DATA, the Adapting of a New Currency

Todd Gifford, MBA      6/13/2012     tgifford@ermconsultinginc.com

“US warns of cyber-attacks on medical devices”

A man uses a robot to practice surgery in Melle on April 15, 2013. US authorities on Thursday warned makers of medical devices and hospital networks to step up efforts to guard against potential cyber attacks.

http://www.rawstory.com/rs/2013/06/13/u-s-warns-of-cyber-attacks-on-medical-devices/

Can you imagine the next episode of Criminal Minds you encounter, experiencing the plot twist of the often overlooked, angry underling rising up to reach out and commit murder by causing the wireless malfunction of the CEO’s perfectly working internal cardiac device” internal defibulator”.It would prove disarming if a medical device could be manipulated to cease performing it’s incredibly important function being turned into an instrument of murder. The malfeasant would soon be caught by the electronic foot print, for this I am sure but the possibility is frightening none the less in light of the world in which we live .

I am comfortable with the math of Big Data, two plus two can equal 3.9 or 4.1.  We accept these parameters not because we rely on big data for the sole factor in our decision making but as reinforcement for our collective theories toward improvement.

I find it unnerving that Target a massive retailer can send correspondence to a man that causes strong anger and resentment due to the giant retailer sending a congratulations on being pregnant to his home targeting “no pun intended” his teenage daughter barely out of Jr. High ,not even 16 years old yet for Heaven’s Sake . The much upset father called the corporate office and complained at length about the mistake.                                    

He felt all the worst when he had to pick up the phone and call the individual he reamed and apologized because it seems his young daughter was indeed pregnant. Kindly explain how Target can know more about a Fathers Household than the Patriarch himself. How do they have the ability to know so much about us? Data mining big data is the easy answer.

To truly understand the scope is beyond my humble mind , but it does make for a genuinely Scary Story.

AFP - US authorities on Thursday warned makers of medical devices and hospital networks to step up efforts to guard against potential cyber attacks.

The US Food and Drug Administration said implanted devices, which could include pacemakers or defibrillators, could be connected to networks that are vulnerable to hackers.

An FDA warning notice was sent to medical device manufacturers, hospitals, medical device user facilities, health care technical staff and biomedical engineers.

It said the agency has recently "become aware of cybersecurity vulnerabilities and incidents that could directly impact medical devices or hospital network operations."

"The FDA is recommending that medical device manufacturers and health care facilities take steps to assure that appropriate safeguards are in place to reduce the risk of failure due to cyberattack," the warning said.

These devices or systems could be compromised "by the introduction of malware into the medical equipment or unauthorized access to configuration settings in medical devices and hospital networks," the FDA said.

"This may sound like it is out of a science fiction movie, but the threat is conceivably a serious one," said Jon Ogg at 24/7 Wall Street.

"Can you imagine a device being retooled maliciously, like an inserted pacemaker/defibrillator? Or imagine if a robotic surgery system was maliciously recalibrated in even a slight manner for surgeries.

"The list of threats is endless."

The FDA said it was "not aware of any patient injuries or deaths associated with these incidents" nor does it have any specific information on targeted devices.

The FDA said it had been working with other federal agencies as well as manufacturers, which it said are "responsible for remaining vigilant about identifying risks and hazards associated with their medical devices."

Among the measures that should be taken, the FDA said, are limiting unauthorized device access, "particularly for those devices that are life-sustaining or could be directly connected to hospital networks."

 

Is big data the new oil?

June 12, 2013 | Tom Sullivan, Editor

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Paul Lambert, president emeritus, Point B, Inc. speaking at the Government Health IT Conference

“This is a story about oil and data,” Paul Lambert, president emeritus of Point B Inc., began, “two resources basically useless in their raw state but that can be very valuable when refined.”

Data has striking similarities to oil, namely in how you store it, transform it, make sure to use it in the right way, Lambert continued during a session at the Government Health IT Conference and Exhibition on Tuesday afternoon.

“Healthcare in general really needs this tool,” he added. And as industry moves from the current five zetabytes (one zetabyte is a billion petabytes) to an order of magnitude, and beyond. “There seems to be a lot of convergence on what we need do to but not a lot on how. We’re seeing a lot on the e-commerce side, but there’s not a lot of big data going on in healthcare.” 

