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Medicare – Part 2

BooksHard for me to believe but I am about to go on Medicare! As I described in a rant about browser issues, the experience to date has been only with the administrative aspects– the clinical part does not start until next month. The entire enrollment was able to be completed online at medicare.gov — no faxes, no forms, no paper — and once I got the password issue resolved, I concluded that the mymedicare.gov web site is pretty good. Several improvements have been made to the site since I first learned about it a few months ago and it provides a broad range of information. I was particularly pleased to see that they are promoting e-prescribing. Appears like the site is comprehensive — seems it handles most aspects of life with Medicare. Most — but not all.
Today I received the first payment notice from Medicare — the coverage is not free. Medicare requested payment for the first three months. A second letter referred to a higher amount that I would pay and it referred to a third letter that would explain where the higher amount came from. Turns out it comes from an income adjusted premium. Health and Human Services gets data from the IRS and determines what the 2010 Medicare premium should be based on 2008 adjusted gross income. Just like airline seats there is a wide range of premiums that people pay toward their government provided healthcare. It is also clear that the differential premium between those who pay and those who don’t will grow. I’ll leave it to the politicians to debate that and use this posting to talk about the payment method.
The premium payment notice offered the choice of using a credit card or sending a check. The web site has no payment options and  credit card payments can not be done by phone. An option for automatic ACH payments is available but you have to call to set it up. The call results in an “order” being placed to have a “package of forms” sent out. After returning the forms the setup will take 6-8 weeks. In the meantime the monthly premium will need to be paid by check or credit card. I can not think of a reason that such old fashioned payment methods are all that are available. Security and complexity would appear simple compared to the billions of dollars that Amazon handles so smoothly with no checks and forms. Perhaps the priority is not high to automate the payment side of Medicare since most payments are handled as deductions from social security payments. This will not be the case until I start receiving social security payments a year from now when I turn 66.
One good thing that HHS is doing is chasing after fraud. Ninety-four medical professionals around the U.S. were charged yesterday for their alleged involvement in a scheme to submit $251 million of false claims to Medicare. If it is a choice between automating my monthly payment versus deploying technology to eliminate or at least drastically reduce fraud I will clearly vote for the latter. IBM has been assisting in fraud detection for a long time (See  Fraud Reduction Could Fund A Chunk Of Healthcare). If ever there was a strong need for analytics it would be in fraud detection. By looking at patterns of provider applications, payment requests, repeat visits, diagnosis versus treatments, etc. it is possible to discern likely fraud. Billions of dollars have been recovered so far and unfortunately there are many more billions to go after. The amount of data is huge but the power of supercomputers and advanced analytics software is even more awesome. With thirty million more people coming into the healthcare system the number of transactions and potential for abuse will increase dramatically. The bad news is the likely increase in criminals targeting Medicare but the good news is that the tools are getting better and better and it appears that HHS is giving a high priority to applying the tools to the task at hand.
IBM is making large bets in healthcare beyond just fraud detection. Yesterday the company announced a three year Research investment to help medical practitioners and insurance companies provide high-quality, evidence-based care to patients and reduce costs.  As part of this initiative, IBM is hiring medical doctors to work alongside its researchers to develop new technologies, scientific advancements, and business processes for healthcare and insurance providers.

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