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Health Insurers Are Vacuuming Up Details About Customers

193 points by marchenko 8y ago

mtgx 8y ago
This will ensure the death of the private healthcare system. It won't happen overnight, but eventually the private/hybrid healthcare system will have no redeeming qualities other than to extract as much profit as possible out of anyone's health issues. That's when no one will support it anymore (except the politicians taking bribes to support it).
- Analemma_ 8y ago
  Why the downvotes? He's right. The thing about insurance is that the only reason it works is because of imperfect information about the future. The more accurately people can be priced, the more pointless private health insurance becomes: the expensive patients (pre-existing conditions, or just people with bad luck) will get accurately priced and have impossible premiums and won't bother, and the cheap patients will realize they probably don't need it, take a gamble and also not bother. Microtargeted health insurance will be its own undoing.
  - mindcrime 8y ago
    It sounds like you're doing something that most people do, despite it being incorrect. That is, conflating "health care" and "health insurance". Everybody has gotten so conditioned to the idea that "health insurance" pays for everything health related, that we all seem to take this for granted. But it doesn't have to be so. I believe that our goal should be to reduce the cost of health care so that most of it can be afforded without insurance - with insurance then returned to its role as a hedge against the more extreme/unlikely events.
    - poulsbohemian 8y ago
      >Everybody has gotten so conditioned to the idea that "health insurance" pays for everything health related, that we all seem to take this for granted. But it doesn't have to be so. Try this experiment. Walk into your doctor's office and ask what a procedure would cost. Ask the doctor, the receptionist, the billing clerk - ask everyone. No one will be able to give you an answer. That's why they are conflated. Fix that (very ripe for disruption) problem and you'll fix health care. PS: I agree with you, it should generally be affordable without insurance.
      - mindcrime 8y ago
        Try this experiment. Walk into your doctor's office and ask what a procedure would cost. Ask the doctor, the receptionist, the billing clerk - ask everyone. No one will be able to give you an answer. That's why they are conflated. Fix that (very ripe for disruption) problem and you'll fix health care. Agreed.
      - jsoc815 8y ago
        > Try this experiment. ...ask everyone. No one will be able to give you an answer. Funny you say this. A friend just went through this. Not even the insurance company could say. The calls to everyone got so ridiculous that I had to construct lawyerly questions so that people couldn't default to weaselly answers. The provider billing staff seemed to feel put upon that they were being asked to coordinate w/the insurer to figure out patient out of pocket cost would be. And in the end they still couldn't figure it out.
        poulsbohemian 8y ago
        Here's what gets to me as well... providers love to talk about how little they get reimbursed from medicare and from many insurers. But, for example, I'm not going to have a surgery that I would really like to have (and that a doctor agreed I should have) because nobody can tell me what the cost would be. The 15 minute appointment with the doctor who recommended it to me was $700 out of pocket - so I'm unlikely to return if that's the kind of bill I get hit with for having a cup of coffee with them. So, I'd like to believe that at some point, given the current environment in which people are paying for insurance but can't afford to go to the doctor, that we'll see providers realize they are losing out on revenue opportunities by not actually serving their customers.
- mindcrime 8y ago
  This will ensure the death of the private healthcare system. We don't have a private health-care system, and haven't for a very long time. The government and big corporations[1] are so deeply entwined into the current system that it barely approaches anything that could be called "private". [1]: Corporations are a legal fiction which depend on the State for their existence.
- poulsbohemian 8y ago
  > will have no redeeming qualities other than to extract as much profit as possible out of anyone's health issues. We're already at this point, but I don't see why you think that will be the death of the private healthcare system, see: >politicians taking bribes to support it
ohazi 8y ago
Isn't this super illegal? Who are the lawyers at these companies who are signing off on these projects?
- throwaway5752 8y ago
  No. Using that data might be. In any case, it's only illegal if the Supreme Court interprets it to be illegal. If you have been following the recent years of Supreme Court decisions/dissents it will not be comforting.
  - icebraining 8y ago
    Can you point to the cases that concern you? I haven't been following it closely enough.
    - throwaway5752 8y ago
      I'm sorry, I can't right now in detail. The general trend started with Citizens United and followed through Masterpiece is a increased set of precedents for corporate personhood, with some harsh dissents from the Alito/Thomas/Gorsuch contingent in cases where that was at issue (but corp. personhood side lost). When Kennedy retires and of Kavanaugh is his replacement, that will give put an awful lot on Robert's judgement as the swing decision. If I'm really getting picky, the lack of consistency in Trump v Hawaii and the Masterpiece case shows a certain amount of prioritizing partisan concerns over logical consistency (imo, ianal). edit: taking corporate personhood to logical extremes reverses a lot prior precedent and I would have doubted it would have happened until recently.
- kevin_b_er 8y ago
  What would be illegal? As long as corporate profit is viewed as more important than human health and safety, there will be no laws against such things. The Republican-controlled supreme court likes to rule that corporate "rights", due to corporate personhood, cannot be contained or curtailed in favor of human ones.
smileysteve 8y ago
> And it could raise your rates And it could lower your rates.
- Analemma_ 8y ago
  Please be serious here: stuff like this never causes prices to go down, only up. As information becomes perfect, the "problematic" expensive patients will see their premiums rise to the level of their actual cost to the system-- which is huge and impossible to pay, so they'll drop out-- and premiums for everyone else will stay the same, except with the added anxiety that anything you do could cause your rates to go up at any time.
- yourapostasy 8y ago
  > And it could lower your rates. Lack of a national competitive market for healthcare insurance in the US ensures an oligopoly within each state, and thus argues against your reply. Also, keep your eye upon demographic rate trends, not individual rates. In other words, for the same demographic over time, have rates been going up or down as the insurance market consolidates players over the past few decades? The trend is inarguable [1]; it is a monotonic function. What data do you have that convincingly advocates including data brokering of lifestyle data into insurance actuarial calculations makes a material change in this function or the marketplace? [1] https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878 https://www.thebalance.com/causes-of-rising-healthcare-costs...
- s73v3r_ 8y ago
  No, it will never be used for that.
exabrial 8y ago
That's ok with me? I wish it were like life insurance where they can ask you anything and then you get that rate locked down for the term. I also actually liked the proposal in Congress that got rejected: allow people to make their own groups. So if you are a person who likes to work out and get your fat levels tested once a year, you could join a group of like minded individuals and insurance companies would bid to insure your group.
- ceejayoz 8y ago
  > That's ok with me? I wish it were like life insurance where they can ask you anything and then you get that rate locked down for the term. That's an understandable attitude for a healthy person. What is the person born with a disability or a gene making cancer, Alzheimers, heart disease, etc. likely supposed to do? "Your insurance premium is $25k/month. We take checks!"
  - sDlEzAtyoNAz 8y ago
    If they can't afford to pay anyone enough to insure them, they should ask for charity, because that's what they need.
    - 5874-4b22-a4e0 8y ago
      They should go to the emergency room, iirc its free if they can't extract the money.
      - ceejayoz 8y ago
        You can't get stuff like chemo or a transplant at an ER. They are only required to (attempt) to (temporarily) stabilize you. "Just go to the ER" also is pretty much the most inefficiently stupid way of handling healthcare for the needy you can come up with.
    - ceejayoz 8y ago
      Shockingly, it turns out that most charities don't have the financial resources to dedicate a hundred thousand dollars for a single heat transplant.
jesseryoung 8y ago
Heard about this article on NPR this morning. Thought the concern was valid but a little on the alarmist end of things. Most of the data they need to know if you are going to be an expensive subscriber or a cheap one you're required to give them directly: Your age, your gender, your home address and the list of services you received at your doctor's visits that they were billed for. Both healthcare providers and insurance providers know that the most efficient way to lower your healthcare costs is to get the patient to go to preventive care visits and keep them out of the ER. It doesn't matter how much money you give them each month, if they can prevent you from going to the doctor all together it's 100% (roughly) profit.
- lvspiff 8y ago
  I work alongside healthcare informatics and I got to say this is entirely the case from what I have experienced - the less you go to the ER the more the insurance profits. All of our research and data collection revolves around people getting tests and treatment PRIOR to something major happening. Regular bloods tests, proactive bp and a1c monitoring, etc lead to better heart disease and diabetes treatments so you don't go into a crisis. The collection of data allows treatment to be better for the population not to charge a higher rate to specific people. Keeping you out of the hospital is monumentally cheaper than a couple doc visits a year for a couple lab tests.
