Steward Healthcare Outlines New Insurance Plan Called the Community Choice Plan Limiting Most Care to Their Owned Hospitals

It’s all turning out to be about contracts as to where consumers can get care today and we have this here in Massachusetts and there’s a bit of this too in California with the HMO managed programs.  The pricing is quoted as being 30% less than other policies so we have a hospital system now selling insurance.  We have seen quite a bit of this with Prime Healthcare in California relative to “contracts” and they run Cadillac ER rooms for the most part.  In addition, Steward, owned by Cerberus bought a hospitals in Florida and recently they stated they intend to go national.

Caritas Hospital Owner Steward States They Aim to Go National Under Management from Private Equity Firm Cerberus Capital

What I found interesting too is the name of the administrator of the plan, Tenet Health Plans?  Is this part of Tenet Healthcare hospital systems, a good guess might say there’s a very familiar ring here.   The insured will also be able to go to Mass General or Brigham & Woman’s for more complicated care if the services needed are beyond those offered in the Steward System.  Now if you go back to January of this year, Blue Cross has their offering which encourages consumers to avoid what they determined to be 15 high costs hospitals and their agreement left out Mass General and Brigham and Woman’s as they were part of the 15 member group high priced hospitals. 

Blue Cross Launching New Health Coverage Option in Massachusetts-Encourages Consumers Via Employer Plans to Avoid 15 Named High Cost Hospitals

When you are sick, you want care so again who knows how this will end up shaking out as all are marketing and contending for business.  Contracts get signed and it’s tossed out to consumers to make heads or tails of what each plan offered and which would be the best choice…complicated and getting more so every day. 

So the next step here for consumers, someone is going to make some money writing another algorithm on a website to make the complication easier for you to wade and select the plan that may work best for you.   Software just works this way and keeps building on itself. 

HHS has their hospital compare website for looking at both prices and quality of care and I might guess they are challenged as well to keep up with the the formulas and prices.  I read somewhere on the web that someone from Steward said they are happy to be the “Filene’s” of hospitals.  BD 

Right now, health insurers and hospitals are separate entities. This is something different: a hospital selling coverage, with the restriction that  you only seek care at its locations. The hospital chain is Steward, a Massachusetts-based business that has been buying up community-based hospitals for more than a year now. And the gamble it made was rolling out a health insurance plan that almost-exclusively serve its hospitals (there are a few exceptions). The plan, administered through Tenet Health Plans, is called Steward Community Choice.

The Community Choice plan, as outlined Friday, is targeted at small businesses in Massachusetts. It offers them a trade-off. Premiums will be 20 to 30 percent less than what other Massachusetts insurers charge. In return, subscribers will by-and-large be limited to treatment at Steward locations (there are some exceptions to this, helpfully outlined in this report from WBUR’s Martha Bebinger).

“A lot of what health reform is is a public finance problem,” he told me. “As we’ve done health reform in Massachusetts, it’s been a lot about how do we pay for coverage. A lot of these small businesses are really struggling as premiums keep going up. This is about making insurance affordable for them.”

That could create more of a space for a less expensive, more limited insurance product. As de la Torre described Steward’s strategy to investors recently, “In a world of Neiman Marcuses, we’re OK being Filene’s. “ Now that we have a hospital that wants to be the Filene’s of health insurance, we’re about to find out whether Americans are willing to shop there.

http://www.washingtonpost.com/blogs/ezra-klein/post/when-the-hospital-becomes-the-health-insurer/2011/09/16/gIQAUYXLYK_blog.html

Technorati Tags: Caritas Christi Health,private equity,healthcare,hospitals,Cerberus,money,investments,acquisitions and mergers,Steward,health insurance,Massachusetts

Florida Man Who Owned Largest Community Mental Health Center Gets 50 years for Medicare Fraud and A Fine of $87 Million–Subsidiary Watch

This is good to see the law finally catching up with these folks and the article elaborates on how “subsidiaries” add to the fraudulent actions taken by some companies and I focus on this quite a bit as the big corporate office may not be able to work in certain areas, but the subsidiaries can and nobody seems to do enough questioning in these areas today, but they should, especially with buying and selling data and how it is used and potentially abused as well. 

Guess what, this guy had a major lobbying effort going on too, so surprise there you might say.  50 years is a long time and I am guessing that when the case broke, the lobbying efforts may have had some influence on the long sentence given.  In addition in this scheme, patients benefited too with giving out their information for false billings, although their benefits were small compared to what the company did to benefit.  Records were manipulated so patients would have to stay longer and some patients had no clue what they were doing there at all and again only the patients who were coherent enough mentally were the ones who may have made a couple of bucks with divulging their Medicare numbers. 

Just think of it folks, this is the shape of some of the folks lobbying Congress today.  This is where analytics can really help HHS and Medicare with tracking suspicious activities outside the normal parameters found with most claims too.

CMS Announces Anti-Fraud Algorithms Will Begin Auditing Claims on July 1, 2011 Just As Insurance Companies Have Done For Years

It’s all about those algorithms and that’s why that word hold center stage at this blog and those who have been reading here for a while are already in tune with what all this means.  We hear of one case after another coming forward and how everyone worked the numbers for years and here’s one more example. 

Med Solutions and Blue Cross Caught On the Stress Test Denial Algorithm (video)

It seems like the cast of characters in fraud takes on many faces so it can be internal, or it can be those who are awarded contracts, but one thing for sure, getting smarter with analytics ahead of starting an investigation is going to pay off and catch many.  BD 

MIAMI — A federal judge on Friday sentenced a Miami man who had owned the nation’s largest community mental health center chain to 50 years in prison for his role in a $205 million Medicare fraud scam.

The sentence is the longest ever for a case brought under a Medicare fraud strike force.

Federal authorities said Lawrence Duran, 49, preyed on patients with Alzheimer’s disease and severe dementia, orchestrating an elaborate scam where staff forged patient charts to bill Medicare for therapy sessions and other services it never delivered.

Prosecutors said doctors and employees at American Therapeutic Corp. and its sister companies were instructed to alter diagnoses and medications to make it seem that they qualified for expensive sleep studies and mental health treatments. Patients suffering acute mental illness and on the verge of hospitalization were supposed to get intensive counseling, but federal officials said ATC didn’t provide any.

