My father is 92 years old and lives in a very nice
retirement community. He received a call
from his health insurance plan, Tufts Medicare Advantage, inviting him to have
a free in-home doctor visit. He was told
that the doctor would do a complete evaluation and make recommendations to
improve his care. He was a bit puzzled
and flattered. He remembered having a
doctor visit many decades ago and was nostalgic about doing so again. He was urged to accept the invitation quickly
as “doctors are in the area now” and “this is a limited time offer.” The doctor spent an hour with him and told
him he was in great health but should consider taking testosterone for his
fatigue.
All of this seemed rather suspicious to me. I called Tufts and they referred me to
CenseoHealth, a firm that contracts with Tufts to provide doctor visits. I got the same script about doctors in the
neighborhood, how it would improve his care, and act now. I asked if the information gathered would be used
for any other purpose but to improve his care and was assured that it would not. I asked my father to request a copy of the
report. He has not received it.
After some research, I now understand that the purpose of
the visit was to gather information on his “risk score” that could lead
to the insurer getting much higher payments from Medicare. According to a recent investigation by the
Center for Public Integrity, Medicare made nearly $70 billion in “improper”
payments to Medicare Advantage plans from 2008 through 2013, mostly due to over-billings
based on inflated risk scores. But, my
personal concern is not that health plans are gaming the system to increase
revenues. After all, they have been the
target of gaming for a long time from providers “upcoding” billing records to
get better payments. It just seems to
be part of the culture of health insurance.
My concern is about trust.
My father did not derive any benefit from the visit. He was deceived about the purpose. The purpose was to extract information from him
so that Tufts could increase their revenues while pretending to do the doctor-thing
to improve his health. He was preyed
upon as an elderly person. This type of
deception has no place in health care and especially not from the #1 health
plan in the US, as Tufts promotes itself.
Health insurers need to work on trust. Let’s face it, it took an act of Congress to
force them not to discriminate against the sick by denying coverage for
pre-existing conditions. Health plans
come in dead last among major industries when it comes to customer engagement
according to Forrester Research. And a
recent Gallop poll found that only 26% of Americans place a lot of trust in
health insurance companies to keep their personal information secure.
Indeed, the use and abuse of personal data is at the cutting
edge of gauging the trust factor of companies today. Health insurers harbor a vast amount of data
about us. They know our diagnoses and
medications. In addition, many buy
personal data on what we buy, who we voted for, and where we travel and use it
to drive algorithms about whether we are worthy of health management programs,
deserve good customer service, and offer a high lifetime value as members worth
keeping on. For example, one company
that services health insurers, Predilytics, touts that its use of advanced
analytics results in “more accurate identification of risk adjustment
opportunities” and that these “high opportunity members generated 25% more
coding value than prior models.”
I want my father to live a long and healthy life. That should be job #1 for those he pays to
look after his health. Decisions about
his health should respect his point of view and his privacy and abide by the
saying “nothing about me, without me”.
Tufts says on its website, “We strive every day to be a health plan you
can brag about to your friends and family.
Do you have ideas on how we may improve your experience?” Here’s an idea: Use all the data you have collected on my
father to identify ways to make him healthier.
Coordinate with him and his health care providers to make sure it
happens. And, use your precious
information resources wisely to make a difference in people’s lives rather than
to scrounge for more revenues.