FireBeyond 8y ago
> Insurers contend they use the information to spot health issues in their clients — and flag them so they get services they need. Horse shit. And I say that as someone who writes claims management software for the healthcare industry. I challenge ANY health insurer to provide examples of this. Of course, they won't, because they'll cite "patient confidentiality", but that just doesn't happen. They've wanted to do this for years, though, and try to. Requests to be able mine claim data for familial predispositions to diseases was one that we fended off multiple times.
- sidlls 8y ago
  You may have fended it off but I assure you there is a whole industry devoted to using claims and other health data to manage care and costs. Insurers are primary partners of these companies and act as both providers and consumers of the data. Not just insurers, but big hospitals and provider networks, too.
  - pishpash 8y ago
    We're going down some kind of bizarre path. Insurance is ultimately about risk sharing. If every risk is modeled then there is no insurance, just expensive prepayment.
    - tlb 8y ago
      If I have a 1% chance of a car accident, I’d be happy to pay 1.5% the cost of hospital bills for insurance. Someone else with a 2% chance of an accident should be happy to pay 3%. That’s still insurance. Only if you deny free will and assume perfect information and deterministic laws of physics, can every risk resolve to either 0% or 100%.
      - zAy0LfpBZLC8mAC 8y ago
        What is the practically relevant difference between 100% prediction capability and 99.999% prediction capability?
kyrieeschaton 8y ago
This is complete nonsense and entirely speculative. They admit as much when they inform you they can find no evidence of any individual underwriting decision being made based on this data, which the companies strongly deny, and would be illegal. Insurance is highly regulated, both on a state and federal level. Pricing algorithms and variables are public in most states (albeit obfuscated). What does seem to be happening is the companies are using third party data providers for marketing and market analysis, as literally every other company from your local HVAC guy to McDonald's does.
- deleted 8y ago
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deleted 8y ago
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a_d 8y ago
Whenever someone says that AI and IoT would automate insurance underwriting, I start to fret — because it very quickly starts to imply more and more data collection. This is like pre-crime but for your health. Meaning, you start paying high premiums right away because later in life you might be at a high risk for a specific condition. (I know this already happens for smoking, but that is declared on a form — not by a company sending a drone to spy on you) Since this is a startup forum — I believe health insurance to be so dark and morbid (with things like companies haggling with living relatives about ventilator care) — there is got to be a better way! (I realize this is more of a lament than a constructive suggestion)
- richrichardsson 8y ago
  There is a better way, it's called single payer universal healthcare!
  - frockington 8y ago
    Please no, I don't trust the government at all to handle healthcare efficiently. And I enjoy my insurance company through work, its the equivalent to a significant raise each year
    - shadowtree 8y ago
      DO you trust it with defence, etc.?
      - nostromo95 8y ago
        To play devil’s advocate, a government’s primary duty has been defense since the dawn of organized government. The U.S. government began in an armed rebellion. Moreover, there’s no reasonable alternative to the government having a monopoly on defense.
      - frockington 8y ago
        I trust it with defense and that's about it. I don;t even trust local governments to efficiently maintain roads
stakhanov 8y ago
I think there's something to be said IN FAVOR of the notion that person A's health risks don't trade off against person B's health risks at a 1:1 rate. The crucial thing however, in a data protection sense, is that there are too many people who don't realize the implications of giving away data about themselves. A shopper signing up for a loyalty card scheme in a grocery store might sign a blanket waiver allowing the scheme operator to pass the data on to whoever they please to be used in whatever way they want, without thinking about the possibility that it may end up in places where it won't serve their best interests. So there should be something similar here to health warning on cigarettes. Kind of like "Warning: Signing up for this loyalty card may make you uninsurable." Also, I think there should be legal infrastructure in place to ensure that there are certain rights that you can't sign away as part of a contract that, in practice, you don't have the option not to sign (like Google's general terms & conditions).
- koolba 8y ago
  Which is also why you should use a fake phone number, name, etc for those loyalty cards. Also a neat trick is to just (XYZ)-867-5309 as someone already signed up with the number from that song and it’s not a real number.
  - jasonjayr 8y ago
    It's a real number in the 401 area code. https://www.askgem.com/ https://www.askgem.com/ See the contact info in the lower left of the page.
  - stakhanov 8y ago
    I agree that "gaming the system" is usually the most practicable way to deal with this stuff in real life, but that doesn't mean it shouldn't be sorted out on a more principled basis eventually.
staticautomatic 8y ago
I buy data from LexisNexis. AMA.
- 1996 8y ago
  What do you have from the healthcare part now? Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses because hipaa? How is the data linked? ssn, phone numbers? (just a best guess, in case you spotted some linking anomalies) Is the primary key still a number internal to lexis nexis? How detailed is the social network now? (just people living together and neighbours, or does it includes relatives and family members)
  - 394549 8y ago
    > Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses? If they had access to that, wouldn't it be a HIPAA violation?
    - 1996 8y ago
      Yes, there are laws now. I edited my comment to mention that. Outside the US, labs are still a goldmine of data: time indexed numerical value that are used by providers to decide medical interventions. Except medical record or insurance history, you can't get any better than labs! Still I noticed in the US that labs selling directly to clients (like private md labs, only in some states) insist that the patient provide an accurate phone number. Given how phone numbers are used in the industry, I think they may want to keep the database accuracy for "future uses" when the law will change.
  - staticautomatic 8y ago
    >What do you have from the healthcare part now? Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses because hipaa? Nothing. The data at issue in this article belongs to a category called "Non-FCRA" (Fair Credit Reporting Act), which means they cannot (really, are not supposed to) be used for things like credit and hiring decisions. Most of the data are from the public domain, although there are some data that are only quasi-public (meaning they're nominally public but you must have special privileges to see them). I haven't seen any truly non-public data. >How is the data linked? ssn, phone numbers? (just a best guess, in case you spotted some linking anomalies) ?Is the primary key still a number internal to lexis nexis? The primary key is an internal UID, where each person has his/her own. There are edge cases where people in their DB do not have UID's at all or where a single person has multiple UID's. They obviously have some linking but I've seen little indication that they have a robust graph under the hood. For example, Lexis may "know" that you've cohabitated with a member of the opposite sex about the same age as you for 10 years starting when you were 30, and also "know" that you're married to someone with the same name as the cohabitant, but fail to identify that person as your spouse because the marriage records are siloed in their back end. >How detailed is the social network now? (just people living together and neighbours, or does it includes relatives and family members) There are lots of data available on your relatives and family members, but again, the linkages are piss-poor. For example, your record may say that your name is "John Smith Jr." and you lived with a man who is 30 years older than you named "John Smith Sr." until you were 18, but fail to identify that person as your father.
Cieplak 8y ago
Just clicked for me why “healthcare” companies spend so much money on hard discs and data storage.
gascan 8y ago
There are surely privacy concerns, but it seems like the evolution of all insurance markets trend towards better risk profiling. This is a good thing IMO. The point of insurance is to pool risk, not get your high risk subsidized by some sap with low risk. The better insurance companies can profile risk, the more fair the pools. Then if we want subsidies for high risk individuals, we can work on that separately.
samfisher83 8y ago
While its called its called Health Insurance, it should be called health care costs. The US is the only 1st world country without universal healthcare. The thing is most of us already subsidize the healthcare industry. The hospital has to treat someone in an emergency if they take medicare or medicaid. A lot of times people are using the emergency room as their primary care since they can't afford primary care. The hospital increases the rates it charges everyone else to cover this. You can use data to predict who is going to be more sick and charge them more. However do you want them to die or suffer. I wouldn't. So why not try to fix the big problem instead of all these little ones about data misuse and just cover everyone since you are paying for them anyway.
- chimeracoder 8y ago
  > The thing is most of us already subsidize the healthcare industry. The hospital has to treat someone in an emergency if they take medicare or medicaid. The "subsidies" run the other way. Medicare reimbursements do not cover COGS, which means that providers cannot sustain themselves solely on Medicare reimbursement rates; they need to take privately-insured patients (whom they charge dramatically more) in order to stay afloat[0]. These costs get passed on to privately-insured patients in the form of higher premiums. [0] Medicare acknowledges this, and in fact, Medicare even runs multiple stipend programs to essentially pay extra to hospitals who don't see enough privately-insured patients that they can make up the difference. If they didn't, those hospitals would close, because you can't lose money on a per-patient basis and still run a practice, even if you managed to recruit doctors, nurses, and staff who agreed to work for free as volunteers.
