[Dialogue] Emailing: Prescription Data Used To Assess ConsumersRecords Aid Insurers but Prompt Privacy Concerns - CommonDreams.org.htm
Harry Wainwright
h-wainwright at charter.net
Tue Aug 5 12:26:14 EDT 2008
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Published on Monday, August 4, 2008 by Washington Post
<http://www.washingtonpost.com/wp-dyn/content/article/2008/08/03/AR200808030
2077_pf.html>
Prescription Data Used To Assess Consumers
Records Aid Insurers but Prompt Privacy Concerns
by Ellen Nakashima
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.
Traditionally, insurance companies have judged an applicant's risk by
gathering medical records from physicians' offices. But the new tools offer
the advantage of being "electronic, fast and cheap," said Mark Franzen,
managing director of Milliman IntelliScript, which provides consumers'
personal drug profiles to insurers.
The trend holds promise for improved health care and cost savings, but
privacy and consumer advocates fear it is taking place largely outside the
scrutiny of federal health regulators and lawmakers.
Ingenix, a Minnesota-based health information services company that had $1.3
billion in sales last year - and Wisconsin-based rival Milliman - say the
drug profiles are an accurate, less expensive alternative to seeking
physician records, which can take months and hundreds of dollars to obtain.
They note that consumers authorize the data release and that the services
can save insurance companies millions of dollars and benefit consumers
anxious for a decision.
"Some insurers can make a decision in the same day, or right on the spot,"
Franzen said. "That's the real 'value-add.' "
But the practice also illustrates how electronic data gathered for one
purpose can be used and marketed for another - often without consumers'
knowledge, privacy advocates say. And they argue that although consumers
sign consent forms, they effectively have to authorize the data release if
they want insurance.
"As health care moves into the digital age, there are more and more
companies holding vast amounts of patients' health information," said Joy
Pritts, research professor at Georgetown University's Health Policy
Institute. "Most people don't even know these organizations exist.
Unfortunately the federal health privacy rule does not cover many of them. .
. . The lack of transparency with how all of this works is disturbing."
Ingenix and Milliman create the profiles by plumbing rich databases of
prescription drug histories kept by pharmacy benefit managers (PBMs), which
help insurers process drug claims. Ingenix, for instance, has servers in the
PBM data centers, updating the drug files as frequently as once a day, said
John Stenson, senior vice president of consulting for Ingenix, which is a
division of UnitedHealth Group. The corporation also owns UnitedHealthcare,
the nation's second-largest insurer.
When an insurer makes an online query about an applicant, Ingenix or
Milliman's servers scour the data and within minutes or less return reports
to a central server at the company. The server aggregates the information
going back as far as five years, including the drugs and dosages prescribed,
dates filled and refilled, the therapeutic class and the name and address of
the prescribing doctor.
Then comes the analysis.
Ingenix's MedPoint tool provides insurers a "pharmacy risk score," or a
number that represents an "expected risk" for a group of people, such as 30-
to 35-year-old women who have taken prescription drugs, Stenson said. Higher
scores imply higher medical costs.
Milliman's IntelliScript codes drugs red, yellow or green, according to the
insurer's instructions, with red signaling the greatest risk, Franzen said.
Red codes could include the so-called AIDS cocktail drugs and cancer
medications, he said.
The companies receive data only on individuals who are in clients in PBMs'
databases, generally excluding, say, people who pay for drugs in cash. The
profiles cost insurers about $15 a search. IntelliScript gets about 1
million queries from insurers a year, largely individual health insurers.
The system can save money for insurers, said Richard Dick, an entrepreneur
who built the database system that Ingenix acquired in 2002.
For instance, if MedPoint produces a report that an individual has been on
the highest dose of the cholesterol-reducing drug Zocor for 18 monts, the
insurer "would be able to know that you have a very high, near-intractable
cholesterol problem," Dick said, and could avoid a costly blood test.
>From a business standpoint, it makes no sense for an insurer to sell a plan
with a $200 monthly premium if the company knows that the consumer is taking
medications that cost $400 every six months, industry experts said. That is
why having access to an "objective" source of third-party information is
valuable, said Tia Goss Sawhney, a Chicago area health insurance actuary who
has used both companies' tools. "Though most people tell the truth most of
the time, there are people out there who don't, who leave out something
that's incredibly relevant, who may even be able to defraud a company," she
said. "That's important because ultimately the people who tell the truth
have to pay for those who don't."
