United Protesting Yet Another Contract Award–State of Georgia Where They Claim “It Was Rigged”…

Here we go again and there sure seems to be quite a few of these contract stories in the news of late.  You know folks might be afraid to ask the company to bid?  The contract was awarded to Blue Cross, which by the way seems to be the competition where United seems to be protesting.  We all remember United sued the DOD to get the west coast Tri-Care contract a short while back and we have never heard as to why and what the outcome was other than DOD gave United the contract. 

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?

A couple weeks ago, they filed suit against the City of Birmingham.

United Healthcare Files Lawsuit Against the City of Birmingham Disputing Contract Award To Blue Cross

Louisiana rejected the United protest 

State of Louisiana Rejects United Healthcare’s Protest Over Awarding Blue Cross/Blue Shield Contract To Manage State Employee Health Insurance–Battle of the Insurance Algorithms Continues..

This case was different but it’s a dispute between a government contractor and United for non payment of premiums..

United Healthcare Sues Government Contractor, Paragon for Unpaid Health Insurance Premiums

Last year a protest in Texas over a contract award where Blue Cross was protesting as the contract gave members literally no out of Network with United

Blue Cross Protesting Award of Texas Employee Retirement Health Plan to United Healthcare–Price Cut by $25 Million With Little or No Out of Network Coverage for Members

This was from last year as well in Nebraska…

Blue Cross and United Healthcare Duking It Out In Nebraska Over State Health Insurance Contract–We Have More Subsidiaries My Cost Algorithms Are Better Than Yours?

This is interesting as United Contracts are tested all the time and complaints arise and AAFP found out that United  by use of complex contracts was paying doctors less than Medicare in several states.  BD

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UnitedHealthcare has filed a strongly worded protest of the awarding of a state employees benefits contract, alleging that Georgia officials “rigged’’ the bid in favor of a competitor.

A letter from United and its attorneys at law firms Alston & Bird and McKenna, Long & Aldridge asks the Department of Community Health’s commissioner to review the award made to Blue Cross and Blue Shield of Georgia, which was formally announced Friday.

The attorneys’ letter, dated Monday, alleges the agency engaged in “state-sponsored bid-rigging.’’

Blue Cross was the single insurer selected to deliver health plan administration and medical management services to the more than 650,000 state employees, teachers, other school personnel, retirees and dependents in the State Health Benefit Plan.

United’s protest letter accuses the Department of Community Health (DCH) of engaging “in a biased, unfair, opaque, and uncompetitive process more like the ‘old Georgia’ of backroom deals and shady politics than a state government that, at least on the surface, claims to value free and open competition.

Separately, he said, United has filed a motion for a temporary restraining order and an injunction in Fulton County Superior Court.

http://www.georgiahealthnews.com/2013/08/united-claims-blue-cross-special-favors/

Cigna Buys Alegis Care aka Home Physicians Management From Private Equity Firm Triton Pacific, Senior Home Care And Hospital Discharge Home Services

You can kind of figure out what this one is about as when you look at ACOs today the insurers are in the driver’s seat so Cigna is no different and the focus here is to also reduce readmissions to the hospital.  You can read on their website about their marketing targets for HMOs.  Their focus is the elderly to offer home service care. 

They also offer services to help with hospice care follow up so gee will they be working with United’s Hospice for profit along the line?  As you can see all the actions are taking place with insurer subsidiaries.  At some point one subsidiary of an insurers works with a subsidiary or more from another insurer these days.

Hospice In the “For Profit” Sector As Subsidiaries of Health Insurance Companies-Subsidiary Watch

The physicians are managed by Alegis and offer primary care, wound care, and a list of other chronic conditions.  I wonder how the contract are here and they might change with an insurer owning the company now, that’s what all the doctors are wondering.  From the website:

“Founded and headquartered in Chicago, Illinois, Alegis Care and its providers deliver direct patient care in the home from locations across the country, including Illinois, Delaware, Indiana, Maryland, Michigan, New Jersey, Pennslyvania, Utah, Washington, Washington, D.C.,  and Wisconsin. Alegis Care is currently expanding to new locations.”

Back in 2011 Cigna purchased this group…

Cigna Buys HealthSpring Inc For $3.8 Billion, Who Bought Bravo Medicare HMO Who Had Profits of a Billion in 2010-Subsidiary Watch

And bought some business in Texas from Humana last year…and in 2011 they relocated their corporate offices to Connecticut. 

Cigna To Purchase Medicare Advantage Plans In Texas and Arkansas From Humana To Satisfy Purchase of Arcadian Medicare Advantage Business & More Plans Left To Sell –Subsidiary Watch

Alegis personnel  will also go to the home and provide a health assessment to work on keeping the costs down as well as providing care.  No mention of what Cigna paid.  BD 

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Cigna Corp., Bloomfield, Conn., has acquired Chicago-based Alegis Care, a portfolio company of private equity firm Triton Pacific Capital Partners since 2006.

Alegis Care, founded in 1995, specializes in serving chronically ill and elderly patients in their homes and will continue to do so as a Cigna company. This year, Alegis Care will provide physician services and comprehensive care coordination to nearly 31,000 seniors across 10 states, including customers in the Cigna-HealthSpring plan.

http://www.modernhealthcare.com/article/20130903/NEWS/309039962/cigna-acquires-home-healthcare-company-alegis&utm_source=twitterfeed&utm_medium=twitter

Kaiser Permanente IT Center Opens in Colorado–Looking to Add More Employees to Existing Base of 350

This is interesting to watch how different companies in healthcare are expanding in some areas and retreating in other.  Aetna for one pulled out of the Colorado insurance market a while back and they continue to leave other markets.  Just the size of the number of employees should give all an indication today as the time and expense required in healthcare today.  It is something that most may not even think about.  The plan is grow to approximately 700 employees when full staffed.  It sounds like they have all the “green” IT options in place as well.  In Ohio Kaiser is trying to sell their operations by contrast.

Kaiser Permanente Working On Deal to Sell Their Ohio Operations to Catholic Health Partners–Not Making Any Money Here

In addition to Epic Medical Records, Kaiser is a big client with Oracle, relying on their Identity Manager software for security, same as what Harvard and a few other places use.  Video at the link below from the Kaiser IT department along with a couple Oracle related links. 

Kaiser Permanente Using Oracle Access and Identity Manager for Healthcare Security And Some Other Oracle Solutions at Harvard and University of Maryland

What I found interesting as well is the use of the Bloom Boxes by Kaiser and I would guess they are in place here too.  IT/Data  centers use a lot of power.  There’s a 60 Minute segment video at the link below that tells you all about them, EBay, Google and others use them too. 

Kaiser Permanente to Install Bloom Box Fuel Cells at California Facilities

Kaiser is now also one of the largest employers in Colorado and they have plans for more additional clinical medical facilities in the near future.  BD 

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Nearly 350 employees are now working at the new information technology center opened by Kaiser Permanente in Colorado on Aug. 22. Kaiser officials say they want to fill an additional 95 positions there by year's end.

