Tuesday, July 28, 2015

Fitbit vs HIPAA

As who's actually subject to HIPAA restrictions becomes ever murkier, technology continues to pile on. And it's not just Electronic Health Records (EHR). As we noted a few months ago, John Hancock is tapping into the FitBit craze, offering policyholders the chance to trade laps around the track for dollars off their premiums.

It seems pretty obvious that buying and using a FitBit for oneself doesn't entail HIPAA issues (although it could cause problems for would-be criminals). But what if it's tech that was prescribed (and/or provided) by a medical provider?

We've posted about who actually owns the data in these kinds of cases, but not really addressed HIPAA considerations (if any). According to David Reis, Ph.D., vice president of information services and chief information security officer at Lahey Hospital and Medical Center in Burlington, MA (there's a mouthful!):

"[I]f a person receives a wearable device through their hospital or doctor, the healthcare data that device collects is covered by HIPAA. At least, the data HIPAA defines as protected healthcare information (PHI) is safeguarded."

So what does HIPAA consider as "healthcare data?" Well, ostensibly that could be anything from your latest MRI but probably not your BP (if not linked to you specifically).

But is that really the case?

Security litigation specialist Kirk Nahra is skeptical. He thinks that wearables may fall outside HIPAA's authority (well, CMS's authority to enforce the regs).

Here's the problem, though: he posits this example to bolster his position:

"If a person is in a car accident, both the health insurer and auto insurer receive that person's medical bills. The health insurer protects that person's health data under HIPAA, while the auto insurer does not."

That struck me as unlikely, so I contacted a claims supervisor for a major P&C company to confirm whether or not this was the case.

In a word: No.

Any medical info that the auto insurer receives is absolutely subject to HIPAA confidentiality rules. Still, Mr Nahra's basic point, that 1996-era (when it was written) tech couldn't realistically predict the explosion of so much new technology and its ramifications is sound.

In the event, the key question remains: How, if at all, does HIPAA apply to "wearables?"

Part of the problem is that one doesn't necessarily know exactly where one's data is going to end up:

"[The] U.S. Federal Trade Commission recently tested 12 mHealth and fitness applications and discovered these apps sent consumer data to 76 third-party companies."

Did users agree to this? Well, one presumes that the info was disclosed in the EULA (and, of course, we all read those religiously). So there's that.

The sticking point seems to be: what happens to the data when it hits the end-vendor? Well, that seems to depend on whether that vendor has some kind of relationship with a "HIPAA covered entity" (basically, one that deals with personal health info, such as a provider or insurer).

I've reached out to FoIB David Williams, who's written extensively on wearables and health care, for his insights on this.

Meantime, something to think about while you're walking up and down the stairs.

[Hat Tip: FoIB Holly R]

Monday, July 27, 2015

Feel the Love

Anthem wants to add Cigna to their stables. But Blue Cross is not pleased.
Anthem (ANTM), may be causing anxiety for fellow Blue Cross and Blue Shield plans across the country with its $54 billion purchase of Cigna (CI). - Forbes
Why is that you ask? Aren't they the same company?

Nope.
The (Blue Cross) association’s rules prevent Anthem from using the well-recognized Blue Cross and Blue Shield brand in regions where Anthem doesn’t have the Blue Cross license or own a Blues plan, Anthem is forced to sell health insurance under a different brand like Amerigroup, which will fight for business against other Blues plans.
“The deal sets Anthem in direct competition against other Blue Cross Blue Shield plans nationwide,”
Tough.

Blue Cross needs to put on their big boy pants and move into the 21st century.

But have no fear.
In the past, Anthem’s commercial businesses that operated without the benefit of the Blue Cross license haven’t always done so well when they couldn’t market as “Blue.” 
“There’s amazing wellness programs that Cigna’s developed,” DeVeydt said. “I think our Blue brethren, they compete today in those markets with us and others and have always welcomed competition. From our perspective, we hope the consumer can get the best of both brands, and that includes the value of the Blue network.”

Sounds like Anthem is looking forward to competing with their Blue brethren.


State HIX circling the drain

Who could have seen this coming?

"State-run health insurance markets ... are struggling with high costs and disappointing enrollment."

Well, the high costs were a given (as we correctly predicted almost 6 years ago!), and not exactly a surprise.

But low enrollment? Whatever do they mean?

"The viability of state health insurance exchanges has been a challenge across the country, particularly in small states, due to insufficient numbers of uninsured residents."

Whoa - hold the presses!

What was that again?