Franzen, whose firm expects revenue of $575 million this year, said his
clients tell him that about 10 percent of applicants do not disclose
pertinent medical conditions in their applications that are later revealed
by prescription drug history.
Some health experts worry that insurance companies can make faulty
assumptions by looking at prescription drug records, because many drugs have
multiple uses. "I had a patient on Amitriptyline for migraines and they were
denied life insurance because it's also an antidepressant," said physician
Kate Atkinson of Amherst, Mass. "I had to explain it wasn't being used for
depression." Another patient was on Prozac - not for depression, but for
menopausal hot flashes. "I wrote an appeal letter, and they still wouldn't
give it to her," Atkinson said.
Services such as MedPoint are just "one of many tools" underwriters use to
make coverage decisions, said Tyler Mason, a spokesman for UnitedHealthcare,
which uses MedPoint. A high-risk score on a profile will often lead to
requests for more information from the applicant, he said.
Ingenix and Milliman officials stress that they provide data only with the
patient's consent, as required by the Health Insurance Portability and
Accountability Act (HIPAA), a 1996 law that governs personal health records
information. But HIPAA does not give the Department of Health and Human
Services the ability to directly investigate or hold accountable entities,
such as pharmacy benefit managers or companies such as Ingenix and Milliman,
who are not covered by HIPAA.
A health privacy proposal pending in Congress would expand federal
officials' ability to regulate such "downstream" organizations, audit their
activities and impose civil fines. The bill also includes a prohibition on
the sale of electronic medical records.
Tim Sparapani, senior legislative counsel at the American Civil Liberties
Union, said that the products that Ingenix and Milliman are marketing
represent the "commodification" of electronic medical records by third
parties. "We've got to stop these practices before the marketplace is fully
developed and patients lose all control over their medical information," he
said.
The field is growing rapidly. Realtime Solutions Group, a company in
Woodridge, Ill., is testing whether lab data can be aggregated with
prescription and other data for underwriting purposes. The firm is working
with two major commercial labs and three large insurers, using thousands of
real applicants. Initial results are promising enough that the company plans
to proceed to the data-analysis stage, company co-founder Tedd Determan
said.
"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."
Staff researcher Magda Jean-Louis contributed to this report.
C 2008 The Washington Post Company
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13 Comments so far
1.
Truth_Forward August 4th, 2008 5:02 pm
I remember reading a neative article about how medical records are
routinely being inspected and decisions made from the contents.
They were talking about Cuba.
There, if your lifestyle choices don't match what the government
thinks is good, they send people around to "talk" to you and "persuade" you
to change your lifestyle.
How long will it be before the insurance companies 'send the boys
round' to "talk" to you about your lifestyle choices or other health issues?
I for one do not want some insurance company thug banging on my door to
"talk" about how I live my life.
2.
DaSparky August 4th, 2008 7:08 pm
You are right T_F. Ofcourse the way insurance companies will handle
it is to adopt the least cost method and that is to limit coverage. Their
computer modeling and actuarial tables will ensure their profits! Every
insurance company has an IT department working to mine and glean the public
data for just such limitations. Through in a little marketing about how
efficient they are and bingo, they have an edge on the competition.
3.
Voice4progress August 4th, 2008 8:26 pm
If the insurance companies have their way, they will use this kind
of information to deny coverage to anyone who has ever had a health claim. A
database like this will be used to determine coverages, rates and even
insurability. It will be a major step backwards in the rights of all
patients in the United States. We need national health care!
4.
shakker August 4th, 2008 9:22 pm
The insurance company won't come around and talk to anybody about
their lifestyle. They will deny you health insurance, life insurance,
employment, disability insurance, car insurance, car loans, mortgages,
student loans for you and your children, rental contracts, credit cards,
passports, driver's license etc. etc etc.
Remember all of the functions of government are being outsourced to
a few global corporations that have little to fear from anyone and no reason
not to maximize their profits by grinding the humanoid production units to
dust.
5.
LambsieDivy August 4th, 2008 10:30 pm
Essentially this access to records will prevent people like me from
having insurance, because I have a couple of chronic medical problems with
expensive pharmaceutical solutions as a result of lifestyle choices made by
my grandfather - pedophilia. This is a little like an experience I had
recently with an orthopedic surgeon to whom I was referred for a
consultation. Before I could see him, I had to sign away my rights to sue
for medical malpractice. I refused to sign and walked out, but who did that
hurt? Me. If you haven't yet seen Michael Moore's "Sicko," please do. It's
an eye-opener.
