspecified “programming error,” CVS Caremark, pharmacy benefits manager for the Tufts Medicare Preferred Plan, said in a statement.

“We are monitoring this situation and CVS Caremark’s response and outreach to Tufts Health Plan’s Medicare Preferred Plan members,” said Sonya Hagopian, vice president at Tufts Health Plan, which is based in Watertown and operates in Massachusetts and Rhode Island.

CVS Caremark spokeswoman Christine Cramer said the company would not discuss the incident beyond what it said in the statement.

http://www.boston.com/Boston/businessupdates/2012/03/cvs-caremark-mistakenly-sends-personal-information-about-drugs-and-medical-conditions-wrong-members-medicare-prescription-plan/yuPzeD7N7uwbJkLSbWrJnO/index.html?p1=News_links

Technorati Tags: CVS,Caremark,drugs,conditions,healthcare,Heatlh IT,medications,algorithms,Massachusetts,Health Plan,flawed data

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Small Businesses Question Health Insurance Tax Being Affordable–Economics Have Changed Since Law Was Written-Tax “Millionaire Data Sellers” Instead - Much Bigger Pot To Make Up for Lost Budget Funds

If you read here often enough you may have stumbled across my little campaign to tax the profits that banks, corporations, high frequency traders, drugs store chains and so on make getting “data for nothing and the profits for free”.  The potential is huge if Walgreens made just under $800 million on their SEC statement in 2010 and I would almost guess they could have broke a billion in 2011. 

Why should the big conglomerates profit so heavily and the “algorithmically generated profits” be so high?  There’s no incentive to set up factories and hire people when a company can grab a couple programmers, write the web mining algos and start running a few queries and reports and sell the data which they get for free.  We try and base too much of our economy today on algorithms and while we need them, we all need balance with manufacturing too.  You know the best part of this idea is that insurance companies make millions selling data too so maybe a nice little revenue/tax bonus here and they still make enough to keep shareholders happy to boot. 

Here’s my thoughts on this topic and the average consumer has no clue that all this is made as you can’t see, touch, feel or talk to those algorithms but they have teeth and take your money and your data behind scenes if written to “maximize financial dollar profits” whether they are accurate or not.

Start Licensing and Taxing the Data Sellers of the Internet Making Billions of Profit Dollars Mining “Free Taxpayer Data”–Attack of the Killer Algorithms Chapter 17 - “Occupy Algorithms”– Help Stop Inequality in the US

Small businesses are being pinched and this is no exception.  It’s not that the Healthcare Law was bad but the economy evolved and a few modifications are needed, and especially in the math areas.  Nobody is accountable there and with some of the big data capabilities coming in it’s hard to get to the bottom with multiple layers of code running.  By the way thanks to all who are now searching for “The Attack of the Killer Algorithms” on search engines as it looks like that’s becoming a keeper. 

There are many very good provisions of the Healthcare law and who’s the fool that thinks this doesn’t need to be revisited and adjusted all the time, it’s the world we live in so a total repeal like some folks talk just shows a lot digital illiteracy with politicians and lawmakers. 

I said a while back that our new consumer protection chief better have some good understanding of math and algorithms as big business is using all of it for profit. I have no problem with companies making profits but when technological formulas are widening the inequality someone needs to dig in here and get with the math and algos.  The link below has about 20 chapters on the Attack of the Killer Algorithm examples if you want to dive in further and see how formulas that run on servers 24/7 make life impacting decisions about out with a bunch of flawed data in the works.  BD 

President Appoints Richard Cordray as New Consumer Financial Protection Chief - Hope He Knows And Understands Correcting Flawed Math and Formulas To Battle the “Financial Attack of Killer Algorithms” On Consumers With Banks and Corporate USA

Small businesses are very mindful of their spending especially when it comes to healthcare. The Health Insurance Tax that's included in the Patient Protection and Affordable Care Act is raising eyebrows among business owners.

He's talking about the Health Insurance Tax that's included in the Patient Protection and Affordable Care Act.

http://www.khastv.com/news/local/Tax-143727746.html

Technorati Tags: Healthcare,taxes,small businesses,affordable care act,jobs,economics,algorithms

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Roche Cutting the Price of 2 Cancer Drugs in India To Potentially Avoid Compulsory Law Provisions That Allows Generic Drugs When Cost Is Not Affordable

It was just last week that India took the very first step to make cancer drugs more affordable with Bayer and it looks like Roche might see some writing on the wall.  We all know how expensive cancer drugs are and how unaffordable they can be for the patients who need them most.

India Authorizes Local Drug Manufacturer to Make and Sell Generic Copy of Patented Bayer Cancer Drug To Make It Affordable

By jumping ahead of the game and making the drugs affordable up front they could stand to remain outside of the laws in India and again hopefully they will be affordable.  The two drugs Herceptin and Mabthera will also be renamed to market under a different name.  After last week I wondered if some flood gates would begin to open and it looks like pharmaceutical companies, at least Roche took notice.  BD 

Roche Holding AG is cutting the price of two expensive cancer drugs in India—and giving them new names—in an effort to gain market share and avoid competition from generic drugs in the fast-growing economy.