ATC also paid the owners of assisted living facilities and halfway houses to round up patients for their seven mental health centers in south and central Florida for therapy sessions that were never held. In some cases, elderly and infirm patients were left in rooms for hours and weren’t cognizant of where they were or what was happening around them, authorities said.

http://www.washingtonpost.com/national/fla-man-gets-50-years-for-medicare-fraud-owned-major-us-community-mental-health-center-chain/2011/09/16/gIQAblzTYK_story.html

Technorati Tags: Medicare,fraud,HHS,insurance,mental health,diagnosis,billing,mergers and acquisition,subsidiary watch,hospital,doctors,patients

Satori World Medical Tourism Contract With City of Hartford Gets Cancelled Based on Fraudulent Medical Business Background and Conviction of CEO

It now appears that going to Puerto Rico is not going to be an option after all as was announced back in July of 2011.  In addition to the activities questioned by the City of Hartford, also keep in mind the former CEO of Cigna works there too, which makes one wonder maybe about his choice of affiliates? 

City of Hartford First Major US City to Offer Medical Travel Benefits to Employees With Approximately 6% in Total Budget Savings

The contract had a 90 days clause and it looks like they have exercised the option to say no.  So what did he do?  He was ordered to pay more than $36 million for defrauding share holders in a former company that went bankrupt.  The value of the company was over inflated and he received 51 months in custody.  I’ll tell you today you really need some due diligence everywhere you go and check out everything as thoroughly as you can. 

They said this fact was omitted in his background and sometimes on the web folks do what is called reputation restitution, to where spam blogs are created that buries this type of information in Google and other searches too.  I know about that because I had a couple of them spam this blog with comments, but they weren't too smart as when you use a robotic program that repeatedly spams a legitimate blog with the hopes of creating more back links to the “splogs” it can backfire and thus so I know of a couple, just because I got spammed.  With all the money at stake it boggles my mind how someone chooses a somewhat amateur solution that may be cheap when they have so much money at hand to pay and at least get it done right without spamming.  Oh well, that could be perhaps what this person may have entertained but folks on the web are getting wise to it now and no Puerto Rico hospital visits for now for the folks in Hartford.  They also have a couple other contracts with press releases out there, one in Austin and I wonder some of the others will work out.  BD 

The chequered past of Satori Wold Medical’s CEO, Steven Lash, has resulted in the cancellation of Satori’s contract with the US city of Hartford to provide discounted surgery in Puerto Rico for city and board of education employees, before a single employee has gone abroad. In a July press release Satori claimed that Hartford was the first major city in the United States to offer this innovative medical travel benefit to their employees and dependents.
Local newspaper, the Hartford Courant ran a feature on the Satori medical tourism scheme entitled 'City's New Benefit: 'Medical Tourism’.  The columnist, Kevin Rennie, a lawyer and a former Republican state legislator wrote:
“It's all in the hands of Satori, which won the competitive bid for the Hartford contract. Satori president Steven Lash has a wide array of experience. He was sentenced to 51 months in federal prison in 2004 and ordered to pay $36 million in restitution for his role in a $60 million fraud prosecution involving a physician network management company, according to newspaper reports. This is omitted from his extensive online company profile. After executing a pump and dump stock scheme, Lash will not fear employees' Connecticut primary care physicians who cavil at patients flying to San Juan for sophisticated treatment”
City spokeswoman Sarah Barr said, ”The city decided to cancel the contract because of fraudulent behavior that was brought to light in lawyer Kevin Rennie's opinion column. When Satori World Medical Inc. was confronted about Steven Lash's prior convictions, the city was not satisfied with the answers it received and the contract was terminated."
The city has invoked a 90-day cancellation clause in the contract. There has been no criticism of the hospitals in Puerto Rico.

http://www.imtj.com/news/?entryid82=307508

Technorati Tags: Cigna,Medical Tourism,heatlhcare,Satori,Mexico,CEO,health insurance,algorithm,healthcare reform,James Buncher,board of directors,fraud,healthcare

Healthcare Reform Omission of Public Option Having a Big Effect in California With Medicaid Budget Cuts And Things Just Not Working With The Passing of a Fragmented Law

When you stop and look back on how the reform law was created with the give and takes, every day you can see in the news that the omission of a public option would have truly completed the framework for the US law and now everyone blames the President, but how can you do that when you end up passing a law that was fragmented due to lobbyist efforts and as you can see things have changed a lot in 2 years.  Insurance companies have gone on huge buying sprees for Health IT companies to make money in those area outside of just selling premiums.  You see it all over today with Untied Health and Aetna and I call it “subsidiary watch”.  We have the GOP I guess to thank for this with continued digital illiteracy in their stands and just basically what we hear today coming out of their mouths with all the OMG stories in the press.  They still live in the old days and keep trying to force old methodologies our way and they just don’t work. 

Now back California, it’s already hard enough to find doctors who will see patients covered by Medicaid and this will make it worse with what the projected cuts are of 10% less reimbursement for doctors and co-pay and visit charges. 

Digital Illiteracy Still Plaguing Lawmakers With Not Using High Powered Technology to Model and Simulate Healthcare Laws–Ryan Hasn’t Figured Out He’s No White Hope Yet (Video)

With all the health insurer mergers and acquisitions we are entertained today by headlines about the folks in Health IT marching on Washington, for what, bigger insurer profits?  All of Health IT is not owned by insurers so at this blog I try to point those out who are not and can also offer good services, etc. without being owned by a corporate conglomerate and the key is to not any them get too big as that’s the insurers come knocking to buy them up. 

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

If we had approved a public option, things would have been different by now and there could have been some who can afford, paying premiums in but it didn’t work out that way and some folks couldn’t use high tech to model and project this and I kind of guess the White House knew some of this, but hands are tied.  It’s more important to see side shows about abortions these days rather than tackling the real issues out there. Things changed too over the last couple of years and lawmakers don’t get that and today you can’t hardly wonder through the world of healthcare without somewhere along the line dropping some money into the United Healthcare till as they are everywhere, imaging, medical records, banks, medical claims, wellness, behavioral analytics, HIE, and more with partnering with drug stores, the YMCA and more.  Even the VA, through acquisitions they made is in business with United so again they a drop in the till all over the place and some may be small contributions but they all add up for shareholder profits. 

We don’t even have judges that can figure this out as they get caught in their own conflicts of interest with not keeping up with acquisitions in healthcare and wit the amount of data and items to look at, each ruling is like another box of Forest Gump chocolate, we just don’t what we are going to get:)

One More “Forest Gump” Judicial Ruling on Healthcare Law-Insurer Business Models and Algorithms Have Changed So What’s Wrong With A Law That Can Adjust to Accommodate

You have Dr. Berwick over there at Medicare trying to do the right thing and he’s actually participating in Medicare personally himself now with his last birthday, but how’s he supposed to impact all of this?   He doesn’t have control over all this outside his area of Medicare. 

