Monthly Archives: August 2014

Federal CTO to Begin Tenure as Another Type of CTO

Most people probably don’t realize that the Federal government has a CTO, Chief Technology Officer.  Through the end of 2014, this person is Todd Park.  In this article, he announced that he will step down from this position but still stay w/a civil servant but this time as another a top tech recruiter for the Feds but in Silicon Valley.

From Chief Technology Officer to Chief Talent Officer?

EDGE Server and How It Fits into the HIX Ecosystem

One of the requirements tucked into the HIX landscape is a requirement for QHPs (Qualifying Health Plans–insurers participating in the exchanges) to submit de-identified plan level information to CMS for the purposes of risk adjustment and reinsurance.  One of the major concerns by the health insurance industry was trying to price premiums for a newly insured membership that maybe utilizing health resources more frequently than expected b/c they have lacked health coverage in the past.  In other words, this population would be getting treated for medical conditions they previously had not gotten treated b/c they didn’t have health insurance.  What this means to an insurance company is the expense (claims paid) would be higher than the premium they initially set for them.  This also means they would either not make any money off this population or could even potentially be in the red because of this.  A concession made by the Obama administration to offset this is for the Federal government to underwrite any excessive utilization of exchange members by creating a risk adjustment and reinsurance program.  The Federal government would monitor at a plan level the risk QHPs were facing and institute stop/gap  measures to offset losses to an insurer’s bottom line.  This is similar (but very different in the details) to what CMS does for Med Advantage members w/the RAPS process.  However, unlike the RAPS process, the QHP submits de-identified claims data into the EDGE server (b/c this server sits on the ‘edge’ of a QHPs operations) that is loaded w/CMS software, calculates risk scores at the plan level, and both the plan and CMS can generate detailed analysis and reports from it.

Read more here.

 

Will More Data Change Personal Health Behavior?

The increasing in use in technology for, well, EVERYTHING is also spilling over into healthcare and especially the individual person’s role within the healthcare continuum.  From all kinds of trackers (Nike FUEL band, Jawbone’s UP band, fitness apps for measure one’s runs or walks), we are becoming more and more comfortable with using technology for personal health matters.  What about all the data these devices and apps generate?  Will it make a meaningful impact in steering people towards healthier lifestyle decisions and health habits?  Will this make a dent ever rising healthcare costs?

Read this interesting article that talks about the ‘quantified self’ and possible impacts to the healthcare discussion.