By 2015, Kaiser Permanente anticipates that some 700 professionals will work at the new IT center. Some of the new positions currently being recruited there include solutions architects, managers/directors, software developers, project/program managers and programmers.

"As healthcare evolves, there is an increased demand for IT solutions and support to deliver quality patient care," said Phil Fasano, executive vice president and chief information officer, in a statement. "This new IT location is a center of excellence where best in class employees use technology to ensure the delivery of high-quality, affordable healthcare to Kaiser Permanente members living in Colorado and across the country."

With more than 6,000 staff in Colorado, Kaiser Permanente is one of the state's largest private employers. This December, it will open a new multi-specialty center in Lone Tree, where approximately 130 positions will be new hires, officials say. As Kaiser adds new membership in Colorado, it's estimated that hundreds of additional jobs could be created in the state in the next three to five years.

http://www.healthcareitnews.com/news/new-kaiser-it-center-seeks-fill-jobs?topic=06,17,24

California Insurance Exchange Website Live for Price Comparisons and Information–A Quick Walk Through…

I read it was open so off I went to look around.  In addition there are new commercials that have begun running advertising “Covered California”.

So I plugged some numbers in for a person being 55, income of $40k a year and no dependent and insurance for only one.  I was presented with the tiers of Platinum, Gold, Enhanced Silver70 and Bronze.

This was interesting to take a quick look and get a preview of how it’s all going to function.  California is one of the states that chose to set up their own health insurance exchange versus the federal government doing it.  

 

 

 

 

 

 

 

 

 

 

Here’s the next screen…in two parts…

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

So you do get a quick comparison here of how each level covers each item with MOOP, co-pays, etc.  No prices yet until you clear the window and then you get to see the insurance carriers and here we go…more screenshots…

 

 

 

 

 

 

 

 

 

On the next screenshot only Health-Net is shown while the others are “grayed” out a bit but they seem to work on the Platinum Screen.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You get to see the monthly premiums before and after tax credits which makes huge difference. 

So I went to Health Net Enhanced Silver 70…for the next bit of information…there might be a formatting issue but this window pops up and this might be done on purpose too until everything is finished.  I checked a couple others and it’s the same thing. 

 

 

 

 

 

 

 

 

When I looked at the enrollment instructions it looks like contingency plans are in place as again we all know the situation with the federal data hub being designed by a subsidiary of United Health care and the issues with connecting to IRS and Social Security Legacy COBOL system.  It says now you can call, find a center in person and you will need to “mail” the application.

These are the two contracts given out to cover contingencies until they figure out how to get COBOL to scale and delivery results online.

Obama Administration Doles Out Yet One More Contract to Help With Eligibility Infrastructure And to Operate One Massive Mail Room-With Insurance Exchanges - Serco The Biggest Company You Have Never Heard Of

Government Gives Contract to Equifax to Verify Incomes of Those Who Apply for Health Insurance Via Exchanges That Qualify For Subsidies–There Goes the Honor System

It’s getting interesting with government contractors as if they are not owned by an insurance company they have their own issues as Serco is a UK company with a US branch that is under investigation in the UK for fraud and has been frozen from any new contracts and Equifax just had to put out $18 million for not correcting a woman’s credit information as we are seeing a lot more flaws in data today as the data selling epidemic in the US continue to grow.  Overall it looks very good and represents a lot hard work and very long hours for a lot of IT folks so hats off to them. 

IT infrastructures take a lot  more time than they used to and as a cross example the state of California itself has been trying to replace it’s legacy COBOL payroll system for 20 years and still has not been successful with a few vendors, last being SAP and millions spent so keep that in mind when you look at complex IT infrastructures such as the insurance exchanges.  As I said above contingencies are in place right now as all cannot be done online and connect to the federal data hub.  There was some recent misinformation of course from the political side recently that said the IT work was done and it’s not. 

Nancy DeParle Returns to What She Knows, Private Equity-Technology Experience, Knowledge And Being In Touch With Reality Is What Government Needs Today

There’s also a nice FAQ page and some information on qualifying for Medicaid, called Medi-Cal in California. 

http://www.coveredca.com/

HHS Rules Exchange Customers Who Are “Unbanked” Can Use Prepaid Credit Cards To Pay Premiums

That’s the first time I have hear this term “unbanked” as I have heard “inadequately banked” and “under banked” before.  If this is not a sign of the times on how much control banks have, even the terminology!  Unbanked means you don’t have an account at a bank so to allow payments from those who either can’t afford it or just simply don’t want an account at a bank they can now use prepaid credit cards for premium payments. 

To hear the insurers complain about the “high fees” they have to pay on prepaid and debit cards is enough to make you choke with the billions in profits they make every year as well.  A lot of people are unbanked as they are members of credit unions.  BD

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In a victory for health insurance exchange customers with lower incomes, HHS issued a final rule (PDF) Wednesday that will allow individuals to pay their premiums with a prepaid debit card. The move allows individuals who do not have a bank account, called the “unbanked,” to pay premiums with a card they add money to that's issued by a credit card company.

The rule responds to widespread concerns that insurers would only take payment by check and credit card, while millions of lower-income Americans who will be buying coverage on the state insurance exchanges are unbanked because they can't afford the costs associated with checking accounts and credit cards. Some insurers had said they wanted to be able to set their own payment policies. They don't necessarily like credit or prepaid debit cards because the fees they have to pay are high.

http://www.modernhealthcare.com/article/20130829/NEWS/308299967/reform-update-rule-allows-unbanked-consumers-to-pay-premiums-with&utm_source=twitterfeed&utm_medium=twitter

Aetna Will Not Sell Insurance on New York Health Insurance Exchange

Here we go again, and if you have not caught wind of this yet, “it’s a business decision” based on extreme math modeling and profits.  Aetna not too long ago also pulled out of California on both the exchanges and is no longer selling individual policies, they all want the business accounts via employers.  This is a big issue today as all the insurers are competing in this area quite aggressively.  Government contracts are also heavily coveted by insurers and those too have been very aggressively pursued.  In California some policy holders got an extra bonus of a 19% increase for their last 3 months of coverage, so was this a move to say “hurry up and switch”?

Aetna Who Is Leaving the California Individual Health Insurance Market at the End of the Year Jacks Up Policies 19% for the Remaining 3 Months And Withdraws From Participation in the Connecticut, Maryland and Georgia Exchanges

I have said it before and it’s worth repeating that our government doesn’t model very well and end up behind the 8 ball and this is everywhere from Congress and of late even the White House is failing here.  White House used to do a lot better but of late, not so good with putting more lawyers in places to where a technologist backed up with a team of lawyers would be much better as they are just totally out done.  I read every day and when I see stuff like “hurry up Health IT and having Facebook contests”, I just have just shook my head in disbelief on some of it and where some feel the perception of reality lies.  The reality is math models that manipulate risk for profit, either up or down.  Insurers are experts at this for sure.