So again we are back to the missing public option that insurers thought was going to take all of their business and in hind their fears I think are pretty unfounded as if this keeps going the way it is and with bad economic conditions, why not have the President come in and do a Roosevelt and take them all over?  It’s been a while since something like this has occurred in the US but it’s not getting any better and laws are not keeping up with the hi-tech algorithms running the insurance business either, they just keep adjusting and bringing out new business models they can construct in as little as 48 hours. That’s one way to get your hands on new technology when companies are so corrupted that they can no longer serve the public interest.

If California doesn’t work, there goes the whole system and again, with a fragmented law passed that took out some of the very need cores, we have what’s out there today, a mess and insurers just making record profits and moving into more and more areas of healthcare with algorithms to control cost and sadly some of the care we get.  It may not be to late to consider a public option either but again if California falls, so goes the rest.  BD 

Reporting from Washington -- For more than a year, as conservative states have battled President Obama's sweeping healthcare law, California was supposed to be a model that showed the law's promise.
But the state is emerging as one of the biggest headaches for the White House in its bid to help states bring millions of Americans into the healthcare system starting in 2014.
Though still outpacing much of the nation, cash-strapped California is cutting its healthcare safety net more aggressively than almost any other state, despite billions of dollars in special aid from Washington.
And state leaders are pressing the Obama administration for permission to place some of the toughest limits in the nation on government-subsidized healthcare, including a cap on how often people with Medicaid — the healthcare program for the poorest Americans — can go to the doctor.
A decision on some of California's requests is expected this month. If approved, the limits could open the door to deep cutbacks nationwide.

California already spends less per beneficiary than any state. It is now seeking waivers from the federal government to impose copays of $5 for office visits and prescriptions, $50 for emergency room visits and $100 for hospital stays. Few other states come close to charging Medicaid recipients that much.
Cost sharing in Medicaid is tightly restricted under federal law because it can discourage people from seeking needed care. A family of three at the federal poverty line makes just $356 a week.
The state plans to limit Medicaid beneficiaries to seven doctor visits a year, with exceptions for essential care. No state has imposed such stringent limits.

Many doctors have already closed their doors to Medicaid patients. Other providers are following suit. In June, Sharp Coronado Hospital in San Diego County stopped taking new patients at its facility providing long-term life support.
"I'm afraid no one is going to take these people," said Chief Executive Marcia Hall.

"We want to honor the flexibility that the states need and want," said Dr. Donald Berwick, who heads the federal Medicaid and Medicare programs. "But beneficiaries are also having a tough time, and we want make sure their interests and access are being protected."

http://www.latimes.com/business/la-na-california-healthcare-20110915,0,1214204.story?track=rss&dlvrit=52116

Technorati Tags: california,nsurance,red tape,paperwork,money,claims,referrals,healthcare,patients,charts,doctors,Health IT,mergers and acquisitions,Obama,judges

Rite-Aid and OptumHealth (Subsidiary of UnitedHealthcare) Offering Face to Face Virtual Clinic Consults with Optum Doctors and Nurses Inside Stores in Michigan–Cost $45.00

The service is provided via American Well, which has been around for quite a while and their efforts were first used in connection with Blue Cross in Hawaii a couple years ago.  When using the service you get to see an OptumHealth (UnitedHealth care) doctor or nurse for your consultation.  There’s a disclaimer on the Rite-Aid page that states they are “independent providers”.  The nurses and doctors will also be able to refill prescriptions and give out educational information, along with of course grabbing that data and adding it to a data base somewhere in the data bases maintained by the company.  It’s not all a bad thing for care, but as we know prescription data is sold on the market like crazy so you get this at any pharmacy any more as a consumer.  I don’t know what value it holds for Rite-Aid but Walgreens said their data selling business is worth just under $800 million, lot of money.  Prescription costs are not included in the visit and are separate. 

The website says during the promotion period with getting started you get a nurse consult for free and the doctor charge is $45 for a 10 minute visit, so when you log on, clock’s running so be prepared as you can pay more if the visit takes more time. 

Now Clinic

You will need to submit your own claims as that part is not connected but I can guess it kicks out the summary you need to submit your claims and have your credit card ready to pay or an ATM card.  BD

“Services provided via NowClinic online care are not submitted by NowClinic or the provider to your health coverage plan, Medicare, or any state Medicaid program for reimbursement or any other third-party payor. When you use NowClinic online care, you are responsible for all fees for services provided.^”

CAMP HILL, Pa., Sep 15, 2011 (BUSINESS WIRE) -- --Rite Aid and OptumHealth First to Provide "Virtual" Clinics in a Retail Pharmacy Setting

Rite Aid and OptumHealth are bringing the latest in quality, convenient online health care to Rite Aid customers in the greater Detroit area with the introduction of NowClinic(SM) Online Care services, now available inside select Rite Aid pharmacies. NowClinic offers Rite Aid customers real-time access to convenient medical care, information and resources from doctors and OptumHealth nurses. Rite Aid and OptumHealth are the first to provide a virtual clinic in a retail pharmacy setting.

Through private, face-to-face consultations using the Internet, Rite Aid customers can see and speak directly to doctors who are able to discuss symptoms, provide guidance, diagnose and prescribe certain medications when appropriate. Customers can also interact with OptumHealth nurses, who are able to address a range of health care needs such as basic health care education, information on common acute issues and assistance in identifying appropriate provider options for care. A customer record is automatically captured at the end of each interaction and is available for immediate sharing with a customer's primary care provider, maintaining continuity of care.

Customers can also access NowClinic Online Care 24/7 by visiting www.myNowClinic.com/RiteAid , which is especially convenient when customers are not able to visit a doctor's office or for when offices or their local Rite Aid are not open. Currently, conversations with nurses are complementary and a 10-minute consultation with a doctor is $45.

http://www.marketwatch.com/story/rite-aid-and-optumhealth-introduce-nowclinicsm-online-care-services-in-detroit-2011-09-15

Technorati Tags: Rite-Aid,OptumHealth,American Well,video conference,consultation,virtual clinic,nurses,doctors,patients,providers,HealthIT,UnitedHealthcare

New ICD-10 Codes Get Very Specific–Was the Patient Bitten by an Orca or a Macaw–What’s the Big Rush for All of This (Video)

You have to love this video and the conversations between the 2 and anybody in medical billing will certainly jump on this one for sure.  I liked it and thought this is really good for the general public to know.  When I was writing my medical records program I had to import all these updates to the current system all the time, each quarter codes are added and codes are deleted.  When doctors create their super bills, this means change if any of them affect the most commonly used codes. Shoot years ago I had a doctor hit the ceiling when all the diabetes codes were expanded and this was 5-6 years ago.

