the algorithm pushing patients out of rehab care
November 15, 2023 5:38 AM Subscribe
From STAT: UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care. (Archive link) "The nation’s largest health insurance company pressured its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehabilitation care for older and disabled Americans as profits soared, a STAT investigation has found. [...] Its strategy is integral to a growing national business at UnitedHealth to deliver more care in patients’ homes using a network of providers it has spent billions of dollars acquiring in recent years."
So long as the main driver of health policy is profit, this will happen.
posted by grumpybear69 at 6:19 AM on November 15, 2023 [13 favorites]
posted by grumpybear69 at 6:19 AM on November 15, 2023 [13 favorites]
We are seeing frustrating moves towards privatization in my province right now, so I'm feeling with a lot more empathy today than usual.
posted by jacquilynne at 6:21 AM on November 15, 2023 [5 favorites]
posted by jacquilynne at 6:21 AM on November 15, 2023 [5 favorites]
“People are being forced out of the [nursing home] because they can’t pay or because their insurance sucks,” Obermeyer said. “And so the algorithm is basically learning all the inequalities of our current system.”
Oh my gosh how unforeseeable and unprecedented
posted by Baethan at 6:22 AM on November 15, 2023 [18 favorites]
Oh my gosh how unforeseeable and unprecedented
posted by Baethan at 6:22 AM on November 15, 2023 [18 favorites]
UHG $5.3 billion profit Q1 2023
UHG CEO took home $23.8million in 2022
everything-is-fine.gif
posted by mcstayinskool at 6:25 AM on November 15, 2023 [8 favorites]
UHG CEO took home $23.8million in 2022
everything-is-fine.gif
posted by mcstayinskool at 6:25 AM on November 15, 2023 [8 favorites]
Um...The linked story fades-out/cuts-off after only a couple of paragraphs. The archive.is link puts me into an eternal captcha loop. And, the archive.org copy is the same fade-out as the original link.
Anywho...I was able to read enough to see this was done as part of an Advantage plan. Not surprising. Advantage plans are pure evil, and are quickly hollowing-out Medicare, killing the system that proves universal healthcare can work in the US.
posted by Thorzdad at 6:29 AM on November 15, 2023 [7 favorites]
Anywho...I was able to read enough to see this was done as part of an Advantage plan. Not surprising. Advantage plans are pure evil, and are quickly hollowing-out Medicare, killing the system that proves universal healthcare can work in the US.
posted by Thorzdad at 6:29 AM on November 15, 2023 [7 favorites]
> Of course it's UnitedHealth. The most mustache-twirlingly evil healthcare company in the U.S.
see i know that there are depths to which a united states healthcare company can plunge that are deeper than any i can imagine, but based on my experiences with kaiser permanente the idea of that outfit standing next to anybody and seeming comparatively less mustache-twirlingly evil causes my brain to make sounds like an actively dying 1980s cassette tape.
like, the company's name is kaiser permanente. kaiser. permanente. i can't be the only one who's noticed that "kaiser permanente" is less the sort of thing you'd name a healthcare provider and more the sort of thing a supervillain would write at the top of their vision board.
posted by bombastic lowercase pronouncements at 6:29 AM on November 15, 2023 [27 favorites]
see i know that there are depths to which a united states healthcare company can plunge that are deeper than any i can imagine, but based on my experiences with kaiser permanente the idea of that outfit standing next to anybody and seeming comparatively less mustache-twirlingly evil causes my brain to make sounds like an actively dying 1980s cassette tape.
like, the company's name is kaiser permanente. kaiser. permanente. i can't be the only one who's noticed that "kaiser permanente" is less the sort of thing you'd name a healthcare provider and more the sort of thing a supervillain would write at the top of their vision board.
posted by bombastic lowercase pronouncements at 6:29 AM on November 15, 2023 [27 favorites]
Empire BCBS was the nastiest company we dealt with when I worked in a homecare office getting insurance authorizations. Named for the empire state but a good villain name as well.
Across the board with patients who had private insurance, they had a set number of days/visits allowed in their plans for homecare. Use them up? Bye. Over to private pay with you. When you hit your plan limit, that's that. And usually that limit was for all disciplines (RN, PT, OT).
Are Medicare advantage plans like that? 'Cause if they're pushing people out of rehab places & into homecare services faster, they're going to need longer stints of homecare...
We'd talk regularly with a few kindly case managers at the insurances (shout-out to that nice guy at Aetna) but we always joked that most acted like we were taking their personal money directly out of their pockets. Particularly workers comp care coordinators, ugh.