Lack of Modeling and Algorithm Sleuths and Stalkers In Government, Part of Why We See Such “Silly” HHS and Congressional News About Financial Donations And/Or Solicitations…

I just wrote yesterday about the “app contest” now for behavioral health, again where’s the perception here?  We have some lost folks out there I swear.  Is this the Miley Cirus bunch calling some of these shots?  I’m beginning to wonder. Also cluttered news about Steve Ballmer, hey maybe he’s tired and wants to retire, but I full understand that a ton of news articles needs to be generated to allow those investors using software that reads the news to have something to base their sells and buys upon in the markets.  If you have not watched the documentary, Quants, the Alchemists of Wall Street, roll on down to the footer here and watch it as it will explain how this works, so again maybe Mr. Ballmer is just tired and want to have some family fun.

Back on target here, will United pull out too, probably not as they have a pretty high stake in New York already with their Oxford insurance subsidiary but who knows.  Recently Oxford was in the news regarding a US Supreme Court decision that over turned the rules from insurers that doctors could not collaborate and group together with insurers with litigation issues.  This was a long time coming and goes back quite a while. 

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

Also there’s been a very confusing doctor-insurer matter that has hit and I don’t know if others outside of United have been hit but contracts with their reimbursement and pay for performance provisions are actually paying doctors less than Medicare.  When you have business intelligence math models and algorithms it gets to be quite complex.  This was first noticed a few years back with the calculations for out of network pay to where most of the major insurers licensed and used formulas created by a United subsidiary.  BD

The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job

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(Reuters) - Aetna Inc, the No. 3 U.S. health insurer, said on Thursday it has decided not to sell insurance on New York's individual health insurance exchange, part of the country's healthcare reform.

New York is the fifth state where Aetna has pulled its application to sell the plans that go on sale on October 1 and into effect on January 1, 2014. It has also reversed course in Maryland, Ohio, Georgia, and Connecticut, where it is based.

Aetna spokesman Cynthia Michener said it made the move after assessing its business strategy, following the acquisition of smaller insurer Coventry Healthcare in May. Coventry also filed applications to sell plans in more than 10 states.

http://news.yahoo.com/aetna-pulls-york-health-insurance-exchange-145710678.html

United Healthcare to End Denial of Speech Therapy Reimbursement in California

This was brought about by the Department of Managed Care as California has 2 entities that over see health insurance.  This division is specific to monitoring HMOs.  With the new agreement patients will be given the care they need for speech therapy when it is medically needed  and many were improperly denied over the years.  Routinely United has denied requests from members.

Consumer complaints brought this to light with identifying the patterns of denial.  Patients basically have a year to request reimbursement where they have had to pay out of pocket.  BD

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The Department of Managed Health Care announced Tuesday it has reached an agreement with UnitedHealthcare to end routine denial of speech therapy services requested by members.

Terms of the agreement require the health plan to provide coverage for medically necessary speech therapy services and reimburse members who paid out-of-pocket for these services after they were inappropriately denied. UnitedHealthcare also must revise all current health plan documents to ensure they comply with California law.

http://www.bizjournals.com/sacramento/news/2013/08/27/unitedhealthcare-speech-therapy-denial.html?page=all

Insurers Certainly Like Consumer/Business Healthcare Apps: Subsidiary of Blue Cross Rolls & Couple Others Out $20 Additional Million in Funding to Audax First Backed by Cigna & Cardinal Health

What’s not to like about getting more data to sell?  I took a look at the Audax Health page and it looks like yet one more of those websites that wasn’t to educate people on how to get healthier.  Don’t we have enough of those yet…guess not when it comes to collecting and selling data and profiles.  Why do you think so many of these keep appearing.  Look at who backed the company from the start, Cigna and Cardinal Health, they sell data and run analytics up the ying yang.  Navigy, the company leading the funding is a wholly owned subsidiary of Blue Cross of Florida and the board of Navigy is interesting with former CEO of Aetna on board as well as the VP of partnerships of Facebook.

We need more mobile apps to collect more data?  I just read today to where around 65% of the mobile apps are dead so hey let’s get some more out there, and granted the “dead” numbers included all kinds of apps.  They have some of the usual data selling device companies as partners here, screenshot below.  I looked around but could not find one of those complex “privacy statements” so I guess the ones from the devices apply?  I don’t know, you tell me.  We have the same pitch on how unhealthy citizens are costing us money and it does but let up on it and keep it in focus and stop the constant pounding on projecting how many dollars will be saved as there will be savings but again stop the investors for trying to bank on these numbers, as they will find too they could be screwed eventually too if they suck it all in. 

 

 

 

 

You have to look at the every day life of a person and how much time do consumers have or want to devote to apps like this?  We know that Intuit and Quicken Health went away due to that fact.    They are not fun as all the sites say and require some work so it’s up to the individual and this is where the “quantified self” movement fails as the folks writing and developing as well as selling their good forget about this and some think that everyone who doesn’t use their product is not worth much.  What I like to find once in a while too are the executives and company employees that don’t use their own stuff…yeah that’s out there…do what I say and not what I do (grin).  I’ll give Microsoft credit as they have had this old saying of “eat your own dog food” and they require their employees to use their own software but again for small algorithmic web processes like this who knows.

Not too long ago Blue Cross admitted (their words not mine) that they are buying up your Visa and MasterCard records to see if their members are starting to buy clothes a size larger (grin)..that’s what they said but anyone who has worked with data knows that once they have this data in house off it goes to the hundred of quants they have on the payrolls to figure out how do query it with other data and do something else to create some new analytics or maybe more data to sell..here’s the link on the data purchasing here and it says United does it too.

Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too

Not too long after the Credit card purchase story was out we had this to follow up with more purchasing data with wanting to track what junk food you buy, so I said…hmm…are we back to those credit card data bases?  Jawbone did their thing with a new platform too to get more data. 

Health Insurers and Others Trying to Track Junk Food Consumers Purchase–Attack of the Killer Algorithms for Corporate Profits

So is it not interesting to see insurers funding so many companies like this?  I would really like to see some hard numbers on how many get sucked in here or are maybe through their employers encouraged to sign up as self insured employers are taking names and keeping track too as many of these types of programs are targeted for employers to roll out.

You do wonder how many claims this $20 million could have paid, right?  Maybe it’s just me that thinks this way:)  If you wonder why insurance premiums keep going up, well here’s one example of why as where does the money come to fund more algorithms to mine data?  If you happen to participate and develop healthier habits, well that’s the side effect of the first focus I seem to think.   Do I get excited about these types of products, nope.  We really do need to start licensing and excise taxing the data sellers to create an avenue of regulation which does not exist today with an IT Infrastructure,  as we have way too many companies out there “flipping algorithms” for profit and it’s not balanced with producing tangibles in the US.  Our biggest fear too as consumers is the fact that data may be used “out of context” against us and anyone who has worked with data can tell you how that could and does work.

