This just occurred on Friday if you have not heard the news yet. I have to say in her support that her background was that of a nurse, they are good people and a bit luck and maybe knowing some of the right folks she ended up running Medicare. What has occurred over the last few years has not been a lot of her fault. She accepted the blame for the website and so on as it was her department. Let me tell you though Health IT developed so fast during her tenure and that was not her background. I'm not saying that people can't change where they work but this was a bit unfair, and it goes back to what I like to talk about, called "The Sebelius Syndrome". Now that's a different story as her background was one of bliss. We saw it so public over and over. She should have left long before she did and I'm convinced we have one that's any better now but at least she doesn't show it publicly. I am a tech person and way back in 2009 I made a post that people clawed my face off over in saying "put the smart people in these positions".
My meaning in that was relating to the fact that a leader is going to need some "data mechanics logic" to get the real perceptions and do the job. My post said that the math models and technologies of insurers were going to run Sebelius over and she wouldn't know what to do or say as her perceptions on what was going on with the other side would erroneous and did you see anything contrary? I didn't. I just wrote the post as a I visualize, again I've been around a while and was an early developer of an EMR medical records system and when you develop and work with data it's not too hard to project when you read the news. Anyway this is what I said back then.
2009 Sebelius Nomination Opinion
After she announced leaving, here's a follow up of commentary and there's more than just Sebelius who have the syndrome as we can include many others and Congress too. The problem is that technology has moved so fast you can no longer have just a "figure head" in these key positions that don't have the proper perceptions and get things wrong.
The Resignation of the Sebelius Syndrome
What is more worrysome right now though is who and what the interim leader of Medicare and CMS is going to be. I'll continue on with this opinion.
So moving ahead we will now have the deputy from CMS in charge. His name is Andy Slavitt and let's talk a little bit about his background. First of all he cut his teeth as an investment banker at Goldman Sachs. I figured I would cover this as you may or may not see it in the news today as they kind of skim over the top of things like that. Next he spent time at McKinsey, the CEO farm that companies use to kind of use to build a person into a CEO. Employees from McKinsey end up going to work with their clients and before long, what do you know, they are the CEO there. Read the book "The Firm" on how works. It's been going on for a long time.
Moving forward he started a company that does analytics and then moved on to United Healthcare. Remember there's around 15 pages of subsidiary companies for United. I tell people to look that up all the time if you think they just to insurance as they are into a lot of things from cheap hearing aides, a drug consulting company in China, all kinds of software companies which brings me to where Mr. Slavitt spent a few years as CEO and President. The company was named Ingenix. The lawsuits and what occurred with the company and numerous that they have to change the name to Optum and I'm all recognize that name.
About 3 years ago the class action court case against Ingenix from the AMA finally settled with reimbursement for doctors as they used algorithms and math models to short pay both doctors and patients short for 15 years with a low ball effect to pay as little as possible, keep in mind algorithms and math did this. It was so good that all the other insurers paid Ingenix (the then named subsidiary of United Healthcare) to license it and use it too, Blue Cross, Aetna, Health Net and more. They all got hit with lawsuits too. There were tons of suits all over on this as so many were short paid with the algorithms Ingenix used to create a normal customary fee to pay doctors and patients. Just recently here's a Blue Cross company that still using it after all this time too.
Blue Cross Blue Shield Still Using Ingenix Flawed and Corrupt Formulas
So moving right along Mr. Slavitt moved over to QSSI, who is the big time insurance contractor saving all the exchanges and now all of a sudden he looks like a hero and even Sebelius had so say kind things after she went after the fact that 2 weeks after HHS awarded them a contract that United bought them. She got stuck on an SEC rule to where United didn't have to report it as the subsidiary was not considered "substantially" relative.
SEC Rules on United purchase of QSSI
Ok so from the wrath of all the Ingenix short paying algorithms Mr. Slavitt moves over there and gee with only scratching the surface, oh look, what a great person we have as CEO of QSSI, anything to bury the days of Ingenix to where they literally shut down doctor's office with false positives on many of their anti fraud queries with their software and that was another source of law suits that were plentiful and Ingenix didn't win hardly any of them, so keep that in mind.
So Burwell comes along and appoints Andy Slavitt now as QSSI is the big hero company fixing exchange software with Slavitt as their CEO. Kind of odd is it not after the years he spent with his background as a banker with Ingenix pushing those same type financial models out there to make money. Again the lawsuits during his tenure as the CEO I think kind of tell the story. There's many patients out there too who directly had to fight Ingenix on their false positives their software created. So here's the question how hard was United lobbying to get someone inside of Medicare? Well they certainly did and when Burwell hired him, he received immediate immunity for anything relative in his past career. Sounds a bit fishy?
How Hard Did United Lobby to Get Someone Inside CMS?
