Showing posts with label Medically Related. Show all posts
Showing posts with label Medically Related. Show all posts

Fist Fight and Love Triangle In Pennsylvania Costs One CEO His Job -


A job paying $4.5 million a year is not easy to come by, at least in my area of the world it’s not.  He used to have clout and now with this all over the media, I guess time will tell imageif it stays or goes away.  This is bizarre as his mistress as she is called moved out from her home with her husband, and then the former CEO, Melani hired a private detective to follow her.  Something must have been cooking as he showed up and the husband was there and it sounds like that’s what erupted into a fist fight.  Highmark as a company also has this battle in place with UMPC. 

Hospitals and Insurance Company Competing for Patients In Pittsburgh–Contracts In Question


From the website:


“Our history of helping families and companies with their health insurance needs dates to the 1930s, when our predecessor companies were established to helpimage Pennsylvania's residents pay for health care.

Highmark was created in 1996 by the consolidation of two Pennsylvania licensees of the Blue Cross and Blue Shield Association — Pennsylvania Blue Shield (now Highmark Blue Shield) and Blue Cross of Western Pennsylvania (now Highmark Blue Cross Blue Shield). We are now one of the largest health insurers in the United States.”

In addition Highmark and the Blues Group, which was their origin also bought NaviNet which is a Health IT technology company that connects medical records. So there was a lot going on for sure business wise and otherwise.  BD 

Blue Cross/Blue Shield Insurers and Highmark Acquire NaviNet Transactional Portal And Medical Records Vendor–Subsidiary Watch

Video below and is appears they both the husband and the doctor had bleeding faces and the board of directors held a meeting hours after the assault.  BD



He held the CEO post of one of the largest health care providers in PA and now he is facing serious allegations following a sex scandal.
Here in Central PA, thousands are employed by Highmark and shocked to hear the news that higher-ups fired CEO Doctor Kenneth Melani Sunday morning.

Dr. Ken Melani is out as CEO of Highmark, a post that paid $4.5 million a year and gave him serious clout in the industry.
Melani is accused of getting into a fist fight in a neighborhood near Pittsburgh with the husband of Highmark employee Melanie Myler who he was allegedly having an affair with.
“The reports are scandalous in nature, it isn’t flattering,” stated attorney Robert del Greco.
Melani’s attorney went onto say they don’t know if he was fired under moral grounds or something else entirely.



http://www.whptv.com/news/local/story/Highmark-CEO-fired-over-love-triangle-brawl/ki_NJGqU1EKAeKFIwW16sg.cspx

Neupro Patch Gets FDA Approval for Advanced Stage Idiopathic Parkinson’s Disease and Restless Leg Syndrome

The patch is worn for a day and imagecontains a sulfite, sodium metabisulfite that some are allergic to and you have to watch for a few other drug interactions with anything that causes drowsiness and there’s a side effect of hallucinations and that side effect is higher with those who have Parkinson’s disease. 

Another side effect is an urge to behave unusually, urges to gamble or increased sexual urges.  This is right off the website with the warnings.  The drug is said to stimulate dopamine receptors that regulate movements.  BD


BRUSSELS & ATLANTA--(EON: Enhanced Online News)--UCB announced today that the U.S. Food and Drug Administration (FDA) approved Neupro® (Rotigotine Transdermal System) for the treatment of the signs and symptoms of advanced stage idiopathic Parkinson’s disease (PD) and as a treatment for moderate-to-severe primary Restless Legs Syndrome (RLS). Neupro® was previously approved by the FDA for the signs and symptoms of early stage idiopathic PD. Neupro® is a dopamine agonist patch that provides continuous drug delivery for patients with PD and RLS. The FDA has also approved UCB’s new formulation of Neupro®.

“RLS can be a serious condition with symptoms that affect patients during the day as well as at night; and Parkinson’s disease symptoms can have a broad impact on patients. Neupro® provides a novel way of treating RLS and PD through continuous transdermal dopaminergic delivery. It can help patients manage the unpredictable nature of these chronic conditions,” said William Ondo, M.D., Professor, Department of Neurology, University of Texas Health Science Center at Houston.

http://eon.businesswire.com/news/eon/20120402006986/en/Neupro%C2%AE-Approved-U.S.-FDA-Parkinson%E2%80%99s-Disease-Restless?utm_source=dlvr.it&utm_medium=twitter

Express Scripts and Medco Get Federal Approval To Merger Valued at $29 Billion - Is It All About Data to sell for Bigger Profits?