1996 8y ago
> The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993 I think they just use their point of sales (primary care, etc) to collect data from the client and use it against the client. I know because I used to be in a very similar line of business. It is easy because clients give you a permanent unique id for payment purposes (ssn), or other unique id (phone numbers) that varies with time (now less with people porting their number). Of course, the point of sale has a list of previous items, even from competitors (medical history) but that has become harder to use, due to laws. Still, most places ask for "emergency contact", which you can use to build a social network. Sick people cluster together. I don't know why, it just happens, and it is a good workaround. Of course, you need enough data, but it is then a matter of scale (if you have 75% of the market, you have seen everyone in a county at least once) and trade (buy the same data from your competitors). Personally, due to experience, I prefer to forego insurance and get my healthcare abroad. Better prices than paying deductibles, better services. But I can not recommend that for everyone. Still this is a dirty business, and I strongly recommend to adopt basic opsec precautions if you get healthcare in the US: never give your ssn, give a phone number that is not used for anything else even better if it is prepaid so not linked to a ssn, never ever give an emergency contact, only list medical conditions that will not cause you legal issues.
- 394549 8y ago
  > Personally, due to experienck, I prefer to forego insurance and get my healthcare abroad. Better prices than paying deductibles, better services. But I can not recommend that for everyone. If you're in the US, that choice could bankrupt you if you ever need major emergency medical care, because of an accident or some condition requiring emergency surgery, like a brain hemorrhage. https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html https://www.nytimes.com/2017/03/29/magazine/those-indecipher...
  - 1996 8y ago
    I am lauching my business, I need more money NOW. Healthcare abroads cover everything (eyes, teeth...) and is much cheaper than a deductible even when paying everything cash. And no weird haggling with the insurance or provider to see what is covered, what is not, what is the copay, etc. This may not cover edge cases, but for most of my personal financial decisions, I follow the example set by governments around the world: I spend in the present without caring too much about future, betting on growth of my resources. In other words, if I do have a brain hemorrhage, the last of my worries will be bankrupcy. Why should I bother? If I fail my business, I will be bankrupt anyway.
jadedhacker 8y ago
Whelp, just one more reason why we need Medicare for All. There's no need to enable these people whose business is to find ways to deny people healthcare, just eliminate their industry completely and save money in the process too.
stakhanov 8y ago
There are certain dimensions that it makes a lot of sense to discriminate around: For example, if you're a roofing contractor, I really think you SHOULD be paying higher health insurance rates than I do, as an office worker. You'll just price it into whatever you charge to make roofs, which means the price of a house will start getting closer to what it actually costs the economy. Since I rent, I would otherwise end up subsidizing other people to build or buy houses for themselves, and I don't think that's how an economy should work.
- ceejayoz 8y ago
  > For example, if you're a roofing contractor, I really think you SHOULD be paying higher health insurance rates than I do, as an office worker. Why? Your sitting eight hours a day is remarkably unhealthy, and roofers (at least where I'm located) are typically separately insured for on-the-job injuries.
  - stakhanov 8y ago
    Don't get unduly bogged down with the example: It works equally well with "horse trainer" or whatever. Clearly some professions have a bearing on your risk profile with regard to certain types of insurance, and there is not always a clear distinction between risks you incur as a private person and risks that your business needs to indemnify you against. -- Like, if you're in a job that involves a lot of travelling and being away from your family for extended periods of time puts you at greater risk of developing mental health conditions etc.
    - phil21 8y ago
      I think the numbers may not come out the way you think they will. Sedentary lifestyles are by far the largest medical expense in the country as a whole, so office jobs I would expect to have much higher premiums. Sure you're not gonna get your sternum crushed by a falling 2000lb pallet - but those situations are already typical covered by workmans comp and other company insurance.
    - Broken_Hippo 8y ago
hirundo 8y ago
> But patient advocates are skeptical health insurers have altruistic designs on people’s personal information. It's funny that the article felt this needed to be said. Just how would an altruistic insurance company have survived in such a competitive market? I think I learned the insurance business model early in life. I lived near a horse race track, and used to collect the programs and assemble giant (paper) spreadsheets with various data on horses and their win/loss records. Does the jockey make a big difference? Does the wetness of the track? I would have used any measure that gave me an edge in betting, with zero "altruistic" regard for the horse, its owners, or anyone else but me. You know, like an insurance company. It turned out that there was a datum that significantly improved my odds, and converted me from a regular loser to an irregular net winner. And it didn't come from a program. I figured out that I could just watch the horses as they paraded to the starting gate, pick the one that I thought looked like it wanted to win, and could, and ran to place a bet on it before the race started. Far from perfect obviously, and I didn't win big, but I started winning more than losing. I'd bet that insurance companies wish they could do something similar: Have experienced medical underwriters examine and interview potential customers and then make gut level decisions, then judge more by underwriter stats than patient stats. But that approach seems to be increasingly prohibited, so they make do with what data they can get. It's hard to find that surprising, unless somehow you've confused "insurance" and "altruism" to be related terms.
madengr 8y ago
I've been saying this for years. That discount card you use at the grocery store tells your insurance company how much bacon you eat.
394549 8y ago
Has anyone done any research to map out the relationships between the different data brokers? E.g. who has what data to sell, and who's selling what data to who?
- staticautomatic 8y ago
  I could tell you who is selling what, and a little bit of who is selling what to who, but I don't think any one person has a complete picture.
  - 394549 8y ago
    Would it be too much trouble to share what you know? Even just a list of the players would be helpful. I'd really like to understand more about this industry, but from a consumer perspective, it's very opaque. It's easy to find people search websites (and articles about them), but much harder to understand how they got your data or what else about you may be getting sold.
    - staticautomatic 8y ago
      I'll do my best to explain. I need to start by noting that, as far as I'm aware, there's no generally accepted nomenclature for this stuff. Accordingly, I've invented my own terms (some of them as I write this). At a high level there are two different kinds of brokers, which I'll call "primary brokers" and "secondary brokers." Primary brokers are companies that primarily aggregate their own data and sell it to other businesses. Secondary brokers are companies that primarily buy data from primary brokers and resell them to other companies or to consumers. Each broker can further be defined by the kind(s) of data they sell. Generally speaking, there are 5 categories of data: 1. FCRA records. These are mainly credit records and credit-related data that are permitted to be used in making credit determinations. 2. Non-FCRA public records. This is stuff like birth, death, marriage, property records, DMV records, criminal records, etc. These are explicitly not to be used for credit and hiring determinations (not sure about renting, off-hand). 3. Hiring data. Frankly I'm not entirely sure what these are beyond criminal background stuff, but they are allowed to be used for making hiring decisions, where permitted. 4. Marketing/Lifestyle data. This is stuff like purchase history, magazine subscriptions, hobbies and interests, data sold by companies whose products you sign up for for free, etc. 5. Insurance underwriting data. These tend not to be explicitly tied to a non-anonymous person. However, given someone's street address, you'd be able to pull some info on their property or something. Most brokers sell data belonging to multiple of the above categories. The big primary brokers for FCRA data are, as you might expect, credit agencies (Experian, Equifax, and TransUnion). The big brokers who deal in mixes of data are LexisNexis (a Reed Elsevier company), Thomson Reuters/WestLaw, and TLO (a TransUnion subsidiary). They are primary brokers of Non-FCRA and hiring data but secondary brokers of FCRA data (I believe they mainly purchase it from the credit agencies). There are a couple small companies that are primary brokers of things like hiring data (e.g. Checkr). The big primary brokers of marketing/lifestyle data are companies like Acxiom, BlueKai, Epsilon, US Data, and a number of others. I have heard that credit card companies sell certain kinds of data but I am not sure what exactly and have not used their products myself. The big primary broker of insurance underwriting data (along with a couple other categories) is CoreLogic. The big secondary brokers of Non-FCRA data are Intelius and Instant Checkmate. I do not think they are primary brokers under my definition because most of what they sell is basically an identical copy of what the primary brokers sell, but for a lot more money. It's hard for me to imagine them taking on the expense of aggregating the bulk of their own primary data when they can run a search against a primary broker DB for a few bucks and resell a pretty version of the response to a consumer for $50. They probably aggregate some of their own data but I'd guess it's low-hanging fruit. There are also some purely social media-driven secondary brokers, like Pipl.