Time Has Come to License and Tax the Data Sellers of the Web, Companies, Banks, Social Networks..Any One Making a Profit-Latest Microsoft/Google Privacy War Helping the Cause –Consumers Deserve to Know What Is Being Sold and To Who in a Searchable Format

We need both but right now it’s the wild west with selling data and this is also one of the reasons that the amount of flawed data is on the rise, nobody monitors any algorithms or math models that get marketed so we have some sheep in wolves' clothing out there if you will. 

At the Medical Quack I started some new links called “Posts Worth Reading” to where I chat about some of the intangible processes that you may not be aware of that run on servers 24/7 behind the scenes to help educate all and to encourage you to ask questions when something doesn’t look right.  This is a big deal today as data selling has reached an epidemic stage and is actually beginning to affect the economy with models that change risk in some areas.  Look for this image on the link bar for more.  BD

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Audax Health, a digital health startup backed by former Apple CEO John Sculley and other technology and health executives, has raised $20 million in a Series B round of funding.  The round was led by Navigy Holdings, Inc. a wholly-owned subsidiary of Florida’s largest health insurer, and included current board member Jack Rowe, former CEO and chairman of Aetna, Dan Rose, VP of partnerships at Facebook and others.

The round follows more than $35 million previously raised from corporate partners Cigna and Cardinal Health, venture capital firm New Leaf Ventures and members of the startups’ board.

With the new funding, the company said it plans to invest in product development, build out the company’s mobile and engineering teams and expand partnerships with insurers and providers.

http://gigaom.com/2013/08/28/john-sculley-backed-audax-health-nabs-20m-to-help-people-take-healthier-steps/

Wal-Mart To Offer Health Insurance Coverage for Domestic Partners Next Year With Rules And Parameters to Meet To Qualify

There are some good things in here and specifically where the provisions relate to what a “spouse” or “partner” parameter is.  The company has over a million employees and same sex marriages are recognized.

“Employees' domestic partners can be covered if they are legal spouses, not legally separated; or a domestic partner of same or opposite gender in an ongoing, exclusive relationship similar to marriage for at least 12 months with the intention to continue sharing a household indefinitely, he said.”

You can read below on who the contracts are with for coverage and most notably we have both United and Aetna participating who have pulled out of the individual insurance policy business in several states, California being most notable for both. 

UnitedHealthcare Expands Their Cheap Hearings Aids Subsidiary With Marketing To Add More Profits To the Corporate Bottom Line and Sell More Devices And Policies –Subsidiary Watch

It was not too long ago that Wal-Mart speculated on being their own insurance exchange.

Everybody Wants to be Health Insurance Exchange, Wal-Mart Considering the Idea for Small Companies And Oracle Can Sell You a Software Exchange Platform

In addition Wal-Mart has a surgical procedure unit that has contract directly with major Medical Centers for certain types of procedures.

Walmart Becomes the Next Employer to Negotiate Surgical Procedures Direct With Major Medical Centers, Just Need More Employees Covered

In addition United has the “cheap hearing aides” subsidiary, HiHealthInnovations where they also plan to sell the cheap hearing aide in retail stores and of course the computer test is free for doctors at no charge but Walgreens, Wal-Mart and other majors were mentioned as targets and one would expect some action in this area possibly.  If you haven not figured it out yet with insurers, subsidiaries is where all the action takes place today as there’s a lot more to the insurers than just claims and policies.

United HealthCare Gets In the Medical Device Business–Distributing Cheap Hearing Aides Sold Via Hi HealthInnovations Division –Subsidiary Watch

As the Reuters article states here the most popular Wal-Mart plan is the one with the least cost and should run about $18.40 every two weeks for the employee contributions, so the big thing here is to be full time or be an part timer for over a year with 30 or more hours a week worked.  Some who work there can buy the insurance but can’t afford it.  BD

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The world's largest retailer, based in Bentonville, Arkansas, also plans to begin to offer vision care to its eligible employees and their dependents, according to information the retailer sent to workers this week.

Wal-Mart is the single biggest U.S. employer outside of the federal government. More than half of its 1.3 million U.S. employees are on its health-care plans. The company said it does not know how many workers would use either of the new benefits.

Employees' domestic partners can be covered if they are legal spouses, not legally separated; or a domestic partner of same or opposite gender in an ongoing, exclusive relationship similar to marriage for at least 12 months with the intention to continue sharing a household indefinitely, he said.

About 1.1 million people, including workers' family members, are currently covered by Wal-Mart health-care plans in the United States. Not all of the company's U.S. employees sign up for coverage. Part-time employees must work for Wal-Mart for one year and work an average of 30 hours a week to qualify.  Wal-Mart's U.S. employees are set to pay 3 percent to 10 percent more for their medical coverage next year, depending on the plan chosen.

Wal-Mart's benefits administrators are Aetna Inc, UnitedHealth Group Inc's UnitedHealthcare and Blue Cross Blue Shield, depending on the location of a particular worker.

http://in.reuters.com/article/2013/08/27/us-walmart-benefits-idINBRE97Q0QL20130827?feedType=RSS&feedName=health&utm_source=dlvr.it&utm_medium=twitter&dlvrit=309303

United Healthcare Sues Government Contractor, Paragon for Unpaid Health Insurance Premiums

Here’s yet one more lawsuit from United to where they are stating the company did not pay all their premiums in full.  The company, however says it’s not true and they have moved on to another carrier when the United contract expired at the end of 2012.  The case is for over $200,000 and United states their collection efforts were ignored by Paragon.  Paragon Systems is a subcontractor for companies like L3 Communications and General Dynamics. 

Paragon says they fight the battle as high costs and bad service were the reasons they changed.  BD

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UnitedHealthcare Insurance Co. sued Sterling-based technology company Paragon Systems LLC, claiming Paragon owes more than $200,000 in unpaid premiums on group health care and life insurance policies — claims UnitedHealthcare denies.

Paragon held two UnitedHealthcare policies in 2012 that provided health insurance, life insurance, accidental death, and dismemberment and disability coverage for Paragon employees. According to the complaint, filed in the U.S. District Court in Alexandria Aug. 14, Paragon made payments on premiums "in varying amounts and frequencies" until both policies were canceled Dec. 31, 2012.

http://www.bizjournals.com/washington/blog/fedbiz_daily/2013/08/united-healthcare-sues-paragon-systems.html

Medicare Admissions Rules Causing Havoc, Need a New Model As It Is Becoming Yet One More Way to Shift Cost to the Patients

We all know about the re-admissions rules and penalties that put the fear of God into hospitals today and they all work to be compliant, however, if better intelligence were used ahead of the game to model some of the unintended circumstances, we might have some better rules come out as now they confuse everybody.  Not only Medicare but the hospitals all have the discretion of insurers in this area as well. 

Patients don’t know when they have been officially “admitted” and that’s a good question to ask as noted in this story, if patients are not admitted and spend several days under observation, then any rehab costs get shoved back to the patient.  The model is broken.  Now Medicare is proposing that the status can be changed “after the fact” so again we are talking about shifting money again as the status can be changed up to a year after the time spent in the hospital.  So now what?  Admissions get changed to observation status?  That could happen and again better modeling would help some of this out.