"[I]nsufficient numbers of uninsured"

Um, wasn't the whole point of this fiasco to address the roughly 87 billion Americans without health insurance, affordable or otherwise? And here's Aloha State (Democratic) Gov. David Ige lamenting the fact that this was - how to put it gently? - a big, fat lie?

Who'da thunk it?

[Hat Tip: Ace of Spades]

A Tangled Web Update

A few months ago, we posted on the strange case of the elderly housekeeper and the $1 million life insurance policy. At the time, we wondered how she was able to qualify for that much coverage given her apparently meager income.

More information has come to light that (perhaps) explains the apparent discrepancy.

According to her family's lawyer, Ms Fox "was not some poor, desolate little lady ... Her husband owned and operated mobile homes and RV parks and developed them. They had a pretty substantial income and made some pretty good money selling those.”

And then there's this:

In 2013, Mark Buckland (Mrs Fox's son-in-law) called the agent who wrote the policies [ed: yes, "policies" - told you this was a convoluted situation], and asked about converting them from term pans to whole life. When he was told that the total monthly premiums for such a conversion was north of $6,000 (yes, that's thousands) he took a pass.

Nothing wrong with that, of course, but it's his next move that's, um, interesting:

Allegedly, the agent (Charles Mercier),  "suggested entering into a plan where a third party invested in one of the converted policies so that they could share the benefits when the policy paid out ... that transferring one of the policies to a third party was “legal and done all the time.”

Um, no, it's not, and these kinds of "arrangements" have come under increasing scrutiny. Add to that the fact that Mercier wasn't even licensed to facilitate such a deal, and one has the makings of quite the kerfluffle.

Meantime, the beneficiaries are suing the carriers to try to collect on the policies.

Ellery Queen fans should definitely read the whole piece.

Sunday, July 26, 2015

Provider insurance filing bleg

From email:

"I paid upfront $6900 for a TMJ treatment of which my insurance will pay $2000.

However my doctor is not helping me with the claim since I already paid him. My date of service was back in March and he sent incomplete records to my insurance so my claim was denied. I wrote the doctor a letter demanding he complete the missing documents in my records and he hasn't done it. What can I do? He is depriving me of my right to my insurance benefits. I am in California. Any suggestion will be highly appreciated it
."

Only thing that pops out at me is that, if he's a network provider, perhaps our correspondent could file a complaint with the carrier.

No idea how effective that might be.

Any suggestions would be most appreciated.

Saturday, July 25, 2015

Another Obamacare Co-op Departs

As 2016 approaches when the bell rings for round 3 of Obamacare (full Monty version) the Louisiana Health Cooperative will stay in their corner.

Louisiana Health Cooperative Inc., a nonprofit health insurer created with a $65.8 million federal loan under the health care law is winding down its operations at the end of the year and will not offer coverage in 2016. - New Orleans Advocate
That's another $65 million in taxpayer money pissed away by the Obama administration.

In the two years they were in operation they issued policies on 17,000 residents that applied through the exchange.
The Louisiana co-op was one of 23 companies created nationally by the Affordable Care Act and $2 billion in total loans. The Consumer Operated and Oriented Plans, or CO-OPs, were designed to ensure competition and offer affordable and innovative alternatives to the coverage offered by private insurance companies.
Care to guess what the track record is for these creations?

According to Standard and Poor .......
All but one of the [23] co-ops included in our study reported negative net income through the first three quarters of 2014. … Most co-ops’ weak operating performance is a result of high medical claims trend and not enough scale to offset administrative costs. … In fact, nine of the co-ops (including CoOportunity Health) reported a MLR [i.e., medical loss ratio; the claims compared to premiums] of 100% or more through September 2014.”
During the 2012 presidential debates, Gov. Romney observed the following regarding Obama's "green energy" stimulus programs.  In one year alone, Obama provided $90 BILLION in tax credits to firms like Tesla, Solyndra and Fisker. Romney's summation of this failed policy?

"You don't just pick the winners and losers, you pick the losers."



Friday, July 24, 2015

Anthem Gobbles Up Cigna [UPDATED]

As you've no doubt heard, Anthem has won this round of Carrier Feeding Frenzy '15:

"Earlier today, Anthem Blue Cross and Blue Shield’s parent company announced that it has entered into a definitive agreement with Cigna Corporation, under which our parent company will acquire Cigna in a cash and stock transaction. This transaction will accelerate the realization of our vision to be America’s valued health partner primary Single Payer Health Plan administrator."

Fixed for accuracy.

