Monday, August 04, 2008

Medical Research

We should have seen this one coming around the time patients started being called "healthcare consumers." Health insurance companies are using data-mining technology to see what types of prescription medications we're on and then use that information in deciding whether or not to insure us. Two companies (Ingenex and Milliman) are at the forefront of the practice, which helps insurance companies bypass the traditional method of obtaining an insurance applicants medical records from their doctor:

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.
This would be the perfect moment for a Cindy McCain joke, but we on the Signorile Show Team are classier than that.