If Medicare would follow the money more and create superficial cases that could arise up front, perhaps some of this could be avoided.  There’s also some talk about a rule that would require Medicare to pay for rehab if the patient has spent 3 or more days in the hospital regardless of the status of being admitted or there for observation. 

Readmission Analytics Not Much Better Than Flipping A Coin, Large and Poorest Hospitals At Risk Of Facing Larger Fines, CMS Needs Some New Math Models and Algorithms

It’s sad that everything comes down to shifting the dollar and cost to patients when the analytical opportunities present themselves but we should be ethical as well.  Are the rules being “used out of context”?  One might ask that question when you begin to see 5-10 days of observation billed.  This is what we all fear with data being used “out of context” and it goes beyond hospital admitting too, it’s alive and well in the financial world to where the banks and companies lead the government around by the nose because they can’t model very well. 

Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game

We all know that technology at the top of HHS is lacking and many are duped into the analytics and the confusion of their policies shows it.  Sure it’s not simple but again when you have folks running an agency that is so tied into technology with complex payment systems, well it just makes the problems worse.  Again if the government would employ some better modelers and query potential loop holes up front, some of this could be avoided and you won’t catch it all but it would be a much better formulated rule to begin with as IT Infrastructure runs every thing today and when people’s lives and livelihoods are involved, it’s time to a better job than  look for the “Algo Fairies” for the rules. 

“Dead Patients Can’t Be Readmitted” As Relates to HHS and CMS and the Elusive Search for Some Penalty Assessing Algorithm Fairies…

Gee and people wonder what is happening to the money of the middle class?  BD 

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Harold Engler recently spent 10 days in a Boston teaching hospital, trying to snap back from complications after urgent hernia surgery. Nurses provided around-the-clock treatment, changing the 91-year-old’s catheter, for example, and pumping him with intravenous drugs for suspected pneumonia.

It all seemed like textbook hospital care to his wife, Sylvia. So she was shocked to learn that Beth Israel Deaconess Medical Center had never “admitted” her husband at all.

“Mrs. Engler, we have bad news for you. This was marked ‘medical observation,’ ” said a nurse at the nursing home where her husband was sent for rehabilitation. The hospital had decided Harold Engler was not sick enough to qualify as an official “inpatient.”

The difference in terminology was not a mere technicality: the observation classification left the Englers with a huge bill. It triggered a mystifying Medicare rule that required the Framingham couple to pay the entire $7,859 cost of his rehabilitation care and the medications he needed while at the nursing facility. If Harold Engler, a retired sales executive, had been admitted to the hospital, they would have likely paid nothing.

Medicare officials have said they are concerned about patients being observed for days in the hospital without being admitted, and issued regulations this summer they believe will help provide clarity to hospitals. But advocates for the elderly are not so sure.

“They’re contradictory and unclear,’’ Edelman said.

The rules, which take effect Oct. 1, allow hospitals to change a patient’s care level up to a year after discharge. One worry is that patients will be switched from inpatient to observation status months after they leave the hospital — and get socked retroactively with a rehabilitation bill.

http://www.bostonglobe.com/lifestyle/health-wellness/2013/08/24/despite-long-hospital-stays-some-patients-never-admitted-leaving-them-with-huge-bills/UjD0YLmFZE2XMtBee6KveN/story.html

Nancy DeParle Returns to What She Knows, Private Equity-Technology Experience, Knowledge And Being In Touch With Reality Is What Government Needs Today

This was kind of a funny interview here and during the initial transition of the White House things were different years back and there were quite a few “transition” type people hired.  If you look at the US CTO and CIO jobs, both of the transition folks got out of Dodge too as the job requirements changed to be heavy on technology.  Back in 2009 I questioned both Sebelius and DeParle and wondered how long they would stay around.  DeParle left her job a while back and Sebelius is still there.

Nancy-Ann DeParle and Kathleen Sebelius – Business Intelligence?

What is happening here is that it comes out in the press with things that are not relative.  A few weeks ago I read where DeParle stated the “IT work was done” as it relates to insurance exchanges and there’s nothing further from the truth as you can read about it every day, again we come back to digital literacy and political comments made to sway opinions that are not accurate.  Here’s a recent past that talks about some of the technologies for the exchanges…

Obamacare Health Insurance Exchanges “Will It Blend”….Cobol Lives On With the Feds

Once you read articles like this with the technologists who are actually doing the work with first hand technology experience, it becomes more transparent that the comments made by politicians are kind of useless as they give somewhat of a digital illiterate translation.  Here’s another one where Sebelius wants to “speed up Health IT”, well we would all like that of course but we are still humans writing code and these are embarrassing moments.

Speed Up Rate of Change in Health IT?–“Short Order Code Kitchen Burned Down a Few Years Ago and There Was No Fire Sale”..IT Infrastructure Chance and Revisions Takes a Lot of ”Code”, “Time” and “ Most Importantly Money”

So again we come back to many folks that were in fact “transitional” and when the real work is needed, just as you see with the current US CTO and CIO jobs, the folks with the technology talent are tasked to do the job.  In this interview, she says she’s having fun with Private Equity, so how many others are having “fun” while Algo Duping for profit continues to grow along with the data selling epidemic.  I guess it’s nice that folks with some money at the top can have “fun” while the rest of us are at the mercy of the code and algorithms running on servers 24/7 making like impacting decisions about all of us along with this huge problem of the data selling epidemic that few have recognized that is cutting away at the focus of the economy.   She couldn’t talk about this issue or even acknowledge it I don’t believe as she references he own kids being addicted to apps?  What’s up with that? 

The rest of us out here are not having fun, ask any doctor, hospital, etc.  She just doesn’t get it and is now so removed in her focus that the least involvement she has right now I think is better as it is time for some real truths to be brought forward with Health IT, which is what I try to do here.  From the way this article reads, she’s all about money and again back in the early days with organizing she had some input and value but it’s certainly not what we need today for consumers, patients and providers.  It’s dangerous sometimes to have “transitional” executives hang around too long in my opinion.  BD 

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The former director of the White House Office of Health Reform, since 2011 DeParle had been deputy chief of staff for policy, helping the president develop policy in multiple areas. Still, DeParle is best known as a chief architect of the Affordable Care Act, and a former administrator of the Centers for Medicare & Medicaid Services (CMS) during the Clinton administration.

Earlier this month, DeParle returned to a healthcare focus, albeit in the world of private equity, as a partner with the New York-based firm Consonance Capital Partners. She'll help guide CCP's investment decisions in lower middle market healthcare enterprises.

