Brooklyn medical supply co. owner, staff nabbed for $3.2M Medicaid fraud | Brooklyn Daily Eagle

NYS Attorney General’s Office

Nkem Udeh, the owner of Advance Medical Supply Inc. in Crown Heights; her brother and store manager Humphrey Udeh; two of her employees, Keva Johnson and Yolane Fouche; and the store itself have been accused by the state Attorney General’s Office of fraudulently billing Medicaid over $1.7 million and billing HealthFirst, a health insurer for Medicaid recipients, for another $1.5 million.

The company and its employees billed the state Medicaid program, both directly and through managed care, for nearly a million units of a highly-specialized and expensive liquid pediatric nutritional formula for kids that they claimed the dispensed.

In fact, according to the state Attorney General’s Office, the company did not dispense the expensive formula. Instead, it reportedly dispensed over-the-counter nutritional supplement formulas, such as Pediasure. The defendants face up to 25 years in prison on grand larceny charges.

“The defendants’ formula for fraud was to file inflated claims for medicine designed to help needy children with rare illnesses. The scam drained millions of taxpayer dollars, money the defendants turned around and used for their own personal benefit,” NYS Attorney General Eric T. Schneiderman said.

The investigation found that between January 2010 and September 2012, Advanced Medical, a supplier of orthotics and prosthetics located at 1162 St. John's Place, fraudulently received $3,178,183 from Medicaid and HealthFirst, a managed care organization, for allegedly dispensing 946,874 units of a high-priced liquid pediatric formula to Medicaid recipients.

Certain types of liquid nutritional formulas are prescribed for patients who cannot chew or swallow food and must obtain nutrients via a feeding tube.
These nutritional formulas are also prescribed for children who cannot absorb or metabolize nutrients from more substantial food.

The Attorney General’s investigation revealed that Advanced obtained reimbursement for a liquid that is known as B4162 formula but only dispensed Pediasure or other over-the-counter nutritional supplements -- when they dispensed anything at all.

According to the Attorney General’s Office, Johnson and Fouche participated in the scheme by fraudulently obtaining prescriptions from physicians. They did so by convincing doctors and their staff to write generic prescriptions for “pediatric formula” rather than specifying the exact type of nutritional supplement required by the patient.

The case originated with a referral from the Office of the Medicaid Inspector General, whose investigators looked at Advanced Medical’s inventory and discovered that the company had none of the formula on hand for which it was charging Medicaid.

New York’s Medicaid Inspector General James C. Cox said, “Billing for medicine that isn’t provided is fraud. OMIG took a look at Advanced Medical’s shelves and saw none of the products that Medicaid was paying for. We are pleased that our referral led to arrests by the Attorney General’s Office, and we will prevent this company’s further participation in the Medicaid program by pursuing an immediate exclusion.”

In addition to the indictment, the Attorney General’s Office also obtained an order freezing the bank accounts and other property held by the indicted individuals and corporation up to $3,178,183, and freezing the bank accounts of other corporations and another individual up to the amount of proceeds they received from the conduct of the indicted criminal defendants.

Brooklyn medical supply co. owner, staff nabbed for $3.2M Medicaid fraud | Brooklyn Daily Eagle

Miami doctor and therapists charged with $63 million Medicare-fraud scam - Miami-Dade - MiamiHerald.com

BY JAY WEAVER

JWEAVER@MIAMIHERALD.COM

A psychiatrist who has been practicing in Miami since the 1970s was arrested Tuesday along with six therapists on charges of scheming to steal $63 million from the taxpayer-funded Medicare program.

Roger Rousseau, 71, the former medical director for a defunct mental-health clinic operation, was indicted on charges of conspiring to commit health care fraud.

Rousseau, who had his first appearance along with the other defendants in federal court, was released on a $375,000 bond.

“We don’t think the evidence supports those allegations,” said Miami defense attorney Sam Rabin. “We look forward to defending Dr. Rousseau against these charges in court.”

Rousseau served as the medical director of Health Care Solutions Network in Florida, owned by Armando “Manny” Gonzalez. The owner was sentenced in February to 14 years in prison after pleading guilty to Medicare fraud charges stemming from operations in his chain of clinics in South Florida and North Carolina.

Gonzalez, 50, a previously convicted cocaine trafficker, pocketed $28 million in Medicare payments for purported psychotherapy sessions that patients didn’t need or receive between 2004 and 2011, according to federal prosecutors.

In the mid-2000s, Gonzalez opened a pair of mental-health clinics in the Kendall and Cutler Bay areas. By 2008, he had moved himself and his business to North Carolina to stay one step ahead of federal agents.

But agents with the FBI and Health and Human Services caught up with him, leading to the arrest of Gonzalez and a dozen others involved in his company, including patient recruiters and assisted-living-facility operators who took kickbacks for supplying a stream of Medicare beneficiaries.

Since their arrests last year, almost all of those defendants have pleaded guilty and been imprisoned.

In the spin-off case, Rousseau was charged along with six Miami therapists: Doris Crabtree, 61, Angela Salafia, 65, Liliana Marks, 46, Ruben Busquets, 49, Alina Fonts, 47, and Blanca Ruiz, 59. They also were granted bonds Tuesday.

According to the indictment, Rousseau routinely signed what the psychiatrist knew to be fabricated and altered medical records without ever reviewing the materials and, in most instances, without ever meeting with patients.