On some level I assumed they were under pressure from their managers, but it's really interesting to see how the joke was kinda true. In a way, we were likely a constant threat to their livelihoods: give us too much auth and get fired.
posted by Baethan at 6:59 AM on November 15, 2023 [4 favorites]
Across the board with patients who had private insurance, they had a set number of days/visits allowed in their plans for homecare. Use them up? Bye. Over to private pay with you. When you hit your plan limit, that's that. And usually that limit was for all disciplines (RN, PT, OT).
Are Medicare advantage plans like that? 'Cause if they're pushing people out of rehab places & into homecare services faster, they're going to need longer stints of homecare...
We'd talk regularly with a few kindly case managers at the insurances (shout-out to that nice guy at Aetna) but we always joked that most acted like we were taking their personal money directly out of their pockets. Particularly workers comp care coordinators, ugh.
On some level I assumed they were under pressure from their managers, but it's really interesting to see how the joke was kinda true. In a way, we were likely a constant threat to their livelihoods: give us too much auth and get fired.
posted by Baethan at 6:59 AM on November 15, 2023 [4 favorites]
Dealing with this has made me leftier and crankier over the last ten years. Teaching residents (junior doctors) 'how to deal with insurance shenanigans' is an unspoken major part of my job. Thankfully I work with a physiatrist who knows how to play the insurance games as well.
Unfortunately office time dealing with this are 'non billable hours', so the MBAs at the hospital don't give a shit either.
(Pertinent recent Glaucomflecken)
posted by cobaltnine at 7:09 AM on November 15, 2023 [6 favorites]
Unfortunately office time dealing with this are 'non billable hours', so the MBAs at the hospital don't give a shit either.
(Pertinent recent Glaucomflecken)
posted by cobaltnine at 7:09 AM on November 15, 2023 [6 favorites]
> In a way, we were likely a constant threat to their livelihoods: give us too much auth and get fired.
it's interesting, though, you put it that way and it looks like people interacting with these goons maybe have an actual moral duty to do everything they can to get them fired.
like, they've accepted a deal that's something like "make sure as many extra people as possible die in the next quarter and get a bonus, fail to make sure that n extra people die in the next quarter and you're fired." anyone who accepts that throffer is either:
it's interesting, though, you put it that way and it looks like people interacting with these goons maybe have an actual moral duty to do everything they can to get them fired.
like, they've accepted a deal that's something like "make sure as many extra people as possible die in the next quarter and get a bonus, fail to make sure that n extra people die in the next quarter and you're fired." anyone who accepts that throffer is either:
- a vampire, in which case they must be destroyed
- being eaten from the inside out by the moral injury they're accruing every day, in which case getting them fired would be doing them a great kindness
But Fox News told me that government healthcare would have Death Panels!
posted by Abehammerb Lincoln at 8:08 AM on November 15, 2023 [4 favorites]
posted by Abehammerb Lincoln at 8:08 AM on November 15, 2023 [4 favorites]
But Fox News told me that government healthcare would have Death Panels!
The difference here is with private insurance you get to choose which death panel is in charge of whether you live or die, you're not forced to use the same death panel as everyone else.
posted by AzraelBrown at 8:18 AM on November 15, 2023 [18 favorites]
The difference here is with private insurance you get to choose which death panel is in charge of whether you live or die, you're not forced to use the same death panel as everyone else.
posted by AzraelBrown at 8:18 AM on November 15, 2023 [18 favorites]
United previously on the Blue
posted by CheesesOfBrazil at 8:29 AM on November 15, 2023 [2 favorites]
posted by CheesesOfBrazil at 8:29 AM on November 15, 2023 [2 favorites]
To me, the key to the evil is in the sentence I ended the post with: "Its strategy is integral to a growing national business at UnitedHealth to deliver more care in patients’ homes using a network of providers it has spent billions of dollars acquiring in recent years." UnitedHealth, as you may know, owns Optum, and Optum is--among several other things--a pharmacy and a pharmacy benefit manager (i.e. the middleman between a drug manufacturer and the pharmacy that sells you the drug). Oh, and a bank too--your HSA may be with Optum. The goal is to own as much of the profitable parts of the process as possible. With size, with network effects, with integration, we're looking at a complex new thing that has some of the efficiencies of centralization/nationalization with none of the benefits. It's hard to look at that structure and not think of the 2008 crash, because at a certain level of complexity, you simply cannot have this much stuff all under one roof, powered by a profit motive rather than a stability-of-services motive, without something massive and systemic breaking.