I am increasingly using them, and from watching my own teenage children I can tell you that they’re hooked on them. Whether it will apply to the population at large is still something of a question. In the last few weeks, I’ve been speaking with CEOs at insurance companies, and they are all over this trend. They see mobile apps and tools as a way to help manage patient engagement. They are trying to go where people are living these days, which is on their smartphones, their tablets, and giving them something that can help them manage their health.

http://www.healthcarefinancenews.com/news/aca-architect-returns-private-equity?single-page=true

Humana Offers Financial Incentives for Primary Care Physicians To Use Greenway EHR PrimeSUITE–Up to 85% Reimbursement Possible

I just read today that Greenway posted a lost for their last quarter due to changing over to web or cloud based services from the old client/server EMR systems.  It was a little over a year ago that Greenway went public with their IPO to raise $100 million, so if investor revenue was raised and they still lost money this quarter, might be one to keep an eye on and see how they come out next quarter.  There could have been some charge back with going public as well.

Greenway Medical Records IPO–Videos and Pictures at NYSE Getting Old as Hospitals and Doctors Struggle for Income And Close

Greenway Medical Records Company Files to Go Public To Raise $100 Million

In addition, Seamless Medical also announced they will be reselling the Greenway EHR and joins the Greenway market place.  In addition a former Humana executive also started a private insurance exchange a few months ago.  It is interesting to see the EHR folks and insurers getting closer and closer all the time.  United Healthcare owns a few EHR companies in their huge portfolio of subsidiary companies.  BD

One More Insurance Exchange Started by Former Humana Executive–Currently There Are Over 100 Private Exchanges in Place To Compete With State Exchanges

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LOUISVILLE, Ky., Aug 13, 2013 (BUSINESS WIRE) -- Humana Inc. HUM -0.02% , one of the nation's leading health and well-being companies, recently announced its partnership with Greenway Medical Technologies, Inc. to provide integrated technology to primary care providers, which will help doctors and payers exchange clinical information.

The strategic alliance of Humana's Electronic Health Records (EHR) Rewards program and Greenway's integrated solution for EHR, practice-management and interoperability will provide physicians the information and point-of-care opportunities necessary to support patient management and enable automated reporting for contractual performance measures.

Humana's EHR Rewards Program offers financial incentives to assist qualified physician practices in using EHR systems. Specifically, Humana will subsidize up to 85 percent of the cost of purchase of Greenway's PrimeSUITE EHR solution for physicians practicing in the Humana network. Such incentives encourage the sharing of clinical information between Humana and physicians.

http://www.marketwatch.com/story/humana-and-greenway-medical-technologies-partner-to-provide-advanced-information-technology-to-primary-care-physicians-2013-08-13

UPS To Remove Thousands of Working Spouses From Health Insurance Coverage Beginning in 2014

A working spouse is one who has coverage else where for health insurance so there goes the additional second payer to pick up what the first insurer may not cover and this will lead to increased costs for the spouses.  UPS is not alone and many other companies are doing the same.  After reading the article it appears those who do not have coverage elsewhere, are ok to remain eligible.  In addition this policy only pertains to the non union employees as they have their own health insurance plans and options, but there’s still a ton of non union folks at UPS.

Also in the article is the mention of the money made by UPS, as $807 million in profit from revenue of over $54 billion is not a huge profit margin.   BD

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Partly blaming the health law, United Parcel Service is set to remove thousands of spouses from its medical plan because they are eligible for coverage elsewhere.

Many analysts downplay the Affordable Care Act's effect on companies such as UPS, noting that the move is part of a long-term trend of shrinking corporate medical benefits. But the shipping giant repeatedly cites the act to explain the decision, adding fuel to the debate over whether it erodes traditional employer coverage.

Rising medical costs, "combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost," UPS said in a memo to employees.

While acknowledging that overall health spending continues to rise, the company also blamed cost increases on the Affordable Care Act's research fee (initially $1 per health plan member, then rising to $2) and a temporary fee of $63 per member to stabilize new online marketplaces for consumers buying directly from insurers.

Other factors are the act's ban on annual and lifetime coverage limits and its requirement to cover dependent children up to age 26, UPS said. The law's mandate for individuals to obtain coverage will nudge employees who previously opted out to enroll, also raising costs, the company said.

The health law is "one of the reasons that UPS is implementing the changes," McGowan said.

http://www.usatoday.com/story/money/business/2013/08/20/ups-spouses-health-insurance/2651713/

United Healthcare and Partner Develop Insurance Exchange Specifically For US Employees Working for India Owned IT Services

If you are a US employee working for an Indian owned IT company looks like United Healthcare and their partner, Hanna Global will have a new health insurance exchange to service this niche.  United did say they would limit their participation in US Health insurance exchanges a short while back and it looks like they are out creating their own exchanges instead.  Just this week United bowed out of participating in the Wisconsin exchange. 

We know with all the quants and business intelligence algorithmic formulas and contracts United has they probably designed this with their analytics as a good guess.  This move follows along with their focus with employer provided insurance.  By the way, have you ever seen the number of subsidiaries the company has..truckloads of them..more at the link below, with everything from housing, medical records, consultants for the FDA and so on.  BD

Health Insurance Business Under the Radar With Tiered Subsidiaries–Where All the Action Takes Place With Mergers, Acquisitions and Profit Centers-Subsidiary Watch

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CHENNAI, India--(BUSINESSWIRE)-- Hanna Global Solutions (HGS), a global human resource and employee benefits management and consulting company, today announced the launch of their unique U.S. Healthcare Exchange solution, developed specifically for Indian companies with employees in the United States. This solution has been developed in partnership with UnitedHealthcare (UHC), the most diversified health care company in the United States.

The HGS Healthcare Exchange offers employees more choice, more control and the opportunity to buy a health benefit plan that better meets their needs, including the chance to access coverage at a lower cost depending on the plan selected and the individuals’ health status. In addition to medical insurance, employees will be able to choose dental, vision, life and disability insurance plans from this exchange.

An employer decides how much they want to contribute or subsidize for the employees. The employees then use the subsidy to select the plan design and coverage level that best meets their personal needs.

http://nz.finance.yahoo.com/news/hanna-global-solutions-launches-unique-130000960.html

New York City to Put Out Bids For Multi-Billion Dollar Health Insurance Contracts–Some Insurers Sue If They Are Not Selected, Caution Needed With Bid Invitations?

Here’s a couple examples below on how the bids go today with one insurer just suing municipalities if they don’t get the contract.  Just recently the company lost a big lawsuit with their Oxford Insurance division in New York to where the Supreme court ruled that doctors now can “group together” to dispute and litigate insurance problems, billing and accusations of fraud. 

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?

United Healthcare Files Lawsuit Against the City of Birmingham Disputing Contract Award To Blue Cross

State of Louisiana Rejects United Healthcare’s Protest Over Awarding Blue Cross/Blue Shield Contract To Manage State Employee Health Insurance–Battle of the Insurance Algorithms Continues..

Here’s the recent ruling from the Supreme Court where the decision was made relative to insurance contracts as for years doctors, to be in network, have had to sign contracts that did not allow them to work as a group to litigate, so it has always been the big corporation against “one single doctor” so you know what advantages are had there with big insurer conglomerates.  If you were not aware of this, it has been going on for a long time and at the end of 2012 the AAFP confronted United as they found these complex contracts also ended paying doctors at a rate less than Medicare. 