The indictment, filed by prosecutors Allan J. Medina and William Parente, alleges the six therapists fabricated the clinic’s medical records to back up false Medicare claims for psychotherarpy services. Those purported treatments were not medically necessary because many of the patients suffered from dementia or Alzheimer’s and could not have benefited from the therapy.

Read more here: http://www.miamiherald.com/2013/07/16/3503464/miami-doctor-and-therapists-charged.html#storylink=cpy

Miami doctor and therapists charged with $63 million Medicare-fraud scam - Miami-Dade - MiamiHerald.com

Rep. Smith Asking for Input on Medicare, Social Security Reform - KHGI-TV/KWNB-TV/KHGI-CD-Grand Island, Kearney, Hastings

By Jordan Onwiler, Web Producer - email

 

Congressman Adrian Smith is asking residents of central and western Nebraska to share comments and ideas on ways to reform Medicare and Social Security.

The House Committee on Ways and Means is asking that input be emailed to entitlementreform@mail.house.gov.

Smith says he hopes that residents in Nebraska's Third District submit their ideas and comments concerning the entitlement reform process.

"Without reform, these popular programs will collapse," Smith said. "Public comments will help inform the committee as we seek bipartisan solutions."

Comments for upcoming proposal meetings are due by August 10. Those proposals include Using the Chained Consumer Price Index to Determine Social Security Cost-of-Living Adjustments and Benefit Increases for Long-Time Social Security Beneficiaries.

More information can be found at www.waysandmeans.house.gov/entitlementreform.

Rep. Smith Asking for Input on Medicare, Social Security Reform - KHGI-TV/KWNB-TV/KHGI-CD-Grand Island, Kearney, Hastings

GAO Reports Physicians Who Self-Refer Anatomic Pathology Cost Medicare Millions | SYS-CON MEDIA

CAP Calls on Congress to Act Immediately

NORTHFIELD, Ill., July 15, 2013 /PRNewswire-USNewswire/ -- The College of American Pathologists today called attention to a new report from the Government Accountability Office (GAO) documenting millions of dollars in wasteful health care spending by physicians who self-refer anatomic pathology services, and called on Congress to take immediate action outlawing this business practice.

(Logo: http://photos.prnewswire.com/prnh/20120314/DC69899LOGO-a)

"GAO issued a report today with irrefutable evidence that physician self-referral is a national problem," said CAP President-Elect Gene Herbek, MD, FCAP. "It contributes to widespread abuses, increased medical costs and over utilization, and it allows physicians to exploit a loophole that permits them to bill Medicare for certain additional services they provide to patients at the time of the office visit."

"However, this provision was never intended to protect self-referral of anatomic pathology services because unlike clinical laboratory services they can almost never be performed at the time of an office visit," Herbek said.

The GAO study found that financial incentives for self-referring providers were likely "a major factor driving the increase in anatomic pathology referrals", and in 2010, providers who self-referred made an estimated 918,000 more referrals for anatomic pathology services than they likely would have if they were not self referring. CMS estimated these additional referrals cost Medicare about $69 million in 2010.

While CAP applauded the GAO's findings and call for action, CAP said it disagreed with some of the GAO's recommendations for correcting the problem.

"The only correct course of action now is to remove anatomic pathology from the In-Office Ancillary Services (IOAS) exception as quickly as possible," said CAP's Gene Herbek.  "There is no better way to protect patients and eliminate a wasteful loophole that lets physician entrepreneurs line their pockets without any added benefit or convenience for patients."

In fact, CAP believes the reverse is true. Self-referral of anatomic pathology leads to added inconvenience, increased testing procedures, and increased costs for patients, which is completely counter to the intent of the law. "We call on Congress to act on behalf of patients and their constituents and pass legislation to close this loophole," Herbek said.

There is a mountain of research documenting wasteful Medicare spending by self-referring physicians. So much that the overwhelming evidence compelled a diverse group of leading patient and health policy groups such as the Simpson-Bowles Commission, AARP, the  New England Journal of Medicine, and the Bi-Partisan Policy Group to call for tighter restrictions and closing the loophole.

CAP was instrumental in drawing attention to the problem in anatomic pathology by co-sponsoring the first independent research published last year on the impact of self-referral of anatomic pathology (AP) services on utilization, patient care, and health care costs.

The research was conducted by well known health care economist, Jean Mitchell, Ph.D., and published in the leading peer-reviewed health policy journal, Health Affairs. It compared Medicare billing practices for anatomic pathology services related to prostate biopsies by self-referring and non self-referring urologists, and using Medicare's own data showed that self-referring urologists billed Medicare for 72% more prostate biopsy specimens compared to non self-referring physicians, with no increase in cancer detection.  In fact, self-referring urologists had a 40% lower cancer detection rate than those who did not self refer despite billing for nearly twice as many specimens. 

The Loophole

The CAP is the leading critic of a loophole that exists in the IOAS exception in the physician self-referral law, aka the Stark Law. The IOAS exception allows physicians to bill for certain medical services where an ownership interest exists.  It was intended to apply to services provided at the time of an office visit as a convenience to patients.  It also specifies clinical laboratory services rather than anatomic pathology.

Clinical pathology tests such as blood tests and urinalyses that do inform diagnosis and treatment at the time of the patient visit are rightly included in the exception. However, anatomic pathology services, which require extracting and analyzing human tissue or specimen during a biopsy or other surgical procedure and a complex multi-step process that cannot be performed at the time of an office visit were never intended to be included in the IOAS exception.