posted by mittens at 8:36 AM on November 15, 2023 [8 favorites]
posted by mittens at 8:36 AM on November 15, 2023 [8 favorites]
> The difference here is with private insurance you get to choose which death panel is in charge of whether you live or die, you're not forced to use the same death panel as everyone else.
or rather, your employer gets to chose.
posted by bombastic lowercase pronouncements at 9:14 AM on November 15, 2023 [11 favorites]
or rather, your employer gets to chose.
posted by bombastic lowercase pronouncements at 9:14 AM on November 15, 2023 [11 favorites]
United Healthcare has always been surprisingly good to me. But I got tired of hearing what a crap company they are and how they deny the most needy the money they deserve, while also making it so difficult for some people to submit bills to them at all. So at this year's medical insurance sign up at work, I switched insurance companies. Suck it, UHC.
posted by ceejaytee at 10:12 AM on November 15, 2023 [2 favorites]
posted by ceejaytee at 10:12 AM on November 15, 2023 [2 favorites]
While I've no doubt that the people/algorithm in charge at UH are evil, I submit this for your consideration: Cigna sued over algorithm allegedly used to deny claims.
TL;DR: Cigna is also a mustache-twirling villain.
posted by tuesdayschild at 10:18 AM on November 15, 2023 [3 favorites]
TL;DR: Cigna is also a mustache-twirling villain.
posted by tuesdayschild at 10:18 AM on November 15, 2023 [3 favorites]
I've been on the clinician end of this, where we have to decide whether to just go with the algorithm's discharge date or to push back (or, more effectively, get the hospitalized patient to push back). We would actually mark on the big board which patients were UHC just so we were aware that it was going to be an issue. And that is why I always say "friends don't let friends get UHC"
And we're not in an area that has their integrated home health options... Or any home health options for a non-negligible number of patients.
posted by DebetEsse at 10:22 AM on November 15, 2023 [6 favorites]
And we're not in an area that has their integrated home health options... Or any home health options for a non-negligible number of patients.
posted by DebetEsse at 10:22 AM on November 15, 2023 [6 favorites]
The difference here is with private insurance you your employer gets to choose which death panel is in charge of whether you live or die
FTFY, for the 54% of Americans who get health insurance through their employers. (Of course the ACA is always an option for those Americans, but from what I’ve seen those plans are usually much more expensive and even worse… but see, you have options!)
(Though the article is about patients on Medicare, so let’s not let this derail the conversation…)
On edit: whoops, bombastic beat me to it…
posted by purple_frogs at 11:57 AM on November 15, 2023 [2 favorites]
FTFY, for the 54% of Americans who get health insurance through their employers. (Of course the ACA is always an option for those Americans, but from what I’ve seen those plans are usually much more expensive and even worse… but see, you have options!)
(Though the article is about patients on Medicare, so let’s not let this derail the conversation…)
On edit: whoops, bombastic beat me to it…
posted by purple_frogs at 11:57 AM on November 15, 2023 [2 favorites]
bombast beats amphibian. it says so right there in the rules to the twice-expanded rock-paper-scissors-spock-lizard midwestern conservationist wetlands variant, great lakes region council of 1912 deluxe edition.
posted by bombastic lowercase pronouncements at 12:20 PM on November 15, 2023 [2 favorites]
posted by bombastic lowercase pronouncements at 12:20 PM on November 15, 2023 [2 favorites]
Ha! One more
...mustache-twirlingly evil healthcare company in the U.S.
But saying a corporation is at fault kind of hides the reality--it isn't faceless evil insurance companies promoting this, it's actual evil people behind these policies that prioritize their greed rather than society's good. They have faces. CEO guilty of policies that active hurt people should be stripped, tarred and feathered, and taxed like hell after being fined till they squeak. They're the ones that think up this crap and deem it good. Board members and stockholders should be pointed out and forced to do a walk of shame, and then fairly taxed on their profits, because they turn a blind eye and keep their hands out. When are we going to call for accountability?
posted by BlueHorse at 12:27 PM on November 15, 2023 [2 favorites]
...mustache-twirlingly evil healthcare company in the U.S.
