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Anyone else find it strange in the US with the self-insured health care plans (the norm with large companies) your company has complete visibility into every he
by undefined3840 7y ago
Anyone else find it strange in the US with the self-insured health care plans (the norm with large companies) your company has complete visibility into every health care interaction you have while employed through claims data?
- tedsuo 7y agoThis is not true. I don’t like having my health care tied to my job - they are orthogonal concerns. But in the US, your employer does not have access to your healthcare records.
- AlexandrB 7y agoIf it's a "self-insured" plan[1], your employer potentially has access to all insurance claims because they are the insurer. That's not the same as access to complete healthcare records but it's pretty telling information. [1] https://www.healthcare.gov/glossary/self-insured-plan/ https://www.healthcare.gov/glossary/self-insured-plan/
- chimeracoder 7y ago> If it's a "self-insured" plan[1], your employer potentially has access to all insurance claims because they are the insurer. That's not the same as access to complete healthcare records but it's pretty telling information. No, companies almost never manage the claims themselves. They underwrite the plans, but managing claims is cost-prohibitive, as it's outside the core competency of most large companies.
- marcinzm 7y agoSure but they can get access to the claims data from whomever is managing it as they're paying for them.
- astura 7y agoHence Tim Armstrong's comments about AOL spending a couple million dollars on "distressed babies" being the reason 401(k) benefits were cut. https://www.newyorker.com/news/amy-davidson/whose-distressed-baby-is-it https://www.newyorker.com/news/amy-davidson/whose-distressed...
- reureu 7y agoThey definitely do if they’re self insured. That doesn’t mean your boss can just pull it up willy-nilly, but I promise someone in HR can. I’ve sat in on conversations at my company where we’ve been pitched on claims analysis tools for our own HR department to use.
- chimeracoder 7y ago> They definitely do if they’re self insured. Self-insured doesn't mean they manage claims themselves. For most companies, managing claims would be cost-prohibitive and an absurdly wasteful use of resources.
- undefined3840 7y agoMost companies use a Third Party Administrator (TPA) for the actual back office claims management. That doesn’t mean people in HR and Finance don’t have visibility into claims data.
- chimeracoder 7y ago> Most companies use a Third Party Administrator (TPA) for the actual back office claims management. Yes > That doesn’t mean people in HR and Finance don’t have visibility into claims data. I mean, this is technically a true statement - "A does not necessarily imply not-B" - but kind of irrelevant, because as it turns out, HR and finance generally do not have visibility into individual-level claims data (as opposed to aggregate data, which is necessary for underwriting).
- undefined3840 7y agoI mean key word “generally”? I’m not suggesting that there’s a team of employees watching you every time you pick up a prescription, but of course they could access an individual claim if there was a legitimate reason to. Not sure why it’s so unbelievable to think that an insurer would be legally barred from doing so if they are literally taking on the risk themselves, even if it is to audit the TPA to make sure they aren’t stealing from them. If you are an extremely ill employee and you’re using a lot of healthcare your employer will know without you needing to inform them.
- hn_throwaway_99 7y agoRemember when Tim Armstrong, CEO of AOL, blamed an employee's new baby's health issues on benefit cuts [1]? He may not have had "full access", but he basically blamed an employee's family health issues, publicly, as the reason for employee benefit cuts. [1] https://slate.com/human-interest/2014/02/tim-armstrong-blames-distressed-babies-for-aol-benefit-cuts-hes-talking-about-my-daughter.html https://slate.com/human-interest/2014/02/tim-armstrong-blame...
- kjeetgill 7y agoYour sentence confuses me. Did he blame the cuts on the baby? Or the baby's issues on the cuts?
- ryandrake 7y agoIt’s in the linked article. The CEO (after a great financial quarter) announced benefits cuts, blaming costs and using as examples two “distressed babies” that cost the company $1M each. Armstrong was making $12M, by the way, so in other words, 12 Distressed Babies per year in compensation.
- virtuallynathan 7y agoThey definitely have access to at least aggregate data, see this kinda thing: https://collectivehealth.com/solutions/actionable-insights/ https://collectivehealth.com/solutions/actionable-insights/
- jm4 7y agoThey do if the plan is self funded. If it’s not, they still get anonymized usage reports from the carrier that list all the claims with basic demographic info like gender, age range and whether it was the employee, child or spouse who the claim was for. You probably wouldn’t know if your company’s plan is self funded or not.
- AlexandrB 7y agoIt's super strange and ripe for exploitation. The US needs some form of single-payer health care badly.
- big_chungus 7y agoAre you sure the government is any more trustworthy? More importantly, are you sure that _everyone elected in the future_ will also be trustworthy? Remember, the "other side" can always gain power, so any system you conjure needs to work under the control of either party.
- roywiggins 7y agoThe VA seems to work approximately as well (or as badly) regardless of who's in charge.
- jki275 7y agoOddly enough, the VA works far better today than it did 3 years ago. YMMV.
- nickthemagicman 7y agoBased on what?
- jki275 7y agoIt used to be 18+ months to get a VA claim of any kind completed. The norm now is less than 90 days. I've seen some faster than that. They are a whole different organization now than they were.