This means more mail order prescriptions on the way

eventually as almost all health plans today have one.  I wonder how this affects chain pharmacies like Walgreens who are still disputing contract amounts with Express Scripts.

  Blue Cross members can’t get prescriptions there so now does it all switch over to Medco? 

Express Scripts to buy Medco for $29 Billion–Medco 2nd Quarter Profits Were Down 4% And the Profit Algorithms Once Again Are Hard at Work To Control Costs via Acquisition
 
The initial announcement of Express Scripts was announced in July of 2011.  When you add in Caremark as the other large PBM that’s like a huge amount of the mail in pharma business in the US.



Walgreen Dumps Express Scripts Pharmacy Benefit Manager–Contract Dispute With Reimbursement to Retail Chain Too Low


Now let’s look at something else going on in the drug business with FICO selling software to companies such as PBM managers and now it gets interesting with analytics that are using mismatched data that has been spun and marketed, with FICO claiming they can predict medication adherence.  How man PBMs are buying this and what will it do for access for patients?  This is just one more example on how marketing today puts a wild spin on things and it goes on behind the scenes and denies due to parameters not being met, whatever they are.



FICO Analytics Press Release Marketing Credit Scoring Algorithms to Predict Medication Adherence–Update (Opinion)

One thing to keep in mind today is that with mergers and acquisitions, along comes aggregation of data for analytics and to sell for a profit and PBMs do that big time and companies are making billions selling data so again keep that thought and the acquisitions of today might look a little different to you as if Walgreens in the SEC statement in 2010 made short of $800 million selling data, just think what these two conglomerates make, it makes my head spin and wonder if selling prescriptions is merely the gateway to profits on selling data.  I’m not the first one to say this and I won’t be the last.  If you know math and see that Walgreens number, you can’t over look it.  BD

 



Despite potential antitrust concerns and vocal opposition by some lawmakers and consumer groups, Express Scripts and Medco Health Solutions, two of the nation’s largest pharmacy benefit managers, said Monday that federal regulators had approved their $29 billion merger.

The decision, by the Federal Trade Commission, to let the merger proceed was not unanimous, indicating conflicting views among the agency’s top regulators over whether to challenge — or impose limitations on — the combined company. After eight months of review, the F.T.C. commissioners voted 3-to-1 to close the agency’s investigation.

The acquisition of Medco by Express Scripts, based in St. Louis, creates what is now the industry’s largest player, with $116 billion in 2011 revenue. CVS Caremark, itself the product of a merger between a large drugstore chain and a benefit manager, is now the second-largest competitor with $107 billion in revenues.

Pharmacy benefit managers, known as P.B.M.’s, manage prescription drug plans for employers and insurers. They serve as middlemen between the drug companies and the payers.

Two groups, which represent community pharmacists and chain drugstores that have strenuously objected to the combination, filed a lawsuit last week seeking to block the merger. The National Community Pharmacists Association and the National Association of Chain Drug Stores, which see the combination as problematic for pharmacies, said they planned to pursue their litigation.

http://www.nytimes.com/2012/04/03/business/ftc-approves-merger-of-express-scripts-and-medco.html?_r=1&smid=tw-nytimeshealth&seid=auto

Over Diagnosing for Breast Cancer? Report Suggests Some Treatments Were Not Needed

This is one that I know about through my mother as we had this happen.  It turned out she did not have breast cancer and a “mass” was found.  I’ll make this brief but she imagewas over-diagnosed when the x-ray was blown up to further investigate.  That lead to a biopsy which was also messed up and if she would have gone for treatment for this tiny miniscule mass they found with radiation, she may not be here today at age 87 and this was about 3 years ago when all this occurred. 

Upon consulting with a veteran surgeon who went over everything in detail he said yes she has a mass but it was not cancer and he has done a ton of surgeries for breast cancers so he was experienced. 

He gave her the choice though of having it removed or not and when we discussed it we decided against it and keep in mind too this was at a time when propofol was hard to get all the time and he informed her he would need a “special anesthesiologist” to work with another drug and keep her “under” time down to an absolute minimum as even he knew after seeing her chart that her health was a bit on the fragile side with a long history of blood pressure, heart problems and diabetes. 

After all was said and done the insurance company went back to investigate the original oncologist and radiologist. 