140,000 codes will be there for the physician to choose from.  There are some that are insulting like “bizarre personal appearance” and gee what a code huh?  Let’s see what CPT code would unite with this one?  You can go all over the place with that one.  Granted new technologies needed to be added but listen up and hear about the 3 codes for walking into a lamppost too.  This is hilarious.  Heck what if the patient doesn’t know if they were bit by a turtle or tortoise?  Water skis on fire is yet one other great code!  October 1st on 2013 is the transition date and there’s a lot of companies just ready to cash in here for the big bucks.  India is ready to help us with our IT misery on this one.

Healthcare's ICD-10 Project Deadlines Could be a Jackpot for India’s IT Companies

There are also a lot of US companies who have produced the software to translate between the old and the new, again cha ching ching in Health IT expenditures and how long before that bubble bursts one day?  In addition there’s a lot of talk requesting that the process be delayed and Dr. Halamka up at Harvard has been one who has voiced his opinion on this simply due to the fact that it is too much on the plate for healthcare CIOs today.  You can read more about his recent interview on ICD10s and the over stressed CIOs of healthcare below and I have touching and blogging about that here on several posts for the last year myself. 

Dr. Halamka Speaks About Health IT–“CIOs are on Overload” and It Would be A Blessing to Stall Off ICD-10 to 2016 - The Straw Breaking the Camel’s Back

That is very true and the folks who make and set these timelines are usually those without any real “hands on” experience in this area and just project. 

Should ICD-10 Implementation Be Delayed With A SnoMed Adoption Focus Come First?

This has a snowball effect with rolling over to the public CIOs who have said they know more about health IT now than they ever expected to learn and absorb, not to mention be responsible for implementation.  WellPoint plans on having machine learning do some of this for you with IBMWatson technologies it seems with some machine learning techniques soon with maybe just jumping in a plucking those new codes out…time will tell how that will work:)  I used to work in logistics and the harmonized tariff for customs is not anywhere near this level, and that is from business that is highly automated too by comparison.  BD 

Healthcare Reform Putting Additional Pressure on Public and Medicaid CIOs-The Health IT Bubble Gets Closer As Money And Digital Literacy is Scarce

http://online.wsj.com/video/new-medical-billing-system-provides-precision/52CE9481-CE69-4F50-BA15-9DA789751728.html

Technorati Tags: ICD-10,medical billing,coding,healthcare,HealthIT,doctors,hospitals,insurance,Medicare,ICD-9,meaningful use,reimbursement,patients,claims

Mitochon Free EHR/PHR/HIE Systems Connecting to Medicity HIE (Subsidiary of Aetna) at Hoag Hospital in the OC

Mitochon software as a service is located in Orange county as well.  Along with Practice Fusion, they are another free medical records system for doctors to take advantage of and received their stimulus package for attesting and using the product.  Not being familiar with their business model I am guessing to support the free offering that data is some where along the line here sold as that is usually the business model found as something has to support the free offering unless there’s a few big millionaires that are donating all the money.  A little history here the HIE services used by Hoag are a subsidiary of Aetna the insurance company and Hoag was already into their integration and use of Medicity before the Aetna acquisition.  You can clearly begin to see the effects with mergers and acquisitions today in healthcare. 

Hoag Memorial Hospital Connects 250 Community Physicians To Their HIE Via Medicity (Recent Acquisition By Aetna)

Aetna to Acquire Medcity-Health IT Connectivity Vendor-Former CEO Takes Position on Board at Boeing

A few days ago the biggest HMO group in Orange County was purchased by United Healthcare, so insurer stakes in Health IT are all around us and thus I try to bring this awareness around so when making a purchase today you know where your bottom line profits could be going, especially in light of trying to get more smaller and mid size companies in existence in the US to create jobs. In Health IT areas it’s getting down to the linking and competiveness of the insurance IT infrastructures going way beyond just processing medical claims with all the various subsidiaries that are out there today and sometimes hard to recognize as some have some pretty long daisy chains.  I also wonder how much life there will end up being for the non profit HIEs that were set up as commercial competition here seems to be knocking on their doors all over the US. 

United Healthcare To Buy Huge Chunk of Orange County, California Managed Care Business with the Purchase of Monarch Healthcare–Subsidiary Watch

Mitochon systems uses a partner named BAC Medica Marketing who also has a long list of consulting and Health IT support they sell, so again I don’t know in full the partnership relationship in detail between the two companies and the Mitochon systems website has a number of other partners listed.  The EHR  has been certified by the Drummond Group to quality for stimulus money and users of the system will be able to connect to Hoag Hospital for electronic exchanges.  BD 

Mitochon Systems Demo

NEWPORT BEACH, Calif., Sep 8, 2011 (GlobeNewswire via COMTEX) -- Mitochon Systems, a provider of free certified electronic health records systems and connectivity solutions for physicians, has announced that it now has built in connectivity from its EHR to Hoag Hospital's Health Information Exchange, which is powered by Medicity, an industry leader in the architecture, implementation and support of HIEs across the US, bringing robust content, proactive care communities, and meaningful applications together in a coherent, connected environment.

"Medicity is a fine partner for Hoag and we are thrilled to be working with them to connect physicians, patients, outpatient offices and Hoag itself," said Andre Vovan, M.D. Mitochon Founder and Hoag affiliated Physician. "This is a tremendous step toward our goal of generating better outcomes for patients, controlling costs and saving lives."

Mitochon Systems, located in Newport Beach, California, is a free certified HIE/EHR/PHR service that connects physicians, hospitals and patients into a Healthcare Information Exchange (HIE). Mitochon offers a free EHR (Electronic Health Record) and PHR (personal health record) systems for the synchronization of healthcare information. Mitochon seeks to empower physicians, hospitals and patients to make the most accurate, efficient and cost effective healthcare decisions through the deployment of its HIE and EHR products. More information about Mitochon Systems is available via its corporate website at www.mitochonsystems.com or by calling 1.877.817.0902.

Technorati Tags: Mitochon,Aetna,Medicity,mergers and acquisitions,healthcare,health insurance,Heatlh IT,technology,medical records,EHR,Hoag Hospital

Volunteer, Sponsors And Supplies Needed for The Largest Ever “Free Clinic” At the Los Angeles Sports Arena October 20-23, 2011

We have another free clinic coming up in October in Los Angeles and CareNow is looking for volunteers, professions, food, and more.  There are already quite a few sponsors and one worth a note is Bill Maher, the comedian.  Most sponsors are in the healthcare business, but not all, and you don’t have to be a healthcare related business to contribute.  Los Angeles over the last couple of years is becoming a regular host to the free clinics for those who can’t afford care and do not have health insurance.  RAM has put on a couple clinics in LA and even more in other cities in California, the last was in Sacramento and CareNow coordinated with their efforts. 