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

There’s other instances of contract disputes over the last couple years floating around out there too, but it does make one wonder about the bidding process and also wonder about Steve Larsen who left HHS to work as a VP at the Optum division of United too. 

US Health Insurance Regulator Leaving to Take a Job at UnitedHealth Care As Vice President of the Optum Division – Moving to the “For Profit Side” With Business Intelligence Algorithm Dollars To Review

So who’s going to be invited to bid on this big contract?  There’s a lot of money involved here and are we to the point of lawsuits if not selected?  There seems to be some kind of a trend going on here.  It is also interesting how QSSI, a subsidiary of United is also building the federal data hub, as they purchased QSSI two weeks after HHS awarded the contract…very aggressive analytics company here and also has hospice services for profit as well…scary when an insurer has so many subsidiaries and has to profit from end of life care as well.  It really make you wonder about the bidding system as a whole when business intelligence algorithmic formulas are used as the sole basis for most of the business practices of insurers and this is what we are stuck with.  On the topic of exchanges I don’t think it’s Obamacare itself that is the bottom line, but rather the requirement by law to have to purchase from what is beginning to morph out as “too big to fail” insurers, just like the banks, way too much power.   BD

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NEW YORK — Mayor Michael Bloomberg says New York City will seek bids within days for its multibillion-dollar health insurance contracts.

The step comes amid a standoff between the city and unions over expired contracts.

Bloomberg re-emphasized his stance on the labor issues during a speech Tuesday.

He wants more city employees to contribute to their health insurance. He also wants changes to a pension system he says is becoming too costly.

http://online.wsj.com/article/AP4fe4a7ccbf234c859b5a0f02f308a149.html

Aetna Who Is Leaving the California Individual Health Insurance Market at the End of the Year Jacks Up Policies 19% for the Remaining 3 Months And Withdraws From Participation in the Connecticut, Maryland and Georgia Exchanges

Now is this really necessary to jack up the cost of a health insurance policy 3 months before it is ended?  This is really soaking the consumers here and besides Aetna said their market is not that big here.  Here’s the original story about their departure below.

Aetna Individual Policy Consumers In California Will Have to Find a New Carrier By The End of The Year-Pulling Out of The Consumer Insurance Business

Now the excuse given by Aetna is this is to cover their expenses in exiting the market?  Give me a break!!  Today, in Connecticut where Aetna’s headquarters are located, they said they are pulling out of the health insurance exchange there as well!  Aetna is located in Hartford, Connecticut.  I swear if the government doesn’t get some Quant sleuths on board soon, the will remain behind the 8 ball as insurers play the business intelligence analytics by the minute, finding loopholes and other areas to profit as soon as they are created. 

Boy this doesn’t say a lot for supporting the state where their corporate offices are located does it.  It’s all about the math models. In addition, they won’t participate in Maryland and Georgia. These folks are beginning to resemble a miniature United Healthcare group with the way they are operating as they seem to be following their foot steps all over the place.  They started with buying up Health IT companies and it has now expanded into the math business models as well.  Here’s a quote below from a recent article discussing Aetna, in United Healthcare style if you will. 

“Unlike the other carriers, Aetna also included in its rate proposals an assumption that the newly insured would use more medical services to make up for years of going without care.”

Let’s also not forget how their profits are growing as indicated with their second quarter results.  Last year they bought Coventry too for over 5 billion and then they also have this Cayman Island reinsurance deal in place. 

Aetna To Buy Coventry Healthcare for $5.7 Billion in Cash and Stock

In the meantime I guess the best we might look forward to is another Facebook contest from Sebelius, nothing personal but she’s over run by people who are a thousand times smarter than her and it’s really showing and we all suffer, she better hire some sleuths.  She still seems pretty enamored over herself using Twitter. 

HHS Secretary Sebelius Still Looking for Tech Breakthroughs To Save the Day

This is really sad that the President’s own cabinet is not being of much help of late and it’s not just HHS, we have bunch of digital duds in there that can’t understand math and the power and we are so screwed.  Link below has a few more details on how that works as well as the videos on the Algo Duping page.  BD

Lack of Modeling and Algorithm Sleuths and Stalkers In Government, Part of Why We See Such “Silly” HHS and Congressional News About Financial Donations And/Or Solicitations…

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Speaking of companies with less heart than the Tin Woodman, a tip of the funnel cap to health insurer Aetna.

The company announced in June that it would terminate most individual insurance policies in California at the end of the year, leaving thousands of customers high and dry.

Harlan Lassiter, 58, is one of the Aetna customers who will lose coverage as part of the company's efforts to save a buck. For the last five years, the Newport Beach resident has been paying Aetna $389 a month in premiums and swallowing an $8,000 deductible.

Now, adding insult to injury, he's just received a notice from the insurer saying that his monthly premium will rise 19% in October for his final three months of coverage.

Anjie Coplin, an Aetna spokeswoman, told me the rate hike is intended to cover expected medical costs prior to the company decamping from the individual insurance market.

http://www.latimes.com/business/la-fi-lazarus-20130806,0,2801752.column?track=rss&cid=dlvr.it&dlvrit=52116

Health Net to Offer Small Business Health Insurance in California Via the Exchange

Last time I wrote the offerings for small businesses went from 1 to zero in California with Blue Cross pulling out so now there’s Health Net to fill the bill in all counties.  The California Insurance Commissioner recently was hammering on WellPoint for their rate increases so one might wonder if this had anything to do with their decision as he demanded they be barred from the small group market, so maybe they just decided to leave on their own.

Small Business California Insurance Exchange Option Went From a Choice of One to a Choice of Zero as WellPoint Pulls Out–Stay Tuned As More Develops

Health Net will offer both PPO and HMO services.  We knew there had to be someone step to the plate sooner or later.  BD

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Health Net Life's bid to provide health care coverage to eligible small businesses is accepted for all 58 counties in the state

Health Net Life Insurance Company, a wholly owned subsidiary of Health Net of California, Inc., today announced that the Covered California health insurance exchange has accepted its bid to provide preferred provider organization health insurance policies to eligible small businesses in all 58 counties. Health Net of California is a wholly owned subsidiary of Health Net, Inc. (NYSE: HNT).

"Health Net is excited to be part of the Covered California small business exchange," said Steve Sell, president of Health Net's Western Region Health Plan. "No matter where in the state a small business is located, it will be able to select Health Net plans designed to be affordable and easy to use."

