The Medical Quack

February-11-2015

9:25

Hands down if you look at the revenue that is produced from prescriptions, there’s a lot of it.  It’s amazing where all your data goes today when you fill a prescription.  Selling prescription data is nothing new and has gone on forever but software builds on itself and the data has been maximized for profits.  If you are not aware of what is called “medication adherence” well get used to it as there are tons of software programs that analyze you every time you fill your prescription, from the time it takes you to fill it, if you fill the prescription from the doctor, and so on.image  In addition the software that is attached here from the likes of the FICO Medication Adherence scoring kicks in, as well as Milleman and Optum.  Those two companies have been tied in forever to collect the data and some of it is used for reporting obviously, but they have found new markets as well for the same old data, so again from one prescription filled we go back to the “Secret Scoring of America”.

Secret Scoring with analytics behind the scenes are things you can’t see, touch or even know about unless someone tells you it’s going on.  In order to compete with CVS and Walgreens, this seems to be the missing piece of the puzzle here for Rite-Aid to capture some of this money and also moved more prescriptions over to a cheaper mail order system as well.  Of course EnvisonRX has a Medicare part D plan so more business from seniors will be analyzed and sold as well.  The World Privacy Forum wrote a very good report about the “Scoring of America” a while back and you can find a link to read more at the link below.  I have added my own commentary here and it is true that Data Selling coupled with the excessive scoring of US consumers is a contributing factor to the acceleration of inequality in the US, as you are scored right and left everywhere (and they sell that data for money) and you come up with “no, no, and no”..for access. 

Data Selling and the Direct Correlation To Accelerated Inequality - Epidemic Spreading Like A Virus Moving Money Keeping Corporations Cash Rich and Consumers Cash Poor

CVS has done a good job at going after analytics code and this is somewhat of a race too in the US as they opened not one, not two, but three e-commerce centers to hire developers in this “code rush” for data that has captured the interest of all companies, banks and so on to make use of and sell what ever data they have under their own roof.  You can look at MasterCard too as a big pioneer there too as they have an extremely motivated marketing and sales staff to convince prospective clients that “they just can live and make money without having all this data to analyze and snoop through to create better efficiencies.  Have you noticed how much easier it is to get a credit card?  Some of the defaults are offset from selling consumer data and boy do they do it.  Here’s the latest scoop on what CVS has going, looking for the magical code that can provide a service at the front end for you, and at the back end collect and mine data.

CVS to Open New E-Commerce Technology Centers in Boston, New York and Palo Alto– Need “New Code” to Make Bigger Profits While They And Others Continue to Destroy “US Consumer Dignity” With the Exploitations…

This is so competitive that they fight over the application software and here’s an example here where Walgreens and CVS were doing a patent war. 

CVS Settles Patent Dispute With Walgreens on Mobile Prescription Apps “CVS Wrote New Software”…

CVS took their case a little bit further with consumers and will now penalize consumers who fill their prescriptions at a store who sells tobacco, like Rite-Aid and Walgreens.  Sure this a move CVS did and they maximized the marketing on the tobacco thing and were demonizing timagehe other stores.  Wal-Mart as we know does prescriptions too, so again see what CVS really did here and it’s find and dandy that they wanted to take a stand, but you know what I don’t care as all I want a prescription filled and could care less if they sell tobacco products as that’s not why I go there, I want the prescription filled correctly.  So see what a fool you could have been at times with sucking in the CVS marketing and forget the fact that the DEA a short while back closed a couple of their stores due to the pain killers just running out the doors.  You need the big picture today and CVS has now used this to charge consumers a higher co-pay as their basis to look like the “good guys”.  You can’t believe every angle the media projects today without seeing the entire big picture.   You know the bankers are sitting up there watching such a marketing campaign and just counting the new revenue that comes in with demonizing the competition at CVS. 

CVS To Charge Consumers Higher Co-Pays With Prescriptions Filled at Drug Stores That Still Sell Tobacco Products–Killer Algorithms Attacking Once Again To Make Sure CVS Gets the Prescription Revenue And Your Data To Score And Sell

Pharmacy Benefit managers do have a purpose as well with negotiating prices for drugs that we pay for and that’s an interesting line too as they have to watch what consumers can afford on one side and yet on the other side keep the prices as high as they can to maximize profits when filling your prescription.   If this article is boring you at this point, you can stop here and return to the Brian Williams news if you like, a huge public distraction where it appears NBC has chosen him to be the sacrifice to drum up more clicks and ratings, at least that’s what I see in yet one more of these mass media distraction campaigns today.