6.
jamadison4 August 4th, 2008 11:39 pm
.
Freedom and Civil Rights have been sold out in 7 short years by this
Bush/Cheney Administration...
These Fascists have "Big Brother" spying on us just as Orwell
predicted....
Americans should rise-up and demand that our elected Congressional
Representatives IMPEACH both Bush and Cheney ... IMMEDIATELY !!!!!!!!!
God Save Our INDEPENDANCE !!!!!!!!!!!!!!
,
7.
jclientelle August 5th, 2008 2:33 am
Doesn't HIPAA apply? Any hospital employee knows that HIPAA is a set
of regulations meant to protect patient privacy. It has spawned an industry
of bureaucrats, training sessions and repetitive paperwork that is supposed
to insure compliance. Evidently HIPAA applies only to individuals on the
ground dealing with patient care, not to insurance corporations.
It would be hard to overestimate the amount of waste and distortion
that results from a grabby chaotic market driven health system. We need a
rational single payer national plan.
8.
jdparis August 5th, 2008 7:25 am
That was my question also. What's the sense of HIPPA if it is not
protecting medical information.
Time for national healthcare is NOW>
9.
shakker August 5th, 2008 9:43 am
HIPPA was designed to restrict information to corporations for their
benefit and to protect them in case you are upset with the way they use
their proprietary information about you. You sign a notice carefully written
to waive your rights and massively expand corporate rights.
Don't ever think any law passed in the last 40 years will restrict a
corporation more than it liberates them. We should be proud to have the best
government money can buy.
10.
lwhunt330 August 5th, 2008 10:38 am
This is the best reason yet for a national health care system so
that this rating game can end. Insurance companies can deny coverage and
deny insurance and are not even obligated to tell you why you have been
denied. They have been granted a license to steal with their premium rates
and now have a license to steal your personal information.
11.
Little Brother August 5th, 2008 10:59 am
A couple of years ago our medical insurance plan introduced a
voluntary program called "Get Healthy" or somesuch; they knocked off .5% of
the cost as an incentive to participate.
Participants had to complete a detailed questionnaire about their
medical history, and were assigned a "coach".
I'm fuzzy on the details because the last thing I need is another
busybody hawking me about my fondness for cheese steaks. But even though I
took a pass, I'm still periodically bombarded by voice-mail messages and
letters wondering why they haven't heard from me.
I feel sorry for the "nurse practicioners"; judging from both the
automated and seemingly-live phone messages (God bless Caller ID!), they
sound like they're glorified call-center grunts.
Less skeptical folks may buy the upbeat pitch that they're doing all
this more or less altruistically, i.e. as a socially responsible effort to
encourage healthy habits. Maybe some participants even benefit from this
service.
But their persistent refusal to take "no" for an answer confirms my
initial hunch that this is another racket to control customers/patients and
obtain personal information to use for nefarious corporate purposes.
I'm certain that it has nothing to do with frolicking over a grassy
field flying kites with happy children, as the photos festooning their bogus
literature would have one believe.
12.
softspoken August 5th, 2008 11:28 am
I just yesterday received notice in the mail that our insurance
company was "giving us a wonderful new benefit" that would now monitor our
family. A lovely company called "ActiveHealth Management" will now keep a
"personal health record" for us, so we can be "protected" and our healthcare
can be more effectively "managed". I am so horrified I don't know what to
do. The best part (the colorful brochure filled with laughing families
hiking in the woods assures me) is that I need do nothing to participate! I
get this wonderful benefit AUTOMATICALLY at no cost as part of my coverage!
This apparently means I have no choice about getting it. They do assure me
that they follow all federal and state privacy laws (very comforting) and
that the information cannot be used to affect employment (what a relief). I
am bouncing back and forth between calling because, while I want to protest
this and have them not start collecting this info on us, I don't want to
automate the "active" portion they also provide which would get even more
invasively into our medical records. All contact numbers and websites listed
are geared toward getting you to "sign up" for more detailed tracking
programs that you do have to authorize.
The sad thing is, it is written in such friendly "we are here to HELP
you!!!" terms, most people will not give it a second thought, I am afraid,
or worse, will welcome it with open arms, and start giving up even more info
to the machine.
We are in very big trouble.
13.
Little Brother August 5th, 2008 11:34 am
softspoken, that's it exactly!
I keep wondering when my plan will phase out the "voluntary" part.
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