Over utilization by self-referring practices is costing Medicare billions, well over six billion dollars according to the President's 2014 budget proposal.

For more information on CAP's position on physician self-referral of anatomic pathology services, visit our Self-Referral Resource Center at www.cap.org/advocacy.

About the College of American Pathologists

As the leading organization for board-certified pathologists, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. With more than 18,000 physician members, the CAP has led as the gold standard in laboratory accreditation for 50 years with nearly 7,500 CAP-accredited laboratories in 50 countries. Find more information about the CAP at cap.org.

SOURCE College of American Pathologists

GAO Reports Physicians Who Self-Refer Anatomic Pathology Cost Medicare Millions | SYS-CON MEDIA

Best practice in wellness: Educate employees to take responsibility and make better choices

As part of the statewide Indiana University Health system with extensive healthcare expertise and facilities, IU Health Bloomington (IUHB) is well positioned to look out for its own when it comes to wellness.

“Our programs have been in place 15 years,” says Karen Danielson, manager of worksite wellness at IUHB, which was a winner of this year’s Well Workplace awards competition “We recognized early on that we have a responsibility to our employees as a healthcare provider to recognize that prevention and wellness are important to our community and to our employees.”

The IUHB program, known as “Live Well,” is built around the idea that employees must be responsible and accountable for their own health. It provides education, instruction, and access. Notes Danielson, “We have a philosophy that we are going to educate people and give them the education to make better choices.”

One example is the hospital system’s approach to its cafeteria. In addition to traditional offerings, daily healthy plates are offered at favorable prices. So, for example, you might see glazed salmon and a fresh green vegetable (all under about 400 calories) for less than you would pay for a burger.

Return on investment

In the early years, there was not a great emphasis on return on investment (ROI). “There was an empirical understanding and acceptance that when people take care of themselves and are given resources and support, it is going to make a long-term difference in health and in health plan cost,” she explains.

The focus has been on what the program will do for individuals and what it will achieve for the organization, which is a nonprofit.

For employees, the impact of poor health can include everything from higher insurance copays and deductibles to the cost of lost wages and family stress resulting from illness. On an organizational level, all employees are affected by poor health through increases in the cost of health plans and premiums.

In recent years, the program has worked harder to measure sick days, turnover, presenteeism, and the cost of illness. These metrics, as well as those that track the reduction in health risk, have been quite favorable.

One size does not fit all

Live Well participants complete a health risk assessment that includes biometric data such as blood pressure, glucose, and body mass index. It also captures information about lifestyle, sleep patterns, stress, and nutrition and exercise habits.

The information is used to segment the population by health risks and status. They are directed to appropriate programs, but only if they have indicated that they wish to be contacted. For example, if a new prediabetes class is being offered, program managers will e-mail or phone those with high blood sugar and other contributing factors to let them know about the offering.

One important segment is those who are basically healthy but are starting to show signs of changes, such as a first diagnosis or new prescription. “They are creeping out of the ‘well’ group and are very motivated,” says Danielson.

The largest segment is the 80 percent of employees who are healthy and use about 20 percent of health plan dollars. The goal for this group is to maintain their good health status, says Danielson. They can take advantage of a variety of health-maintenance programs, including:

• HeartMath, a stress-reduction program that addresses the physiology of stress;
• A 3-month challenge to reduce diabetes was launched with a group walk led by the organization’s CEO;
• "Minutes to Win It," a competitive program co-sponsored with the city of Bloomington to encourage people to walk, garden, cycle, play sports, and swim;
• Caring Caucus, a work/life balance program;
• Healthy nutrition challenges that pit departments against one another; and
• Classes such as Zumba, yoga, and Pilates®.

Best practice in wellness: Educate employees to take responsibility and make better choices

UK celebrates 50 years of lifelong learning with Donovan Fellows and Osher Institute

Early Donovan Scholars participated in a radio drama at the University of Kentucky. (Photo UK Alumni)

Special to KyForward

“For almost half a century, the University of Kentucky has offered special educational opportunities for older adults as part of its outreach to the community,” observes Mike Richey, UK vice president for Development. “Thousands of seasoned learners have benefitted from hundreds of academic and nonacademic enrichment courses, and more than 50 postsecondary credentials have been conferred upon participants.

“UK’s educational initiatives for lifelong learning grew out of the vision of former UK President Herman L. Donovan. And in recent years, the nonacademic enrichment program for mature individuals at UK has been strengthened by generous gifts from the Bernard Osher Foundation,” Richey continues. “In appreciation, the enrichment program was named the Osher Lifelong Learning Institute in 2007.

“Today, record numbers of participants are studying a variety of subjects and engaging in a vast array of other offerings. ‘The OLLI’ — as the institute is affectionately known by its students — is becoming an even more vital service of the university to the Commonwealth with the maturing of the baby boom generation.

“The history of lifelong learning at UK is both fascinating and inspiring. And its future offers exciting new ways for the university to accomplish its historic mission of teaching, research, outreach and service.”

Beginning with a vision

“Education is a life process, and we must not ignore intellectual development simply because of age. Retirement can be the happiest years of one’s life.”