All the details are listed below in the press release and as of tonight, the website appears to have more updates coming soon.  If you can donate time or can volunteer, all the information is included below.  Feel free to refer this post on to anyone in the Los Angeles area as well.  BD 

Press Release:

LOS ANGELES, Sept. 8, 2011 /PRNewswire/ -- CareNow, a local nonprofit organization formed to bring help and hope to the uninsured and underserved in America's urban centers, will transform the Los Angeles Sports Arena into a giant clinic to provide free healthcare services to men, women and children needing medical, dental and vision care. CareNow is looking for healthcare professionals (dental, vision and medical) to volunteer for the event. Volunteers may sign up for half day or full day shifts. CareNow/LA will take place on October 20 to 23 from 7:00 a.m. to 5:00 p.m. at the Sports Arena located at 3939 S. Figueroa Street in Los Angeles.

"Los Angeles is an epicenter of healthcare need, but there is much we can accomplish together to meet that need. There are vast healthcare resources in our community eager to help, and we're expanding our services with every event, providing not only quality care but continuing care for those who need it," said Don Manelli, president of CareNow. "Our success depends on medical professionals who are willing to donate their time."

Last October, CareNow partnered with Maria Shriver to produce the Modern House Call – a massive free clinic in Long Beach that ran in conjunction with the Women's Conference. Prior to that, the same team of local providers and organizers collaborated with Remote Area Medical (Knoxville, Tennessee based) to produce two large free clinics in Los Angeles. Together, these three events served 15,330 Angelenos and provided 36,120 medical, dental and vision services – free care valued at more than $7.1 million. This year, the same group of dedicated community stakeholders and CareNow team of volunteers will undertake yet another groundbreaking effort.

CareNow is looking for the following healthcare provider volunteers:

"As a returning sponsor of the country's largest free health clinic, we've seen firsthand the difference this clinic will make in peoples' lives," said Howard Kahn, CEO of L.A. Care Health Plan, the nation's largest public health plan. "We're proud to be a part of the LA healthcare community that has been inspired to continue the event."

In addition to professionally trained medical specialists, CareNow is looking for non-medical volunteers to help register patients, manage patient flow and assist professional staff. For more information or to register as a medical or non-medical volunteer please visit www.CareNowUSA.org.

"The Los Angeles medical, vision and dental communities have shown an amazing level of commitment, from our local medical and dental schools and businesses, to individual volunteers and the entertainment community, we have received overwhelming support," said Manelli.

To date, CareNow has confirmed the following sponsors and partners: Bill Maher, Mark Gordon, Jason Flom, Tzu Chi Medical Foundation, L.A. Care Health Plan, Keck School of Medicine of USC, Geffen School of Medicine of UCLA, VSP Vision Care, Marisa Foundation, Live Nation, Molina Healthcare, Southside Coalition of Community Clinics, Los Angeles Dental Society, VOSH, Loma Linda University School of Dentistry, Henry Schein Dental, Western Reserve University, Southern California School of Optometry, and more than fifty other healthcare organizations, manufacturers and suppliers.

CareNow is also seeking in-kind donations, including bottled water/refreshments, food, pharmaceuticals (excluding narcotics) ultrasound equipment, dental, vision and medical supplies.

For more information on sponsorship opportunities or to provide an in-kind donation, please contact Adrian Marquez at 323.202.1453 or adrian.marquez@edelman.com. 

While most supplies and equipment are donated, there are significant expenses in putting on an event of this magnitude and contributions are still needed. 

For more information about CareNow/LA, please visit the event page on Facebook at www.facebook.com/CareNowUSA or follow CareNow on Twitter at www.twitter.com/CareNowUSA.

About CareNow

CareNow brings help and hope to the uninsured and underserved in America's urban centers. The organization works with local community resources and volunteers to produce free clinics providing comprehensive medical, dental, and vision care to individuals and families who are without access to the healthcare they need. There is no cost to the patient for the services provided. Clinics are staffed by professional and general volunteers, and supported by donations – both financial and in-kind – from local and national supporters. To learn more about CareNow and this year's clinic, please visit the organization's website at www.carenowusa.org.

http://www.prnewswire.com/news-releases/volunteers-and-sponsors-needed-for-largest-ever-free-clinic-at-la-sports-arena-129474573.html

Technorati Tags: CareNow,free clinic,healthcare,Los Angeles,doctors,nurses,drugs,food,water,health insurance,volunteers,uninsured,donations,patients

More Court Debates over Medicaid Contracts in Louisiana–Health Insurance Wars

Contracts are almost getting to be impossible today and here’s one more to where a judge had to intervene over the state Health Secretary’s choice to run Medicaid.  If it isn’t Medicaid contracts, it’s Tri-Care or something else….in this case it appears Aetna gets to stay in place.  Just a few months ago we had the big legal battle with Tri-Care with United suing the DOD as they seem to think they somewhat “deserve” the business.  All they do is fight anymore and no matter who wins, the analytics are the next step to see where cuts and costs take place.  BD

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?

District Judge Judge Janice Clark on Tuesday granted Aetna's request to block the plan. Aetna is protesting the state's selection of three firms—Louisiana Healthcare Connections, a subsidiary of Centene; Amerihealth Mercy of Louisiana; and AmeriGROUP Louisiana—to run "pre-paid coordinated care networks." Louisiana's health secretary, Bruce Greenstein, also selected UnitedHealth of Louisiana and Community Health Solutions of America to operate as "shared savings networks."

http://www.modernhealthcare.com/article/20110908/NEWS/309089931/#

Technorati Tags: Medicaid,insurance,contracts,judge,ruling,Louisiana,healthcare,Health IT,Aetna

Two Orange County Doctors Arrested on Medicare Fraud–Data Analytics Algorithms Were Used to Identify the Activity

Ok here's one for the “good algorithms” that audit and track back and match up claims to ensure everything was in divine order.  With analytics those who bill for things out of the ordinary stick out like a sore thumb when a large dollar amount is shown and good to see it’s finally being used to track down fraud.  In addition to lawmakers efforts there’s also the HHS Most Wanted List you can check as well if you think you have seen any of the individuals out on the loose.  Chinese medicine that was administered obviously didn’t code right:)

HHS Creates 'Most Wanted' List Website for Healthcare Fraud - Office of the Inspector General

Last year it was announced that the data base analytics would be available for law enforcement to use when looking for Medicare fraud.  BD 

Medicare Federal Investigators Getting Algorithms to Analyze And Find Fraud-Good Move as Contractors Efforts Are Weak With Risking Loss Of Transaction Revenue

A doctor and an administrator at a Garden Grove medical clinic have been arrested for allegedly billing Medicare for physical therapy treatment that was never provided, the U.S. Attorney’s Office said Wednesday.

