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Health Management Technology News
  July 1, 2014
In this issue:
 
 When a health plan knows how you shop

 White House review: 'Corrosive culture'
at VA


 Chiropractors to be sentenced for healthcare fraud

 HealthCare.gov to allow automatic
re-enrollments


 Unscaling the healthcare economy

 10 hospital and health system executive moves

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When a health plan knows how you shop

There may be a link between your Internet use and how often you end up in the emergency room.

At least that’s one of the curious connections to emerge from a health care analysis project at the insurance division of the University of Pittsburgh Medical Center.

U.P.M.C. is a $12 billion nonprofit enterprise that owns hospitals in western Pennsylvania as well as a health insurance plan with about 2.4 million members. It is at the forefront of an emerging field called predictive health analytics, intended to improve patients’ health care outcomes and contain costs. But patients themselves are often unaware of the kinds of intimate details about their households that insurers and hospitals may use to try to sway their treatment decisions.

The Pittsburgh health plan, for instance, has developed prediction models that analyze data like patient claims, prescriptions and census records to determine which members are likely to use the most emergency and urgent care, which can be expensive. Data sets of past health care consumption are fairly standard tools for predicting future use of health services.

But the insurer recently bolstered its forecasting models with details on members’ household incomes, education levels, marital status, race or ethnicity, number of children at home, number of cars and so on. One of the sources for the consumer data U.P.M.C. used was Acxiom, a marketing analytics company that obtains consumers’ information from both public records and private sources.

Read the full article from The New York Times
here
 

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White House review: 'Corrosive culture' at VA

The troubled Veterans Affairs health care system is plagued by a "corrosive culture" of mismanagement and distrust that has had significant negative impacts on medical treatment for veterans, according to a White House review.

A summary of the review, which was done by deputy White House chief of staff Rob Nabors and released Friday, says the environment within the Veterans Health Administration hurt morale and affected the timeliness of health care, and the division of the department must be restructured.

The review came in the wake of reports of lengthy wait times for appointments and treatment delays in VA facilities nationwide.

The review offers a series of recommendations, including a need for more doctors, nurses and trained administrative staff. Those recommendations are likely to face skepticism among some congressional Republicans who have blamed the VA's problems on mismanagement, not lack of resources.

The White House released the summary after Obama returned from a two-day trip to Minneapolis and promptly ducked into an Oval Office to get an update on the administration's response to the VA troubles from Acting VA Secretary Sloan Gibson and Nabors.

"We know that unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care," Gibson said in a statement following the meeting. "We can and must solve these problems as we work to earn back the trust of veterans."

Read the full article from FoxNews here  

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Chiropractors to be sentenced for healthcare fraud

Two chiropractors will be sentenced this week for falsifying medical records.

Jennifer Lynne of Milford and George DeCarvalho of Stamford are scheduled to appear in federal court in Bridgeport. DeCarvalho pleaded guilty to conspiracy to commit health care fraud while Lynne pleaded guilty to conspiring to make false statements.

Authorities said Lynne performed unnecessary chiropractic treatments on people involved in auto accidents and falsified medical records for payment to insurance companies.

Prosecutors said DeCarvalho contacted another chiropractor to fabricate medical records to show he suffered certain injuries in an auto accident.

Read the full article from NBC Connecticut
here
 

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HealthCare.gov to allow automatic
re-enrollments

The Obama administration plans to allow consumers to automatically renew for next year the health plans and premium subsidies that they got through the Affordable Care Act's federal exchange.

The move, which will apply to most of the five million people who picked insurance plans through HealthCare.gov for 2014, will make it easier for consumers to stay in their plans next year and retain tax credits lowering their cost of coverage. It also will relieve pressure on the federal exchange, which was crippled during parts of its first enrollment period.

The Department of Health and Human Services said it would allow about 95% of people who signed up for coverage to be automatically re-enrolled if they don't return to the site to switch plans. People who don't take proactive steps to come back to the site and report changes in their income would also have their tax credits renewed based on the information the federal government has on file about them.

The move is likely to be welcomed by big insurers who signed up large numbers of people in the first year by offering aggressively low premiums, since they are banking on many of those consumers choosing to stick with their current coverage by default. Smaller insurers who were hoping to compete afresh for consumers, possibly by lowering their rates to undercut the bigger carriers, could be disadvantaged.

Read the full article from The Wall Street Journal
here
 

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Unscaling the healthcare economy

Healthcare delivery has always been among the top targets for founders seeking to dramatically improve our lives while building great businesses. Yet, with very few exceptions, most founders find it difficult to build scalable software-defined businesses for providing high-quality care.

It is obvious that we are hitting the scale limit of our present system, while virtually bankrupting our nation in the process. The United States spends more per capita on health care than any other nation in the world. And according to the CDC, there are 210,000 active general practitioners in the American health delivery system and they will handle about 555 million patient visits.

This impending healthcare crisis is finally forcing us to think differently, and we are witnessing some of the most out-of-the-box developments in healthcare delivery I have seen in the past decade.

Changing our approach to chronic diseases like diabetes and obesity could save hundreds of billions of dollars alone if we move to software-defined health delivery. I will go on record and say that we can reduce our costs for managing diabetes in America by at least $100 billion if we move to software-defined health delivery.

Read the full article from TechCrunch here  

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10 hospital and health system executive moves

The following hospital and health system executive moves were reported in the past week, beginning with the most recent.

1. CFO of Flemingsburg, Ky.-based Fleming County Hospital, David Boyer, submitted his resignation effective July 18.

2. CEO Brock Nelson of St. Paul, Minn.-based Regions Hospital will step down at the end of this year.

3. Memphis, Tenn.-based St. Jude Children's Research Hospital named James Downing, MD, as its new CEO, effective July 15.

4. Regional West Health Services based in Scottsbluff, Neb., announced the appointment of John A. Mentgen as president and CEO, effective August 1.

5. Bradenton, Fla.-based Blake Medical Center announced Valerie Powell-Stafford will serve as its COO.

Read the full article from Becker’s Hospital Review here  

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Industry News

HHS announces auto-enrollment plans for current Marketplace consumers for 2015

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AMA adopts telemedicine policy to improve access to care for patients


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