These are the words of President Donovan. He attended a White House conference on aging in 1960 and came back to Lexington with a vision for making classes at the university available without cost to individuals age 65 and older. This vision for the intellectual development of older adults became reality in 1964 when the first senior citizens began taking academic classes for credit at the university with tuition waived. Twenty-six students, ages 65 to 84, joined 18-year-old freshman counterparts for the first time. The senior learners were known as Donovan Scholars, and all courses at the university were open to them for audit or for regular credit.

As one of the first universities to make education available to older adults without charge, UK gained national attention. In 1966, Time magazine called the program “Educare,” a reference to Medicare which was in the news at the time. The first students were from the local Lexington area, but publicity brought inquiries from every state and many foreign countries. Some senior citizens even relocated to Kentucky to enroll at the university.

By 1967, nearly 200 older students were participating in the program, and Amanda Hicks became the first Donovan Scholar to receive a degree — a Bachelor of Arts in Education.

In the late 1960s, the university began offering nonacademic courses especially designed for the talents, needs and interests of senior members of the community. These were known as enrichment courses, and art, music and writing were among the first classes taught. There were also offerings in radio drama, and longtime UK campus recreation director, Bernard M. (Skeeter) Johnson, developed an exercise course which he called “gero-fitness.”

In 1970, a weekly series of lectures and discussions was initiated and named the “Donovan Forum.” It continues to this day, and features UK deans, professors and others highlighting their work and addressing special issues of concern to older individuals.

In 1975, Alfred Arthurs became the first Donovan Scholar to earn a doctorate degree. And in 1980, the “Emeritus Corps” was created to coordinate and facilitate the volunteer efforts of senior learners to advance the local community.

Enjoying a long, rich tradition

Both the academic and nonacademic enrichment programs for older adults have continued to flourish over the decades. In response to changing patterns in retirement, the enrichment program now accepts individuals as young as age 50. Today, 1,300 intellectually vigorous members annually enroll in more than 100 enrichment courses being offered in three different communities — Lexington, Somerset and Morehead. And the academic program for older learners enrolls 100 annually.

Michael D. Smith, executive director of the Osher Lifelong Learning Institute at UK, shares, “Our students already have a lifetime of knowledge and experiences. Many have been leaders in their careers, and they bring a rich background to every class. We are also tapping the expertise of several of these individuals to help us improve the OLLI at UK through their volunteerism with us — on our advisory board, as instructors and facilitators, and in various other ways.”

(Photo from UK Alumni)

Lifelong learners are an important part of the university community. They serve in roles as mentors to graduate students, guest speakers in academic classes, and as subjects for significant research initiatives by UK faculty. They also provide an important and tangible example to the university’s younger undergraduate students.

UK President Eli Capilouto notes, “The commitment of our older adult students to learning, and the example they set for younger students on campus and among their peers, add immeasurably to the extended family of the university. Whether they explore Chinese culture, take a fresh look at foreign policy or the human brain, create watercolor paintings, practice yoga, or swim laps at the Lancaster Aquatic Center, they are showing the new generation of students what lifelong learning means.”

A typical OLLI student is retired, on a limited or fixed income, in his or her 60s or early 70s, has had some postsecondary education and has maintained an intellectual curiosity. Several students continue into their 80s and early 90s. Presently, there is a 35-year span in the ages of participants. And many individuals have been engaged in the educational program for five to 10 years.

For others, lifelong learning is a family tradition. Steve Gall is a participant in current classes and serves on the OLLI Advisory Board. His father, Sidney L. Gall, served in a similar position in the 1990s.

Sarah Hall is also a member of the OLLI Advisory Board and is the facilitator of a special interest group. She is enrolled in a course with her mother. “It’s enjoyable to take a class with my mom,” Hall confides. “She has always been interested in learning, and it’s fascinating to observe her processing new information into a lifetime of experiences.”

Growing by leaps and bounds

In the past five years, the UK lifelong learning programs have grown from 900 to 1,400 participants — an increase of over 55 percent. The growth is due in part to a larger number of Kentucky residents in the age group served, as well as greater visibility of the programs.

A low fee structure has purposely been maintained to make it relatively easy for older adults to participate in enrichment classes. Currently, an annual membership in the enrichment program is $25, and individual courses are typically $15, with a surcharge for selected courses. This fee structure is among the lowest of more than 100 similar programs nationally.

Large numbers of volunteer instructors and talented volunteer members also help keep the enrichment program affordable.

The great variety of classes and other educational opportunities offered has also contributed to record enrollments. Smith points out, “Courses are offered each semester in areas as diverse as the humanities, technology, foreign languages, studio and performing arts, and wellness and fitness. Participants can likewise join special interest groups, participate in a musical production, take day trips, attend seminars and use the university’s fitness facilities. There are no tests or homework, and our enrichment offerings are so varied that almost anyone will find something of interest.”

(Photo from UK Alumni)

The popularity of the lifelong learning enrichment courses is spread by word of mouth. “An OLLI class is more than learning something new — it’s sharing in all the experiences and knowledge each member brings into the classroom,” explains Susan R. Bottom, who is a student, a volunteer instructor and the chair of the OLLI Advisory Board. “I love the smiles on the faces — we’re all glad to be here. Curiosity, creativity and wonder exist throughout our lifetimes, and OLLI encourages and gives us opportunities to explore them all.”

The OLLI’s motto, “curiosity never retires,” is more than a slogan. Research continues to show that maintaining an active intellect in a person’s later years is related to physical and cognitive health and overall satisfaction. Lifelong learning brings enrichment to later life.