Not too long ago I did a radio interview talking about the prescription drug business at Rowan radio and you can listen here at the archive.

http://wgls.rowan.edu/player.php?podcast=http://www.rowan.edu/today/data/cast/YHM2015115.mp3&name=Your%20Health%20Matters

So again Rite-Aid has been on the short end of the stick here missing out on the data they could be selling here to keep up with CVS and Walgreens.  IMS is a company that had an IPO last year and is one of the largest medical data collectors and sellers in the business as they have about 85% of the world’s prescription records on file, and yes indeed they pay for this data and buy it all up to create all types of analytics and reports.  So if you don’t think there’s big money being made here, well think again.

IMS Health Buys Cegedim Information Systems to Include CRM and Intelligence Software - Data Selling Business Gets Healthier and Wealthier But Can’t Say the Same for the Health of US Citizens - It’s All About Making Money Selling Data, The Epidemic

So like the banks, CVS, etc. will we see Rite-Aid be the next company to set up a lab in the Silicon Valley?  All the major banks have labs there as they are working frantically to create apps that offer you a service and at the back end mine data to sell.  All want to study your behavior too so some of that data is for shopping and advertisement intelligence and some is gathered to send off to a 3rd party that does even more analytics.  Here’s a good example of a company called Argus and they buy up your credit card data, analyze and score you, and sell it.  This may be a big eye opener for some who are not aware of what’s going on and how deep it goes today with selling consumer data.

Argus Analytics Produces “Share of Credit Card” Data On Consumers - Digs Up The Dirt on Your Credit Card Behavior Patterns-US Consumer Protection Agency Is A Client-We Are Paying for Richard Cordray’s Slow Education Process

At the link below, this is what’s happened to me of late, being on a mailing list of some sort and I don’t know where to go remove it as my data has been repackaged so many times, but it lead up to an offshore company calling me stating they had me on records for taking blood thinners which is totally false.  When prescription data is sold and re-queried, you get sloppy data work and we are stuck as consumers with nowhere to go since all the data sellers have totally free authority out there to step on consumers right and left with their errors.  Bad data gets the same price as good data and they don’t care.  So again Rite-Aid was missing this piece of the puzzle with CVS and Walgreens being miles ahead with the data selling here and needed a pharmacy benefit manager to not only manage prescriptions, but to cash in on the other side of all the consumer data they could gather.  I think it’s between 1-2 billion a year each that Walgreens and CVS each make selling data so there’s your motivation for the money part for Rite-Aid’s purchase of EnvisionRX.

Online Data Brokers Persist, Listing Consumers on Chronic Disease Mailing Lists And More–Need To License and Index All Data Sellers, Brokers, Banks, Companies, Otherwise You Don’t Have a Complete Listing of Who They Are…

EnvisionRX was owned by private equity firm TPG and there’s some folks over there who will make a lot of money on this sale of EnvisionRX to Rite-Aid too as Rite-Aid is paying $1.8 billion for the company.  Envision does around $ 5 billion in revenue with over 4500 pharmacies in 31 states.  BD


Rite Aid, the big pharmacy chain, agreed on Wednesday to acquire a top pharmacy benefit manager, Envision Pharmaceutical Services, for $2 billion in cash and stock .

Envision Pharmaceutical Services, known as EnvisionRx, is owned by the private equity firm TPG, making this one of the year’s early successful exits for a buyout firm.

Rite Aid will pay TPG about $1.8 billion in cash and $200 million in stock for EnvisionRx. The value of the deal also includes an expected future tax benefit of $275 million.

In EnvisionRx, Rite Aid is getting a national pharmacy benefits manager with about $5 billion in projected annual revenue. Rite Aid has more more than 4,500 pharmacies across 31 states and Washington, D.C.

http://dealbook.nytimes.com/2015/02/11/rite-aid-to-buy-pharmacy-benefit-manager-envisionrx/?smid=tw-dealbook&seid=auto&_r=0

February-9-2015

23:18

Here we go again the “too big to fail” health insurer at it again.  Read some of this and see why even the doctors have trouble knowing they are in network, much less patients trying to figure all of this out.  Insurers make money by making contract complex and this is no exception.  Doctors don’t even have a say here as United and their cost algorithms are calling the shots.  So if you hear you can keep your doctor, well you can’t blame this one on Obamacare, this one is all the work of United this time.  They have this algorithmic scoring system that uses some proprietary formulas and what it is, we don’t know.  Do they tell the doctors, probably not as they would have to go in depth and explain how their algorithms work. 

“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..

Doctors don’t have an opt out option on the W500 plan, they have to terminate their underlying PPO agreements.  Now who in the heck can keep track of all of this?  United can’t keep track of what doctors they fire sometimes as they went out and bid and won a Medicare Advantage contract in Maryland, only to find out they had to give it back as they had already fired all the doctors in the area who would be seeing patients.  By the way what does the NHS and Medicare now have in common?  They are both run by former United Healthcare Executives who do everything by the algo. 