The move marks a shift for the Swiss drug maker, which long has argued that consumers everywhere should pay the same price for its medications. By giving the drugs new names in India, Roche hopes to avoid losing pricing power elsewhere, though it isn't clear the company will succeed on that score.

The arrangement involves Herceptin and Mabthera, the wholesale costs of which are about $3,000 to $4,500 a month per patient. Tuygan Goeker, head of Middle East and Asian markets at Roche, said the prices would be cut in India starting next year, though he declined to say by how much. By offering lower-priced versions, Roche also aims to avoid being compelled under Indian law to allow generic-drug makers to produce less-expensive copies.

Roche's plan also partly is aimed at preventing India from demanding a so-called "compulsory license" for Roche drugs, which would allow a generic-drug maker to make less-expensive copies. Indian law gives the country's patent regulator such authority if a medicine is priced beyond patients' reach.

http://online.wsj.com/article/SB10001424052702303812904577297673910205972.html?mod=googlenews_wsj

Technorati Tags: Roche,cancer,drugs,India,generic drugs,laws,Herceptin,Mabthera,pharma

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Worried If your ACO Is Going to Be Too Costly? HCP Offering Accountable Care Reinsurance–Once You Figure Out What Your ACO Model Is…

It didn’t take long for this to pop up especially with so many unknown factors that are out there today as even the best laid plans with analytics are in a model, technology can show up tomorrow and throw a left hook at any time.  We have a lot of created and non-created disruptions in healthcare and some good and some not so good.

ACO Stop Loss Reinsurance is the actual name and there premiums paid and it can be spread over a number of payments.  Many managed care organizations have purchased re-insurance policies as well and sells malpractice insurance to doctors as a primary business. 

Last year in the Cayman Islands, Aetna took out a reinsurance policy in case their medical operating loss numbers went over 104%.  BD 

Aetna Takes Out Reinsurance Deal In The Cayman Islands- $150 Million to Kick When Medical Loss Ratio Hits 104%

HCP National Insurance Services, Aliso Viejo, Calif., is now offering accountable care organization reinsurance for participants in the Medicare Shared Savings Program.

The company, which also specializes in providing medical malpractice insurance, described reinsurance for ACOs as “a big growth area” for the company in a news release.

http://www.modernhealthcare.com/article/20120322/NEWS/303229960/

Technorati Tags: ACO,reinsurance,healthcare,doctors,finance,risk,budgets,Medicare

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IBM Watson Going to Work at Memorial Sloan-Kettering Cancer Center–Data Loading and Training To Begin

This is actually very good to compile cancer data and we can certainly learn from it.  The process will take a while as the data has to be fed in.  When used for diagnosis knowledge, patient input, drugs, and so forth this is great.  Even big data has the same issues though as what we have used for years and that is being assured of what data you load as it’s still a machine.  At the end of 2011 it was also announced that on the west coast that Cedar Sinai was going to explore the system for the same or similar purposes. 

Wellpoint to Bankroll Use of IBM Watson at Cedar Sinai Medical Center to Research Cancer Data/Information To Provide Guidance for Physicians

For research this is great but hold your breath before bringing in the coding and billing portions of all of this as that’s where caution is needed.  If you read the news today how many stories, and there are tons of them with coding, billing and reimbursement thus if one leaves the work of Watson to research and clinical areas without that mess, we might have some good intellectual break throughs.  I commented on that a while back as when you have multiple layers of new code running through the machine does what it learns and is taught and you run close of getting to a bottomless pit at times, but again for research and clinical use this is a good deal. 

Machine Learning Software Working Behind the Scenes Should Move With Caution in Healthcare-Writing the Unreadable With Rogue Algorithms With No Human Intervention

As the article states it’s going to be a while before the Watson processes are going to be available for use and data integrity along with credibility is going to be key in the preparation.  On the other side of the coin though in the financial areas, something for consumers to be aware of with big data as nobody checks the math of banks and a lot of the big investment firms so more place to hide code to enable desired results more so than accurate results as we know what happens when money is involved.  The SEC certainly is going to need some “big data” capabilities soon or as consumers we are sunk.     

IBM Watson Going to Work At Citigroup on Wall Street–Congress Didn’t See Big Data As A Tool (Hadoop Framework) When They Had Their Chance…For Consumers The Attack of the Killer Algorithms–Chapter 22

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When left to it’s own, and not regulated and audited, we get what I have written about below with formulas running a muck and hurting consumers.  BD

Attack of the Killer Algorithms–Digest & Links for All Chapters–See How the Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You

WHITE PLAINS, N.Y. — The medical training of IBM’s speedy Watson computer will continue with a residency at a renowned Manhattan cancer hospital.

IBM and Memorial Sloan-Kettering Cancer Center said Thursday that they will add the latest in oncology research — and the hospital’s accumulated experience — to Watson’s vast knowledge base, and keep updating it.

Watson will be fed textbooks, medical journals and — with permission — individual medical records. Then it will be tested with more and more complicated cancer scenarios and assessed with the help of an advisory panel, Kohn said. It’s expected to speedily suggest diagnoses and recommend treatments, ranking several alternatives.

