An anonymous reader quotes a report from The Wall Street Journal: Cigna plans to expand a system that uses artificial intelligence to identify gaps in treatment of chronic diseases, such as patients skipping their medications, and deliver personalized recommendations for specific patients. The product, called Health Connect 360, integrates data from a combination of sources and analytical tools, some developed at Cigna and others brought in as part of its $54 billion acquisition of pharmacy-benefit manager Express Scripts Holding Co., completed late last year. Express Scripts, which began developing the service two years ago, rolled out portions of it to some customers this year. Health Connect 360 was developed for treatment of chronic diseases, including diabetes and heart disease, as well as for pain management. The system aggregates medical, pharmacy, lab and biometric data -- such as information from glucometers, which measure blood-sugar levels -- into a dashboard that is accessible through an online interface.
The United States doesn't have a market-based economy for prescription drugs. It has a shame-based economy. The latest example of this Scarlet Letter approach to drug pricing came this week as insurance giant Cigna and its Express Scripts subsidiary announced that consumers with drug benefits managed by the company could see their out-of-pocket costs for insulin limited to $25 a month. "For people with diabetes, insulin can be as essential as air," Steve Miller, Cigna's chief clinical officer, said in a statement. "We need to ensure these individuals feel secure in their ability to afford every fill so they don't miss one dose, which can be dangerous for their health."
Yet the algorithm gave healthier white patients the same ranking as black patients who had one more chronic illness as well as poorer laboratory results and vital signs. The algorithm used cost to rank patients, and researchers found health-care spending for black patients was less than for white patients with similar medical conditions. "What the algorithm is doing is letting healthier white patients cut in line ahead of sicker black patients," said Dr. Ziad Obermeyer, the study's lead author and an acting associate professor of health policy at the University of California, Berkeley. Optum advises its customers that its predictive algorithms shouldn't replace physician judgment, a company spokesman said. Efforts to use analytics in health care have only scratched the surface of their potential and should be continually reviewed and refined, he said.
From large corporations assuming multiple roles in the drug supply chain -- as seen with CVS' pending acquisition of insurer Aetna -- to new startups leveraging tech to smooth drug distribution, here's how the complex pharmaceuticals market is changing. With drug prices on the rise in the US, the pharmaceutical supply chain has come under fire. Healthcare providers, patients, and politicians alike have all pointed out the inefficiences in the current system. And this outcry seems to be for good reason: for every $100 spent on prescription drugs, $41 goes to intermediaries in the supply chain, according to a 2017 report from USC. What could healthcare look like in the coming decades?
That age-old question is no abstraction when it comes to your healthcare premiums, as Cigna and Anthem Blue Cross Blue Shield are pushing to merge into the largest health insurance company in America. With consumer groups, physicians and hospital officials insisting that the consolidation threatens to limit medical care and jack up insurance prices for millions of Americans, regulators in one small state, Connecticut, are positioned to play a pivotal role in determining whether the companies get the approval they need. The state is home to Cigna and has long been friendly to the industry, building up a reputation as the insurance capital of America. But some watchdog groups say that with a recent personnel move inside the state government, the friendship has become too close for comfort. When Anthem's plan to acquire Cigna was being negotiated in early 2015, Connecticut's Democratic Gov. Dannel Malloy appointed Katharine Wade as his state's insurance commissioner: She was a longtime Cigna lobbyist whose father-in-law works at a law firm that lobbies for the company, whose mother and brother previously worked at Cigna and whose husband still does. She was also a top official of the major lobbying group for the state's health insurance industry. As commissioner, she appointed a top deputy who worked at Cigna and she had a former longtime Cigna employee serve as an agency counsel in the merger review. As Wade continues to oversee Connecticut's review of Cigna's merger, she recently secured a position chairing a healthcare policy committee for insurance commissioners across the country.