And while common pitfalls include adoption, psychological, and technology barriers, Lambert said “we’re seeing a lot of venture investment in patient engagement, and that’s the absolute first step in putting data to work for the healthcare industry...The second step is data liquidity – both transparency and the interoperability of it.”

Though few and far between, early examples of what Lambert called “quasi-Big Data” in healthcare include evidence-based medicine on real-world validation of research, predictive analytics like Kaiser’s Healthconnect, which saved it a cool $1 billion by reducing visits via telemedicine and a trend similar to the law enforcement practice known as hotspotting. In hotspotting, police departments use data to look at high crime areas and focus resources accordingly on those — some healthcare organizations are delving into correlations in environment, behavior or patient history for population health management purposes.

An oncologist in attendance continued the analogy by saying that unlike a farmer sitting on an oil field, he really wants to share his data and, likewise, many of his cancer patients would be happy to contribute if it helps other people with cancer, but industry has not stepped up to the plate to make that reasonably achievable and the regulatory minefield around sharing patient data poses its own risks. In other words: He cannot even give health data away.

“There’s a buyer beware situation going on that kind of reminds me of when I got out of college,” Lambert said. “Companies were buying a lot of IBM hardware and the joke was that they’d buy a mainframe but not know what they were going to use it for.” 

Just as oil transformed our economy not so long ago, Lambert added data holds a similar promise, and getting there will be more evolution than revolution.

“The U.S. government felt so strongly that about the importance of oil that it created a strategic oil reserve,” Lambert said. “For Big Data, we should treat it as an asset that, as a country, is there for us when we need it.”

http://www.govhealthit.com/news/big-data-new-oil

Competition in Medicare programs: Boon or boondoggle? | TheUnion.com

Competition in Medicare programs: Boon or boondoggle? | TheUnion.com

Does competition to provide insurance for Medicare recipients reduce costs? Or does competition simply increase the tab picked up by taxpayers?

Dr. Ida Hellander, policy director for Physicians for a National Health Program, a nonprofit research and advocacy group, thought taxpayers should know the answers to these questions.

In her research study published in the International Journal of Health Services, Hellander found that competing insurance programs, called Medicare Advantage plans, did not save money. In fact, since their introduction, the private (mostly for-profit) insurance programs have cost taxpayers an extra $282.6 billion.

Hellander adds, “In 2012 alone, private insurers are being overpaid $34.1 billion.” This money, Hellander believes, should have been used to reduce the federal deficit, shore up Medicare’s trust fund or improve patient care — not to enrich private insurance companies.

In 1985, Medicare contracted with private (mostly for-profit) insurance plans such as UnitedHealth and Humana for coverage of Medicare enrollees in a plan called Medicare Advantage. The idea was that Medicare Advantage plans would compete with the traditional fee-for-service Medicare insurance.

(B)ecause of the added benefits, the lower premiums and the need to make a profit, the Advantage programs cost Medicare about 25 percent more than the traditional Medicare program.

Ironically, part of the argument for introducing the Advantage plans was that the competition would lower Medicare costs. Indeed, since their inception, the Advantage plans have become increasingly popular because they offer enrollees additional benefits at reduced premiums. But because of the added benefits, the lower premiums and the need to make a profit, the Advantage programs cost Medicare about 25 percent more than the traditional Medicare program.

Medicare currently pays these privately run plans a set premium per enrollee (about $10,123). This amount is $2,526 more than the premium paid for enrollees covered under the standard Medicare plan.

About 27 percent of Medicare beneficiaries are currently covered under Medicare Advantage plans. Given how profitable the Advantage plans are for private insurers and how attractive the expanded benefits and lower premiums are for enrollees, this number is expected to grow at a fast clip.

Just how profitable are these programs for the private insurers?

UnitedHealth Group could afford to bump the annual compensation of its chief executive officer, Stephen J. Hemsley, to $13.9 million from $13.4 million in the prior year. The increase was based in part on his leadership in solidifying the company’s position as “the biggest provider of the privately run, subsidized versions of the government’s Medicare program for the elderly and disabled people.”

Guess who’s subsidizing Mr. Hemsley’s salary? Look around. It’s you, me and other taxpayers.

Dr. Steffie Woolhandler, coauthor of the study, concludes, “It’s clear that having Medicare Advantage programs compete with Medicare doesn’t save us money. In fact, the opposite is the case. The private plans only add waste, and the aggregate waste is staggering — enough to be a significant drag on the economy.”

