Practicing Medicine Without A License

So Wonks Anonymous hears that a major California Health Insurance Provider - not the one Wonks Anonymous works for - is attempting to design software that will combine individual medical bills to provide information on actual episodes of care. If they pull this one off they will know that a bundle of blood tests, some X rays, a surgical treatment and two days in the hospital actually represent a skiing accident and a broken leg.

Wonks Anonymous has worked on a project that did just this for another health care provider/health insurer. He notes that the project was difficult even though he had information beyond the medical bills to work with.

Wonks Anonymous will offer neither his best wishes nor his experience to this project. He has also heard what it will be used for.


When they get their episodes of care - according to Wonks Anonymous informant - the insurance company plans to use the information to manage care, to evaluate contracting physicians and to set payments for various diseases.

Wonks Anonymous expects that they will use the latest data mining software to find the answers to these questions. He knows that the projects that this new software spawns will not be developed or even supervised by physicians since the Chief Medical Officer of this fine company recently quit for reasons unknown.

Wonks Anonymous further doubts that statisticians will have a lot to say on this one - MBAs generally find statisticians hard to understand and too expensive.

So doctors and patients who contract with this company can look forward to a whole new onslaught of "good ideas" and detailed, supervision of treatment, administered by nurse case managers and accountants and "discovered" by the best data mining software that money can buy.

I guess this is not technically illegal since the doctors and patients, who will take direction from the health insurer in this brave new world, will be free to use their own judgment about treatment - provided they are willing to absorb the costs.

 

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