We'll have more on this in the coming days.

UPDATE: The folks over at Forbes have an interesting take:

"Though insurers say narrow provider lists allow them to keep costs low and ensure high quality doctors are on the menu of preferred providers and bad physicians are not, providers say they will be in greater danger of being shut out of a network if consumer choices dwindle."

This speaks to access, and once again puts the lie to the promise that "if you like your doctor, you can keep your doctor." Fewer carriers means, in this construction, fewer providers.

I'm not convinced that this is necessarily so: if one presumes that the Venn Diagram of Anthem's providers isn't a 100% overlap with Cigna's, it seems to me that this could potentially broaden at least some regional networks.

Forbes also addresses the affordability aspect of the merger as it relates to SCOTUScare:

"One of the main goals of the Affordable Care Act was to restore competition in the health insurance sector ...This consolidation will reverse these gains of the Affordable Care Act.”

Here I think they're on firmer ground: certainly, fewer players means less comptetion, and that in turn likely means higher rates.

Time will, of course, tell.

Thursday, July 23, 2015

It's a small, small (but connected!) world

So what do Facebook, Twitter and other "social media" have to do with insurance? Turns out, plenty:

"When Blanchard called Manulife, the company said that "I'm available to work, because of Facebook," she told CBC News this week. She said her insurance agent described several pictures Blanchard posted on the popular social networking site, including ones showing her having a good time at a Chippendales bar show"

Now, we noted that almost 6 years ago, so why bring it up now?

Well, it seems that other sectors of the insurance world are starting to take notice:

"Historically the insurance industry has operated knowing little about its customers; however, now with new technologies and the Internet, it no longer has to."

I think this may be painted with too broad a brush: certainly insurance companies have never been particularly "connected" or engaged, but good agents always have been (I've always called this a "relationship business"). Still, better late than never, right?

"Usage of social media has not been standardized within the insurance industry yet ... it seems that social media is a boon to underwriters and claims adjusters"

Indeed. one has only to look to our example above to see how adjusters have made use of the tech. On the other hand, it seems that carriers (American ones, at least) are already behind the 8-ball:

"Users of social networking websites could face higher insurance premiums because burglars are using them to 'shop' for victims' personal details."

That's also from 2009, and concerns insurers in the UK. One supposes it's nice that we're finally catching up to them on our side of The Pond©.

Wednesday, July 22, 2015

Wednesday LinkFest

■ Longtime readers may recall our post from 2006 (almost 9 years ago!) wherein we introduced (and applauded) a new transparency program from MN Blue Cross. That was just one example of consumer-centric health care, whereby insured's are encouraged to take more control over their own care. Of course, high deductible, HSA-compliant health plans under-gird and simplify this effort, but they're by no means the only such plans to do so.

One of the arguments against such plans has been that folks shouldn't have to direct the ambulance to the least expensive ER:

"The caricature is that consumer-directed health care means that patients have to shop around when having a heart attack. But in the event of a truly immediate or catastrophic illness, insurance will continue to cover the costs. The truth is that the overwhelming majority of health services result not from emergencies but from chronic, long-term illnesses. Most patients do have the time and the ability to make decisions on the source and course of treatment, from knee replacements to cancer care. But the industry today makes thoughtful choice almost impossible."

■ In this Tale of Two Bob's, our good friend Bob Graboyes tips us to an insightful article by uber-wonk Bob Laszewski on why SCOTUScare likely won't go the distance. In 1,000 words:


The obvious point is that the new regime just isn't attractive to the middle class, who made up (and continue to make up) the bulk of folks most affected by it. But he offers a deeper analysis in the article.

Recommended.

■ SCOTUScare proponents like to point to Medicaid expansion as a net positive aspect of the plan. But is it really?

"Two dozen states immediately took the bait, lured by the promise the federal government would pay 100% of costs in the first three years and 90% for the newly eligible on into the future. Several more have joined since."

Of course, Uncle Sugar has his price, as well, and so many of these states are beginning to suffer a bit of buyer's remorse:

"At least 14 of these states have seen enrollment surge unexpectedly, forcing at least half to increase their cost estimates. And we're not talking about a few percentage points."

Oh really?

Yup:

* The Blue Grass State saw double their anticipated enrollment, thuis increasing their costs twofold.

* Cali experienced an enrollment rate three times what they'd anticipated, and now a **third** of its citizens are on Medicaid.

* That bears repeating: "1 in 3 Californians are on Medicaid."

And the list goes on.

At some point, that dam's gonna break, no?