The July 21, 2015 Forbes article, “How Population Health Became a Multi Billion Dollar Pay Play for Insurers,” is indication of a further step being taken by UnitedHealth Group’s Optum Division in controlling the payment of healthcare benefits for itself, Medicare and the other few remaining insurance giants. We have written extensively on our site about UnitedHealth and Optum and the consolidation of the “too big to fail” medical insurance cartel.
Now comes a brazen effort by UnitedHealth, a company with a history littered with Medicare fraud, refusal to pay benefits, extreme abuse of SEC regulations by its management and an extensive history of litigation against it, to dominate the next big idea in healthcare. Along with the other insurance gorillas, Anthem and Aetna, they are growing their Population Health business lines as they merge into mega players.
A Profound and Grand Change is Underway
Santa Fe, New Mexico, 22 July 2015
By Dr. James Goldberg, Author of The American Medical Money Machine: The Destruction of Healthcare in America and the Rise of Medical Tourism
“Population Health” is an Orwellian extension of UnitedHealth’s plan to profit, beyond reason, at the expense of the real health of the people. In our opinion, the term Population Health is a blatant attempt, supported by Obamacare and the current administration, to unilaterally alter the way in which medicine is practiced in the United States.
Population Health is tied to what’s called The Triple Aim: Care, Health and Cost. The concept has been around for years but it’s still being defined today. Tom Sullivan, Executive Editor of HIMSS Media gives some clues in his post, “What exactly is ‘population health,’ anyway?” but confirms that “what has become eminently clear is that defining population health depends on whom you ask.”
When it comes to asking insurance companies, it’s important to understand that Population Health management doesn’t pertain just to the overall health of a population, it also includes the distribution of health. If a majority of a population is relatively healthy, the goal is to find ways to move the much less healthy population over to the majority side. To accomplish this, the differences in health among a population must be eliminated in the model—or at least substantially reduced—so that everyone is healthy.
Exactly how is this going to be achieved? Well, a patient’s unique circumstances will no longer be taken into consideration. For example, say you live in an area where the majority is unhealthy. The fact that you, personally, are healthy but now have a knee that needs an operation will not be taken into account. In your area, you’ll be subjected to—and required to pay for—a package of pre-determined bundled treatments that are based on a model of care for an unhealthy majority. Do you want to be treated as a model of a person or as the person you are?
Population Health takes into account these factors to determine the policies and programs you’ll be subjected to:
- socio-economic status
- individual behavior
- social environment
- physical environment
Your individual care will not depend on your unique history of recovery, it will be measured by some far-flung analysis of the population’s recovery. The finite granularity of information needed to be able to make these types of broad-based predicative models would take decades to compile and understand (if they ever even could be), but instead United and gang are forging ahead with their obviously biased interpretation of the data, and with the blessing of the government.
Multi-variable analysis, including where you live and your social and economic circumstances, will dictate the equation for what insurance companies will pay. It’s all guesswork on their part. They are creating a model for someone who doesn’t really exist. These decisions should be between a physician and patient. The historical roots of the sacred Hippocratic oath are being ripped out in the name of profits. But if hospitals don’t comply, they won’t be paid. If private practices don’t comply, they won’t get paid.
Based on the unproven pseudoscience of Evidence Based Medicine, the Population Health concept is a mad and premature rush by United, the insurance cartel and the government, to change the very foundation of the way in which doctors care for their patients. Effectively, this scheme—now with an ominous handle that reeks of totalitarian social engineering—amounts to United and Optum practicing medicine without license.
Beware of Medical Care by Criminals!
With Andy Slavitt, the former CEO of OptumInsight, Optum’s health information technology division, set to become the director of the Center for Medicare & Medicaid Services (CMS) at the request of POTUS, United has managed to buy itself into a position of near complete power. They’ve come a long way from their modest size in the early 1990s to become the largest provider of health insurance in the United States. Our articles which examine this rise to power should be of keen interest to those truly interested in how the government has been bought and sold by the insurance cartel with UnitedHealth leading the charge!
Don’t forget that it was Ingenix that became OptumInsight. Our article on Optum put the Ingenix fraud into perspective with Governor Andrew Cuomo, then New York’s Attorney General, describing Ingenix and UnitedHealth’s use of data as “deception, manipulation of data and outright fraud.”
Slavitt is at the heart of these models which will now be applied to Medicare under his direction. It’s a dangerous and arbitrary practice with a consolidation of power that is far reaching. Who will police the validity of their assumptions when they control access to all the data and all of the money that flows for your care?
There is nothing abstract about this power grab. Every person in this country will feel its effect. Please call your Congressional representatives and plead with them to deny the appointment of Mr. Slavitt.
If you want to live under a system where corporate interests dictate what medications you take, what surgeries you can have, what diagnostics are allowable, what diseases to treat, how much you will pay, how your doctors are controlled and restricted to practice medicine, then sit back and let this plague of corporatization, oligarchy and totalitarianism take its course.
The Forbes article hardly scratches the real issue which underlies Population Health. We are talking about the intrusion of the industrial and government complex into the very essence of the way in which we live and… die.