clumsysmurf 8y ago
A recent-ish book that talks a little about this (surprised the article did not mention QuintilesIMS): "Our Bodies, Our Data: How Companies Make Billions Selling Our Medical Records" https://www.amazon.com/Our-Bodies-Data-Companies-Billions/dp/0807059021 https://www.amazon.com/Our-Bodies-Data-Companies-Billions/dp...
dawhizkid 8y ago
Most people who work for medium or large sized companies in the US are working for companies that are self-insured, meaning your company is taking on all the risk, so if anything your own employer is incentivized to do this and not the insurance company itself. When I first heard of the Amazon/JP Morgan/BH heathcare initiative my thought on what that company would actually do is surveillance on their collective millions of employees to better predict if they are prone to disease and use predictive analytics to lower their own claims cost.
- mtberatwork 8y ago
  > meaning your company is taking on all the risk While I wouldn't say there aren't any companies out there that are absorbing the entire cost of insurance premiums, most are splitting this in some proportion with the employee.
  - deleted 8y ago
    [deleted]
  - dawhizkid 8y ago
    by risk I mean that the company is liable for all claims cost, but right premiums can come from the employee, employer, or both.
- Spooky23 8y ago
  > When I first heard of the Amazon/JP Morgan/BH heathcare initiative my thought on what that company would actually do is surveillance on their collective millions of employees to better predict if they are prone to disease and use predictive analytics to lower their own claims cost. ...or avoid claims in the hiring process.
deegles 8y ago
To play devil's advocate, I think data should be used to manage rates for things that a consumer can reasonably change, like diet/exercise. Smokers are already penalized. e.g. "Our data indicates your average sugar consumption is over Xg per day over the last 6 months. If you commit to reducing this to Yg per day over the next 6 months, your insurance rate will drop by 10%. Otherwise rates will increase by 20% to cover your increased risk for diabetes, heart disease, and stroke."
- dsfyu404ed 8y ago
  That'll end well. "our data indicates you're probably a women and therefore have an above average risk of having kids, if you commit to gender reassignment surgery your insurance rate will drop by 30%" Or if that's not allowed they'll just use other things that are a rough proxy for a protected class.
- jschwartzi 8y ago
  On that note, my insurer helpfully put a note in my file that the doctor should tell me about being more physically active based on my BMI. When I listed everything I do, he turned to his intern and said "this is an example of how BMI doesn't tell the whole story." Then he deleted the note. So it has to be the right data and the doctor needs to be the final arbiter of whether it's meaningful or not.
- supertrope 8y ago
  The 2010 ACA law considers employee wellness discounts of 30% or more coercive and potentially a way to get around the ban on individual medical underwriting. While monetary incentives are powerful, people are not completely or even close to rational actors. If poor health and prematurely dying (often painfully) aren’t motivators to take care of your health, what will? Health promoting culture like teaching all kids to cook and eat healthier, encouraging fitness through less car centric infrastructure, etc. are needed to address the metabolic syndrome epidemic. Frequent reminders, small sub-goals, reinforcement, role models are probably more effective than a four figure fine for being unhealthy. Some people can overcome big problems on their own because they are committed, but once you get out into the wider population a lot of marketing, hand-holding, and gimmicks are needed to get everyone to make significant permanent change.
turc1656 8y ago
"The companies are tracking your race, education level, TV habits, marital status, net worth. They’re collecting what you post on social media, whether you’re behind on your bills, what you order online." The only way they can do this and link it to you as an individual is if we have all been lied to about how everything is "anonymized" data being sent between the data brokers and sold to corporations. I've always assumed that the whole narrative about all this data being anonymized was complete and utter bullshit. Now we know with certainty.
- staticautomatic 8y ago
  The companies that sell your data non-anonymously to brokers have always (unless they're shady af) said somewhere in their T&C that they will or may do so, and the brokers themselves have never said the data are anonymous (unless you're talking about the ad targeting space).
adrianhel 8y ago
Free'ish healthcare is the only way...
jschwartzi 8y ago
Considering how inaccurate some of Fitbit's measurements are( resting heart rate, for example ), I would sue my insurer if I found out they were using that data. My doctor shouldn't be using it either. RHR is normally measured within the first 30 minutes of waking while lying in bed, which is something Fitbit can determine. What I've noticed is that on days when my RHR that I've measured using their monitor after waking is 54 BPM, they report up to 61 BPM. There's a very long chain on their forum about how inaccurate the measurement is.
- brlewis 8y ago
  I work for Fitbit but am speaking only for myself. I'm guessing that this is the chain you're referring to since it echoes the "30 minutes after waking while lying in bed" claim: https://community.fitbit.com/t5/Charge-HR/Resting-Heart-Rate-Inaccuracies/td-p/901287 https://community.fitbit.com/t5/Charge-HR/Resting-Heart-Rate... Other sources I checked did not echo that claim. As one commenter in the chain pointed out, RHR is not minimum HR. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/All-About-Heart-Rate-Pulse_UCM_438850_Article.jsp#.W04ycdhKhE4 http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/G... https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/heart-rate/faq-20057979 https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-... https://www.health.harvard.edu/blog/resting-heart-rate-can-reflect-current-future-health-201606179806 https://www.health.harvard.edu/blog/resting-heart-rate-can-r... Also, one of the critics in the chain thinks Fitbit must be inaccurate after his RHR rose from 68 to 71 after "hiking at altitudes up to 14,200 feet" then fell back to 68. I think this criticism stems from a misunderstanding about how altitude affects oxygen levels and how oxygen levels affect heart rate. All that being said, even if the devices are generally accurate, there are defects and they aren't designed as medical devices. To the extent you voluntarily share your data with a doctor or insurer (which is the only way they'd get your data), your doctor or insurer should treat it the same way they treat other useful but potentially inaccurate information.
  - jschwartzi 8y ago
    Thanks! This is way more informative than any of the responses I've seen from your support team in that chain.
mnm1 8y ago
I wouldn't be surprised if people are denied care and left to die due to exorbitant prices based on random, undoubtedly wrong algorithms. Here's where the cost of personal data really becomes huge, at in life or death. Insurers have played god like this since their inception and nothing is going stop them from making more money by shutting out anyone who is a threat to their bottom line. We've only had a law that prevents discrimination on pre-existing conditions for a few years. I'm sure the insurance companies will lobby hard to get rid of it so they can let the very sick suffer and die rather than be forced to pay for their healthcare. This is an end run to that goal in case lobbying to murder people legally fails.
dhimes 8y ago
Exactly why I won't do those genetic-sample tests for "ancestry" or anything else. Eventually, those data will be sold, even if the entire company is sold with it. Eventually, we will be much better at decoding the DNA for predispositions to medical problems like heart disease, diabetes, alzheimers, and so on. That information will also be used against our kids and maybe our other relatives even if they don't undergo the testing.
- supertrope 8y ago
  Data is forever. The Genetic Information Non-Discrimination Act could be repealed in the future. Even governments can change.
bawana 8y ago
LexisNexis said there is no web page to submit a request for info. I tried their chat option and that person said I had to call. 888.497.0011 After 30 min on hold I spoke to someone. They wanted my personal info including SS# and Drivers license# They saifd they would mail out the info in 10 days. I guess this 'personal touch' is a security measure.
DenisM 8y ago
In WA state to price out insurance all you need to provide is your age, gender, and smoking status. I don't see how insurance companies can use any other information in setting the price?
shiburizu 8y ago
As a college student I work taking phone calls for a biz that attends entirely US customer base, my colleague asked why our clients were often leery about sharing things like their photo ID with us, despite being customers with us for many years. As one of the few who lived in the US amongst us I'd have to say it might have to do with how much companies involved in risk assessment really know about you and how much of it goes to the government -- they have no interest in having us show up in their credit or what have you.
mixmastamyk 8y ago
We desperately need some privacy legislation in the US, years ago.
cutler 8y ago
Aren't there obvious GDPR issues with this unless you're limiting the analysis to US insurers?
u801e 8y ago
My employer used to provide additional funding in employees' HSAs (Health Savings Accounts) if they participated in a health screening. The health screening involved measuring height, weight, blood sugar, cholesterol and other lipids. There was also a questionnaire about lifestyle choices related to health in terms of how physically active you were, smoking, drinking, etc.

