This is an actual tweet from conservatives last fall.
Party like it's 1928! ??? pic.twitter.com/Bg2BQssm3k
— Young Conservatives (@YoungCons) November 17, 2016
I was dreaming when I wrote this, forgive me if it goes astrayPost + Comments (132)
by DougJ| 132 Comments
This post is in: Open Threads
This is an actual tweet from conservatives last fall.
Party like it's 1928! ??? pic.twitter.com/Bg2BQssm3k
— Young Conservatives (@YoungCons) November 17, 2016
I was dreaming when I wrote this, forgive me if it goes astrayPost + Comments (132)
by David Anderson| 30 Comments
This post is in: Anderson On Health Insurance, Contraception Clusterfuck
CVS has agreed to buy Aetna for a lot of money. This raises a lot of questions including, what is the value proposition?
Aetna already uses CVS as its PBM, so would a merger yield much more effiencies? Maybe, but not obvious. https://t.co/cLmMRugBJC
— (((Martin Gaynor))) (@MartinSGaynor) December 3, 2017
There is the obvious value proposition that CVS has 10,000 physical locations on the same information platform. I am spitballing and harkening back to my days as an insurance data geek and there are three inter-related items that could generate an incredible amount of revenue for the Aetna/insurance side of the deal. This is a risk adjustment data gold mine.
Every risk adjustment system which drives money that I know needs a claim based event to trigger an action. Previous history of chronic conditions is the easiest to access predictor of current chronic conditions. When I worked at UPMC, I spent three years figuring out how to optimize the risk adjustment revenue for the Medicaid line of business. UPMC Health Plan is a multi-line insurer with products in Medicaid, CHIP, Exchange, Medicare and Employer Groups. It is not at all unusual for people to bounce between Medicaid, CHIP, Exchange and Employer coverage over time. One of my major projects that I was very happy to have completed was building an integrated data model that mined the entire UPMC claims universe instead of just the Medicaid claims universe. That increased the total revenue haul and decreased the number of false positives.
I had it easy. Data geeks working for insurers with either low market share or shallow data had a much harder time optimizing their risk adjustment revenue.
Aetna has a kick-ass data team. They have huge and deep data sets that they control. It is quite likely that a significant chunk of their risk adjusted covered lives in 2018 have shown up in some point in their data bases in the past decade. An individual who is now insured by Aetna Medicare Advantage in Texas may have had an amputation claim from Aetna Medicaid in Pennsylvania that is dated in 2009. That is valuable information to build and curate a risk adjustment optimization list.
However there are always serious holes in the Aetna list. Either someone has never been on Aetna before or there was a major change in health status when that person was covered by someone else. This is where CVS comes in. There is a good chance that CVS has filled some prescriptions for people who do not show up in Aetna’s data banks. Newly covered lives by Aetna can have a risk profile built off of CVS prescription data to minimize the number of surprises and optimize risk adjustment strategies.
This is the most obvious play from my days as a risk adjustment data geek. The other side of the far more complete pre-enrollment data universe for Aetna via the CVS pharmacy data is that Aetna will have far more granular level information on their markets. This will influence plan design, it will influence marketing materials, it will influence whether or not Aetna enters or leaves a market or bids for certain contracts.
Finally, the biggest data bonanza from my point of view is the CVS non-prescription data that is tied to the loyalty card that almost everyone carries on their keychain. This should give a massive predictive edge to the Aetna data geeks. Let me share way too much personal information to illustrate.
Our two children were extremely planned children. My wife used oral contraception until we started trying for our first child. After our daughter’s birth, we switched to condoms as our birth control method as she felt better off the pill and for the most part, we could handle a happy accident or a baby one year premature. I felt that I was tempting fate if I bought condoms from Costco. I walked past a CVS at least twice a day to and from the bus-stop I used for work. If we were running low, I would pick up condoms and a gallon of milk.
If an insurer could see the non-prescription purchases tied to the customer loyalty card, they had an excellent idea of when my wife and I started trying for Kid #2. If this was an insurer that sought to be socially productive and useful, we could expect to get mailings and outreach calls on pre-natal and perhaps pre-conception health enhancers. If the insurer was run by cynical bastards and the time of the year was right, they might try to be enough of a pain in the ass to get us to switch insurers so that someone else could pay for labor and delivery.
That is the most obvious data play that I can think of based on personal experience. I can think of using the CVS retail data as population health monitoring service, I can think of using the over the counter sales data tied to individuals to fuel predictive models for future opioid issues, or arthritis flares, or pulmonary hospital admissions or one hundred other things.
So from my former point of view as an insurance data geek, this merger offers an incredibly rich vein of data that can be mined and minted. This makes a lot of sense to me without even thinking about how the entire pharmacy benefit management function is a messed up situation.
by John Cole| 93 Comments
This post is in: Dolt 45
And there you have it:
Democrats refusal to give even one vote for massive Tax Cuts is why we need Republican Roy Moore to win in Alabama. We need his vote on stopping crime, illegal immigration, Border Wall, Military, Pro Life, V.A., Judges 2nd Amendment and more. No to Jones, a Pelosi/Schumer Puppet!
— Donald J. Trump (@realDonaldTrump) December 4, 2017
Good morning, juicers.
This post is in: C.R.E.A.M., Dog Blogging, Open Threads, Republican Venality, All we want is life beyond the thunderdome
What happens when your dog experiences snow for the first time ever pic.twitter.com/qYwe1Q4RdO
— Jo Ellery (@elleryface) November 30, 2017
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What’s on the agenda as we start the new week?