Can taxpayers afford the extra cost to help private insurers make a profit from Medicare? Given the intent of Medicare to provide basic healthcare coverage to all enrollees, should all enrollees receive the same benefits? Or are some recipients entitled to expanded benefits at reduced premiums? If so, should taxpayers cover the cost of paying for these extra benefits and lowered premiums?

Or does a single-payer, not-for-profit model with universal benefits and premiums make more financial sense?

What do you think?

Carole Carson lives in Nevada City.

Research and Markets: Guide to the Patient-Centered Medical Home: Metrics, Models and Engagement

Published: Monday, Jun. 10, 2013 / Updated: Monday, Jun. 10, 2013 11:21 AM

DUBLIN -- 

Research and Markets (http://www.researchandmarkets.com/research/6dndl6/guide_to_the) has announced the addition of the "Guide to the Patient-Centered Medical Home: Metrics, Models and Engagement" report to their offering.
The patient-centered medical home (PCMH) has become a hallmark of healthcare delivery. Its team-based model is a mainstay of care coordination for thousands of physician practices that have already transformed themselves into medical homes - many of which are poised to step into an accountable care organization (ACO), according to 2012 market data.
In a nod to the PCMH's potential for improving care and controlling cost, many payors have placed case managers in medical homes to assist with stratification and care coordination of high-risk patients.

Guide to the Patient-Centered Medical Home: Metrics, Models and Engagement provides an overview of PCMH adoption and results and examines nuances of the model that have emerged in recent years - including the embedding of case managers on medical home teams.
Besides a complete set of benchmarks from almost 100 organizations on medical home adoption and program components, HIN's sixth annual PCMH analysis, this 155-page guide offers snapshots of thriving medical home programs, including the following:
- The statewide rollout of Florida Blue's medical home program, from practice selection to reimbursement models;
- The comprehensive PCMH consumer engagement and education effort underway at Horizon Blue Cross Blue Shield of New Jersey to position the Blues plan for accountable care;
- Advice on achieving Level III NCQA medical home recognition, joining an ACO, and participating in the CMS Comprehensive Primary Care initiative from Hunterdon Healthcare;
- Roadmap to the embedding of case managers: Geisinger Health Plan's selection, training, skill set, processes and benefits of case managers embedded within the payor's medical home practices, a model that has become an industry template for co-located case management.
Key Topics Covered:
Chapter 1: 2012 Benchmarks in the Patient-Centered Medical Home
Chapter 2: New Models in the Patient-Centered Medical Home
Chapter 3: The Medical Home Case Manager
For more information visit http://www.researchandmarkets.com/research/6dndl6/guide_to_the

Aetna Inc. : Aetna Launches Patient-Centered Medical Home Program in New York

05/20/2013| 12:55pm US/Eastern

-- Rewards Primary Care Physicians for Improved Patient Care Coordination --

Aetna (NYSE: AET) announced today the launch of its Patient-Centered Medical Home (PCMH) program in New York. The program recognizes primary care physicians (PCPs) who more actively coordinate and manage their patients' care across the health care system. By strengthening the role of PCPs, the PCMH program aims to improve patient health outcomes.

"Patient-centered care is something Aetna has always advocated. Our PCMH program rewards PCPs who focus on the patient's entire health needs, not just a single condition," said Elizabeth Curran, head of National Network Strategy and Program Development for Aetna. "As a result, members may experience better health, fewer hospitalizations, improvements in transitions of care, and greater engagement. The PCMH program is one more way we are moving from a system that rewards the quantity of procedures to a system that rewards quality outcomes."

Primary care providers who participate in Aetna's networks, who have been recognized by the National Committee for Quality Assurance (NCQA) as a PCMH, and who are not participating in other quality incentive programs with Aetna were considered for the PCMH program in New York. Recognized providers will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care. The NCQA-recognized PCMH practices are recognized for providing a number of services, including:

• Improved access to care, such as the ability to reach health professionals outside normal business hours;
• Proactive and planned preventive care (screenings, physicals, labs);
• Improved access through e-mail, web or telephone visits; and
• Access to nurses and other health care professionals, allowing more focused physician visits.

Aetna serves 880,000 commercial members in New York. More than 200 physician practices are currently part of the growing program.

About Aetna

Aetna is one of the nation's leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

Aetna

Media Contacts:
Susan Millerick, 860-273-0536
MillerickS@aetna.com
or
Tammy Arnold, 860-273-8553
arnoldtd@aetna.com