193 points by marchenko 8y ago

mtgx 8y ago

This will ensure the death of the private healthcare system. It won't happen overnight, but eventually the private/hybrid healthcare system will have no redeeming qualities other than to extract as much profit as possible out of anyone's health issues. That's when no one will support it anymore (except the politicians taking bribes to support it).

Analemma_ 8y ago
Why the downvotes? He's right. The thing about insurance is that the only reason it works is because of imperfect information about the future. The more accurately people can be priced, the more pointless private health insurance becomes: the expensive patients (pre-existing conditions, or just people with bad luck) will get accurately priced and have impossible premiums and won't bother, and the cheap patients will realize they probably don't need it, take a gamble and also not bother. Microtargeted health insurance will be its own undoing.
- mindcrime 8y ago
  It sounds like you're doing something that most people do, despite it being incorrect. That is, conflating "health care" and "health insurance". Everybody has gotten so conditioned to the idea that "health insurance" pays for everything health related, that we all seem to take this for granted. But it doesn't have to be so. I believe that our goal should be to reduce the cost of health care so that most of it can be afforded without insurance - with insurance then returned to its role as a hedge against the more extreme/unlikely events.
  - poulsbohemian 8y ago
    >Everybody has gotten so conditioned to the idea that "health insurance" pays for everything health related, that we all seem to take this for granted. But it doesn't have to be so. Try this experiment. Walk into your doctor's office and ask what a procedure would cost. Ask the doctor, the receptionist, the billing clerk - ask everyone. No one will be able to give you an answer. That's why they are conflated. Fix that (very ripe for disruption) problem and you'll fix health care. PS: I agree with you, it should generally be affordable without insurance.
    - mindcrime 8y ago
      Try this experiment. Walk into your doctor's office and ask what a procedure would cost. Ask the doctor, the receptionist, the billing clerk - ask everyone. No one will be able to give you an answer. That's why they are conflated. Fix that (very ripe for disruption) problem and you'll fix health care. Agreed.
    - jsoc815 8y ago
      > Try this experiment. ...ask everyone. No one will be able to give you an answer. Funny you say this. A friend just went through this. Not even the insurance company could say. The calls to everyone got so ridiculous that I had to construct lawyerly questions so that people couldn't default to weaselly answers. The provider billing staff seemed to feel put upon that they were being asked to coordinate w/the insurer to figure out patient out of pocket cost would be. And in the end they still couldn't figure it out.
      - poulsbohemian 8y ago
        Here's what gets to me as well... providers love to talk about how little they get reimbursed from medicare and from many insurers. But, for example, I'm not going to have a surgery that I would really like to have (and that a doctor agreed I should have) because nobody can tell me what the cost would be. The 15 minute appointment with the doctor who recommended it to me was $700 out of pocket - so I'm unlikely to return if that's the kind of bill I get hit with for having a cup of coffee with them. So, I'd like to believe that at some point, given the current environment in which people are paying for insurance but can't afford to go to the doctor, that we'll see providers realize they are losing out on revenue opportunities by not actually serving their customers.
mindcrime 8y ago
This will ensure the death of the private healthcare system. We don't have a private health-care system, and haven't for a very long time. The government and big corporations[1] are so deeply entwined into the current system that it barely approaches anything that could be called "private". [1]: Corporations are a legal fiction which depend on the State for their existence.
poulsbohemian 8y ago
> will have no redeeming qualities other than to extract as much profit as possible out of anyone's health issues. We're already at this point, but I don't see why you think that will be the death of the private healthcare system, see: >politicians taking bribes to support it

ohazi 8y ago

Isn't this super illegal? Who are the lawyers at these companies who are signing off on these projects?

throwaway5752 8y ago
No. Using that data might be. In any case, it's only illegal if the Supreme Court interprets it to be illegal. If you have been following the recent years of Supreme Court decisions/dissents it will not be comforting.
- icebraining 8y ago
  Can you point to the cases that concern you? I haven't been following it closely enough.
  - throwaway5752 8y ago
    I'm sorry, I can't right now in detail. The general trend started with Citizens United and followed through Masterpiece is a increased set of precedents for corporate personhood, with some harsh dissents from the Alito/Thomas/Gorsuch contingent in cases where that was at issue (but corp. personhood side lost). When Kennedy retires and of Kavanaugh is his replacement, that will give put an awful lot on Robert's judgement as the swing decision. If I'm really getting picky, the lack of consistency in Trump v Hawaii and the Masterpiece case shows a certain amount of prioritizing partisan concerns over logical consistency (imo, ianal). edit: taking corporate personhood to logical extremes reverses a lot prior precedent and I would have doubted it would have happened until recently.
kevin_b_er 8y ago
What would be illegal? As long as corporate profit is viewed as more important than human health and safety, there will be no laws against such things. The Republican-controlled supreme court likes to rule that corporate "rights", due to corporate personhood, cannot be contained or curtailed in favor of human ones.

smileysteve 8y ago

> And it could raise your rates And it could lower your rates.

Analemma_ 8y ago
Please be serious here: stuff like this never causes prices to go down, only up. As information becomes perfect, the "problematic" expensive patients will see their premiums rise to the level of their actual cost to the system-- which is huge and impossible to pay, so they'll drop out-- and premiums for everyone else will stay the same, except with the added anxiety that anything you do could cause your rates to go up at any time.
yourapostasy 8y ago
> And it could lower your rates. Lack of a national competitive market for healthcare insurance in the US ensures an oligopoly within each state, and thus argues against your reply. Also, keep your eye upon demographic rate trends, not individual rates. In other words, for the same demographic over time, have rates been going up or down as the insurance market consolidates players over the past few decades? The trend is inarguable [1]; it is a monotonic function. What data do you have that convincingly advocates including data brokering of lifestyle data into insurance actuarial calculations makes a material change in this function or the marketplace? [1] https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878 https://www.thebalance.com/causes-of-rising-healthcare-costs...
s73v3r_ 8y ago
No, it will never be used for that.

exabrial 8y ago

That's ok with me? I wish it were like life insurance where they can ask you anything and then you get that rate locked down for the term. I also actually liked the proposal in Congress that got rejected: allow people to make their own groups. So if you are a person who likes to work out and get your fat levels tested once a year, you could join a group of like minded individuals and insurance companies would bid to insure your group.

ceejayoz 8y ago
> That's ok with me? I wish it were like life insurance where they can ask you anything and then you get that rate locked down for the term. That's an understandable attitude for a healthy person. What is the person born with a disability or a gene making cancer, Alzheimers, heart disease, etc. likely supposed to do? "Your insurance premium is $25k/month. We take checks!"
- sDlEzAtyoNAz 8y ago
  If they can't afford to pay anyone enough to insure them, they should ask for charity, because that's what they need.
  - 5874-4b22-a4e0 8y ago
    They should go to the emergency room, iirc its free if they can't extract the money.
    - ceejayoz 8y ago
      You can't get stuff like chemo or a transplant at an ER. They are only required to (attempt) to (temporarily) stabilize you. "Just go to the ER" also is pretty much the most inefficiently stupid way of handling healthcare for the needy you can come up with.
  - ceejayoz 8y ago
    Shockingly, it turns out that most charities don't have the financial resources to dedicate a hundred thousand dollars for a single heat transplant.

jesseryoung 8y ago

Heard about this article on NPR this morning. Thought the concern was valid but a little on the alarmist end of things. Most of the data they need to know if you are going to be an expensive subscriber or a cheap one you're required to give them directly: Your age, your gender, your home address and the list of services you received at your doctor's visits that they were billed for. Both healthcare providers and insurance providers know that the most efficient way to lower your healthcare costs is to get the patient to go to preventive care visits and keep them out of the ER. It doesn't matter how much money you give them each month, if they can prevent you from going to the doctor all together it's 100% (roughly) profit.

lvspiff 8y ago
I work alongside healthcare informatics and I got to say this is entirely the case from what I have experienced - the less you go to the ER the more the insurance profits. All of our research and data collection revolves around people getting tests and treatment PRIOR to something major happening. Regular bloods tests, proactive bp and a1c monitoring, etc lead to better heart disease and diabetes treatments so you don't go into a crisis. The collection of data allows treatment to be better for the population not to charge a higher rate to specific people. Keeping you out of the hospital is monumentally cheaper than a couple doc visits a year for a couple lab tests.

