We all know insurers have cancelled and added new types of polices for years but now with the law it's accelerated and very few of the big players are participating to any real level with insurance exchanges, they got what they wanted. Nobody wanted to see this happen but unfortunately it has an the entire idea behind the law with 10 new areas to be covered was to make sure people had "real" health insurance and not bare bones. In addition to having to pay more for some people we also have insurers pulling out of certain markets, i.e. Aetna and United in California for individual policies and that's catching a few in the downside too. Aetna even decided to boost the lat 3 months premiums for many by 25%...like get out of town as fast as you can leave..
Their reason for doing this was delivered to they by "their machines"...the servers running 24/7 making life impacting decisions about all of us.
Obamacare: The Continuous Rise and Fall Of The Machines With Complex Insurance Math Models Resulting In Spasmodic, Executing “Killer Algorithms”–And Gov Can’t Model…
Algorithms Doing Battle With Other Business Intelligence Algorithms….One Algo Executes And You’re Off the Map
Sounds like I’m talking about Wall Street doesn’t it? Not this time but there are a ton of similarities as you see it’s the same players that exist in the financial field. Stock market has tons of algorithms that are programmed to seek out other algorithms and react with them in one fashion or another and Obamacare, well it’s also a battle of the algorithms. Healthcare just doesn’t have that extra element of “need for speed” like they do on Wall Street as a split second won’t make a difference on what policy you get; however the clashing busy little algorithms are calculating what a replacement policy will be if you need to get a new one. If you have employer insurance, they have algorithms too that are constantly at work. No matter what kind of exchange you have today, they all have glitches and algorithms that don’t like each other too.
Just today in California, one exchange carrier has to be removed by the state as their algorithms with proving solvency were not sufficient.
So are you one of those who is in the process of having to replace your health insurance policy? Well the math business models of insurers have designed it that way for their profitability. Insurers have been deleting policies and adding new ones for years, way before Obamacare was created. It happened to me around 10 years ago, so this is not new, but what is new is the intense business analytics on steroids that insurance companies use, the math models and yes they are in fact just like the ones on the financial markets run by Wall Street and banks. Nobody I don’t believe expected it to play out this big but “algorithms said”…business math models and executing algorithms run the processes as programmed…
The ACA minimum benefits were set up to also deal with the “under insured” (and remove some insurer algorithms)as identified by the government and there were about 10 or so rules and stipulations to be met so those insured had a “real” policy without huge deductibles with basic preventive care needs met. Sad thing is we are finding out how many “bare bones” policies were probably sold out there that can’t conform. Some may not be all “bare bones” but fail to meet maybe one or two areas. Hospitals don’t want to see the “under insured” show up either if it can be avoided as what is not covered now becomes a payment and collection issue between the patient and the hospital.
There have been enough of those stories in the news to go around too, some where patients are charged full book prices that may be double of what an insurer would pay them. Still see them but many hospitals are now doing a better job working with the non or under insured patients on charges. Some are getting huge price increases quoted and again what “algorithms” are the insurers using to calculate?
When you add on the next issue with determining who’s in and who’s out of network, it gets more challenging and again this has been going on for a while and not new as insurer contracts with doctors and hospitals change all the time. At the link below I have several examples to where insurers notified patients and doctors in error that they were no longer in network and had to retract notices right and left, “bad algorithm letters” in this case.
One other matter that adds to the complexities is the large number of mergers and acquisitions that have occurred and some of them would not have happened without some of the financial pinches out there today. You can have some potential conflicts when you have one arm or subsidiary of an insurer remove some access, lower reimbursement, etc. or even form an ACO and then have one of the insurer’s other subsidiaries who sells software rush in for a sale as a company will need some kind of tools to keep up with the insurance algorithms and methodologies they use.
Some people are having to change who were on Medicare Advantage plans…Algorithms says…even though CMS surprisingly gave the insurers who run the advantage plans a 3.3% increase for next year. The doctors who were fired received no explanation and some has just signed a new contract with United in August…but again the math and spreadsheets say we don’t make money here so …a goodbye algorithm kicked out the letters. We are seeing more and more of those “corporate algorithm balls” to where notification is done by computer, sometimes out the blue to where no face to face human explanation is even offered and there’s no forewarning.