- jhayward 7y agoIn your opinion, what changes made that happen? When did the changes start, and how did they affect care, scheduling, etc.?
- s_y_n_t_a_x 7y agoEmployees must authorize health care providers first before they are able to to disclose any healthcare related information to their employer. What you're saying simply is not true.
- undefined3840 7y agoI mean claims data, which is arguably a good record of your present health care intersections while employed at that company. They definitely have access to it.
- s_y_n_t_a_x 7y agoThey do not have access to claims data. They know your plan and your dependents, but that's it.
- undefined3840 7y agoYes they do if they are self insured, meaning they are literally the insurance company taking on the risk. This is the norm for large companies.
- s_y_n_t_a_x 7y agoWhere is the goal post? And no even they wouldn't have individual data, even if they self-insured. They don't manage the claims themselves, that's ridiculous. Do you have any source for your suggestions, or is this just a random hypothetical?
- slashtom 7y agoby "health care interaction" you would mean every billed / paid charged interaction, even so not usually identified down to a single member. However, the employer would not have your medical records without consent of the employee, this works for self funded or fully insured.
- undefined3840 7y agoClaims are a pretty solid proxy for health care interactions. That’s what I mean.
- deleted 7y ago[deleted]
- jki275 7y agoself insurance is not the norm in the US, and in general employers have no visibility at all into your medical records in the US. You've been misinformed.
- undefined3840 7y agoSelf insured is definitely the norm for large companies in the US.
- jki275 7y agoWhich ones? I'm sure somebody does it, but it doesn't even exist in my industry.
- rabidonrails 7y agoThis is a misleading statement. Corps that offer insurance as a benefit can get reports that tell them how the benefit is being used by employees in the aggregate. However, corps cannot see each employee interaction as this would be a huge HIPAA violation.
- undefined3840 7y agoThey can access individual claims because they themselves are the insurer. Claims have medical codes that map to treatments, diseases, prescriptions, doctor visits, etc. That’s what I mean by visibility.
- ohazi 7y agoThis is not what the parent is talking about. "Corps that self insure" is corporations that are so large that it's more effective for them to use a large bank account as the insurance plan for their employees than to buy a corporate policy from an actual health insurance company. Huge companies like SAP or Microsoft or Oracle will do this, even though they may also hire a traditional branded health insurer to "manage" this large-bank-account health plan (i.e. give out cards, negotiate with hospitals, etc.). But the bank account (brokerage account, really) remains in control of the corporation, and the traditional plan premiums are not paid to the health insurance company named on the card. Fees for managing the plan are paid separately. Doctors and hospitals get paid from the corporation's account. This is what the parent means when they say that the corporation has visibility into employees' healthcare usage.
- wmfiv 7y agoJust so it's clear to everyone, companies much smaller than SAP or Microsoft self insure. In the United States virtually every employer with more than 500 employees is going to self insure. And while these companies do have access to detailed claim data in theory, in practice access to this data is typically heavily limited a small number of HR or finance employees who are responsible for healthcare accounting and financial management and the data presented is typically restricted to a large claim report within a monthly/quarterly reporting period.
- 7y ago
- throwaway_tech 7y agoIts funny reading the comments to your comment. For the most part people can't seem to distinguish claims data vs healthcare records...its pretty scary as these are the most likely people to receive funding to "disrupt" the health care industry. Claims data is not equal to medical records, but to your point it is extremely valuable data and can easily act as a proxy for medical care. Even more so when tied together with Rx claims data. Even providers (Doctors/hospitals) themselves don't have access to insurance claims data for patients...which unironically results in perhaps a million hospitalizations and billions of dollars in healthcare costs per year because of the lack of data sharing with providers.
- undefined3840 7y agoIt’s actually pretty shocking how few people seem to realize this about large employers...this is clearly not well understood at all.
- samatman 7y ago"potential founders of healthcare startups" are likely to be in the set "reads Hacker News", but would be a tiny subset. Even if they all know the difference between claims data and healthcare records, that wouldn't show up in the commentariat at large. Your fear is unfounded.
- noelsusman 7y agoAs you mentioned, claims data is arguably worse from a privacy standpoint. I work for a hospital and we constantly struggle with the fact that we can't assume we have a full medical record for any given patient. As an easy example, we have no idea if our patients actually fill their prescriptions properly once they leave, making it impossible for us to do any sort of intervention on medication adherence. With that said, we actually do have access to claims data for a significant chunk of our patients now, and that percentage is growing fast. It's part of a big push towards shifting risk from payors to providers to incentivize cost reduction.
- throwaway_tech 7y ago
- chimeracoder 7y ago> Anyone else find it strange in the US with the self-insured health care plans (the norm with large companies) your company has complete visibility into every health care interaction you have while employed through claims data? Self-insured plans means that the companies underwrite their own plans, but they almost never manage their own claims. That would be cost-prohibitive and absurdly disadvantageous. The employer never touches raw claims data at all. Companies have access to aggregate claims data, but they absolutely do not have "complete visibility into every health care interaction you have while employed".
- undefined3840 7y agoMost companies use third party administrators to do the day to day management, but that doesn’t mean people in HR or Finance can’t access data on individual claims if there was a reason to. If an employee used $1M in healthcare believe me you don’t have to tell your company - they will know.