Benefitting from the generosity of others

Private philanthropy has been an important part of the history of lifelong learning at the University of Kentucky. The generosity of others has accounted for a major source of revenue that has supported the operations of the programs for senior learners down through the decades.

Soon after the advent of the first enrichment art courses in the late 1960s, the university experienced cutbacks in funding which affected the older adult educational programs. One of the participants — Marguerite G. Simpson — was convinced of the value and necessity of the programs and made annual gifts sufficient to keep them operating. She also bequeathed the bulk of her $400,000 estate in 1979 as an endowment to ensure that lifelong learning at the University of Kentucky would survive.

Programs at the university continue to benefit nearly 35 years later from her visionary philanthropy, and from other participants who followed her lead. Bernice Peo Koehnlein was an enthusiastic student for 33 semesters and a volunteer and recruiter for the programs. She bequeathed $10,000 for UK lifelong learning when she died in 2005 at age 96.

And most recently, the Bernard Osher Foundation has given substantial support to the University of Kentucky for the lifelong learning enrichment initiative. Beginning in 2006, the Osher Foundation has made operating grants totaling $250,000 and endowment gifts totaling $2 million. And the philanthropist behind the foundation — Bernard Osher — has given a personal gift of $25,000.

“We are deeply appreciative for the support of Mr. Osher and the Bernard Osher Foundation,” observes Richey. “These very significant gifts will help ensure that lifelong learning at UK will continue to thrive as we honor our promise to Kentucky in new and creative ways.” Richey continues, “These gifts also serve as a very noteworthy endorsement of UK’s educational enrichment program for older adults.”

The Bernard Osher Foundation has provided funding for similar programs at other universities in all 50 states, including 12 of UK’s 19 benchmark institutions. This generosity has resulted in a network of lifelong learning initiatives around the country offering opportunities for professional collaboration among the various member universities.

(Photo from UK Alumni)

UK’s educational enrichment program for older adults was renamed the Osher Lifelong Learning Institute at the University of Kentucky in 2007. This follows the tradition of other universities receiving Osher Foundation grants. The academic course tuition waiver initiative for older learners at UK continues to be known as the Donovan Fellows program.

Smith shares, “We are grateful for the support the Osher Foundation provides. We likewise appreciate being a part of the national OLLI network.

“We are also pleased that our current OLLI members are supporting lifelong learning at UK with their personal gifts. Private philanthropy will continue to be very important to our program as the number of older adults increases.”

The OLLI at UK is a part of the College of Public Health.

Anticipating the future

Lexington is one of the five best communities in the nation for learning in retirement, according to rankings by Money magazine in 2010. This distinction is due in large part to UK’s lifelong learning offerings. Other national publications have also listed Lexington as a desirable city in which to live during retirement.

Looking ahead, UK’s lifelong learning programs can expect even more significant growth in the number of students to be served than the increases experienced in the past five years. By 2025, total membership in UK’s initiatives could grow to 2,275 because of a larger elder population. If the programs expand geographically, increase marketing, or offer new kinds of educational experiences, that number could increase still further.

The goal is for lifelong learning at UK in the next 50 years to be every bit as enriching and satisfying for future generations as it has been for generations in the last half century.

“The vision of those who created, developed and valued education for older adults in Kentucky through the decades has ensured the survival of lifelong learning at UK and made it accessible for nearly half a century. Their legacy is profound,” Richey notes.

“Future students will benefit from the innovation, hard work and philanthropy of many individuals who came before them. When we celebrate the 50th anniversary of lifelong learning at UK in 2014, great recognition will be due to those who made these treasured programs endure. And as we plan for the next 50 years of lifelong learning at the University of Kentucky, I am reminded that we indeed stand on the shoulders of giants.”

This article first appeared in the spring 2013 issue of Kentucky Alumni magazine and is reprinted with permission. Content was supplied by the UK Office of Development.

http://www.kyforward.com/2013/07/uk-celebrates-50-years-of-lifelong-learning-with-donovan-fellows-and-osher-institute/

The Big Data Conference -

Co-located with Cloud Connect Chicago

In 2020, data production will be 44 times greater than it was in 2009. (Source)

Are you ready to transform your business with data?

Attend The Big Data Conference, October 21 – 23 in Chicago and take part in a world-class event designed for business and technology professionals charged with developing their company’s big data strategies.

The Big Data Conference provides three days of comprehensive content for every IT, marketing or digital professional seeking to capitalize on the boom in data volume, variety and velocity. Through the examination of large enterprise case studies bringing the practical application of big data techniques to life, The Big Data Conference fills a gap in the US market for businesses looking to capitalize on the big data opportunity and look for efficient solutions to manage the ever growing amount of structured and unstructured data.

Why Attend?

For companies, the big data movement represents an opportunity to identify correlations, connect new dots, and unlock unprecedented business opportunities. But how do businesses get started? And who should own big data initiatives that straddle the entire organization?

There’s no doubt that big Data is growing fast; each year, the generation of global data is doubling, and as it does so it becomes increasingly challenging to manage, interpret, store and secure. As data sets become more complex, standard database management tools and traditional data processing applications aren’t equipped to process and analyze these enormous data sets in their respective domain. This data is often accessed from different sources and is therefore difficult to utilize to its maximum potential.

But the big data market is not just about technologies & platforms – it’s about creating new opportunities and solving problems. Smart companies seeking to set a holistic big data strategy and discover ways big data technology can be an enabler to business solutions need an independent forum to engage, learn and glean best practices.

