Killer Algorithms at the Drug Store

Guest post by Barbara Duck, @MedicalQuack: http://ducknetweb.blogspot.com/

Cigna & United Healthcare Face Class Action Suits-PBM Over Charging Customers for Prescriptions, OptumRX Pharmacy Benefit Management Software-“Front Running” Consumers With Killer Algorithms at the Drug Store

Here we go again.  If you haven’t figured this out yet, when you buy a Cigna Health insurance policy you get a two for one with 2 insurers.  Cigna provides the insurance benefits and then it’s pharmacy benefit manager, PBM OptumRX (biggest revenue sector subsidiary of United Healthcare) that runs all their formulas via the computer and tells the pharmacist what to charge you.  (Video at the break below-watch it!)

If You Are Insured byCigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

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United Healthcare’s Bank Enables Even More Data Mining About You

Guest Post From Barbara Duck, Proprietor of The Medical Quack Blog

How many people know that United-owned Optum has a bank?  They don’t offer any retail services outside of an Health Savings Account to the public but many companies offer this for people who have a high deductible health insurance policy.  You can read through Yelp and make your own opinions if you want to dive in a bit more.  The bank is located in Salt Lake City and most of what one would do with this “custodial” bank would be onlineimage of course.  There are other Health Savings Accounts around of course to choose from.  Well here we have MasterCard who we should all know by now are just marketing and mining your data to who ever seems to have the money to buy anymore.  Here’s a company names Argus, who buys credit card information and then continues on to “score” you.  We’re not talking credit scores here, but anything they can think of where they can take data, score you with some query some Rogue software engineer came up with to make money. Continue reading

If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

Guest Post From Barbara Duck, Proprietor of The Medical Quack Blog

imageFirst question out of the barrel might be “how can that be”.  It’s really not too difficult to figure out.  A short while back United Healthcare bought a pharmacy benefit manager named Catamaran, and actually took on $10 billion in debt to acquire them.  This has been in the news for a while actually, so how did you end up with United Healthcare.  It’s easy, Catamaran is the Pharmacy Benefit Manager for Cigna, so when United bought the company, it became a subsidiary of United Healthcare, so there you go.  The company is now a subsidiary of the huge too big to fail health insurer, who actually gets 2/3rds of their revenue from insurance policies and the rest from selling software and algorithms for a big chunk of the other third. Continue reading

MOC: This Abuse Has to End NOW

Dr. Ken Lee weighs in on KevinMD blog post “The Real Cost of MOC is Stunning” :

This profession is too used to abuse . It begins in pre-med, medical school and our training as “students” where our US labor rights are violated. Even college athletes have won a Federal case to get classified as employees of the colleges that were using them as “students”.

We have to influence our colleagues to stop swallowing each cup of poison they want us to drink. The costs of MOC for Int Med exceeds what I get paid from any contract I have with United, Aetna or Cigna, making the MOC a huge loss anyway you look at it. The summer months are supposed to be slow for medical care but I was seeing 23 patients a day with another 90 minutes of computer work at night to just do the documentation, MU, PQRS etc.

The only way I could do MOC is to not sleep or sacrifice my family time which my wife says will never happen again as she has seen hundreds of hours lost in the past due to the re-certification exams. I have lost entire weeks of my life for this certification scam.

The human cost of MOC is not fully exposed and must be. The hundreds of hours of our scarce free time is lost for trivial pursuit that we all know does NOT improve patient care ( 2 JAMA studies 2014 prove this ) . The psychological toll of fear , potential loss of income and actual loss of money on this coercion is glossed over, as if we were all CEOs making $4million a year at a non-profit hospital.

I never see written interviews of the families who suffer the absence of a parent who is hostage to recertification /MOC; what does it do to them? This abuse has to end now . People call us doctor which seems to elevate us but in reality we have become almost slaves. One of my long times friends finally got his BA degree and he runs a hospital physician system that employs 22 MD/DOs ; they have to answer to him . So much for the doctor title.

Ken Lee , Internal Medicine, private practice.