10 ways to detect health-care lies

Lawton R. Burns and Mark V. Pauly
thehill.com
Originally posted December 9, 2018

Here is an excerpt:

Why does this kind of behavior occur? While flat-out dishonesty for short-term financial gains is an obvious answer, a more common explanation is the need to say something positive when there is nothing positive to say.

This problem is acute in health care. Suppose you are faced with the assignment of solving the ageless dilemma of reducing costs while simultaneously raising quality of care. You could respond with a message of failure or a discussion of inevitable tradeoffs.

But you could also pick an idea with some internal plausibility and political appeal, fashion some careful but conditional language and announce the launch of your program. Of course, you will add that it will take a number of years before success appears, but you and your experts will argue for the idea in concept, with the details to be worked out later.

At minimum, unqualified acceptance of such proposed ideas, even (and especially) by apparently qualified people, will waste resources and will lead to enormous frustration for your audience of politicians and outraged critics of the current system. The incentives to generate falsehoods are not likely to diminish — if anything, rising spending and stagnant health outcomes strengthen them — so it is all the more important to have an accurate and fast way to detect and deter lies in health care.

The info is here.

Actuaries are bringing Netflix-like predictive modeling to health care

By Gary Gau
STAT News
Originally published on December 13, 2016

Here is an excerpt:

In today’s ever-changing landscape, the health actuary is part clinician, epidemiologist, health economist, and statistician. He or she combines financial, operational, and clinical data, such as information from electronic medical records, pharmacy use, and lab results, to provide insights on both individual patients and overall population health.

I see a future where predictive modeling helps health care companies not only suggest healthy behaviors but also convince patients and consumers to adopt them. Predictive modeling techniques can be applied to information that can influence an individual’s decision to use preventive care, accurately take prescribed medication, book a doctor appointment, lose weight, or become more physically active.

The trick will be identifying the trigger that gets him or her to act.

Insurers must understand their patient populations, including the barriers they face to achieving better health. To create solutions, insurers must first understand the psychology of motivation and what leads individuals to change their behavior. That’s where the precision approach comes into play.

The article is here.

Cyber security: Attack of the health hackers

Kara Scannell and Gina Chon
FT.com
Originally published December 21, 2015

Here is an excerpt:

Hackers accessed over 100m health records — 100 times more than ever before — last year. Eight of the 10 largest hacks into any type of healthcare provider happened this year, according to the US Department of Health and Human Services.

Insurers scrambled to hire cyber security companies to scrub their systems. Premera Blue Cross, CareFirst BlueCross BlueShield, and Excellus Health Plan announced breaches affecting at least 22m individuals in total since March, including hacks that stretched back more than a year. Investigators told the FT that they believe some of the hacks are related and trace back to China.

The insurers face multiple investigations from state insurance regulators and attorneys-general and some could face fines for failing to comply with state data privacy laws, while federal law enforcement agencies are investigating who is behind the hacks.

The article is here.