The radiologist had called my mother about her experience with the oncologist as well and about the office since they were new partners.  The radiologist left and went elsewhere and the insurance company ended up fining the oncologist who seemed to be more interested in making my mother a case study than treating her cancer.  This is not representative of most doctors thank goodness and the pressure to sign up after the consult from the messed up biopsy was horrendous.  She could not get out the door without making her appointment for the treatment with the brand new Mammosite machine they had just purchased. 

FDA Clears Hologic's MammoSite(R) Multi Lumen Radiation Therapy – Breast Cancer


She made the appointment, went home and then cancelled the next day and the girl in the office was scared half to death over her job as she was evaluated on her patients relations and bookings for treatments for productivity.  So much for pay for performance at this level I said. 
 

So in summary screenings are still good in my opinion; however involving the patient here as we were with my mother lead to a very different outcome and results from the moment that she was told she had cancer.  Of course she signed all the releases for the doctors stating that she was declining radiation treatment.  After our experience with weighing everything and especially after the consult with the surgeon we felt we made the right decision. 

Again this was a very tiny spot and the following year her mammogram was clear!  But wait, 2 years later next mammogram and they again find a tiny spot and again blew it up to investigate and again I’m not picking apart the procedure or doctors at all, but, it was good to have case history and see almost the exact same thing as what set off whistles and bells 3 years prior and again we stopped there once more and opted out for surgery.  She’s still here today and again I can’t emphasize enough that each case is its own and we were and are lucky but I also understand that this is just her case and everyone needs to get all the information they can and make their own decisions.   BD

(Reuters Health) - A new report suggests that when a breast cancer screening program was rolled out in Norway, up to 10 women were diagnosed and treated for cancer unnecessarily for every breast cancer death that was prevented.

That’s because when doctors screen for cancer in women who don’t have symptoms, it’s impossible for them to tell whether a tumor picked up by mammography will grow quickly into advanced cancer or will only progress slowly or not at all, said lead author Dr. Mette Kalager.


You have to really consider the benefit and the harm against each other, and really think through: what is my risk of dying from breast cancer, and what is my risk of being overdiagnosed?" she said.

http://www.reuters.com/article/2012/04/02/us-breast-cancer-idUSBRE83112U20120402

Oracle Buys Cloud Based Clinical Trial Application Company–ClearTrial

It was not too long ago that Oracle Larry Ellison received an award for his contributions

to Health IT from the NIH.  We see the move with analytics all over healthcare today so this makes sense for Oracle to be in this business.

image

Oracle and Clear Trial will continue to operate as separate companies and biopharmaceutical, device and diagnostic companies are under more pressure than ever today to keep things in a budget for sure.  BD

 

Larry Ellison Announced As Distinguished Medical Informatics Awardee for His Contributions to Health IT and the Ellison Foundation From the Friends of the National Library of Medicine (NIH)

Summary: Oracle plans to combine its analytics resources to ClearTrial’s imagecloud-based clinical trial operations applications to produce a single, cheaper option for biopharmaceutical and medical device companies.

Oracle is beefing up its health sciences suite (and its cloud-based solutions portfolio) with the acquisition of ClearTrial.

ClearTrial is a provider of cloud-based clinical trial operations applications intended to facilitate the planning, sourcing, and tracking of clinical projects while ensuring a more accurate and faster financial performance. Its customer base ranges from emerging companies to top-tier biopharmaceutical companies

.

http://www.zdnet.com/blog/btl/oracle-acquires-cloud-based-clinical-apps-provider-cleartrial/72748

Study Suggests that Pay for Performance Incentives for Hospitals Is Not Leading to Better Patient Outcomes

Back in January of 2011 we had another study saying the same thing so we can add one more bit of information to the theories that pay for performance are worthwhile?



Does this further suggest that insurers all over are not getting their money’s worth?  If imagehear from their side, which if focused on reimbursements you might hear a different story but I’ll take the clinical side any day as we know all about the algorithms built for profit and it’s getting harder to do both with better clinical outcomes and at the same time apply fixes for the payments.  Sure hospitals are getting to be a lot smarter with “running the business” but what are we here for, better outcomes or better financial management and you sometimes wonder about the financial side as hospitals are still going broke all over.  BD 


Pay For Performance Is Not All That It Has Cracked Up to Be-Time to Rethink As Money Is Not Creating Better Health Outcomes


(Reuters) - A program to pay hospitals bonuses for hitting key performance measures, or dock them if they miss, failed to improve the health outcomes of patients, according to a large, long-term study.