The Big Data Conference provides three days of comprehensive content for every IT, marketing or digital professional seeking to capitalize on the boom in data volume, variety and velocity. Through the examination of large enterprise case studies bringing the practical application of big data techniques to life, the Big Data Conference fills a gap in the US market for businesses looking to capitalize on the big data opportunity and look for efficient solutions to manage the ever growing amount of structured and unstructured data.

Topics to include:

• Large enterprise case studies
• The big picture: A lifecycle for big data management
• Structuring the organization to take advantage of big data
• Setting a big data strategy
• Data visualization & interfaces
• Domain-specific data types centered on people, money, time, and location
• Hadoop and other big data platforms & architectures

Target Audience – An exclusive group of 150 Big Data Decision Makers:

• Marketing & other line of business executives
• CTO, CIO & technology executives
• Technology strategists & enterprise architects
• Business & technology leaders seeking to drive new business opportunities & outcomes through big data
• Mid to large-sized companies
• Enterprise spanning diverse major industries

The Big Data Conference -

Hospitals see alignment with doctors as boon to patient care

■ Executives say in a survey that the growth of physician employment eventually will lead to improved coordination of care, market share and better outcomes.

By KAREN CAFFARINI — Posted July 15, 2013

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Hospital executives believe physician relationships are key to their success in the quickly developing accountable care environment.

Those relationships are expected to result in continued growth in physician employment by hospitals, co-management arrangements and other opportunities with independent practices.

But there will be growing pains: An overwhelming majority (76%) of 139 surveyed chief financial officers said they don't expect a return on their investment on physician employment in the first few years, according to a June 14 report on hospital-physician affiliation strategies. But most executives in the survey say the strategy will pay off later with improved coordination of care, market share and patient experience, among other factors.

The survey, conducted by Healthcare Financial Management Assn. and sponsored by the health care services and information technology company McKesson Corp., asked hospital executives about physician affiliation strategies to assess current and future trends and the impact changing care models have on employment. Fifty-four percent of respondents are with urban hospitals, and 46% work at rural hospitals.

The survey supports other research that indicates future physician compensation will be driven by value, not productivity and volume as in the current model. Cost-of-care or efficiency-related incentives in physician agreements are expected to grow from 16% to 67%, and quality-related incentives should increase from 65% to 85%. Productivity-related incentives, on the other hand, are expected to drop from 77% to 59%.

“The survey demonstrates the shift from the 'fill your beds' mentality of the past based on fee for service,” Janice Wiitalia, director of research for the HFMA, who led the research project, said in a statement. “Everyone is starting to realize that the focus in a value-based environment is keeping patients healthy, not the volume of care provided.”

Debra Williams, a marketing manager with McKesson, said the survey results show that the growth in physician employment will be steady, with 37% of respondents believing it will continue to grow at a rate of 10% to 24% a year. Meanwhile, 30% of hospitals will continue to pursue clinical relationships, directorships and co-management opportunities with independent practices.

“They want to align with physicians who want to remain independent,” Williams said.

Ashley Thompson, vice president of policy and deputy director of the American Hospital Assn., said the landscape is vastly different from the 1990s, when hospitals purchased a lot of practices and lost a lot of money in doing so.

“This time around there's more of a desire to improve patient care, and hospitals are working more closely with physicians to achieve this,” she said.

Thompson said hospitals are looking at different strategies to achieve a close physician alignment. Kaiser Permanente, for instance, employs many physicians, while Advocate Health Care has an expansive network of practices in the Chicago area.

“Advocate doesn't employ physicians. It works with them,” Thompson said.

Hospitalists in the boardroom

More physicians will find their way to the boardroom and executive seats as well, according to the survey and industry experts.

“You'll see more hospitalists in management positions,” said Larry Wellikson, MD, CEO of the Society of Hospital Medicine. “We already see many of them becoming CEOs and chief medical officers at hospitals.”

Williams said having physicians in key roles at the executive level will be critical for hospitals to understand the accountable care environment and to make decisions on the coordinated care level.

Dr. Wellikson said it's difficult to make money from physician services, but with care coordination there could be better outcomes and more efficient care for patients. He said in the accountable care environment, in which physicians and administrators would devise a strategy to reduce the number of patients with infections instead of just treating the infection, for instance, this would mean more money for the hospital and doctor.

While hospital CFOs reported more collaboration with physicians in an effort to improve care coordination, only 20% said they are “very prepared” and have the necessary infrastructure to support quality and outcomes-based management. Fifteen percent said they are very well-prepared to analyze and communicate physician-specific data, 14% are very prepared to manage case coordination and only 7% are very prepared in population health management.

Most practice functions, such as physician IT and billing, report to hospital/system leadership or are co-located, the survey found. Most hospitals are somewhat or completely satisfied with these functions of their employed physician groups. And they are more satisfied with hospital- or system-based billing, coding and collections than those by group practices.

Nervousness about ACOs

Williams said McKesson has held several briefings on the survey's findings with hospitals and found anxiety on executives' parts concerning the transition to an accountable care environment, including how to report on the metrics they collect and how to educate physicians on the difference between incentives for quality and for fee for service.

“Overall, we got the general sense of executives asking, 'Should we do this, and are we ready to do this?' ” Williams said of the move to accountable care. “The overall consensus was: We're moving in this direction, so we better be prepared.”