Watson can even be instructed about individual patient preferences, Kohn said. When evaluating treatments, for example, it could take into account that a patient feels strongly about not losing her hair.

http://www.washingtonpost.com/national/health-science/ibms-famed-watson-computer-to-be-trained-in-cancer-to-diagnose-treat-patients-at-ny-hospital/2012/03/22/gIQA2RPtSS_story.html

Technorati Tags: BMWatson,technology,machine learning,computers,digital illiteracy,queries,intelligence,algorithms,cancer,big data,Memorial Sloan-Kettering Cancer Center,medical records

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Rite Aid Stores Hosts RV Tour From the Skin Cancer Foundation Coming To A Store Near You For a Free Skin Cancer Screen

This is pretty cool as a big RV comes around and had 2 private exam rooms so each person has privacy while being screened.  All locations in each state have not been posted yet but it looks like Florida is right at the top of the tour. 

The tour is accredited with finding over 5,000 cases of pre-cancer and 239 cases of melanoma as well.  There’s also a page where dermatologists can sign up to volunteer.  Most states have laws to where MDs can’t cross state lines to assist so they need local doctors to make it work.  BD 

Rite Aid Road to Healthy Skin

Press Release:

CAMP HILL, PA (March 22, 2012) – Thousands of Americans can receive free full-body skin cancer screenings this spring and summer thanks to The Skin Cancer Foundation's annual Road to Healthy Skin Tour presented by AVEENO® and Rite Aid. Starting this week, the Tour’s 38-foot customized RV is stopping at more than 50 Rite Aid stores as it zig-zags across the country.

The Tour draws on the expertise of local dermatologists who volunteer  to perform free, full-body skin cancer screenings, which The Skin Cancer Foundation recommends receiving annually. In its fifth year, the Tour is reaching out to new communities and adding new stops in Georgia, Virginia, Pennsylvania, upstate New York and Ohio. Many of the Tour stops are at Rite Aid Wellness Stores, which are Rite Aid's latest store prototype and feature expanded pharmacy services, an enhanced selection of wellness products, and regular health events and screenings such as these.

“We're proud to have sponsored the Road to Healthy Skin Tour every year since its inaugural journey," said Robert Thompson, Rite Aid executive vice president, pharmacy. "These screenings are a great example of the kind of proactive health and wellness resources that Rite Aid is committed to providing. Rite Aid pharmacists can help customers select the right sunscreen and counsel on possible medication interactions, such as the increased sun sensitivity that accompanies many common prescriptions."

The four past Tours have caught nearly 5,300 potential skin cancers and pre-cancers including more than 200 suspected cases of potentially deadly melanoma. Visitors are screened in one of two private exam rooms on the RV on a first-come, first-served basis. They also can sample sun protection products and learn about skin cancer prevention and early detection.

Visit www.skincancer.org/tour to view an interactive map of the Tour.

The Skin Cancer Foundation is the only global organization solely devoted to the prevention, early detection and treatment of skin cancer.  The mission of the Foundation is to decrease the incidence of skin cancer through public and professional education and research.  For more information, visit www.SkinCancer.org.

Rite Aid Corporation (NYSE: RAD) is one of the nation’s leading drugstore chains with approximately 4,700 stores in 31 states and the District of Columbia and fiscal 2011 annual revenues of $25.2 billion. Information about Rite Aid, including corporate background and press releases, is available through the company’s website at www.riteaid.com.

Technorati Tags: Rite Aid,skin cancer,screenings,pharmacy,wellness,patients,melanoma

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United HealthCare Awards Contract to One Blue Cross/Blue Shield Subsidiary to Process Tri-Care Claims While The Other BlueCross BlueShield Company Lost the Over All Tri-Care Bid To United In the West

This is getting interesting as the entire Tri-Care situation has drug on forever and we don’t know if the lawsuit United filed against DOD had any influence on this recent award.  There’s some history from a couple days ago at the link below. 

United Healthcare Secures Tri-Care Military Defense Contract for Western USA Presently Handled by Blue Cross Contractor TriWest

Palmetto (PGBA) has been around in the west for quite a while as the contractor as I have sent claims through them when doing medical billing.  I found this one page at Palmetto kind of interesting as it has all the billing and EDI information and questions, except right in the middle they will tell you how to tweet on Twitter:)  I have never seen a compilation like this before. 

TriWest is owned by 11 Blue Cross and Blue Shield plans and two University Hospital systems so this gets even more interesting and do they use software that was created by United’s Optum division?  They could as it’s been around for a long time so integration would be easier.  So through subsidiaries and ownership Blue Cross/Blue Shield has been all over the Tri-Care processing portion of the business for a long time.  Ok so what’s next?  We can speculate maybe and wonder if Untied will be offering Blue Cross some money for the Palmetto subsidiary some day?  I say that as they kind of come in and buy all types of technology companies and if they are integrating with their own systems…well..hmmmm…

Back in 2009 the Tri-Care contracts all began and United was originally awarded the north from HealthNet, they protested and got it back.  Right after this, Health Net sold  its Northeast insurance and HMO units in Connecticut, New York and New Jersey to UnitedHealthcare.  BD

HealthNet Will Keep the Tri-Care North Contract – GOA Investigated the Original Award to Aetna

FLORENCE, SC – PGBA, a BlueCross BlueShield of South Carolina subsidiary company has been awarded a new contract by UnitedHealth Military and Veterans Services (UMVS) to help process TRICARE claims.