The study could lead to a re-examination of financial incentives in healthcare, as policymakers seek ways to reward results rather than paying doctors and other providers for each service they provide, such as a diagnostic test.

Such an incentive program for hospitals is a key provision of the U.S. healthcare overhaul law that is being challenged this week before the Supreme Court.

The study looked at pay-for-performance incentives similar to those in the law and found no evidence that the program helped more patients live longer. It was published on Wednesday in the New England Journal of Medicine.

http://www.reuters.com/article/2012/03/28/us-usa-healthcare-compensation-idUSBRE82R1F720120328?feedType=RSS&feedName=healthNews&utm_source=dlvr.it&utm_medium=twitter&dlvrit=309303

Hospitals and Insurance Company Competing for Patients In Pittsburgh–Contracts In Question

In this case it’s Highmark and UPMC in the Pittsburg area.  It’s interesting to listen to the comments in the video and the “deals” are discussed here.  They bring up United Healthcare buying up physician’s groups and we have that big in the OC.  image

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


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…


This is really getting tough for patients and again being here in the OC I am hearing a few issues and Blue Shield is suing the part of United that is part of the two big doctor groups.  It was just a couple months ago that Blue Cross and Highmark bought NaviNet which is used by several insurance companies so the insurers here have a joint effort.  Highmark also handles a lot of Medicare through contracts from CMS. 


Blue Cross/Blue Shield Insurers and Highmark Acquire NaviNet Transactional Portal And Medical Records Vendor–Subsidiary Watch


Blue Cross and Highmark back in 2009 tried to merge with each other which I believe was not allowed as they are both obviously different companies still.  I’m glad this is starting to get some national attention as again I see it here in the OC and it’s doing nothing for patients here either.  BD 

 

WSJ's Anna Mathews examines a battle being waged between Pittsburgh's UPMC hospital and insurer Highmark over patients and how consolidation in the health-care industry is spurring similar tensions.

 

http://online.wsj.com/video/a-supercomputer-to-rival-watson-from-jeopardy/C18EA6E2-E536-48E8-8A43-8774D80306A7.html

Orange County Oncology Doctor Who Couldn’t Stop Defrauding Medicare Will Get His License Back After He Serves Time & House Sold for Just Under $10 Million

This was the oncologist that couldn’t help himself and made millions and on top of this the government seems to have messed up with the auctioning of his big house.  The sale of his house was supposed to pay off damages and give the government some money back but the government liens were not filed against the Justices as individuals so the trustee says they will get zero.

The house by the way sold for just under $10 million so the defrauding business was good while it lasted and this was his second go around as he was slapped on the hands basically the firs time.  If there were big payments due on that house, no wonder he couldn’t help himself maybe?  BD

 

Orange County Oncologist Gets Sentenced to 18 months Prison – Diagnosed With “Co-Dependency”- Couldn’t Stop Fraudulently Billing Medicare

A technical glitch overlooked by federal prosecutors may impede the U.S. government from collecting nearly $7.6 million owed by an Orange County physician convicted of Medicare fraud.

The sale of Dr. Glen Justice’s beachfront Corona del Mar house was supposed to pay off damages and restitution he owes the government.

But a court-appointed trustee maintains that the government should get nothing from a sale now in the works because government liens were filed against the Justices as individuals and not against the trusts named on the deed.

Justice pleaded guilty in 2010 to five counts of fraud for billing the government and private insurers for expensive cancer drugs that were never given to patients.

http://lansner.ocregister.com/2012/03/23/did-feds-goof-in-convicted-doctor-case/160064/

The Wrath of Dr. Khan–ER Versus Medicine Video (Humor)

This is just too funny…only an ER doctor…and glad he has a sense of humor too.

 

Wrath of Dr. Khan

 

 

We certainly need a break now and then.  BD

Discussion on Supreme Court Hearing on Healthcare Reform–How Will This Play Out With Current Day Algorithms of Commerce And Unintended Consequences-Video

Do we think that they are immune from politics is one of the questions discussed here.  Granted there are changes to be made and amendments but to throw out Healthcare revision totally is not wise. When you stop and think of all the unintended consequences that will arise, it’s scary.  Again I go back to reviewing how it will play out with IT infrastructure as that’s what’s running the country anyway once it is put in place. 