But saying a corporation is at fault kind of hides the reality--it isn't faceless evil insurance companies promoting this, it's actual evil people behind these policies that prioritize their greed rather than society's good. They have faces. CEO guilty of policies that active hurt people should be stripped, tarred and feathered, and taxed like hell after being fined till they squeak. They're the ones that think up this crap and deem it good. Board members and stockholders should be pointed out and forced to do a walk of shame, and then fairly taxed on their profits, because they turn a blind eye and keep their hands out. When are we going to call for accountability?
posted by BlueHorse at 12:27 PM on November 15, 2023 [2 favorites]
> Board members and stockholders should be pointed out and forced to do a walk of shame
let's do it. this sounds like the sort of thing that requires assembling a menacing mob, and, well, if there's one thing you can know about me for sure, it's that i'm always down for a bit o' mobby menace.
> and then fairly taxed on their profits,
that taxation thing is gonna require establishing a democracy first, though. let's stick with mob action, it's cleaner.
> When are we going to call for accountability?
presumably it'll have to wait until after we've doxxed all the executives what need doxxing and then assembled and deployed enough sufficiently large sufficiently menacing mobs.
posted by bombastic lowercase pronouncements at 12:36 PM on November 15, 2023 [2 favorites]
let's do it. this sounds like the sort of thing that requires assembling a menacing mob, and, well, if there's one thing you can know about me for sure, it's that i'm always down for a bit o' mobby menace.
> and then fairly taxed on their profits,
that taxation thing is gonna require establishing a democracy first, though. let's stick with mob action, it's cleaner.
> When are we going to call for accountability?
presumably it'll have to wait until after we've doxxed all the executives what need doxxing and then assembled and deployed enough sufficiently large sufficiently menacing mobs.
posted by bombastic lowercase pronouncements at 12:36 PM on November 15, 2023 [2 favorites]
Serious question for people in the know - is there actually any health insurance company that is notably worse than the others? Or are they all just pretty bad?
posted by atoxyl at 1:04 PM on November 15, 2023
posted by atoxyl at 1:04 PM on November 15, 2023
atoxyl...Before I transitioned to Medicare, I got insurance on the Marketplace. I had a silver plan from Ambetter/MHS for several years. To be honest, it was pretty good coverage, and I never had an issue with being denied services. There was the usual “let’s try an x-ray before we authorize an MRI” kind of stuff, that is pretty normal across-the-board with insurers. And, whenever I had a reason to call their customer service line, they were always very helpful and pleasant to deal with. YMMV, of course.
posted by Thorzdad at 1:39 PM on November 15, 2023 [1 favorite]
posted by Thorzdad at 1:39 PM on November 15, 2023 [1 favorite]
Optum is--among several other things--a pharmacy and a pharmacy benefit manager (i.e. the middleman between a drug manufacturer and the pharmacy that sells you the drug). Oh, and a bank too--your HSA may be with Optum.
I have UHC through my employer, and Optum just reached out to me to make sure there wasn't anyone else who maybe possibly could be on the hook for the less than $1000 in charges it cost UHC when I fell off my bike because the road was wet and sprained my wrist a few weeks back. Gotta subrogate everything you possibly can! Including forcing you to sue your grandma or whatever because it was her steps you fell on and by golly her homeowner's insurance is gonna pay for it! I kinda expected it when I tore an ACL years back and needed surgery, but I'll admit to being surprised it's worth the effort for them for a couple x-rays, a brace, and a 5-minute visit with an orthopedist.
(Also, re: Cigna, my partner used to have them through his employer and when he was at the emergency room after being hit by a car and it was expected he would need surgery the next morning, they did a routine blood panel. Cigna came back two weeks later and specifically denied the Vitamin D test part of the panel, as if my partner had any say in what exact tests they were doing on his blood while spending the night in the hospital. And as if knowing you're deficient in Vit D isn't relevant when your tibial plateau has been crushed into many pieces. As I'm sure their algorithm predicted, it was easier for him to pay the $200 than fight them over it while recovering from major knee surgery.)
posted by misskaz at 2:11 PM on November 15, 2023 [7 favorites]
I have UHC through my employer, and Optum just reached out to me to make sure there wasn't anyone else who maybe possibly could be on the hook for the less than $1000 in charges it cost UHC when I fell off my bike because the road was wet and sprained my wrist a few weeks back. Gotta subrogate everything you possibly can! Including forcing you to sue your grandma or whatever because it was her steps you fell on and by golly her homeowner's insurance is gonna pay for it! I kinda expected it when I tore an ACL years back and needed surgery, but I'll admit to being surprised it's worth the effort for them for a couple x-rays, a brace, and a 5-minute visit with an orthopedist.