TRICARE is the U.S. military's health care program for active-duty and retired service members and their families.
PGBA, based in Florence, S.C., announced March 16, it would process TRICARE claims and provide claims-related customer service and sophisticated systems platforms, integrated with UnitedHealth Group systems, on behalf of beneficiaries, physicians and hospitals as a subcontractor to UMVS.

http://www.healthcareitnews.com/news/bcbs-south-carolina-company-process-tricare-claims?topic=04,28

Technorati Tags: United,Tri-Care,DOD,healthcare,health insurance,contracts,protest,proposals,military,GAO,assessment,algorithms,Super Committee,TriWest,Palmetto

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Healthgrades Hospital Report is Out and Still Think Their Algorithms Needs Work…

This time they appeared not to even touch Massachusetts is appears as last time MDs from some great hospitals were upset they were either not on the list or not ranked properly.  Healthgrades said themselves a while back that their algorithm needs work and now they merged with a marketing company but I wonder how long the rankings here will continue to be of public interest.  I know it’s sure slowed down a lot with consumers I talk to. 

HealthGrades to Merge with CPM Marketing–Will Their Data and Questionable Algorithms Will Be Improved For Consumers?

They have their share of flawed data out there like many who report on healthcare and they were just ahead of the rest when I found my former doctor who has been deceased for 8 years still on their listings.  I know she’s no longer on there but it brought attention to what we get out on the web as far as aggregated data sometimes.  I didn’t see any of the Kaiser Permanente hospital on there either for that matter.  BD 

HealthGrades 'Best Hospital' List Algorithm Needs Work Again - Flawed Data

DENVER, CO – HealthGrades, a provider of consumer healthcare information, named America’s best 50 and 100 hospitals for 2012 in a report issued today.

These hospitals demonstrated superior and sustained clinical quality, ranking them in the top five percent of all hospitals in the nation, according to a press release issued by the company.

Key report findings include:

• America's 50 and 100 best hospitals are located in 88 cities in 25 states.
• The majority of America's 50 and 100 best hospitals are nonprofit (87 percent), 7 percent are for profit, and 6 percent are government owned.
• America's 50 and 100 best hospitals range from 100 beds to more than 500 with 45 percent having less than 350 beds and 55 percent having more than 350 beds.

"As our nation seeks to elevate the quality of care at all hospitals, these elite facilities provide a roadmap for success," said Arshad Rahim, MD, HealthGrades director of accelerated clinical excellence, in a written statement. "Consumers increasingly are demanding greater transparency and quality when selecting healthcare providers. These hospitals are delivering. We commend them for their dedication to excellence in patient care."

http://www.healthcarefinancenews.com/news/healthgrades-names-americas-top-hospitals?page=0,0&topic=19

Technorati Tags: HealthGrades,data bases,health insurance,human resources,tech denial,infrastrucure,lazy,employer insurance,CPM

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J and J Sold Vaginal Mesh Implant Without FDA Approval for 3 Years

J and J also has a part in the vaginal mesh mess with their product and lawsuits are starting here too.  The questions here are the fast track approval for the Prolift mesh due to the fact that it is similar to Gynemesh a product made by another company.

The product was put on the market in 2005 and was not given approval by the FDA until 2008.  The FDA asked in 2007 for a 501k submission and again after it has been out there for a couple of years already.  All companies now who make the mesh product were ordered by the FDA to study organ damage and other complications from the mesh.  In 3 years the FDA accumulated over 100 complaints on the Prolift product.  This is yet one more issue for J and J to work with and settle.  BD  

Johnson & Johnson sold a vaginal mesh implant for three years before U.S. regulators approved the device, now the subject of more than 550 lawsuits by women who claim it injured them.

J&J introduced the Gynecare Prolift device in March 2005, touting it in an annual report as an “innovative and effective surgical option” for weakened pelvic muscles. The U.S. Food and Drug Administration said it learned of the Prolift in 2007, when J&J sought approval for a related product. The FDA cleared both devices in May 2008.

The company, the world’s second-biggest health-care products maker, said it could market the Prolift without approval because it was so similar to an approved device, the Gynecare Gynemesh, said Morgan Liscinsky, an FDA spokeswoman, in a March 16 e-mail. “FDA disagreed with this assertion,” concluding distribution began “without appropriate” clearance, she said.

J&J’s unauthorized sales might cost it more to resolve lawsuits over the product. J&J already has endured recalls of artificial hip implants and over-the-counter drugs. Three J&J units have pleaded guilty in the past two years to bribery or illegal marketing of drugs. A fourth agreed to plead guilty in a marketing case.