Dr. Byung Ho Pak and Mary Lim were arrested Wednesday morning as part of federal sweep in six regions of the U.S. Pak and Lim, while working at Seoul East West Medical Center, billed Medicare $2 million for physical therapy, according to an indictment. Patients, however, were given treatments that weren’t covered such as acupuncture and moxibustion, a traditional Chinese medicine skin treatment.

The clinic collected more than $1.4 million in payment, according to the indictment.

In all, the Medicare Fraud Strike Force charged 70 people across the U.S. with $264 million in Medicare fraud. The multi-agency team uses data analysis to help identity fraud.  Also arrested in the sweep was a Los Angeles doctor who once practiced in Fountain Valley. He was charged with fraud for allegedly performing unnecessary tests or billing for ones never performed. Dr. Owusu Firempong, 60, submitted $1.3 million in fraudulent claims, according to prosecutors.

http://www.ocregister.com/articles/fraud-315957-pak-million.html

Technorati Tags: HS,fraud,Medicare Fraud,healthcare reform,Office of the Inspector General,websites,report,tips,hotline,FBI

Stanford Hospitals and Clinics No Longer Accepting Blue Cross Health Insurance–Contract Expire-Patients Have to Go Elsewhere While the Cost Algorithms Churn With Contract Negotiations

Here we go again, it’s the contracts and the costing algorithms of the insurance companies that are their business models that determine what reimbursement will be.  The article states that now they are “close’ to agreement so maybe this won’t last too long, but in the meantime you can’t go there as of Setember1st and letters went out back in February that this would come around, and it did.  See how long it takes to negotiate insurer contracts today?   This means for right now you can’t go there or visit some of their physicians to get care where Steve Jobs reported went for some of his care.  About a year ago they opened a premier medial school. 

Stanford University Opens State of the Art Medical School

It’s complicated and their algorithmic business models have to allow for the projections they have analyzed and determined with their predictive software. Blue Cross has an entire IT infrastructure for this to calculate and sell to clients too, have had it for a while.  Now Stanford is pretty advanced with everything they do all over and I would expect nothing less here so in essence we may have this with the contract negotiations…as a matter of fact Stanford is probably giving them a real run for their money:)

The battle of algorithms…that’s what contracts pretty much amount to anymore.

The care given relative to Catheterization is very superior and you should read about their advanced MDs and procedures and outpatient procedures.  Sounds like Blue Cross though says we don’t want to pay that much for it maybe? 

At Stanford Hospital Coronary Stent Processes Are Done On As an Outpatient Procedure–Using the Radial Artery in the Wrist

Stanford Hospital Gives Ipads To Patients in the Catheterization and Angiography Labs

And they have the very much anticipated clinical trials for stem cell treatment of the spinal cord.

Stanford Joins Geron Spinal Cord Clinical Trials Program as the 3rd Location in the US

Anthem filed a letter of transition with the State Department of Managed Care and as I read here access to the doctors will be extended until September 16th.  One nice plus though here is that transplant patients don’t have to make a change, thank goodness and the ER rooms don’t require pre-authorization so maybe Stanford ER rooms might be a little busier.  They have been going at this since before February on a new contract.  It further states that Blue Cross HMO has the right to send patients to another doctor.  If one is PPO you might face higher co-pays since I would maybe guess you could be subject to out of network charges.  Just a couple months ago HP committed $25 Million to the Children’s Hospital and Intel has kicked millions to the University as well. 

HP Commits To Invest $25 Million To Stanford’s Lucille Packard Children’s Hospital To Include HP Labs Collaboration

All of this with medical care today just really stands to strengthen the need for a Public Option for sure.  Contracts leave peoples lives, and in the case of the doctors, their livelihoods up in the air. 

Again Stanford is world known for their technology with healthcare, but we are like I said, back to those costing algorithms and with Blue Cross figuring out how to maximize share holder dividends.  Insurers can’t negotiate a contract in a years' time so its time for inconveniencing patients and consumers off in other directions as deadlines today seem to mean zero as far as getting that part of the job done.  BD 

Patients with Anthem Blue Cross health insurance stopped having coverage at Stanford Hospitals and Clinics on Thursday (Sept. 1) after contract negotiations were not resolved, according to an Anthem document Palo Alto Online received yesterday.
The contract termination means that Stanford University Hospital, Lucile Salter Packard Children's Hospital (LPCH) and Stanford Medical Group might not be in the Anthem insurance-plan network. Authorizations and copay amounts could change for patients with the HMO and PPO plans, Lucile Packard spokesman Robert Dicks said.
The hospitals sent Anthem a letter on Feb. 25 informing the insurance giant of the termination on the contract's Sept. 1 expiration date.

http://www.paloaltoonline.com/news/show_story.php?id=22374

Technorati Tags: Stanford,Blue Cross,Health Insurance,hospitals,healthcare,Heatlh IT,doctors,patients,in network,disruptions,co-pay,contracts

LabCorp Settles with State of California Over Kickback Marketing Scheme–Lab Wars

Both Quest and LabCorp were doing this and this is funny in the information here from BNET that he had the actual PowerPoint slides.  Quest settled up for $241 million for their portion of gaining market share. 

Quest Diagnostics Agrees to Settle California Medicaid Suit for $241 Million-Overcharging for Lab Tests

Quest does not appear to be done yet though as now they have a whistle blower alleging even more fraud, maybe a billion and this case is a little more complex and has to do with billing during the time of the Uni-Lab purchase. 

Lawsuit Filed Against Quest Diagnostics–Whistle Blower Case Alleging Medicare and Medicaid Over Charges of $1 Billion Or More

Labcorp is to pay up $49.5 million to settle the claims billed to Medi-Cal during a 14 year period.  A whistle blower was also who brought it to the attention of the State of California in this case as well.  To get a discount doctors were told to refer to LabCorp versus the other lab companies.  BD   

Labcorp’s (LH) $50 million settlement with the California attorney general over a kickback scheme highlights the federal government’s bizarre lack of interest in whether Medicare is being ripped off for hundreds of millions of dollars nationally by companies that provide diagnostic tests for doctors and hospitals.

The scheme wasn’t difficult to figure out — the company described it in PowerPoint slideshows that told employees what “not” to do. Prohibiting employees from breaking the law is fine, of course, but the Labcorp slideshows only made sense if the company knew how to execute a complicated “pull-through” kickback scheme, and knew it was wrong. One PowerPoint had a chapter labelled “Kickbacks.”

http://www.bnet.com/blog/drug-business/meet-the-company-that-outlined-its-kickback-scheme-in-powerpoint/9532?utm_source=twitterfeed&utm_medium=twitter

Technorati Tags: LabCorp,lawsuit,fraud,marketing,Medi-Cal,whistle blower,medical claims

Non Profit HEALTHeLINK Partners with United Healthcare Subsidiary Optumsight to Remote Monitor Diabetics In Buffalo in Pilot Program

I try to keep track of mergers and acquisitions here and the partner Axolotl was purchased by Ingenix in August of 2010, about a year ago, so when you hear of insurers buying up technology companies here’s one and where bottom line revenues end up contributing to for profit insurers. 