You do have to admit as complicated as things are today you have to do your best to look at each portion and what changes would take place.  The business and banking areas are prepared as they always are to adjust their algorithms to maintain profit levels and THEY WILL RUN THEIR ANALYTICS and probably already have done some work in this area with projecting several different outcomes so they can move quickly in whatever direction they need.  It is what it is today with intelligence and formulas.  One health insurance company United recently hired the former US Assistant Attorney General from Minneapolis as a general counsel so that somewhat signals an area of preparedness on the part of big business here. 

Supreme Court Likely to Rule on Healthcare Law Early Next Year–This Gives The Justices Time to Rent Some Computing Space from the DOE As They Will Need It

With other attempted rulings we have had judges with potential conflicts of interest arise and this was mainly due to the fact that there seemed to be a huge neglect of mergers and acquisitions within the industry, which is pretty much still ignored to a degree and not discussed enough. 

3 Judges in Health-Care Lawsuits Caught Up In Potential Conflict of Interest-It’s Called Subsidiary Watch-Be Aware of Your Investments With Mergers and Acquisitions

Last year too I did raise the question of any judge being capable of a decision as it’s not easy and how will the language be interpreted.  Once the text goes into place, next stop is the IT infrastructure and I know many don’t like to hear this or talk about it much but again it’s the reality of world we live in today. 

Healthcare Reform Law– Is Any Judge Fully Capable of A Decision on a Law That is Challenged By Constantly Changing Algorithms?

If the ruling is not modeled correctly with looking at how each part would change and affect consumers and those in the industry, we are in for a huge roller coaster ride and perhaps more of a return to the Wild West.

The Good and the Killer Algorithms will move forward based on rulings and decisions made so again I hope the court is cognizant of this fact in what ever they choose. 

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

How many laws come to think of it are “unworkable” today?  Intellectual arguments can be made but the ultimate answer here I think is to embrace a single pay system as the bandaids are not working and again economic times have changed since the law was put in place, so to strike it down completely would also be foolish at this point.  We don’t live in times any longer where laws last forever as passed.  BD 

Does Congress have the power to mandate that everyone in the U.S. have health insurance? The Manhattan Institute's Avik Roy and Columbia University's Gillian Metzger discuss the Supreme Court's hearing of the case with WSJ Legal reporter Ashby Jones.

http://online.wsj.com/video/the-constitutionality-of-health-insurance-mandate/5714E905-AFB2-4F72-91DB-51F40A352358.html

US Chamber of Commerce Working on Full Scale Mission With Seeking Life Sciences Opportunities in Israel

You can see some of the major companies included in this area and when you think imageof it a lot of the Intel technologies for chips has come from Israel for a long time; however in this instance the focus is Life Sciences.  Biotech conventions in Israel are also very hot and I do website that features interviews with many of the CEOs of Israeli companies and you can view a collection here.  

Another example is the Mayor of Akron who attended the ILSI BioMed Conference last year, getting educated and seeing what biotech interests he could bring back to hospitals in his city.  BD 

video platformvideo managementvideo solutionsvideo player

The U.S. Chamber of Commerce on Sunday embarked on its first full-scale mission to Israel, with the focus on the nation’s burgeoning life-sciences sector.

The U.S. Israel Business Initiative, a special section of the U.S. Chamber of Commerce launched in 2010, is meeting with key Israeli business and political leaders. A dozen high-ranking executives from major U.S. companies, including General Electric [GE 19.78  -0.07 (-0.35%) ], Boston Scientific [BSX 5.97  -0.03 (-0.5%) ], Oracle [ORCL 28.55  -0.08 (-0.28%) ], Merck [MRK 38.005  0.41 (+1.09%) ], and MedImmune, are on the tour. Myron Brilliant, senior vice president of the Chamber of Commerce’s international division, is leading the delegation.

One of the main goals of the trip is to facilitate investment and cooperation between American companies and Israeli leaders in life-sciences industry, including companies that specialize in medical devices, bio-pharmaceutical firms, and genetic research. Over the next few days, executives on the Chamber's mission will meet with leaders in Israel’s life-sciences sector directly.

“There’s a real entrepreneurial spirit in Israel,” said Marc Perlman, global vice president, health care and life sciences, for Oracle. “It’s clear Prime Minister Netanyahu is very excited about Israeli innovation. When it comes to bringing investment into this country he gets it.”

http://www.cnbc.com/id/46850417

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 imageFargo 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 image
  • 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

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 imagewould 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

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
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

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

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.image

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

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.image

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/

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 Physiciansimage

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

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

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  imageto 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 imagecancer 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.

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. 

image

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

 
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