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Showing posts with label ncqa. Show all posts
Showing posts with label ncqa. Show all posts

Friday, February 7, 2014

Small Data

Health care and health reform are being influenced by seemingly unrelated spheres of influence. Many industries are effected by these same interactions in banking, transportation, defense, technology, basic science, education and government.

The age in which we live is both exciting and terrifying. Now that I am a septagenerian I see it is both. And somehow we will survive, grow stronger and thrive.

The catalyst is largely information technology and cyber technology, whether it is functions for gathering data, analytics,pseudo artificial intelligence, or robotics.  All of it is shaped by bits and bytes.  Even the basic materials of the integrated circuit and computer microprocessors will undergo basic changes perhaps away from silicon to carbon or even biological compounds such as the building blocks of DNA, nucleic acids.

Rather than having a simple bit or byte, nucleic acids as we know them, offer 4 different subunits that form a lexicon for building proteins from amino acids.

Big Data is often quoted in health care for analytics, for biological and research discoveries.















We in health care are now being continuously bombarded about the essentiality of gathering more and more information. Our government is underwriting some of the costs and also placing a large burden upon not only physicians but all providers, and hospitals to enter health data into the IT infrastrucure for some future use, some of which is still not defined, and some which is truly unproven.  Despite this billions of dollars have been and will be spent on this endeavor.

There have been some precautionary notes offered from other sectors:

Viewpoint: Why your company should NOT use “Big Data”


The latest trend is “Big Data”. The original concept of Big Data was the concept of using all of the information a company collect that was being thrown away due to costs and capacity constraints. With the rapidly declining cost of storage and retrieval, combined with machine learning, we should be able to find insights in all that ‘garbage data’ and use it to make better decisions in the core business. At least that’s the theory. As far as the basic theory goes it’s all true, but it’s not the full story.

Like a lot of trends, the drive to mastering Big Data has gone a little overboard. Google searches for the term “Big Data” has grown from practically nothing in 2010 to almost 200,000 searches a month by the end of 2013

It has become so ingrained in company cultures that to say you don’t want to use Big Data is a bit like saying you are against data-driven decision making. It would be career suicide to say Big Data is a waste of company time and resources.

The graph below depicts the exponential growth of big data over time.












The details can be found at the original article on ViewPoint

Wednesday, January 29, 2014

Covered California Rates Plans It Sells

Sorcea:

 San Diego UT
 CMS

For many people enrolling in Covered California this may be their first time in many years to enroll in any health  insurance plan.  For some it may be the first time they have qualified to be insured.

The array of plans is overwhelming at best and the enrollment program (contrary to  President Obama's statemtn) is not user friendly (such as buying on Amazon.com).  In fact the process has been made more difficult by this attempt to make health care fit into a business model for shopping.

Health Insurance has been like no other, and labelling a web site to encourage enrollment as the "Market Place" demeans the process further.  It equates health along with such things as a meat packing plant, and a piece of steak.

Although statistics can be misleading and subject to interpretation , this attempt to rank plans is a starting point for 'newbies'.

Nevertheless in order to assuage critics of Obamacare by pretending to offer quality comparison Covered California has listed their 'ratings'.

Several articles have appeared, one in the San Diego Union Tribune,  which stated that the two plans in San Diego which  rated the highest were Kaiser Permanente, and  Sharp Health Plan. Sharp and Kaiser each got four stars, one better than Anthem Blue Cross and Blue Shield of California.  This applies specifically to the San Diego region.  This is a truly unique area in terms of Kaiser and Sharp Health Plan for which there is no equivalent plan in other regions of California.

There are several organizations that rate health insurers based upon selected criteria.

NerdWallet Health offers The Best Hospitals tool which includes the most recent hospital data available through Medicare. The data features the 100 most frequently performed inpatient procedures from over 3,200 hospitals across 50 states. This website offers a straight forward chart which ranks hospitals/plans

NerdWallet devised the Easy Index, which ranks each company as Easy!Decent, or Painful, based on our experience calling each company and health plan data from the National Committee for Quality Assurance (NCQA’s Private Health Insurance Plan Rankings 2012-2013 and NCQA’s Medicaid Health Insurance Plan Rankings 2012-2013).  NerdWallet Health's ranking differ significantly from what Covered California rated.

The other organizations that rank healthplans and/or hospitals are:

     NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA         accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care.

Hospital Consumer Assessment of  Health Care Providers and Systems (HCAHPS) is a national, standardized survey of hospital patients about their experiences during a recent inpatient hospital stay. These rankings appears at Data.Medicare.Gov





NerdWallet Health offers their criteria for ranking.
  
 This is a beginning for some. For many assessing co-pays, deductibles, and benefits will be more of a challenge, especially those on subsidized plans who were previously covered by Medi-caid.  It is unclear to me whether Medi-caid will upgrade their coverage, provider lists, or hospital eligibility.