So moving forward this is who's going to be running CMS until a new leader is found and it go for a few months or it could go for years. I have a couple CMS former employees who give me some tidbits as well and told me he's hung around CMS for a long time. As a matter of fact a lot of the models that Medicare uses today have been mentored by United Healthcare. One of my informants said "having problems designing your model, just call United Healthcare to help you'. Actually one of them told me United Healthcare has had on open door to HHS/CMS every since Hillary hired a former United Healthcare Executive, Lois Quam. Lois at the time was anxious to find another home as that was back in 2008 where she was also named as well as the rest of the executives at United for back dating stock. I think it still stands as one of the biggest derivatives case with a fine paid today.
So again once Lois Quam was hired it opened the door for a lot of United Healthcare influence from the Hillary days. There's also the CAP, Center for American Progress which is a think tank to write policy for HHS, and if you remember the article in the news from Zeke Emanuel to where he thought all are useless after 75, well he's over there too.
At the CAP you can also find Gruber as a limited member at the think tank. In addition over the years there have been quite a few members with United Healthcare affiliations so remember this is the place where US healthcare policy is written. You can look it up and see Zeke Emanuel and Jonathon Gruber's writing over there.
At present many of the quantitative models CMS has been using or trying out are failing just as the models are on Wall Street and yes there's a correlation how the models are built and used. So there's a lot of heat to come with math models and algorithmic formulas CMS is using. It's been a tough spot for Tavenner but be ready for Mr. Slavitt as he's all numbers. Back in 2009, Senator Rockefeller with the CEO of Unite and Slavitt testifying wasn't too happy with either and thought they both wreaked of arrogance.
United has not been very kind to doctors and where I am in California, most through complex contracts are now paid at rates less than Medicare and they own half of of Orange county. Again keep in mind the actions take place with subsidiary companies and United has grown so big with tons of them. They did it in plain site as most don't dig beyond the surface but like banks, pay attention and oh yes they have a bank too. Low income housing has now become an interest for United as they want some rent checks too, last investment was in Boston. You can go to my blog and search all of this in one place as major media may or may not have this all covered. Anyone who buys an insurance policy via an exchange that is a United policy, will be going to a doctor that gets paid a shade above Medicaid. I thought I should add that as some doctors may not participate at that pay level.
So be ready for the roller coaster here and like I said with all the work done while at Ingenix with lawsuits and doctors put out of business with the way they operated, will a leopard change his spots...they don't seem to do it very often so be aware that this what's moving in, a quantitated numbers person, not "people" person and that's why I wrote this background up so you know what's coming.
Here's an older link to where Ingenix, a United sub was used to buy another company, lots of tiered ownerships like this.
Ingenix Buys Picis Hospital Software
In addition some of these have settled but here's another example of some big Ingenix lawsuit actions.
Outpatient Surgery Centers file Ingenix lawsuit
Here's another example archive too where the State of Connecticut had to demand Ingenix stop requests for patient records. Remember this was while Mr. Slavitt was the CEO over there.
Connecticut Demands Ingenix Cool It
Even Safeco Car insurance got called into the Ingenix suits.
Safeco and Ingenix
So again this is the person coming to run and head up Medicare and it will all numbers drive and we do hope there's no patient harm and when Tavenner was in charge I think we had that value and consideration even as much as people picked on her a bit. I think we are losing that to a clear numbers person so we warned and perhaps I'm wrong but the past does need to be thought about and us not be oblivious as to what's coming to be in charge. Healthcare is becoming just like Wall Street in many ways, you read it in the news every day.
If you want to understand, go the Killer Algorithms page, book mark it and take some time to watch some videos that are all pretty much at laymans' level and you'll get the explanations on how both good and flawed data are all around us today and how we are experiencing our loss of freedoms over this. Data Selling is a huge accelerator there.
Attack of the Killer Algorithms
Also too this week I did a radio show about Medical Privacy and it's different and not what you usually hear, as again I'm a bottom liner who used to write code and I know what runs in the background so if you want you listen there. It was done at Rowan Radio University in New Jersey. Hint, pay cash for your meds and avoid the reward program to keep some of your data safe and private. I just got hit myself this week with being solicited for a clinical trial for blood thinners. They had my name and said they had on record I took blood thinners...they were wrong, never been prescribed or taken any and that's the flawed data floating around out there.
Rowan University Radio Interview
I doubt anyone else out there will put all this together so you know what's coming up so I thought I should and I hope you find interesting is not aggravating but it's the truth. If you go to any of my links there's also a link to my campaign to index and data license data sellers that secretly collect and sell all our data. That's a full on additional topic and the World Privacy Forum and myself are involved in lots of conversations there and if you go to their site you'll find a couple links back to me at the Medical Quack on privacy. Pam from the World Privacy Forum has testified a couple of times in front of Congress on privacy too.
Anyway here's the awful reality if you will and again I hope it was worth my while to take some time here with some of what I call important history to make sense of what's going on. Thanks for reading....