Andrew Sokol, an associate professor of obstetrics/ gynecology and urology at the Georgetown University School of Medicine, said he was “absolutely concerned” after hearing that J&J marketed the Prolift without FDA approval.

“That information would have been important for most surgeons,” Sokol said. “Most surgeons probably would have not used a completely new product if there was no oversight.

http://www.bloomberg.com/news/2012-03-21/j-j-sold-vaginal-mesh-implant-without-u-s-regulatory-approval.html?

Technorati Tags: J and J,Ethicon,surgery,mesh,vaginal mesh,regulation,fast track,recalls,drugs,marketing,lawsuits

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Robotic Tek Mobilization Device Could Someday Make Wheelchairs Obsolete–The Device Moves Like A Segway and Supports and Uplifts User to Standing Position

The device was created in Turkey and they are looking to market in the US and the price in the article here said around $15k would the cost and so I don’t think the Scooter Store has to worry too soon about immediate competition.  This would be nice if insurance and Medicare get in the act here with considering the device.

The man in the video has no use of his legs and the chair does it all as far as moving him from a sitting to a standing position. It has controls so you can call it to your bedside or where ever you need to it respond.  This is great watching him get around and go up and down as needed.   It has been through a full set of clinical trials so it’s just about ready to go and will be sold in Turkey this week.  BD 

Wheel Chair substitute

The young man in this video looks like he's riding a Segway. But Yusuf Akturkoglu was paralized after falling from a horse five years ago, and he's being mobilized by an amazing device invented by Turkish scientists. It's going to change lives.

It's called the Tek Robotic Mobilization Device, and it not only allows people who can't walk get around more independently than any device has before, but it also helps them stand up on their own, which is crucial for maintaining basic health functions in people who have spinal cord injuries.

Instead of entering from the front like a normal wheelchair, people using the Tek RMD enter from the back of the device. That way they don't have to hoist themselves with a momentum that can be dangerous and is next to impossible to do alone. By attaching a thick padded strap around the hips, Yusuf maneuvers himself into the Tek RMD on his own.

The makers of Tek RMD says it's the most compact device of its kind, which allows Yusuf to navigate crowded grocery aisles, libraries, and who knows, Coachella, maybe? All without knocking into the people and things around him. Users still need ramps in place of stairs, but the device eliminates the need for special bathroom stalls and other facilities that allow space for bulky wheelchairs.

http://gizmodo.com/5894489/segway+style-device-for-paraplegics-puts-wheelchairs-to-shame

Technorati Tags: wheelchairs,TEK,RMD,compact,paraplalegic,mobility,spinal cord injuries,stand,medical devices

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Kaiser Permanente Opens New Medical Center in Gaithersburg, MD With Dual Monitors So Patient Views Same Chart Information as Physicians in Real Time

This is a good size facility for sure and again as noted in the title here, patients can see the exact same information as the physician in real time whether it’s their chart or perhaps other educational information that would be relative.  There are 72 provider offices and over 350 physicians and staff members.  They are right with the dual screens though as far as engaging the patient.  I don’t know if they do this out side of California but here they use Bloom Box fuel Cells for energy just as Google and EBay do. 

Kaiser Permanente to Install Bloom Box Fuel Cells at California Facilities

A while back I had the chance to interview one of their physicians from the Atlantic region and our focus was on how the electronic medical records helped her with giving better care in her area of pediatrics. 

Kaiser Permanente Pediatrician Patricia Richards Explains How The Use of Electronic Medical Records Enhances Knowledge With Obesity and Adds Focus to the “Let’s Move” Obesity Prevention Campaign

Last year they also opened this state of the art center in the DC area which is also a learning center and a nice video to watch and see what they do.  In addition here in California outside of Bakersfield they now have a mobile unit that also goes around to offer primary care services and it is connected to the medical records system so everything done is documented on the spot.  BD 

Kaiser Permanente Opens State of the Art Facility in Washington DC-Kaiser Permanente Capitol Hill Medical Center

ROCKVILLE, Md. — Kaiser Permanente of the Mid-Atlantic States, a leading not-for-profit health plan and care provider, opens the doors to its new Gaithersburg Medical Center today, March 19, 2012, offering Montgomery County, Md. members more medical services conveniently located under one roof.

“The new Gaithersburg Medical Center is Kaiser Permanente’s largest medical center in Montgomery County and is situated in a key location convenient to our members,” said Marilyn Kawamura, president, Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. “We are committed to the health of Montgomery County residents and are thrilled to be opening our doors.”

Designed with the member in mind, medical center exam rooms are fully wired with Kaiser Permanente HealthConnect®, the most advanced electronic health record system available today, featuring dual monitors allowing patients to view the same information, in real time, as their physician, further enhancing the member experience.

http://xnet.kp.org/newscenter/pressreleases/mas/2012/031912gaithersburgopening.html

Technorati Tags: Kaiser Permanente,Intermountain Healthcare,Group Health,healthcare,patient,medical records,Health IT,non profits,Gaithersburg,Maryland

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And Now A Word About Medical Data Privacy-Something To Think About Today as The Data Selling Business Explodes and Accountability is Diminishing–Video

Yes this is the age old topic once again but it’s not going away.  Today with data mining and selling on the rise, it would be nice to have a federal disclosure page where all who distribute and sell data would list what and who they sell to.  You can’t make any sense today out of the very crafty written by attorneys privacy pages on websites and it’s mean to be that way.  Here’s a good example where privacy got out of hand and where Wall Street investors were looking at actual patient medical records from 3 hospitals…it was the 3rd party consultant who is now being sued, which is a good thing for all those folks who’s records were exposed.  If it was not for the stolen laptop, we would have never known.