FireBeyond 8y ago

> Insurers contend they use the information to spot health issues in their clients — and flag them so they get services they need. Horse shit. And I say that as someone who writes claims management software for the healthcare industry. I challenge ANY health insurer to provide examples of this. Of course, they won't, because they'll cite "patient confidentiality", but that just doesn't happen. They've wanted to do this for years, though, and try to. Requests to be able mine claim data for familial predispositions to diseases was one that we fended off multiple times.

sidlls 8y ago
You may have fended it off but I assure you there is a whole industry devoted to using claims and other health data to manage care and costs. Insurers are primary partners of these companies and act as both providers and consumers of the data. Not just insurers, but big hospitals and provider networks, too.
- pishpash 8y ago
  We're going down some kind of bizarre path. Insurance is ultimately about risk sharing. If every risk is modeled then there is no insurance, just expensive prepayment.
  - tlb 8y ago
    If I have a 1% chance of a car accident, I’d be happy to pay 1.5% the cost of hospital bills for insurance. Someone else with a 2% chance of an accident should be happy to pay 3%. That’s still insurance. Only if you deny free will and assume perfect information and deterministic laws of physics, can every risk resolve to either 0% or 100%.
    - zAy0LfpBZLC8mAC 8y ago
      What is the practically relevant difference between 100% prediction capability and 99.999% prediction capability?

kyrieeschaton 8y ago

This is complete nonsense and entirely speculative. They admit as much when they inform you they can find no evidence of any individual underwriting decision being made based on this data, which the companies strongly deny, and would be illegal. Insurance is highly regulated, both on a state and federal level. Pricing algorithms and variables are public in most states (albeit obfuscated). What does seem to be happening is the companies are using third party data providers for marketing and market analysis, as literally every other company from your local HVAC guy to McDonald's does.

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a_d 8y ago

Whenever someone says that AI and IoT would automate insurance underwriting, I start to fret — because it very quickly starts to imply more and more data collection. This is like pre-crime but for your health. Meaning, you start paying high premiums right away because later in life you might be at a high risk for a specific condition. (I know this already happens for smoking, but that is declared on a form — not by a company sending a drone to spy on you) Since this is a startup forum — I believe health insurance to be so dark and morbid (with things like companies haggling with living relatives about ventilator care) — there is got to be a better way! (I realize this is more of a lament than a constructive suggestion)

richrichardsson 8y ago
There is a better way, it's called single payer universal healthcare!
- frockington 8y ago
  Please no, I don't trust the government at all to handle healthcare efficiently. And I enjoy my insurance company through work, its the equivalent to a significant raise each year
  - shadowtree 8y ago
    DO you trust it with defence, etc.?
    - nostromo95 8y ago
      To play devil’s advocate, a government’s primary duty has been defense since the dawn of organized government. The U.S. government began in an armed rebellion. Moreover, there’s no reasonable alternative to the government having a monopoly on defense.
    - frockington 8y ago
      I trust it with defense and that's about it. I don;t even trust local governments to efficiently maintain roads

stakhanov 8y ago

I think there's something to be said IN FAVOR of the notion that person A's health risks don't trade off against person B's health risks at a 1:1 rate. The crucial thing however, in a data protection sense, is that there are too many people who don't realize the implications of giving away data about themselves. A shopper signing up for a loyalty card scheme in a grocery store might sign a blanket waiver allowing the scheme operator to pass the data on to whoever they please to be used in whatever way they want, without thinking about the possibility that it may end up in places where it won't serve their best interests. So there should be something similar here to health warning on cigarettes. Kind of like "Warning: Signing up for this loyalty card may make you uninsurable." Also, I think there should be legal infrastructure in place to ensure that there are certain rights that you can't sign away as part of a contract that, in practice, you don't have the option not to sign (like Google's general terms & conditions).

koolba 8y ago
Which is also why you should use a fake phone number, name, etc for those loyalty cards. Also a neat trick is to just (XYZ)-867-5309 as someone already signed up with the number from that song and it’s not a real number.
- jasonjayr 8y ago
  It's a real number in the 401 area code. https://www.askgem.com/ https://www.askgem.com/ See the contact info in the lower left of the page.
- stakhanov 8y ago
  I agree that "gaming the system" is usually the most practicable way to deal with this stuff in real life, but that doesn't mean it shouldn't be sorted out on a more principled basis eventually.

staticautomatic 8y ago

I buy data from LexisNexis. AMA.

1996 8y ago
What do you have from the healthcare part now? Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses because hipaa? How is the data linked? ssn, phone numbers? (just a best guess, in case you spotted some linking anomalies) Is the primary key still a number internal to lexis nexis? How detailed is the social network now? (just people living together and neighbours, or does it includes relatives and family members)
- 394549 8y ago
  > Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses? If they had access to that, wouldn't it be a HIPAA violation?
  - 1996 8y ago
    Yes, there are laws now. I edited my comment to mention that. Outside the US, labs are still a goldmine of data: time indexed numerical value that are used by providers to decide medical interventions. Except medical record or insurance history, you can't get any better than labs! Still I noticed in the US that labs selling directly to clients (like private md labs, only in some states) insist that the patient provide an accurate phone number. Given how phone numbers are used in the industry, I think they may want to keep the database accuracy for "future uses" when the law will change.
- staticautomatic 8y ago
  >What do you have from the healthcare part now? Drugs, diagnosis, lab test (from the like of labcorps), or just point of sale addresses because hipaa? Nothing. The data at issue in this article belongs to a category called "Non-FCRA" (Fair Credit Reporting Act), which means they cannot (really, are not supposed to) be used for things like credit and hiring decisions. Most of the data are from the public domain, although there are some data that are only quasi-public (meaning they're nominally public but you must have special privileges to see them). I haven't seen any truly non-public data. >How is the data linked? ssn, phone numbers? (just a best guess, in case you spotted some linking anomalies) ?Is the primary key still a number internal to lexis nexis? The primary key is an internal UID, where each person has his/her own. There are edge cases where people in their DB do not have UID's at all or where a single person has multiple UID's. They obviously have some linking but I've seen little indication that they have a robust graph under the hood. For example, Lexis may "know" that you've cohabitated with a member of the opposite sex about the same age as you for 10 years starting when you were 30, and also "know" that you're married to someone with the same name as the cohabitant, but fail to identify that person as your spouse because the marriage records are siloed in their back end. >How detailed is the social network now? (just people living together and neighbours, or does it includes relatives and family members) There are lots of data available on your relatives and family members, but again, the linkages are piss-poor. For example, your record may say that your name is "John Smith Jr." and you lived with a man who is 30 years older than you named "John Smith Sr." until you were 18, but fail to identify that person as your father.

Cieplak 8y ago

Just clicked for me why “healthcare” companies spend so much money on hard discs and data storage.

gascan 8y ago

There are surely privacy concerns, but it seems like the evolution of all insurance markets trend towards better risk profiling. This is a good thing IMO. The point of insurance is to pool risk, not get your high risk subsidized by some sap with low risk. The better insurance companies can profile risk, the more fair the pools. Then if we want subsidies for high risk individuals, we can work on that separately.

samfisher83 8y ago

While its called its called Health Insurance, it should be called health care costs. The US is the only 1st world country without universal healthcare. The thing is most of us already subsidize the healthcare industry. The hospital has to treat someone in an emergency if they take medicare or medicaid. A lot of times people are using the emergency room as their primary care since they can't afford primary care. The hospital increases the rates it charges everyone else to cover this. You can use data to predict who is going to be more sick and charge them more. However do you want them to die or suffer. I wouldn't. So why not try to fix the big problem instead of all these little ones about data misuse and just cover everyone since you are paying for them anyway.

chimeracoder 8y ago
> The thing is most of us already subsidize the healthcare industry. The hospital has to treat someone in an emergency if they take medicare or medicaid. The "subsidies" run the other way. Medicare reimbursements do not cover COGS, which means that providers cannot sustain themselves solely on Medicare reimbursement rates; they need to take privately-insured patients (whom they charge dramatically more) in order to stay afloat[0]. These costs get passed on to privately-insured patients in the form of higher premiums. [0] Medicare acknowledges this, and in fact, Medicare even runs multiple stipend programs to essentially pay extra to hospitals who don't see enough privately-insured patients that they can make up the difference. If they didn't, those hospitals would close, because you can't lose money on a per-patient basis and still run a practice, even if you managed to recruit doctors, nurses, and staff who agreed to work for free as volunteers.