The acceptance of Health Net Life's statewide participation in California's small business exchange follows Covered California's announcement in May that Health Net of California and Health Net Life will offer HMO and PPO health plans, respectively, in the state's individual health insurance exchange.

http://online.wsj.com/article/PR-CO-20130801-917502.html

Half or Better of the Accountable Act Call Center Jobs Will Be Part Time With No Benefits in Contra Costa County, California

This pertains to one of the call centers and ironically these people get no benefits and might just have to fork out and pay for insurance themselves through the exchange.   In reading this article, there seems to be some confusion, mismanagement or both of the above in how many of the jobs were to be full time and how many were to be part time.  It sounds like everyone thought they had a full time job until decisions were made.  The full time employees work the day shift and the part time fill in after regular hours it sounds like. 

They had over 7000 applications for just over 200 jobs and one person said they quit another job to take this job and found out later it was only going to be part time.  Part time pay will range from $15.33 to $18.63 and the part time are given the option of purchasing their own insurance but it runs from $600 a month all the way up to $2900 a month, typical of what we see in many places today so the part timers might really have to depend on getting a break by purchasing their own insurance through exchanges.  You can see where the union has become involved too with asking the county to pick up 80% of the cost of the premiums since the employees will be Contra Costa County workers.  

I guess things could be worse if they were outsourced to the Philippines, India or elsewhere but I think due to the complexities of the project and the constant changes it will be challenging enough to stay on top of it here without adding that element..  BD

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CONCORD -- Earlier this year, Contra Costa County won the right to run a health care call center, where workers will answer questions to help implement the president's Affordable Care Act. Area politicians called the 200-plus jobs it would bring to the region an economic coup.

Now, with two months to go before the Concord operation opens to serve the public, information has surfaced that about half the jobs are part-time, with no health benefits -- a stinging disappointment to workers and local politicians who believed the positions would be full-time.

The worker said no clear reasons for the change were given.

Those who became part-time were told they would have to pay full freight on their health plans, ranging from $600 to $1,200 a month for a single worker and between $1,400 to $2,900 a month for an employee with a family. That is a steep bill for employees with part-time jobs paying from $15.33 to $18.63 an hour.

Another applicant said he ditched another job offer after getting a congratulatory hiring letter from call center operators in June, only to be given the runaround in the months since.

During negotiations months ago, Service Employees International Union Local 1021, which represents the customer service agents, demanded 80 percent of health insurance premiums be paid by the county, and 20 percent be paid by the employee. SEIU did not return a call for comment.

http://www.contracostatimes.com/news/ci_23733819/concord-half-call-center-jobs-will-be-part

UnitedHealthcare Expands Their Cheap Hearings Aids Subsidiary With Marketing To Add More Profits To the Corporate Bottom Line and Sell More Devices And Policies –Subsidiary Watch

If you read here often enough then you know United has more subsidiaries than Carter has pills as the old saying goes.  I do these posts so people are aware when they spend their money today so they have an idea as to what big conglomerate benefits with profits to their bottom line.  The article states provided via Optum, which is a “tiered” subsidiary of United.  Back in October of 2011 we had this with seniors by way of claims/billings/contracts basically getting a free hearing aid if they signed up for a certain United Healthcare policy.

UnitedHealthCare Throws in Free Hearing Aids for Those Who Enroll In AARP Medicare Advantage, HMO & POS Plans in Miami-Dade County From Their New Subsidiary

The company distributing the hearing aids is a subsidiary United created to market and sell them, tiered subsidiaries again.  So if you sign up for a policy and buy a hearing aid they win twice if you will with getting more money from you. 

United HealthCare Gets In the Medical Device Business–Distributing Cheap Hearing Aides Sold Via Hi HealthInnovations Division –Subsidiary Watch

The devices come from China and by the way here’s another United subsidiary, a company in China working to promote Chinese drugs and devices worldwide to include the US.  I3 is a company owned by Minnetonka-based UnitedHealth's technology division and is located in Shanghai.  In 2011 i3 sold part of their clinical trials business (yes they were in that too) but kept ChinaGate. 

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

Many employer plans with United already offer the Chinese manufactured hearing aids as well.  Again especially today it’s interesting to know where your bottom line dollars go and to where shareholders benefit based on your purchases.  In other United news they are suing the city of Birmingham over a contract award and as we all know they sued DOD to get a chunk of the Tri-Care contract.  You know if those folks are not under contract with United, they can’t get access to the “cheap hearing aids” (grin). 

Who knows if this will be the next marketing push to get more folks to buy policies or will the company sign contracts with all the other major insurers to sell their hearing aids?  I’m sure they will run their business analytics to see which path will generate more money and profits before making such decisions.  If you go back to the out of network data base that Ingenix( now OptumInsights) had to short pay doctors and hospitals that went on for 15 years and ended in lawsuits, all the other insurers paid United to license it to increase their profits, so who knows. If the other insurers complain about a marketing edge here, well they cut them in right? An AMA subsidiary makes money selling software analytics developed by a United subsidiary too and the AMA were the ones who filed the class action suit against Ingenix so strange bed fellows at time and it all goes back to money.

We also have a subsidiary of United building the new federal data hub, as United bought the company two weeks after HHS awarded the contract so there’s a lot of buying up government contractors going on here too.  All of the tiered subsidiaries allows big conglomerate to “hide under the public radar today”. 

QSSI, Subsidiary of United Healthcare Building Federal Data Hub Gets Busted by the Inspector General Regarding USB Security And Compliance With Federal Requirements

So many think that all the health insurers are just focused on selling polices and that is not the case today as with subsidiaries there’s a lot more strategic mergers and acquisitions going on than you may be aware of.  We also do wonder about former HHS regulator, Steve Larsen leaving last year who was responsible for writing a big portion of the Healthcare law and he now has a big VP job at the Optum division of United.  Years ago this didn’t make a ton of difference but it does today with tiered subsidiaries as that’s where a lot of the action is taking place. 

Anyway, if you want to read more on subsidiaries just search for “subsidiary watch” here and here’s a group of United subsidiaries linked on a post I made recently.  They are everywhere and even some day might be one collecting your rent check as an example with their investments in middle and low income housing in New Mexico.  In addition, there’s the ever growing purchase or acquisition of physicians and surgical groups across the US, latest being Beach Surgical Holdings, another new subsidiary that has been created under the umbrella of the non profit Memorial Care Foundation which is a physicians group they purchased a while back.  BD 

Health Insurance Business Under the Radar With Tiered Subsidiaries–Where All the Action Takes Place With Mergers, Acquisitions and Profit Centers-Subsidiary Watch

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High-tech, custom-programmed hearing aids are now available at affordable prices – starting at just $649 each – to people enrolled in UnitedHealthcare vision benefit plans, including employer-sponsored and individual policies.

Hearing aids can often cost thousands of dollars, but UnitedHealthcare’s new discount program enables its vision plan participants to save hundreds of dollars on hearing aids by purchasing them for as low as $649 each*. The discount program already has been available to people enrolled in many UnitedHealthcare medical plans, including employer-sponsored, individual and Medicare Advantage plans, as well as Medicare Part D plans. Some UnitedHealthcare Medicare plan customers pay no out-of-pocket costs for the hearing aids.

http://finance.yahoo.com/news/affordable-hearing-aids-now-available-123000046.html