Accretive Health Debt Collector Employee Has Laptop Stolen With Non Encrypted Patient Data from 2 Hospitals And Had Access to All the Data Via Revenue Cycling - Patient Information Was Shared With Wall Street Investors – Algorithms For Profit Again?

We actually had consent until 2002 until the government took it away and with the way data runs and is mined through out healthcare today, which is on steroids compared to the year 2002, we need it as math and algorithms confuse all of us depending on how naïve and gullible we are.

Privacy Medical Records

Depending on how honest this 3rd party was with their algorithms, people may have not received the care they needed in the name of saving money.  It is time to license and tax the folks selling data and get some transparency out there along with asking patients for their permission.  There’s tons of tax money potential there with using the Walgreens SEC 2010 statement to where they made just short of $800 million selling data, intangibles so you wonder are prescriptions just a side line business in order to capture data for sale?  Sure there are folks that say there is no privacy and in part it’s true but we can fix the US budget with the tax revenue that makes corporations rich with selling data they get for free and in the meantime consumers suffer with no privacy at all.  There needs to be a balance and soon. 

If we had disclosures that told the real story on what is sold and where it goes then could make better decisions as consumers and patients too instead of being in the dark.  Next week I’m sure we will have yet one more item in the press that says how stupid consumers are again as that topic floats in and out. 

The Alternative Millionaire’s Tax–License and Tax Big Corporations Who Mine and Sell Taxpayer Data They Get for Free From the Internet-Phase One to Restore Middle Class With Transparency, Disclosure and Money

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You can read more on the topic of “The Attack of the Killer Algorithms” at the link below but it makes corporations rich and keeps consumers poor in essence, and we do need a say in all of this.  BD

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 3-11-2012

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The U.S. government is spending billions of dollars to help move everyone's health care records onto electronic databases. There are many good things about this: electronic health care records can be accessed from anywhere, they take up less physical space and they are very portable.

However, with these benefits come severe privacy concerns as well. The Health Insurance Portability and Accountability Act of 1996 (or HIPAA, for short) claims to protect your medical data from probing eyes. The problem is, its language is weak. Your records are already an open book to millions of providers, employers, government agencies, insurance companies, billing firms, transcription services, pharmacy benefit managers, pharmaceutical companies, data miners, creditors and more. This is considered “routine” use, and is not covered by HIPAA.

In fact, in 2002 HHS actually amended the HIPAA “Privacy Rule” to eliminate the patient's “right of consent” altogether. So, you do not own your data, someone else does. It's time we changed this.

http://www.pop.org/projects/medical-privacy

Technorati Tags: privacy,medical reocrds,disclosure,transparency,heatlhcare,medical records,permission,investors,consumers,patients,doctors

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Next Version of Connect Gateway for the Nationwide (NwHIN) Exchange Will be Called Connect+ Making It Easier for Organizations to Put in Place

This is a nice welcome as it will enable more providers, hospitals and so forth to connect and share medical information securely.  From a data standpoint this is interesting that the two areas of code are being separated so I am guessing we have a little bit more on the back end with changing the front end to have fewer working parts as far as creating the ability to use the NwHIN network.  Below is a map that shows some of the work in progress with practices and other healthcare IT entities connected t the NwHIN system.  BD 

Hospitals and Providers Using NHIN (Nationwide Health Information Network) To Connect and Share Medical Records With the VA and DOD And Even With Each Other

One does not need the CONNECT protocol to connect to the NwHIN but an open source project that all can contribute to is certainly a winner.  BD 

“CONNECT is an open source software and community that promotes IT interoperability in the U.S. healthcare system. CONNECT enables secure electronic health data exchange among healthcare providers, insurers, government agencies and consumer services. CONNECT 3.3 includes new features, support for new NwHIN technical specification for health information exchange, and more. “

ARLINGTON, VA – The Office of the National Coordinator for Health IT has made available the next version of the Connect gateway software that incorporates the most up-to date technical standards and descriptions for the nationwide health information network (NwHIN) Exchange to support functions like patient discovery and query for and retrieve documents.

Connect gateway and adapter software uses NwHIN standards and services to enable healthcare organizations and federal agencies to share patient information securely through the Internet.

We plan to separate out the gateway from the adapter lines of code, which are fairly tightly coupled. That means it’s been difficult to implement for many organizations,” Thompson said at a March 15 conference about military electronic health records (EHRs).

The NwHIN Exchange has been an organization for advanced exchange for primarily federal agencies and large healthcare organizations because of a requirement that limited participants to federal contractors or grantees.