Ingenix Acquires Health Information Exchange Services/EHR Provider Axolotl-United Health Group Behemoth Continues to Grow–Subsidiary Watch

Here’s another post from the past that gives a little more background on the HIE and business intelligence algorithms used by United subsidiaries. 

Axolotl (A Subsidiary of Ingenix) Creates Reporting and Analytics Solution for Health Information Exchanges–Algorithms for HIE–Business Intelligence -Subsidiary Watch

In addition other subsidiaries sell electronic medical records as well and Care Tracker has been around for a number of years, sold by Ingenix, now under the Optum name.  

ClickFreeMD Selling Software EHR, Practice Management Bundled Records Solution–Emphasis on AMA Endorsement And Software “Powered” by Ingenix–Tethered or Untethered

At a cost of $250 per patient per month that adds up to some additional income and yes it is less expensive than visits to the ER room if that can be avoided.  If this ends up being a workable solution with proper implementation for a national model, that’s a lot of profit for the subsidiary to add to the corporate bottom line too. Buffalo has has their IT issues reflected too in this story from a year ago where it was found that the City paid over $2 million in premiums for dead city employees and from what I understand, they were having to go to court to get it back?  I’m sure all the folks being monitored though are not in that group.  I’m just curios too as to who all really has access to the data as analytics are are part of the deal here as that’s the way it works out there today with everyone wanting data.   

City of Buffalo Has Paid Over $2 Million to Provide Health Insurance for Hundreds of Dead People-Some as Many as 4 Years

I’m just curios too as to who all really has access to the data as analytics I’m sure are part of the deal here as that’s the way it works out there today with everyone wanting data. Another division of United sells prescription data for underwriting and other purposes. 

The RHIO didn’t want to be in the monitoring business though so it appears this is where the technology subsidiaries of United came in to play here.  The article said there was some resistance but again if they are United approved MDs and have had any recent cuts, then that could maybe stand to reason for some of it and I don’t know how many United policy holders are in this part of New York.  BD 

BUFFALO, NY – One hundred patients with diabetes have signed up for a telemonitoring pilot spearheaded by HEALTHeLINK, the regional health information organization (RHIO) serving Western New York State. The nonprofit’s innovative approach to telemonitoring could serve as a model for the rest of the nation, according to Todd Norris, Western New York Beacon Project Director.

HEALTHeLINK is one of the 17 Beacon Communities tasked by the Office of the National Coordinator to positively impact quality, cost and population health through the use of healthcare IT. The RHIO is focusing on several initiatives to "move the needle in a positive direction" for diabetes care management, which is its specific goal under the Beacon Community Program. With more than 60,000 diabetic patients under the care of 250 healthcare providers, Western New York has one of the largest diabetic populations per capita in the country, Norris said. The telemonitoring pilot, which will accommodate 150 patients, is one of 12 interventions the RHIO is deploying for diabetic care.

Blood pressure readings and other vital signs pertinent to diabetic management are downloaded from mobile devices and transmitted to healthcare providers in the form of alerts through HEALTHeLINK's health information exchange platform, which is powered by OptumInsight, formerly Axolotl. The RHIO, however, has adjusted the traditional model to address known barriers to telemonitoring adoption.

The cost is approximately $250 per patient per month. Norris pointed out that the elimination of one emergency department visit per patient pays for the program and also contributes to better health of the diabetic population. With economies of scale, the cost per patient per month for 40,000 patients would be $150 per month. At this level, Norris said, "You're going to see lively acceptance."

Technorati Tags: HEALTHeLINKS,United Healthcare,RHIO,healthcare,health IT,remote monitoring,data,diabetes,Buffalo,Beacon,Health IT,Communities

California Bill to Regulate Health Insurance Rates Dies Due to Lobbying By Insurers and Other Groups So No Serious Audit Algorithms for Now to Control Premium Hikes

Well here’s one more not for the consumer.  If you read through the article in the LA Times the bill died as lobbying efforts claimed here would not allow for a majority of votes to pass.  It will be tried again next year.   It’s funny that we go through great lengths and trouble to audit and certify medical records, but the payers in all of this run their business intelligence models and reconstruct and change them with their analytics and laws can’t keep up.  I said back in August of 2009 we need a Department of Algorithms but until we get lawmakers that understand how business models worth and how math moves money, we are kind of stuck here.

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

You have to some day sooner or later start auditing this stuff or we are all screwed.  It’s easy to fleece the digital illiterates and I see it all the time with those in denial who can’t get this function yet.  On another note, we are looking at the same on Wall Street too as the hardware wars are almost over and then….we have data and the algorithms that process it and it will get really tough then with writing code that can no longer be read with layers of aggregation, so remember you heard it here first.  It too Medicare long enough to get to that point with using technology to audit medical claims for fraud. 

CMS Announces Anti-Fraud Algorithms Will Begin Auditing Claims on July 1, 2011 Just As Insurance Companies Have Done For Years

We don’t have an executive in charge of HHS that has enough Health IT in her background and thus 2 years ago when she took office she could not forecast how this was going to move forward, but folks that write code do and that’s what you see here and I’m just a tiny ant in the coding world for that matter but I can predict easy enough and add on a number of years in PR and Sales and it just flows.  Granted HHS has hired some really spiffy folks, but again as a director she has to go to them and needs additional reports where as someone with on hands experience thinks a lot different and can picture the future with the mechanics of code, so executives without this ability are just flat out behind an 8 ball when it comes to such decisions.  When she was nominated I made that call, nothing personal at all but said in 2 years the director of HHS was going to be about 80% health IT, so here we are today and I don’t think I’ll get any arguments there. 

Times were a little different back then too but again the code heads can see and project where others cannot.  This is what I said in February of 2009 and it makes it hard for people in those positions to function with the crazy unpredictable world we live in today and others just eat their lunch and we all suffer.  I think was politically correct and just stated facts as a coder sees them.  Are people just now starting to listen to folks who know math?  So once again we are late coming to the table but we can’t go backwards and have to some how work with what we have, and it changes every day. 