(Also, re: Cigna, my partner used to have them through his employer and when he was at the emergency room after being hit by a car and it was expected he would need surgery the next morning, they did a routine blood panel. Cigna came back two weeks later and specifically denied the Vitamin D test part of the panel, as if my partner had any say in what exact tests they were doing on his blood while spending the night in the hospital. And as if knowing you're deficient in Vit D isn't relevant when your tibial plateau has been crushed into many pieces. As I'm sure their algorithm predicted, it was easier for him to pay the $200 than fight them over it while recovering from major knee surgery.)
posted by misskaz at 2:11 PM on November 15, 2023 [7 favorites]
UnitedHealth, as you may know, owns Optum, and Optum is--among several other things--a pharmacy and a pharmacy benefit manager (i.e. the middleman between a drug manufacturer and the pharmacy that sells you the drug).
Our BCBS plan has all the pharmacy stuff managed by CVS Caremark. It's probably not technically anticompetitive, because wouldn't it be shut down by now if it was? But I couldn't switch from CVS to the small independent pharmacy I wanted to use because they weren't able to do 90 day fills on a chronic condition medication. They could do 30 day fills but that's not allowed by Caremark. 90 day supply or go f yourself. Oh you don't want to buy a huge number of pills? F you
(If it's a mental health med you can request an override! IT'S A GODDAMN NIGHTMARE and you better know your magic words to get it or instead of just 45 minutes on the phone with caremark every single month, it's gonna be a whole lot longer & it's gonna take more than one call)
The amount of incoherent ranting I could do about fricken CVS Caremark.... CVS doesn't own BCBS, at least. Just Aetna.
posted by Baethan at 7:33 PM on November 15, 2023 [6 favorites]
Our BCBS plan has all the pharmacy stuff managed by CVS Caremark. It's probably not technically anticompetitive, because wouldn't it be shut down by now if it was? But I couldn't switch from CVS to the small independent pharmacy I wanted to use because they weren't able to do 90 day fills on a chronic condition medication. They could do 30 day fills but that's not allowed by Caremark. 90 day supply or go f yourself. Oh you don't want to buy a huge number of pills? F you
(If it's a mental health med you can request an override! IT'S A GODDAMN NIGHTMARE and you better know your magic words to get it or instead of just 45 minutes on the phone with caremark every single month, it's gonna be a whole lot longer & it's gonna take more than one call)
The amount of incoherent ranting I could do about fricken CVS Caremark.... CVS doesn't own BCBS, at least. Just Aetna.
posted by Baethan at 7:33 PM on November 15, 2023 [6 favorites]
Coincidentally, today I got a letter from my union telling me that my health care coverage will be switching from Cigna to United. Cigna has been very, very good for me.
---
Wendell Potter on Twitter is very good on anticonsumer health care business practices.
posted by neuron at 9:00 PM on November 16, 2023
---
Wendell Potter on Twitter is very good on anticonsumer health care business practices.
posted by neuron at 9:00 PM on November 16, 2023
The 1% variance from the average stay the story cites *is* the story.
Human health is variable, full stop. Treatments .... need to vary, accordingly. Some patients heal fast, others have complications. Simple, obvious reality.
If the treatments that UHC provided did not vary as much as the data or hospital stays that produced the mean stay length that they are so rigidly imposing as a standard .... that fact is proof positive that some patients were denied necessary care.
posted by Dashy at 4:39 AM on November 17, 2023 [3 favorites]
Human health is variable, full stop. Treatments .... need to vary, accordingly. Some patients heal fast, others have complications. Simple, obvious reality.
If the treatments that UHC provided did not vary as much as the data or hospital stays that produced the mean stay length that they are so rigidly imposing as a standard .... that fact is proof positive that some patients were denied necessary care.
posted by Dashy at 4:39 AM on November 17, 2023 [3 favorites]
> bombast beats amphibian. it says so right there in the rules to the twice-expanded rock-paper-scissors-spock-lizard midwestern conservationist wetlands variant, great lakes region council of 1912 deluxe edition.
now that this thread has died down i must note that i am disappointed that no one, not one single person, responded to this comment with "die, heretic!"
posted by bombastic lowercase pronouncements at 10:33 AM on November 18, 2023 [3 favorites]
now that this thread has died down i must note that i am disappointed that no one, not one single person, responded to this comment with "die, heretic!"
posted by bombastic lowercase pronouncements at 10:33 AM on November 18, 2023 [3 favorites]
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posted by RonButNotStupid at 5:51 AM on November 15, 2023 [8 favorites]