I am not a fan of United Healthcare. It was an insurance bully when I was in practice, and it has grown to become a financial juggernaut in the healthcare space. From my perspective, any improvement in the health of its “beneficiaries” is a happy coincidence. As a former vascular surgeon, I was caught by this article.
“UnitedHealth emphasizes in its marketing materials that early identification of chronic illnesses creates an opportunity to deliver more proactive and effective care. But years earlier, the company’s executives focused on peripheral artery disease to seize a different kind of opportunity — one that directly benefited its bottom line.
….UnitedHealth’s leaders set their sights on the financial opportunity tied to peripheral artery disease in 2007, after regulators revised Medicare Advantage’s payment formula to account for patients’ health status. …The change was based on a bedrock principle of the insurance business: Companies should be paid more for taking on more risk.
In November of that year, Jerry Knutson, then chief financial officer of UnitedHealthcare’s Medicare and retirement division, flagged the money-making potential of vascular disease in an email to Jeffrey Dumcum, a senior vice president at Optum who worked in risk adjustment and now manages clinical performance and compliance. …
“You mentioned vasculatory disease opportunities, screening opportunities, etc with huge $ opportunities,” Knutson wrote to Dumcum. “Lets turn on the gas! What can we do to make sure we are being reimbursed fairly for the members and risk we take on more than what we are currently doing.”
What indeed? This long read from Stat, How UnitedHealth turned a questionable artery-screening program into a gold mine, explains upcoding and why Medicare Advantage costs us more than Medicare. There will be more to say.
Sociologic studies are often hard to replicate, and their wide range of answers has brought more than a bit of skepticism to their value. But consider this.
“The new findings also highlight the value of qualitative research—conducting interviews and talking with human beings can yield insights that a quantitative approach can’t. Some qualitative observations made by sociologists, such as how people interact and form relationships, are hard to translate into a number, says Sotoudeh, and could also be influencing outcomes.”
There, in just a phrase, much of what we wish to know is lost in translation. From Nautil.us, The Unpredictability of Life
I am a big fan of “The Bear,” probably more from a foodie perspective than this one.
“The Bear” dramatizes those choices. The show is set in a Chicago restaurant where the lead chef is a demanding perfectionist whose remarkable meals and angry outbursts alternately attract and alienate co-workers. It’s a tense watch, leaving viewers wondering why high cuisine comes with high anxiety. As a physician, the restaurant reminds me of a hospital: team-based but hierarchical, high effort but ephemeral labor, high skill but a version of a core human activity.”
But sometimes, a metaphor opens up new understanding, which may be the case in this discussion of why medical education remains off the mark. From Stat, a First Opinion piece, How the restaurant drama ‘The Bear’ mirrors working in a hospital
"After having carefully considered and weighed the witness testimony and evidence,” wrote Judge Amit Mehta in his decision of the case United States of America vs. Google LLC, “the court reaches the following conclusion: Google is a monopolist, and it has acted as one to maintain its monopoly. It has violated Section 2 of the Sherman Act."
This is a big decision, and it is worth taking a few moments to understand what was involved and what may follow. From Big, Judge Rules Google Is a Monopolist
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