Hospitals are having to deal with the 2% Sequester Algorithm…that math that pays them 2% less until Congress gets their act together. As patients we get the losing end again as hospitals layoffs become more frequent and we all know what shortages of help cause these days.
One Good Reason to Fix the Sequester as Hospitals and Providers Are Ready to File Lawsuits Against Insurers Passing Back 2% Sequester Cut-HHS and CMS Have Some Real “Perception” Issues And Can’t Model Worth A Darn..
Last but not least we have the algorithms on the insurance exchange website that suck right now, they are sick algorithms and even when they are well, their illnesses might hang on for a while, so you got it the exchange sites are big clusters of algorithms…and that’s what you are fighting on the sites with either registering or trying to buy a policy. In addition, they have to talk to other algorithms and that’s not going so well right now…so do get the message on how algorithms and math models that design them are ruling Obamacare? Some of them don’t like each other, some are programmed to find other algorithms and they can’t find their algo buddies.
Some algorithms have teeth and want to take things away from other algorithms…some algorithms can’t fight back no matter how hard we try to reprogram them (grin). So we are under the Attack of the Obamacare website algorithms right now and they will be tamed in time. Below is a link on every day occurrences where the algorithms come out and bite and the strength of their bite is determined by humans and how they program them…what they allow and not allow…
Long and short of all of this is that we are all under the influence of computer code that runs 24/7 on servers and as the image says above, they eat algorithms so remember nothing a politician says has any meat until those algorithms (computer code) is changed.
Obamacare, is all about the fighting, sick, spastic, and greedy corporate algorithms out there, it’s automated math and we are stuck with it, no going back, but do be a skeptic when you need to be when you think the algorithms are wrong…they just might be with the steady accumulation of “flawed data” everywhere today.
If you want to learn more about the math models used by banks and insurers, hop on over to the Algo Duping page and there are some great videos done by people smarter than me that address a lot of this at the layman level.
This has mostly been a reprint here from my blog and once again my effort to try and bring the message forward as this is where the power is with math models and numbers and how they do it, sub prime could have never happened without complex math models and you don't have to be a mathematician and what I suggested in 2009 was just my logic and data mechanics knowledge where I said to please not put Sebelius in office but the get "the smart people" in there as Health It would eat her up and it has.
And DeParle as well where I questioned if she would have enough business intelligence to handle creating the healthcare law...well without those who know and use the same math models insurers do, you see what happened, both were no contest and this is not personal as DOJ and SEC are headed the same way. We end up with low tech band aids for high problems and we don't get anywhere. Here's the other post from 2009.
I never support Congressman Issa but this one time I'm making an exception as hopefully it will uncover some of the United Healthcare issues as they too, like the banks are becoming too big to fail...they use math and hire quants right and left to create their formulas they use to move money. Banks and insurance companies have really just morphed into big software companies that move a lot of money, and not in our direction at all.
One more here where I questioned the website and it is a bit techy but I am asking where did the QSSI subsidiary of United write their code, in India? On the 15 pages of the United SEC pages it shows India...and again we had other choices possible and both Microsoft and Oracle had "turnkey software platforms built" for state insurance platforms ready and nobody mentioned it or said a word..but they were there in 2011 and would have saved a ton of time with not needing to custom write a lot of code and CMS would have software support...you may want to take a look as I tell everyone to look at the SEC page and and see the truckloads of companies they own and what they do..I have been writing about insurance subsidiary companies for about 4 years now.
United writes a ton of software and sells it (as well as consulting) and they own medical records companies too and they have the foreign Netherlands subsidiaries too which are known for being Tax Havens so eve you don't get the rest of it look at the number of companies and now this same QSSI is in charge of the insurance exchanges...is there any doubt that the insurers used technology and outplayed the government?
Again it's methodologies and I keep trying to let people know what and how it's done and you don't have to be a mathematician, but just understand the process...until the math models are challenged and we get to see some of their formulas, (just like LIBOR they guess and fix numbers) we are pretty well stuck with the corporations and their machines that take just about everything they can, money, our data, our houses, you name it.
Be a skeptic when you need to be by all means...as the machines make tons of errors along the way too.