Kathleen Sebelius, Kansas Governor for HHS – Please not! Put the “Smart” People in these key positions

In the meantime, California lawmakers are kind of behind this 8 ball too and don’t get the math here with how the algorithms with insurers work.  If you look back and read on the recent couple of years, look how many times they adjusted them and ran back to the table with justifying their increases and some were way off too.  It’s all about the math and we have lawmakers in California that don’t get it just like we have in Congress, too complicated, I don’t want to deal with it right?  I think we are seeing a lot of this today.  The COs and folks that do have this in their background are stressed and dropping like flies too all over and I understand that very well as I have dealt with that for much of my time in technology, it’s thankless, misunderstood and you deal with people who have shut off their learning faucet and fabricate a lot and its’ hard.  There are also those who read and want to learn and work with you too but we all have the folks that feel threatened and well look what we see in the news today with the GOP, craziness and to me it all comes back to not knowing what to say or do with not participating in at least a medium level of consumer IT literacy.  Makes for good OMG news but that's about it.  BD 

A bill that would allow California officials to regulate health insurance rates for millions of consumers has died in the Legislature after forceful lobbying campaigns by insurers, healthcare providers and other groups.
Assemblyman Mike Feuer (D-Los Angeles) said he is pulling his measure, AB52, because he could not muster a majority of votes in the state Senate, the final stop in a months-long effort to increase state regulators' authority over health insurance premiums.

Feuer said he is putting his bill on hold until next year, when it can be taken up again. It marks the fourth time in four years that Democratic lawmakers have failed to win support for insurance oversight that would mirror the type of regulation already in place for auto policies.

http://www.latimes.com/business/la-fi-insurance-regulation-20110901,0,4400280.story?track=rss&dlvrit=52116

Technorati Tags: California,lawmakers,digital literacy,healthcare,premiums,consumers,complcated,Health IT

United Healthcare To Buy Huge Chunk of Orange County, California Managed Care Business with the Purchase of Monarch Healthcare–Subsidiary Watch

This is in my back yard in the OC and for a few doctors I know this just might be the big push to start a Concierge Medical Office.  Newport Beach which is south of where I live has a ton of affluent residents and the Boutique practices there do well as money for many in the area is not a problem.  Monarch has been around for many years and they are at all the Hoag Hospital money raising events and is very active, so things might be changing in time. 

What will be interesting though is to see if the reimbursement changes and of course that’s at the top of every MD’s mind, so I don’t see much excitement about this at all here.  I know have friends that won’t be excited with the news who are patients.  Back in March of this year they closed a big office in Orange County and you can read more about how that went down, employees bused to a hotel and given their papers after an instant message. 

UnitedHealthcare Lays Off 180 Employees In Orange County-Initial Notification Sent By Instant Message to Those Affected

With 2300 doctors in the HMO, with recent mergers and acquisitions is this a basket full of doctors to sell an EHR too as they do sell and have sold a medical records system for years under the former name of Ingenix, now known as Optum.  Sometimes you run into situations like this to where one division of a big conglomerate cuts rates with one subsidiary and then the other rushes in to sell software. 

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

Also the company recently bought another huge HMO group in Long Beach and I would say the two are perhaps close in size but bottom line is both are huge

OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch

We never did get our government REC center started in the OC either and I just kind of wonder where the money went on that too, and again with the post above with selling medical records, does this give anyone an unfair advantage for sales?  It does make you wonder and again why the REC center never got off the ground and I’m just speaking out loud here but there’s no REC center to offer any help to the doctors in the OC. 

Orange County California REC Center For Doctor Assistance with Medical Records Appears to be a Bust So Far…

I have heard from a few doctors on how the deductions of claims that get rescinded after payment have been a hassle with United as they just take a deduction out of a check and the claim that is not being paid does not even include the patient who is being denied, a nightmare for doctors and a recent study said it costs a doctor about $83k a year to keep up with the likes of all of this.  We have one first class hospital that kicked United out the door when it came to employer provided insurance and companies all over the OC were looking for another carrier when the United/Pacificare contracts were re-negotiated.

Employers in Orange County Looking for New HMO Contracts as St. Josephs and Some Others Begin Cancelling Agreements with Pacificare (UnitedHeatlhCare) – Employer Capitation Contracts

I guess Hoag Hospital though is happy to have the affluent residents to help make up for the other side of things as who knows how new contracts will end up shaking out when they come up for renewal.  When it comes to patents too with Health IT, United is right up there too so things don’t come cheap in that department or some subsidiaries either. 

QualityMetric/Ingenix (United HealthCare) Receives Patent for Patient Health Survey Algorithms-Subsidiary Watch

And here’s a few more back posts on their subsidiaries…think they are only insurance, well they are very heavily invested in Health IT these days as well and the acquisitions have been steady for them over the last 3 years or so. 

UnitedHealth Group Owns a Bank With Deposits Surpassing a Billion – OptumHealth Bank FDIC Insured

“OptumHealth offers three types of HSAs, as well as tax-advantaged health care savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.”

There’s also the Chinese investment the company bought early in 2010.

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

These are just a few examples of some of the subsidiaries of the company and why even sometimes judges find themselves in some potential conflict areas as the daisy chains of subsidiaries grow, they don’t even keep track or are cognizant that the company they have owned stock in for many years, due to quickly adapting business algorithms used today, is not the same.  The former Ingenix division (now Optum) makes money with pretty much just selling data and creating software algorithms. 

Back a year or so ago the AMA fought and won a lawsuit against the Ingenix division for short paying doctors and patients for almost 15 years and it was Andrew Cuomo of New York who got the ball rolling there.  In some parts of the country through wellness subsidiaries pharmacists even get to earn pay for performance money from signing people up in wellness programs, and what that amount is we don’t know but the retail drug chain, Walgreens says their data selling business is worth just under $800 Million. 

UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P for Walgreens

Last but not least, let’s not forget the CEO is the highest paid in the US for public companies, and they are still making record profits.  I just try to break down the business areas for awareness so consumers and others understand a bit more about the big corporate world of subsidiaries today that normally may not be thought about, seen or recognized.  BD 

UnitedHealth Group Inc. will acquire the operations of a major southern California physician group, in the latest example of how lines are blurring between insurance companies and health-care providers.

The purchase of the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties, establishes United's Optum health-services unit as a formidable presence in the region. Optum had previously taken over the management arms of two smaller southern California groups, AppleCare Medical Group and Memorial HealthCare Independent Practice Association.

Monarch said in a statement that it "has agreed to enter a strategic relationship with Optum to support our physicians in providing high-quality, cost-effective patient care in Orange County, California."

United has said in the past that providers acquired by Optum will not work exclusively with United's health plan, and will continue to contract with an array of insurers. But in one sign of the potential complications that might ensue, Monarch is currently in an arrangement with United competitor WellPoint Inc. to create a cooperative "accountable-care organization" aimed at bringing down health-care costs and improving quality.

Technorati Tags: Monarch Healthcare,HMOs,UnitedHealthcare,revenue,profits,layoffs,Orange County,Medicare,health insurance