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***********
I wish the NYT & other news media would stop calling Social Security & Medicare "entitlements." Millions of Americans worked for decades & paid in for decades to receive Social Security & Medicare. It would be better to call them "social insurance" or "old age insurance" programs https://t.co/ChnQq3qJ7h
— Steven Greenhouse (@greenhousenyt) December 3, 2017
The victory on tax cuts was only the first step. Conservative leaders say the next target will be cuts to entitlements like Medicare. https://t.co/ztmknkcmVC pic.twitter.com/Bt1uxr66lp
— NYT Politics (@nytpolitics) December 3, 2017
Why do we even have a CBO anymore? pic.twitter.com/x5VE1aARpy
— Schooley (@Rschooley) December 4, 2017
Every. Time. They do this every time, and people still vote against their own self-interests. (And they aren't "entitlements." They're "earned benefits.") https://t.co/6s38F9VxBs
— shauna (@goldengateblond) December 3, 2017
This is Senate passage, not the ultimate bill and vote. The backlash of outrage must be fierce. Once Collins and Flake realize they got played, they may flip. Moderate House Rs haven't yet reacted to the official score.
— Topher Spiro (@TopherSpiro) December 1, 2017
It is True. It is still possible to win this. The pressure on R's in moderate states will be enormous from voters. CALL https://t.co/Ec3NLHrZcO
— Howard Dean (@GovHowardDean) December 2, 2017
Monday Morning Open Thread: Remember Joy?Post + Comments (86)
This post is in: Hail to the Hairpiece, Open Threads, Popular Culture, Republican Stupidity, Vagina Outrage, Assholes, Just Shut the Fuck Up
… and he didn’t even have to kneel in the snow for three days. Color me not impressed!
This, from Billy Bush, on Trump & Bush's own personal reckoning, is remarkable: https://t.co/pkAOt9SiAh
— Robert Draper (@DraperRobert) December 4, 2017
NYT, two days from now: “Close friends of Trump have heard him suggest in recent days that Billy Bush might not be a real person…” https://t.co/YyctQpZxQr
— Daniel W. Drezner (@dandrezner) December 4, 2017
3) This is the same doomed-faustian bargain that many politicians have made since 2015 and making now, in enabling Trump as he violates every personal & patriotic standard they claim to believe in.
— James Fallows (@JamesFallows) December 4, 2017
6) BBush is now forthright about how calculating he was, and the damage he thereby both caused and endured.
— James Fallows (@JamesFallows) December 4, 2017
And let’s not forget he’s a Bush. Nephew of GHWBush and cousin of W.
— Steve Spaulding (@SteveESpaulding) December 4, 2017
In fact, Billy’s relationship to the Bush Crime Family is the only real point of interest, as far as I can tell. For all the vast social ineptness of various politically-oriented Bushes, they have demonstrated a keen sense of what the zeitgeist requires, whether that involves banking gold for the Nazi Party or volunteering to shoot down Japanese warplanes. If Billy thinks it’s time to make a public show of renoucing Donny and all his works, it’s a strong indicator that the Permanent Republican Party (such as it is, in these fallen days) still thinks it can shake off the Trump/”populist” (racist) stink with the aid of a few well-placed sacrifices. Since the Bushes have been intimately involved with the CIA since it was the OSS, one can but assume they have some knowledge of what’s been going on behind the Putin curtain…
Late Night Fustercluck Open Thread: Billy Bush Goes to CanossaPost + Comments (27)
This post is in: Hail to the Hairpiece, Open Threads, Republican Stupidity, Russiagate, Clown Shoes
What did #MikeFlynn get his Family for
Christmas? ??
He went to Jared’s #FridayFeeling #Resistance pic.twitter.com/1oDlP3QjXf
— Luna Lovegood ???? (@LunaLuvgood2017) December 2, 2017
Y'know, it's easy to gloat, but I think it's kind of beautiful General Flynn is flipping because he knows his son @mflynnJR is too weak for prison. That's the heartwarming lesson I take out of this.
— John Rogers (@jonrog1) December 1, 2017
President Trump asked FBI Director Comey to go easy on Flynn.
Months later, Flynn got a great deal.
President Trump must be pleased!
— Adam White (@adamjwhitedc) December 1, 2017
'Something was desperately wrong with this guy': US Army general who served with Flynn weighs in on his downfall https://t.co/TNRVHtYTiR via @MilDefInsider
— Crispin Burke (@CrispinBurke) December 3, 2017
Russiagate Open Thread: Cheap Japes EditionPost + Comments (209)
This post is in: Dolt 45, Free Markets Solve Everything, Open Threads, Republican Stupidity, Russiagate, Riveted By The Sociological Significance Of It All
Possibly while peeking through your fingers, as with any great horror movie…
Mueller’s eventual interview with President Trump will be a spectacle, should be broadcast live!
— MATT DRUDGE (@DRUDGE) December 3, 2017
100% sure you could convince him to do it.
100% sure it would be spectacular. https://t.co/4JwWO4p2Dj
— Josh Grubbs (@JoshuaGrubbsPhD) December 3, 2017
Make it Pay-Per-View, and suddenly the US goverment would never have money problems again.
— Alex Edwards (@ohgodscrewthis) December 3, 2017
Trump erupted at Manafort for suggesting he not go on Sunday shows: "I’ll go on TV anytime I goddam f-cking want" https://t.co/zv3SQFAzgF pic.twitter.com/Qwsrm6uEkr
— The Hill (@thehill) December 3, 2017
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Apart from spitballing the optics, what’s on the agenda as we wrap up the weekend?
Sunday Evening Open Thread: Must-See TVPost + Comments (159)