Howard County School Board in Maryland Rescinds United Healthcare Contract As Retirees Didn’t Want the Medicare Advantage Plan, No Providers Available..

They have balls I must say and when you look at all of this, reflect back on a decision made by the Supreme Court that allows doctors to group to litigate and this example here might be a good reason why the court denied United for years trying to fight that, as in the past it was always one doctor up against the big corporation. 

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

This is what you get when insurers hire Quants to add to the Actuaries when modeling policies.  The Actuaries look for the long term goals, while the Quants come in with models that look for the short term and add the impact on their stock.  BD

Data Scientists/Quants in the Health Insurance Business–Modeling Beyond the Speed and Capabilities of Humans To Keep Up With The Affordable Care Act–Turning Into A World of Killer Algorithms That We All Hate..

Anyway this is what’s going on with insurers and some of their Quants may in fact have been employed by the likes of high frequency trading firms and banks, so see how they want to push humans through a mechanism that resembles a stock exchange with their models?  The only problem is we are human and can’t change that fast and keep up, so something is going to have to give pretty soon.  BD


United Healthcare has advised CMA that its new Core plan, which will be marketed to employer groups seeking lower premiums and used for its potential future exchange product, will access a significantly narrowed network of approximately 45 percent of UHC’s current PPO provider network.

UHC plans to send amendment notices to physicians selected to participate in the Core network sometime in March. UHC also reports that the terms of each physician’s United Healthcare base contract will apply to the new Core plan.

According to United Healthcare, physicians were selected to participate in the Core plan network based on their performance in several cost containment areas, including referrals to out-of-network physicians, average episodic cost of care and overall contractual fee-schedule reimbursement during calendar years 2012-2013. Although the cost criteria for the Core program mirrors that of the United Premium Designation program, UHC stated that the two evaluations are unrelated and that physicians achieving Premium Designation status may not necessarily be included in the narrow Core product network.

The amendment for the W500 product does not allow physicians to opt out of just the new product; rather, physicians would have to terminate their underlying United Healthcare PPO agreements in order to opt out of the new Core plan network. Physicians will have 45 days from the date of receipt of the amendment notice to notify UHC if they wish to terminate their participation prior to the April 20 effective date.

http://www.cmanet.org/news/detail/?article=united-healthcare-amendment-introduces-narrow

February-8-2015

11:30

We have a somewhat new breed of hackers out there today.  I'm sure by now you have read one of the many articles about what was taken, but pretty much it was demographics on the insured or prior insured.  80 million files is a lot of data.  Today's hackers want to make money selling data too.  If there was a cause or someone felt they had been wronged someway, we probably would have seen something posted on Pirate’s Bay or some other site as such.  If that were the case the hackers would have stopped at a much smaller number of accounts.  Now we have everyone moving in to take a look, HHS is going to do their investigation and so are several states and a national insurers group as well.  We can’t leave out the lawyers here too as the firm of Hagens Berman is in there for their investigation too. 

Listen to what data sells for on the black market, then change pace and see what it sells for in volume in the legal market…there you go why the crooks will reformat and want to get into selling stolen data to companies without them knowing it was stolen.

You might think that's an odd statement to make but it's true.   With 80 million files, that's a lot of data to repackage and sell.  Repackaging is when a data base is sold from company A to company B who may just happen imageto have data base C sitting around so they query and merge the two together and now you have a brand new repackaged data base.  But let's say there were errors and flaws in either or both, well those move right along with it.

There's no record of who's merging and selling data today and it's a business in the US that is worth $180 billion a year, so see why the hackers want data?  They may sit on it for months and do nothing until things cool off.

The big thing right now though is the connection with SSNs and IRS as they don't match up names and SSNs...as a matter of fact 40% of fake tax returns sail right on through and pay off.  Those who were breached will face this every year for gosh knows how long.  If you missed the news of late, due to tons of fraudulent returns filed, TuboTax has put all refunds on hold temporarily. 

See the video from 60 Minutes on the Tax Hole

For three years now I have had a campaign going to index and license all who sell data.  Why?  Well for one, who are they..here's a company (link below) you have never heard of that buys our credit card data, scores and analyzes the data and sells it to banks and insurers as well as our own consumer financial protection bureau, so what's up with that one?  Ever hear of Argus?  Read the link below and see how they score and analyze your data and sell it to insurers, banks and even the good old US Consumer Financial Protection Bureau.  That last one is nuts as imageRichard Cordray is over his head in that agency with no data mechanics logic. 

