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Your Profile Determines Your Insurability But Inmates Get Free Health Care

August 5, 2008

Prescription Data Used To Assess Consumers

Records Aid Insurers but Prompt Privacy Concerns

Health and life insurance companies have access to a powerful new tool for evaluating whether to cover individual consumers: a health “credit report” drawn from databases containing prescription drug records on more than 200 million Americans.   Collecting and analyzing personal health information in commercial databases is a fledgling industry, but one poised to take off as the nation enters the age of electronic medical records. While lawmakers debate how best to oversee the shift to computerized records, some insurers have already begun testing systems that tap into not only prescription drug information, but also data about patients held by clinical and pathological laboratories. [whole story]

“A lot of insurance companies are starting to use this type of data,” said Determan, who co-founded IntelRx, a company that mined prescription databases and was sold to Milliman in 2005. “They said, ‘All right. Prescription data is working, let’s go and look at other types of data, too.’ It’s because of the success of one, that we’re going after others.”

In February, the Federal Trade Commission issued an order saying that MedPoint and IntelliScript are consumer reports under the Fair Credit Reporting Act, so the companies must notify insurers that consumers denied insurance on the basis of these reports have the right to request a copy of the report and that errors be corrected. The FTC’s order followed a settlement of allegations that the companies violated the credit-reporting law by failing to provide such notice to insurers.

Bob Gellman, an independent privacy consultant in Washington, said the FTC’s decision not to fine the companies sends “the message that it is okay to ignore the law.” That, he said, “is absolutely outrageous.”

As more health records become electronic, he said, more parties will compete to sell more comprehensive patient data to insurers, driving down data prices. “It will all likely be lawful,” Gellman said, “but consumers will likely continue to have no real meaningful choices if they want insurance.”

Dick, who conceived the idea of linking the pharmacy databases for underwriting purposes a decade ago, said the pharmacy benefit managers understood the system’s privacy implications. He said their attitude seemed one of, ” ‘Ooh, this is a 60 Minutes’ story in the making.’ Generally, they wanted to make it a super-secret database, restricted to underwriting.”

But now, he said, “there’s a huge case for it being opened up for all legitimate access,” whether for a patient in an emergency room or for federal government purposes. The key, he said, is full transparency.

He said he has created a privacy tool that requires users to consent before specific data, such as prescription histories, can be released. To work, he said, the tool must be independent of all who hold the data.

“Otherwise,” he said, “you have the fox in charge of the henhouse.”

~~~~~~~~~~~~~~~~~~~~~~~~RELATED~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The problem: Employers are having a hard time paying health insurance premiums, and millions of Americans still have no coverage. Universal American is down 52 percent this year to July 29. UnitedHealth has slid 51 percent; Humana has lost 45 percent. Only one of 19 publicly traded managed health-care companies is up: America Service, which has government contracts to provide care at correctional facilities, has gained 34 percent.

NCCHC, Our Mission
The mission of the National Commission on Correctional Health Care is to improve the quality of health care in jails, prisons and juvenile confinement facilities.

2008 Standards:

Mental Health Standards and Accreditation:

Health Status of Soon-to-be-Released Inmates:

Texas Tech University Health Sciences Center (TTUHSC) has been contracted to provide health (physical, mental, and dental) service for some 32,000 offenders housed in Texas Department of Criminal Justice correctional facilities in West Texas.  The health service is provided on-site at the correctional facilities by using Texas Tech employees or subcontracting with local community hospitals to provide some or all of the unit medical personnel.

Millenia Health Services, Inc. (MHS) founded the private correctional healthcare field on December 8, 1978 when we incorporated in the State of Delaware. The exclusive purpose of the newly formed company was and remains to provide quality, cost-effective healthcare services to prisons and jails at the local, county, state, and federal levels nationwide.

Corrections Corporation of America: As a full-service corrections management provider, CCA specializes in the design, construction, expansion and management of prisons, jails and detention facilities, as well as inmate transportation services through its subsidiary company TransCor America. The company is the fourth-largest corrections system in the nation, behind only the federal government and two states.

CCA houses approximately 75,000 offenders and detainees in 66 facilities, 42 of which are company-owned, with a total bed capacity of more than 80,000. CCA currently partners with all three federal corrections agencies (The Federal Bureau of Prisons, the U.S. Marshals Service and Immigration and Customs Enforcement), nearly half of all states and more than a dozen local municipalities.

Managing the business side of medicine:

There is a mandate to fix what’s wrong with the care provided by Correctional Medical Services. It shows there are still many areas that need attention by CMS and Delaware state correction officials.

This is a VERY short sample of Big Business contracted to service Prisons, Prison management and Inmate Health Care can make the provider RICH!  Big Health Care Corporations cannot get rich serving the average American Citizen. Big business can safely skimp on service, staffing and quality and get few complaints from the inmates they have contracted to serve.

So, yes … inmates get “free” health care paid for by local, state and federal governments.  Those same governments get to spend taxpayer dollars on services contributing taxpayers are denied.  The big disconnect is that Americans pay for shoddy health care for a “captive audience”.  Your own health care is determined by your personal health database, job benefits or personal pocket book.  Yes, Medicare and Medicaid are available for your senior years … maybe.  Your medical history, family history and your economic history provide a “Risk Assessment” formula for Insurance Companies.  There is something very wrong with a system where profit goals outweigh the humanitarian goal.  Profit motive encourages cheating, skimping and short cutting.  The victim is humanity, medicine has lost its way.  For the thousands of Medical Professionals who enter the industry for good reasons, the American Medical System is a slap in the face.  Science and Humanity become secondary to profit and power. 

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4 Comments
  1. Dan permalink
    July 21, 2009 9:37 am

    Pharmacies sell prescribing data, also known as prescriber-identifiable data, to the pharmaceutical industry’s providers of this information. This is known as, ‘data mining.’

    The two largest data mining companies are IMS and Verispan in this 2 billion dollar or so a year data mining industry.

    The data on individual prescribers is purchased by the pharmacies from the American Medical Association. As a result, this association receives between 40 and 50 billion dollars a year, which is nearly 20 percent of the AMA’s budget.

    Over 1 billion prescriptions are monitored every year due to this process.

    Advocates of the pharmaceutical industry have continuously told the public that this prescriber data is to facilitate the care the prescriber gives the patient.

    Nothing could be further from the truth. In 10 years, I worked as a drug representative for 3 of the largest pharmaceutical companies in the world.

    With each employer, the prescribing data that we had on the prescribers was used entirely to increase the market share of the drugs promoted with these companies by manipulating the prescribers targeted for financial gain of these pharmaceutical corporations.

    Also, data mining is utilized by drug companies to target those who need to be gifted, and those who will not,

    Dan Abshear

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