It has 25 partners including DOD and VA, which uses NwHIN to share information at 11 virtual lifetime electronic record (VLER) sites, and the Social Security Administration, which has 300 provider organizations exchanging data to accelerate disability determinations.

More changes are coming. By December, ONC will move Connect out of its purview to a distributed development program in an open source community and is considering a variety of organizational approaches, including adopting a custodial agent process, similar to the Veterans Affairs and Defense Departments to develop their integrated EHR.

http://www.govhealthit.com/news/onc-advances-connect-exchange-tools

Technorati Tags: NwHIN,Direct Project,healthcare,medical records,VA,DOD,Social Security,code,CONNECT,partners,Connect +,aggregattion,gateway,software

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United Healthcare Secures Tri-Care Military Defense Contract for Western USA Presently Handled by Blue Cross Contractor TriWest

I don’t know if you have followed the Tri-Care bidding processes or not but his has been ongoing with bids, protests, rebids and so on since 2009.  There are 3 areas of the country to where carriers can bid, the northeast, southeast and the west and one carrier cannot have more than one area awarded in a big.  Untied has been very active in all of them and in the southeast won the contract, Human filed a protest and got it back.  So the next move it appears was to focus on the western US and again with hiring the former US Assistant Attorney General from Minnesota I guess they must have covered all the legal ends as you can read the link below to see where United filed suit against the government over the Tri-Care contracts. 

Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?

As I read this story it will take a year to wind down and March of 2013 is when the official date is for assuming all the services.  This is a lot of data and medical record information to transfer, as is everything today.  You can read the back link below too and see more about the United protest filed against Humana which was successful in maintaining the contract for the south. 

UnitedHealth Loses Tri-Care Protest Again With Contract Awarded to Humana in the South-Now Protesting Contracts Awarded In Both the South and the Western States

Here we go again with a whistle blower incident with Tri-West and it’s kind of funny as you read that United’s complaint was based on the fact that they felt that Tri-West forced the DOD to focus on costs and not quality of care…well you can read enough here and talk to many primary MDs and find that opinion from many of them as United has actively cut reimbursements and is very aggressive in this area so is the pot calling the kettle black?   HealthNet filed a protest against the award in the northeast and they were able to keep the contract that was awarded to United back in 2010 and HealthNet, not being as large as a conglomerate until the decision was reversed had to sell part of it’s other commercial coverage in northeast to Untied. 

Humana Keeps Tricare In The South And Back in May of 2010 HealthNet Was Able to Keep the Northeast-Both Companies Filed Appeals

United owns enough companies to pretty much get a cut of the action anywhere they go today to include buying up physicians groups as well and in the OC the activity has been huge with lawsuits here as well with Blue Shield filing one based on issues of causing patients and doctors problems that are in their network.   This even get more interesting as TriWest awarded a 5 year contract to Blue Health Intelligence in September for data analytics and saving money. 

Nobody has been in the game as analytics as long as United who for years through subsidiaries has sold analytics services and software even to other insurance carriers.  We all became aware of this with the big class action lawsuit over the use of the old Ingenix analytics for out of network payments where most carriers subscribed to the data base and formulas created by United.   Here’s where the case of the formulas and algorithms created by United ran up against Andrew Cuomo and lead to the big class action lawsuit with low balling payments to MDs and patients. 

AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)

Other lawsuits are still floating around out there on the use of the Ingenix data base which is now Optum and they created it and other insurers licensed and use it.

Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana

Here’s a little bit of recent action in the OC with United and/or subsidiaries owning/controlling two of the biggest physician’s groups in southern California. 

United Healthcare Subsidiary MemorialCare Medical Foundation Acquires Nautilus Healthcare Management Who Manages Greater Newport Physicians-MDs Become Part of MemorialCare System–Subsidiary Watch

With all the emphasis on ACOs today, look what’s happening here as well..mixing everyone up and who’s really going to contract with who and what subsidiaries of insurers are involved?  Good questions to ask as now the data for use is caught in the middle, as are doctors and patients. 

Health Insurance Contracts at the OC Corral–Lawsuits, an ACO and A Lot of Mixed Up and Confused Patients As Data Disruption and Patient Care Move Center Stage…

If you haven’t quite figured this out yet, it’s all about money and care comes in here secondary as the money drives who patients can see, what’s approved for medications and so forth so based on lawsuits and contracts this is not doing much in the way of “real” care being in the forefront as it appears to me and more focus seems to be with providing dividends to shareholders, who on day might wake up to the fact that they to be insured by some health insurance company too so this is where the stock goes and just something again shareholders should take note of as far as their personal involvement as this roller coaster ride speeds up. 

United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County

The sometimes scary part too about United is there huge number of subsidiaries so if they lose on one count, there’s a subsidiary they can send in to work on another angle, again all to put more profit to their bottom line.  Below I discussed this a little as they own 3 companies that provide electronic medical records so as a quick example if a doctor needs an EMR to gain stimulus funds as their insurer reimbursements gets cut, does this happen to where 3 potential solution companies that are subsidiaries rush in for that sale? 