1996 8y ago

> The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993 I think they just use their point of sales (primary care, etc) to collect data from the client and use it against the client. I know because I used to be in a very similar line of business. It is easy because clients give you a permanent unique id for payment purposes (ssn), or other unique id (phone numbers) that varies with time (now less with people porting their number). Of course, the point of sale has a list of previous items, even from competitors (medical history) but that has become harder to use, due to laws. Still, most places ask for "emergency contact", which you can use to build a social network. Sick people cluster together. I don't know why, it just happens, and it is a good workaround. Of course, you need enough data, but it is then a matter of scale (if you have 75% of the market, you have seen everyone in a county at least once) and trade (buy the same data from your competitors). Personally, due to experience, I prefer to forego insurance and get my healthcare abroad. Better prices than paying deductibles, better services. But I can not recommend that for everyone. Still this is a dirty business, and I strongly recommend to adopt basic opsec precautions if you get healthcare in the US: never give your ssn, give a phone number that is not used for anything else even better if it is prepaid so not linked to a ssn, never ever give an emergency contact, only list medical conditions that will not cause you legal issues.

394549 8y ago
> Personally, due to experienck, I prefer to forego insurance and get my healthcare abroad. Better prices than paying deductibles, better services. But I can not recommend that for everyone. If you're in the US, that choice could bankrupt you if you ever need major emergency medical care, because of an accident or some condition requiring emergency surgery, like a brain hemorrhage. https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html https://www.nytimes.com/2017/03/29/magazine/those-indecipher...
- 1996 8y ago
  I am lauching my business, I need more money NOW. Healthcare abroads cover everything (eyes, teeth...) and is much cheaper than a deductible even when paying everything cash. And no weird haggling with the insurance or provider to see what is covered, what is not, what is the copay, etc. This may not cover edge cases, but for most of my personal financial decisions, I follow the example set by governments around the world: I spend in the present without caring too much about future, betting on growth of my resources. In other words, if I do have a brain hemorrhage, the last of my worries will be bankrupcy. Why should I bother? If I fail my business, I will be bankrupt anyway.

jadedhacker 8y ago

Whelp, just one more reason why we need Medicare for All. There's no need to enable these people whose business is to find ways to deny people healthcare, just eliminate their industry completely and save money in the process too.

stakhanov 8y ago

There are certain dimensions that it makes a lot of sense to discriminate around: For example, if you're a roofing contractor, I really think you SHOULD be paying higher health insurance rates than I do, as an office worker. You'll just price it into whatever you charge to make roofs, which means the price of a house will start getting closer to what it actually costs the economy. Since I rent, I would otherwise end up subsidizing other people to build or buy houses for themselves, and I don't think that's how an economy should work.

ceejayoz 8y ago
> For example, if you're a roofing contractor, I really think you SHOULD be paying higher health insurance rates than I do, as an office worker. Why? Your sitting eight hours a day is remarkably unhealthy, and roofers (at least where I'm located) are typically separately insured for on-the-job injuries.
- stakhanov 8y ago
  Don't get unduly bogged down with the example: It works equally well with "horse trainer" or whatever. Clearly some professions have a bearing on your risk profile with regard to certain types of insurance, and there is not always a clear distinction between risks you incur as a private person and risks that your business needs to indemnify you against. -- Like, if you're in a job that involves a lot of travelling and being away from your family for extended periods of time puts you at greater risk of developing mental health conditions etc.
  - phil21 8y ago
    I think the numbers may not come out the way you think they will. Sedentary lifestyles are by far the largest medical expense in the country as a whole, so office jobs I would expect to have much higher premiums. Sure you're not gonna get your sternum crushed by a falling 2000lb pallet - but those situations are already typical covered by workmans comp and other company insurance.
  - Broken_Hippo 8y ago

hirundo 8y ago

> But patient advocates are skeptical health insurers have altruistic designs on people’s personal information. It's funny that the article felt this needed to be said. Just how would an altruistic insurance company have survived in such a competitive market? I think I learned the insurance business model early in life. I lived near a horse race track, and used to collect the programs and assemble giant (paper) spreadsheets with various data on horses and their win/loss records. Does the jockey make a big difference? Does the wetness of the track? I would have used any measure that gave me an edge in betting, with zero "altruistic" regard for the horse, its owners, or anyone else but me. You know, like an insurance company. It turned out that there was a datum that significantly improved my odds, and converted me from a regular loser to an irregular net winner. And it didn't come from a program. I figured out that I could just watch the horses as they paraded to the starting gate, pick the one that I thought looked like it wanted to win, and could, and ran to place a bet on it before the race started. Far from perfect obviously, and I didn't win big, but I started winning more than losing. I'd bet that insurance companies wish they could do something similar: Have experienced medical underwriters examine and interview potential customers and then make gut level decisions, then judge more by underwriter stats than patient stats. But that approach seems to be increasingly prohibited, so they make do with what data they can get. It's hard to find that surprising, unless somehow you've confused "insurance" and "altruism" to be related terms.

madengr 8y ago

I've been saying this for years. That discount card you use at the grocery store tells your insurance company how much bacon you eat.

394549 8y ago

Has anyone done any research to map out the relationships between the different data brokers? E.g. who has what data to sell, and who's selling what data to who?

staticautomatic 8y ago
I could tell you who is selling what, and a little bit of who is selling what to who, but I don't think any one person has a complete picture.
- 394549 8y ago
  Would it be too much trouble to share what you know? Even just a list of the players would be helpful. I'd really like to understand more about this industry, but from a consumer perspective, it's very opaque. It's easy to find people search websites (and articles about them), but much harder to understand how they got your data or what else about you may be getting sold.
  - staticautomatic 8y ago
    I'll do my best to explain. I need to start by noting that, as far as I'm aware, there's no generally accepted nomenclature for this stuff. Accordingly, I've invented my own terms (some of them as I write this). At a high level there are two different kinds of brokers, which I'll call "primary brokers" and "secondary brokers." Primary brokers are companies that primarily aggregate their own data and sell it to other businesses. Secondary brokers are companies that primarily buy data from primary brokers and resell them to other companies or to consumers. Each broker can further be defined by the kind(s) of data they sell. Generally speaking, there are 5 categories of data: 1. FCRA records. These are mainly credit records and credit-related data that are permitted to be used in making credit determinations. 2. Non-FCRA public records. This is stuff like birth, death, marriage, property records, DMV records, criminal records, etc. These are explicitly not to be used for credit and hiring determinations (not sure about renting, off-hand). 3. Hiring data. Frankly I'm not entirely sure what these are beyond criminal background stuff, but they are allowed to be used for making hiring decisions, where permitted. 4. Marketing/Lifestyle data. This is stuff like purchase history, magazine subscriptions, hobbies and interests, data sold by companies whose products you sign up for for free, etc. 5. Insurance underwriting data. These tend not to be explicitly tied to a non-anonymous person. However, given someone's street address, you'd be able to pull some info on their property or something. Most brokers sell data belonging to multiple of the above categories. The big primary brokers for FCRA data are, as you might expect, credit agencies (Experian, Equifax, and TransUnion). The big brokers who deal in mixes of data are LexisNexis (a Reed Elsevier company), Thomson Reuters/WestLaw, and TLO (a TransUnion subsidiary). They are primary brokers of Non-FCRA and hiring data but secondary brokers of FCRA data (I believe they mainly purchase it from the credit agencies). There are a couple small companies that are primary brokers of things like hiring data (e.g. Checkr). The big primary brokers of marketing/lifestyle data are companies like Acxiom, BlueKai, Epsilon, US Data, and a number of others. I have heard that credit card companies sell certain kinds of data but I am not sure what exactly and have not used their products myself. The big primary broker of insurance underwriting data (along with a couple other categories) is CoreLogic. The big secondary brokers of Non-FCRA data are Intelius and Instant Checkmate. I do not think they are primary brokers under my definition because most of what they sell is basically an identical copy of what the primary brokers sell, but for a lot more money. It's hard for me to imagine them taking on the expense of aggregating the bulk of their own primary data when they can run a search against a primary broker DB for a few bucks and resell a pretty version of the response to a consumer for $50. They probably aggregate some of their own data but I'd guess it's low-hanging fruit. There are also some purely social media-driven secondary brokers, like Pipl.