Argus- a Big Data Seller-your credit card transactions

This is very serious with Blue Cross and they have other battles as well.  They also have sunk in $100 million to create what is called an HIE, a facility that allows hospitals to sore and share records between hospitals.  It's not going to be a go now you can almost best with Cal Index. 

Here's my campaign on indexing and licensing all data sellers at the link below, so we know who they are.  If the files in fact are now in China, well they could be repackaged and sold both there and here.  The danger of course is that companies without knowing could be buying breached and flawed data. 

Remember in the bulk data selling business, they don't care and flawed data gets the same price as good data.

At the campaign page you can read about myself getting an offshore call about participating in a "blood thinner" clinical trial.  They had all my information when they called my but there was one big problem, I don't take blood thinners and never have at all in my life, so the data was flawed and I don't know how many times I have been sold and resold on a list of people who take blood thinners.  This is where we do not want any of this data outside of medical records and clinical data to be used.

Index and License All Data Sellers-Please Donate to the Cause here

The need is now two fold for licensing, one to help us consumers track down and get the flawed data fix and this is growing all the time with sloppy data work, I see it all the time. The second reason is to make sure that data sold or linked contains a license reference so the buyer is not accidently buying breached and stolen data. Also the thieves could do all kinds of damage and flaw more of it on purpose if they wanted. 

I have been beating this drum for 3 years now to pass a law that requires licensing for data selling and it goes without enough attention.  Lawyers have been out in the boondocks thinking this industry could self regulate, not when you have $180 billion made imageat year doing this.  Shoot Walgreens and CVS each pull in 1 to 2 billion a year just selling data and I would hate to see the huge dollars that United Healthcare and all their subsidiaries make hawking data, it would be a lot larger than Walgreens or CVS as they are like the #2 or #3 healthcare data seller entity.  You can see that all over various reports that have been on the web for the last few years. 

This is just really nasty stuff and again I hope my campaign catches on real soon as I'm making a big stink about it as I started writing the FTC and a few members of Congress three years ago.  We do need a law and the FTC needs that law to take more action as well.  This is an interesting page to look at, a visual of all the hacking going on in the world from Norse.  Take one look and you'll see how busy the hacking world is out there, screenshot on the right here. 

Live Data Attacks Happening Right now

On thing for sure, Anthem might have to cut back on their Stock Buy Backs as this will prove to be very expensive.  Like I said they want some of this multi billion dollar action and they could sit on it for months or a year before they might swing into action, when the heat blows over.  This is a different type of hacker who doesn’t want to be found really, they want money and are not out pushing a cause.  You think Anthem now might give security more attention and spend money there versus buying up our credit card transactions to see what size clothes we buy (and of course any other data that’s present).

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

Enjoy this video below …it’s game called Data Dealer….but it’s also reality…think Anthem stolen data…this is what the crooks want…and why we need to license all data sellers so we don’t have stolen data mixing in the mainstream and to give consumers an idea on where to go look to find flawed data reported about us to correct. 

February-7-2015

19:57

The MedicalQuack officially did go broke but with the big security breach from Anthem,image I thought this post was necessary.  We don’t know yet or at least I have not read what services Anthem will be supplying but if you want to take your identity in your own hands, here’s an option for you with Lifelock.

Here’s a clip from Dr. Halamka, CIO Harvard Medical (the entire interview can be seen here) on the value of hacked and stolen data.  At the beginning he talks about the new codes doctors will be using soon, a lot.  This was done a couple months ago odd that he just happens to reference “that great Blue Cross Plan”…

You can follow this link and it will take you to the page where you can enroll and get a discount by using the code:  QUACK

If you don’t use the code the discount will not apply so don’t miss that part as it’s not pleasant thinking you might need to enroll so take advantage. 

Here’s a couple videos that explain a little bit more about LifeLock and how it works.  In addition, there’s options for a company to enroll to protect employees as well.  

Lifelock’s Three Layers of Service…

Here’s a preview of what the 3 programs they offer…quick screenshot..

image

 

 

 

 

 

I was looking at their website and there’s a new service just been added:  Data Breach Notifications…

So I hope this helps and at least offers some answers and a place to go.  80 million records is huge and it’s only starting.  I have a campaign as well to establish a law that will require data sellers to be licensed.  Why?  As data is breached and repackaged, just like counterfeit drugs, stolen data that companies believe to be legal will end up in the system. 

We need a way to track data that is sold as well as a way for consumers to look up sellers and be able to locate those who have posted flawed information about them.  Read my story as I’ve been there and I have one now I can’t remove. 

Visit the Privacy/Transparency Campaign and please consider a donation if you will.  I have been working on this for 3 years and even a small $5.00 contribution is really appreciated.

Thank you!!

Barbara Duck

The Medical Quack!

Blog url: 
http://ducknetweb.blogspot.in/

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