Williams said companies like McKesson can help hospitals work their way through the rigorous transition process to become an accountable care organization by doing some legwork for them and providing a revenue management analysis, among other aids.

Dr. Wellikson said CFOs tend to be a cautious group, but that change is moving fast in this case.

“Hospitals in Southern California started doing this [transition to accountable care] in the '90s,” he said. “It took 15 years to do. Now this is happening in the blink of an eye. It's going to be a very bumpy ride.”

But Thompson said many hospitals have been steadily moving in the direction of accountable care during the past four to five years. She said there are more than 250 accountable care organizations.

http://www.amednews.com/article/20130715/business/130719990/1/

Data analytics: Eye-popping results from Intel, UPS and Express Scripts

These three top-tier businesses are reaping huge rewards from data analytics. Here's what your company might be missing out on.

Simply put, data is the lifeblood at Express Scripts, a $44 billion pharmacy benefits management company based in St. Louis.

The Fortune 100 company processes close to 1.5 billion prescriptions for some 300 million consumers per year, all the while analyzing the wealth of information that accompanies each order.

"As we track a prescription through data entry and the pharmacy process and into the fulfillment system, we're tracking all sorts of information that gets fed to an analytics team that is focused on process improvement," says CTO Jim Lammers. Internally, it's how the company speeds delivery and cuts errors, he says.

But Express Scripts also processes more than 1 billion pharmacy insurance claims annually, and they represent a gold mine of information that could help cut healthcare costs and address the multibillion-dollar healthcare problem created by people who don't take their medications as prescribed, says Lammers.

Computers, mobile phones, tablet devices, sensors, tweets, texts and posts to social networks, not to mention run-of-the-mill retail and registration transactions online, are all generating potentially valuable data. A lot of data. By 2020, IDC estimates that the number of business-to-business and business-to-consumer online transactions will reach 450 billion per day. We took a look at three organizations that are ahead of the curve in generating big business value from big data and analytics technology. At the top of their lists of lessons learned: A deeply-rooted culture of analytics and a relentless focus on cost efficiency and process improvement are invaluable.

The Win: Lower Healthcare Costs

At Express Scripts, claims data can show whether patients are filling their prescriptions in the most cost-effective way, which is frequently by mail order. If they aren't, Express Scripts can intercede by providing the patient with additional cost information and offer to switch delivery fulfillment methods for them with a minimum of hassle.

"If they're taking a maintenance medication for high cholesterol and we know they've been taking it but they've been taking it from a retail pharmacy, we know if they move to a mail order, they can save," Lammers says. "We'll do proactive emails and drive the patient to our website and use specific messaging to get them to make [a mail order] decision."

What it boils down to is "doing the data analysis, creating the interaction and getting out the right message so that the patient can make a different choice," Lammers explains. "One of the key tenets is that if we offer people the right choice, they'll take the right path."

It sounds easy, but behind the seemingly effortless redirection is a massive amount of technology, not to mention a strict culture of analytics that permeates virtually all of Express Scripts' operations.

One of the company's largest IT investments has been in IBM's master data management software, which is critical to creating a single record that connects all of a customer's actions, regardless of whether a transaction is made via email, on the Web, by phone or in person at a retail pharmacy.

"One of the biggest challenges is linking all information together across all these different sources," says Lammers. "We've made very heavy investments in master data management. We invested early on and we've been through two or three iterations."

Express Scripts also created what Lammers calls a federated analytics model that includes a business analytics team embedded in each key functional operation, such as supply chain, sales and finance. A single data warehouse and centralized data governance are two other keys to the company's analytics success, he says. "With a centralized core, everyone is looking at the same data," Lammers notes.

With a proven data governance model and a data management foundation in place, Express Scripts recently expanded into predictive analytics, introducing an application called Screen Rx that's designed to reduce the problem of patient non-adherence to prescriptions for chronic conditions such as diabetes and high cholesterol. At a cost of more than $317 billion annually, non-adherence is the most expensive healthcare-related problem in the U.S., according to Express Scripts.

For example, skipping doses of a prescribed cholesterol medication might trigger heart attacks for some patients. Using predictive modeling based on 400 factors, such as a patient's location, family situation and the number of medications involved, Express Scripts can now identify, and proactively intervene with, patients who are likely to skip doses. Interventions might include a timely reminder to the patient to take his medication or a referral to a patient assistance program to help him pay for his medications. A third option is a referral to a clinical pharmacist who can assist with questions or concerns about a drug's side effects.

"This is really one of the key things we've been building to -- to change behavior," says Lammers. He adds that striving to foster healthy behaviors in patients is especially important in light of impending healthcare reform as millions of people gain access to consistent healthcare for the first time.

"We have to train them to take care of themselves," he says. "When we can put Screen Rx into a population that hasn't had consistent access to healthcare, we can get them to get the right stuff right away."

The Win: Fuel Savings and Better Driver Safety

Transportation and logistics giant UPS, which has annual revenue of $54 billion, invests roughly $1 billion per year in IT, and a very hefty portion of that is devoted to data analytics, according to Juan Perez, vice president of information services. The goal -- for now -- is to improve business processes, cut costs and increase efficiency.

The effort has been a success. By analyzing a continuous stream of sensor data from its thousands of delivery trucks, the global company has eliminated 5.3 million miles from its routes, reduced engine idling time by almost 10 million minutes, saved 650,000 gallons of fuel and reduced its carbon emissions by more than 6,500 metric tons.