clumsysmurf 8y ago

A recent-ish book that talks a little about this (surprised the article did not mention QuintilesIMS): "Our Bodies, Our Data: How Companies Make Billions Selling Our Medical Records" https://www.amazon.com/Our-Bodies-Data-Companies-Billions/dp/0807059021 https://www.amazon.com/Our-Bodies-Data-Companies-Billions/dp...

dawhizkid 8y ago

Most people who work for medium or large sized companies in the US are working for companies that are self-insured, meaning your company is taking on all the risk, so if anything your own employer is incentivized to do this and not the insurance company itself. When I first heard of the Amazon/JP Morgan/BH heathcare initiative my thought on what that company would actually do is surveillance on their collective millions of employees to better predict if they are prone to disease and use predictive analytics to lower their own claims cost.

mtberatwork 8y ago
> meaning your company is taking on all the risk While I wouldn't say there aren't any companies out there that are absorbing the entire cost of insurance premiums, most are splitting this in some proportion with the employee.
- deleted 8y ago
  [deleted]
- dawhizkid 8y ago
  by risk I mean that the company is liable for all claims cost, but right premiums can come from the employee, employer, or both.
Spooky23 8y ago
> When I first heard of the Amazon/JP Morgan/BH heathcare initiative my thought on what that company would actually do is surveillance on their collective millions of employees to better predict if they are prone to disease and use predictive analytics to lower their own claims cost. ...or avoid claims in the hiring process.

deegles 8y ago

To play devil's advocate, I think data should be used to manage rates for things that a consumer can reasonably change, like diet/exercise. Smokers are already penalized. e.g. "Our data indicates your average sugar consumption is over Xg per day over the last 6 months. If you commit to reducing this to Yg per day over the next 6 months, your insurance rate will drop by 10%. Otherwise rates will increase by 20% to cover your increased risk for diabetes, heart disease, and stroke."

dsfyu404ed 8y ago
That'll end well. "our data indicates you're probably a women and therefore have an above average risk of having kids, if you commit to gender reassignment surgery your insurance rate will drop by 30%" Or if that's not allowed they'll just use other things that are a rough proxy for a protected class.
jschwartzi 8y ago
On that note, my insurer helpfully put a note in my file that the doctor should tell me about being more physically active based on my BMI. When I listed everything I do, he turned to his intern and said "this is an example of how BMI doesn't tell the whole story." Then he deleted the note. So it has to be the right data and the doctor needs to be the final arbiter of whether it's meaningful or not.
supertrope 8y ago
The 2010 ACA law considers employee wellness discounts of 30% or more coercive and potentially a way to get around the ban on individual medical underwriting. While monetary incentives are powerful, people are not completely or even close to rational actors. If poor health and prematurely dying (often painfully) aren’t motivators to take care of your health, what will? Health promoting culture like teaching all kids to cook and eat healthier, encouraging fitness through less car centric infrastructure, etc. are needed to address the metabolic syndrome epidemic. Frequent reminders, small sub-goals, reinforcement, role models are probably more effective than a four figure fine for being unhealthy. Some people can overcome big problems on their own because they are committed, but once you get out into the wider population a lot of marketing, hand-holding, and gimmicks are needed to get everyone to make significant permanent change.

turc1656 8y ago

"The companies are tracking your race, education level, TV habits, marital status, net worth. They’re collecting what you post on social media, whether you’re behind on your bills, what you order online." The only way they can do this and link it to you as an individual is if we have all been lied to about how everything is "anonymized" data being sent between the data brokers and sold to corporations. I've always assumed that the whole narrative about all this data being anonymized was complete and utter bullshit. Now we know with certainty.

staticautomatic 8y ago
The companies that sell your data non-anonymously to brokers have always (unless they're shady af) said somewhere in their T&C that they will or may do so, and the brokers themselves have never said the data are anonymous (unless you're talking about the ad targeting space).

adrianhel 8y ago

Free'ish healthcare is the only way...

jschwartzi 8y ago

Considering how inaccurate some of Fitbit's measurements are( resting heart rate, for example ), I would sue my insurer if I found out they were using that data. My doctor shouldn't be using it either. RHR is normally measured within the first 30 minutes of waking while lying in bed, which is something Fitbit can determine. What I've noticed is that on days when my RHR that I've measured using their monitor after waking is 54 BPM, they report up to 61 BPM. There's a very long chain on their forum about how inaccurate the measurement is.

brlewis 8y ago
I work for Fitbit but am speaking only for myself. I'm guessing that this is the chain you're referring to since it echoes the "30 minutes after waking while lying in bed" claim: https://community.fitbit.com/t5/Charge-HR/Resting-Heart-Rate-Inaccuracies/td-p/901287 https://community.fitbit.com/t5/Charge-HR/Resting-Heart-Rate... Other sources I checked did not echo that claim. As one commenter in the chain pointed out, RHR is not minimum HR. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/All-About-Heart-Rate-Pulse_UCM_438850_Article.jsp#.W04ycdhKhE4 http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/G... https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/heart-rate/faq-20057979 https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-... https://www.health.harvard.edu/blog/resting-heart-rate-can-reflect-current-future-health-201606179806 https://www.health.harvard.edu/blog/resting-heart-rate-can-r... Also, one of the critics in the chain thinks Fitbit must be inaccurate after his RHR rose from 68 to 71 after "hiking at altitudes up to 14,200 feet" then fell back to 68. I think this criticism stems from a misunderstanding about how altitude affects oxygen levels and how oxygen levels affect heart rate. All that being said, even if the devices are generally accurate, there are defects and they aren't designed as medical devices. To the extent you voluntarily share your data with a doctor or insurer (which is the only way they'd get your data), your doctor or insurer should treat it the same way they treat other useful but potentially inaccurate information.
- jschwartzi 8y ago
  Thanks! This is way more informative than any of the responses I've seen from your support team in that chain.

mnm1 8y ago

I wouldn't be surprised if people are denied care and left to die due to exorbitant prices based on random, undoubtedly wrong algorithms. Here's where the cost of personal data really becomes huge, at in life or death. Insurers have played god like this since their inception and nothing is going stop them from making more money by shutting out anyone who is a threat to their bottom line. We've only had a law that prevents discrimination on pre-existing conditions for a few years. I'm sure the insurance companies will lobby hard to get rid of it so they can let the very sick suffer and die rather than be forced to pay for their healthcare. This is an end run to that goal in case lobbying to murder people legally fails.

dhimes 8y ago

Exactly why I won't do those genetic-sample tests for "ancestry" or anything else. Eventually, those data will be sold, even if the entire company is sold with it. Eventually, we will be much better at decoding the DNA for predispositions to medical problems like heart disease, diabetes, alzheimers, and so on. That information will also be used against our kids and maybe our other relatives even if they don't undergo the testing.

supertrope 8y ago
Data is forever. The Genetic Information Non-Discrimination Act could be repealed in the future. Even governments can change.

bawana 8y ago

LexisNexis said there is no web page to submit a request for info. I tried their chat option and that person said I had to call. 888.497.0011 After 30 min on hold I spoke to someone. They wanted my personal info including SS# and Drivers license# They saifd they would mail out the info in 10 days. I guess this 'personal touch' is a security measure.

DenisM 8y ago

In WA state to price out insurance all you need to provide is your age, gender, and smoking status. I don't see how insurance companies can use any other information in setting the price?

shiburizu 8y ago

As a college student I work taking phone calls for a biz that attends entirely US customer base, my colleague asked why our clients were often leery about sharing things like their photo ID with us, despite being customers with us for many years. As one of the few who lived in the US amongst us I'd have to say it might have to do with how much companies involved in risk assessment really know about you and how much of it goes to the government -- they have no interest in having us show up in their credit or what have you.

mixmastamyk 8y ago

We desperately need some privacy legislation in the US, years ago.

cutler 8y ago

Aren't there obvious GDPR issues with this unless you're limiting the analysis to US insurers?

u801e 8y ago

My employer used to provide additional funding in employees' HSAs (Health Savings Accounts) if they participated in a health screening. The health screening involved measuring height, weight, blood sugar, cholesterol and other lipids. There was also a questionnaire about lifestyle choices related to health in terms of how physically active you were, smoking, drinking, etc.