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT

In healthcare and in the financial areas today this all getting to be a game of money and Algorithms for either desired or accurate results and they should be the same but they are not always.  I have a series in which I discussed “The Attack of the Killer Algorithms” where I have connected dots on flawed data, and so forth on how this works to sell more software sometimes and how the consumer gets hurt.  What do you do when you can’t see, talk to or touch those algos that are making life impacting decisions about you on servers 24/7?  The link below also has an excellent video that’s an eye opener too on how all analytics are not 100% factual and how marketing spins numbers and moves public opinions based on such and how we get suckered in every day. 

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Attack of the Killer Algorithms–Digest & Links for All Chapters–See How the Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You

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United with their various subsidiaries to include a bank with over a billion on deposit is showing up in all types of industries…even low income housing.  Recent subsidiaries include a clearinghouse business and in Florida, the purchase of two more HMO companies. 

United Healthcare Gets in The Low Income Housing Business With Partnership to Finance Housing Projects in New Mexico

United Healthcare Buys Two HMOs in Florida–More Cheap or Free Hearing Aids for Seniors Perhaps–Subsidiary Watch

With all these varied subsidiaries, no wonder they hired former US Attorney General in Minnesota for their general counsel as I too sometimes wonder when the “conflicts of interests” or those of a monopoly of business sector questions will arise. They are also duking it out in Kansas and Nebraska for state and employee managed care contracts.  In Kansas, Blue Cross who is the largest in that state decided not to even bid, and again when up against the mighty subsidiary powers United has been able to bring in profit dollars from so many different areas from introducing a drug to the FDA all the way down to physician reimbursement, I do wonder how they compete not to mention the draw of the crowd for those cheap hearing aides in some areas. 

In addition a few weeks ago this story was big all over the web with United offering their new Cloud services and going to sell and give away apps…what do they not do?

UnitedHealthCare Launching Cloud Platform Via Optum Subsidiary Will Sell Apps Like the Apple Store But They Won’t Be As Much Fun And Solicit Hospitals for Record Storage

Again if you have been asleep at the wheel, folks in the US don’t normally like to discuss math and algorithms and it works in the background while we get distracted over women’s health issues and abortions that make the news mostly due to the digitally illiterate folks we have in office and  they don’t do math either.  All of this and lack of focus has allowed United to grow behind the scenes and acquire such a huge network of subsidiaries and make lots of money in the intangibles and they have a lot of it and also make million selling our data along the way as well. 

“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government

So as a company when they feel they have all the math and formulas to run everything this certainly seems to present a case for protests and so forth to government entities that are pretty much blind to how business in the background works today and while our folks in government maintain full levels of distraction and with the media keeping the public tied into the emotional turmoil that they really have no control over, big conglomerates such as United continue to grow and add to their profits and one day someone will wake up and say “how did all this happen”.  Again it’s all about government and consumers being naïve and gullible over a number of years that has allowed this to take place with nobody minding “the intelligence shop” .  

The company via subsidiaries can even introduce a drug to the FDA and has subsidiaries to consult all the way down to MD reimbursements if a perfect contract solution were given where each step was awarded to one of their subsidiaries…kind of scary isn't it but that’s what has been built in the background  is now coming to forefront…again mostly due to folks being asleep at the wheel and living in technical denial.  Below are a couple other subsidiaries you may not be aware of as well…good reading if you want to stay on top of what is controlling everything today…servers and algorithms that makes billions in profits while the general public and lawmakers run from the math and corporations thrive.  BD 

United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch

UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally

PHOENIX (AP) — Phoenix-based TriWest Healthcare Alliance has lost a $20.5 billion contract to manage health benefits for U.S. military families, and company officials say 1,000 jobs in Arizona are now at risk.
The U.S. Department of Defense announced Friday that it chose UnitedHealth Group over TriWest to serve military family members across 20 western states.
“We are disappointed,” TriWest chief executive David McIntyre said. “We do this work well by every measure. We do it very efficiently for the government.”
TriWest representatives plan to meet with department officials next week to learn why the company did not win the contract, the Arizona Republic reported.

McIntyre said TriWest will file a protest if the company discovers a legitimate reason to do so after meeting with department officials. Otherwise, he said operations will start to wind down after TriWest’s contract with the department ends in March 2013.

In July 2009, the federal government awarded the western region contract to TriWest. It reopened bidding in April 2011 based on UnitedHealth Group’s protest of the contract award. At the time, UnitedHealth Group said the Department of Defense forced contractors to focus on low costs instead of quality care.

In September, TriWest agreed to pay the federal government $10 million to settle whistle-blower claims that the company had failed to pass along discounted rates to the government.
TriWest had been accused of overbilling the federal government for medical services provided to military personnel and their families. From 2004 to 2010, TriWest reportedly submitted claims from health care providers at rates that were more expensive than discounted rates the insurer had negotiated.

http://www.mohavedailynews.com/articles/2012/03/18/news/business/doc4f6597ba5e448967025190.txt

Technorati Tags: United,Tri-Care,DOD,healthcare,health insurance,contracts,protest,proposals,military,GAO,assessment,algorithms,Super Committee,TriWest

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