At the heart of these eye-popping metrics is ORION, which stands for On-Road Integrated Optimization and Navigation, a data-intensive system that lays out the most efficient routes for individual drivers to deliver their loads via a series of complex algorithms. Additionally, the system taps into the mountain of sensor data to predict when a truck part might fail so that preventive maintenance can be scheduled and completed.

ORION also lets UPS managers peer into the habits of individual drivers, pinpointing, for example, the number of times a driver backs up a truck or makes a U-turn. This information can be used to identify drivers who need additional training.

"We have sensors that capture information about the vehicle and the driver's behaviors. We marry that information to delivery and acquisition information, and we can get a complete picture of how a driver is completing his work, day in and day out," Perez says. "That has incredible consequences for the way we manage the business across the board."

Now, the company's appetite for data is extending outward. Its goal is to get closer -- much closer -- to its millions of customers with another analytics-intensive service called UPS My Choice, which lets people set individual preferences for how they interact with the company.

Customers using the service can, among other things, give specific instructions about how and precisely where to deliver their packages to specific addresses, reroute packages if they change locations, and sign up to receive status alerts.

"What we've done is take a new approach to managing personal supply chains. Having that level of connectivity with our customers is going to change our business now and in the years to come. The integration with consumers is what is enabling revenue growth," says Perez. In the first year UPS My Choice was available, more than 2 million customers signed up for the service, and more than 25 million packages were delivered under its auspices.

Data about customers' delivery preferences helps UPS to continue to refine its internal processes in response to those preferences "so we can build a one-to-one experience," Perez says.

But even more critical is the insight that the data provides into what new products and services to offer.

"All of the [tracking and delivery] notifications we provide and how customers respond to notifications tell us what they want so we can create the products and services they want. It's a lot of data to define new products and services."

The next step, as Perez sees it, is to tie everything together and create a graphic picture of UPS's various big data systems so the company can uncover new uses for the data -- and thereby derive more business value from it.

"It starts with process improvements, but once you start tying all of this together, it can mean very big changes in the business," Perez says. "That's what we're getting at."

The Win: Millions in Added Sales

Traditional business intelligence is alive and well at Intel, but big data mining and predictive analytics are the forces driving design and manufacturing efficiencies, and uncovering new revenue sources that added up to tens of millions of dollars in 2012 alone.

"It starts with believing that you can change outcomes," says CIO Kim Stevenson of the chip manufacturer's massive success with analytics. That, she says, requires less time spent on historical questions, which is the purview of traditional BI, and more focus on the future, which is what predictive analytics is all about.

Predicting the future at $53 billion Intel requires analyzing massive amounts of data to discern patterns and then applying predictive algorithms to solve high-value business problems.

In 2012, for example, Intel IT created a new reseller sales tool that worked to increase the chip maker's revenue by enabling its sales team to identify, then strategically focus on, larger-volume resellers. The new software engine mines large sets of internal and external data, then applies a predictive algorithm to pinpoint the most promising resellers. So far, it has helped identify three times as many high-potential resellers in the Asia-Pacific region as manual methods typically would have uncovered, according to Stevenson. That translates to about $20 million in potential new and incremental sales. More gains are expected as the tools are rolled out to other geographies.

On the manufacturing front, Intel is using a predictive analytics tool to reduce microprocessor testing time. The company saved about $3 million in testing during a proof-of-concept period. By 2014, as the tool is implemented more widely, Stevenson expects it to rack up another $30 million in savings companywide.

Intel's analytics success has been fast-tracked, to say the least. The key, Stevenson says, is tackling big-money problems with relatively small and swift-acting teams.

"To get the business to focus on the future and ask better questions that would lead to better outcomes, we knew we would have to do things quickly," she explains. "We were coming out of a traditional BI environment where solving master data is the unsolvable problem. People work on it forever and the business doesn't necessarily see the value."

So Stevenson came up with the "six months and $10 million" rule. "A $10 million problem solved in six months is important. Any general manager would say they'd invest six months if we could save them $10 million," she says. (At Intel, business managers must support and fund IT projects.)

Stevenson recruited five-person teams made up of a business expert, a statistician, a predictive modeler, a machine learning expert and a data scientist. "Each person on the team had a slightly different perspective on the problem we were trying to solve. Doing it in six months was our way of earning the right to prove the capability was there to really change the way we do things," she says.

In addition to the projects that reduced testing time and pinpointed lucrative resellers, 13 other analytics projects have been completed using that approach. So Stevenson has upped the ante by finding $100 million problems and challenging teams to solve them.

"When you have a track record, you can ratchet up," she says. Other ongoing projects include a predictive engine for streamlining Intel's chip design and debugging process and another to predict new information security threats.

But Stevenson cautions enterprises not to underestimate the skills required for analytics initiatives and the time it may take to nurture those skills.

"When I think about our learning curve with Hadoop and some of the more advanced presentation layers that are very different from SAP or traditional BI, I'd emphasize that there is a learning curve there for technical skills that isn't insignificant," she warns.

Her other piece of advice: "Develop an appetite for experimentation," especially since analytics technology is still evolving. "The winners and losers on the tech side are not completely shaken out yet," she says. "Keep your aperture wide."

http://www.computerworld.com.au/article/520871/data_analytics_eye-popping_results_from_intel_ups_express_scripts/?fp=4&fpid=1398720840