Prescription Data Used To Assess Consumers: Records Aid Insurers but Prompt Privacy Concerns

[Guest guest]

Has anyone ever had trouble getting insurance or a job because of their

health issues?

This is an interesting article in today's Washington Post

http://www.washingtonpost.com/wp-dyn/content/article/2008/08/03/AR2008080302077.\

html

*Prescription Data Used To Assess Consumers*

*Records Aid Insurers but Prompt Privacy Concerns*

This data is not covered by any laws, because people sign waivers allowing

them to get it, for example, when they apply for a job or try to buy health

insurance.

Here is an excerpt:

* " Health and life insurance companies have access to a powerful new tool for

evaluating whether to cover individual consumers: a health " credit report "

drawn from databases containing prescription drug records on more than 200

million Americans.

Collecting and analyzing personal health information in commercial databases

is a fledgling industry, but one poised to take off as the nation enters the

age of electronic medical records. While lawmakers debate how best to

oversee the shift to computerized records, some insurers have already begun

testing systems that tap into not only prescription drug information, but

also data about patients held by clinical and pathological laboratories.

Traditionally, insurance companies have judged an applicant's risk by

gathering medical records from physicians' offices. But the new tools offer

the advantage of being " electronic, fast and cheap, " said Mark Franzen,

managing director of Milliman IntelliScript, which provides consumers'

personal drug profiles to insurers.

*

* The trend holds promise for improved health care and cost savings, but

privacy and consumer advocates fear it is taking place largely outside the

scrutiny of federal health regulators and lawmakers. *

*Ingenix, a Minnesota-based health information services company that had

$1.3 billion in sales last year -- and Wisconsin-based rival Milliman -- say

the drug profiles are an accurate, less expensive alternative to seeking

physician records, which can take months and hundreds of dollars to obtain.

They note that consumers authorize the data release and that the services

can save insurance companies millions of dollars and benefit consumers

anxious for a decision. *

* " Some insurers can make a decision in the same day, or right on the spot, "

Franzen said. " That's the real 'value-add.' " *

*But the practice also illustrates how electronic data gathered for one

purpose can be used and marketed for another -- often without consumers'

knowledge, privacy advocates say. And they argue that although consumers

sign consent forms, they effectively have to authorize the data release if

they want insurance. *

* " As health care moves into the digital age, there are more and more

companies holding vast amounts of patients' health information, " said Joy

Pritts, research professor at town University's Health Policy

Institute. " Most people don't even know these organizations exist.

Unfortunately the federal health privacy rule does not cover many of them. .

.. . The lack of transparency with how all of this works is disturbing. " *

*Ingenix and Milliman create the profiles by plumbing rich databases of

prescription drug histories kept by pharmacy benefit managers (PBMs), which

help insurers process drug claims. Ingenix, for instance, has servers in the

PBM data centers, updating the drug files as frequently as once a day, said

Stenson, senior vice president of consulting for Ingenix, which is a

division of UnitedHealth Group. The corporation also owns UnitedHealthcare,

the nation's second-largest insurer. *

*When an insurer makes an online query about an applicant, Ingenix or

Milliman's servers scour the data and within minutes or less return reports

to a central server at the company. The server aggregates the information

going back as far as five years, including the drugs and dosages prescribed,

dates filled and refilled, the therapeutic class and the name and address of

the prescribing doctor. *

* Then comes the analysis. *

*Ingenix's MedPoint tool provides insurers a " pharmacy risk score, " or a

number that represents an " expected risk " for a group of people, such as 30-

to 35-year-old women who have taken prescription drugs, Stenson said. Higher

scores imply higher medical costs. *

*

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