There’s been enough bad behavior in Medicare private health plans to go around, but some of the worst behavior has come from private FFS plans, and some of the worst behavior of all has come from WellCare, a Medicaid and Medicare plan in Florida. Last Wednesday the FBI raided Wellcare, with allegations of fraud and presumably a qui tam suit in the works. And since then the stock is down some 70%.

Just another story of another private organization pushed by Wall Street to over plunder Medicare? After all I’ve been writing about why Wall Street Hates Healthcare Services But Doesn’t Know It for years. (Apparently George Soros, who, despite his liberal foreign policy leanings, isn’t above making the odd buck or two, made out like a bandit from Wellcare).

Well almost, but then there’s one little wrinkle.

Because there are also others apart from the single-payer advocates who don’t like health plans. In fact one prominent consumer advocate from her lofty ivory tower has proclaimed health insurers as one of those who’ve been “killing” healthcare.

Who killed healthcare?

Regina E. HerzlingerPosted 09/07/2007 (Medscape)

We turn over $2.2 trillion of our money each year to those who manage our healthcare, without holding them accountable for efficiency or quality. Not surprisingly, these folks — hospitals, insurers, governments — they use the money to benefit themselves. Jack Morgan, the insured, middle-class protagonist in Who Killed Health Care? was killed by this system.

Insurers, hospitals, and governments have gotten fat on our bloated healthcare costs, which kill the competitiveness of US firms.

<SNIP>

That’s my opinion. I’m Professor Regina Herzlinger of the Harvard Business School.

But funnily enough, there must have been something different between WellCare and those other “insurers” that were “getting fat on our bloated healthcare costs”. Different enough that Regina Herzlinger allowed herself to be appointed to the WellCare board in 2003.

Continue reading…

So Zagats, which is the best known old world ratings guide in the restaurant business, is making a move into health care. And it’s doing it with the biggest blues plan Wellpoint.

So there’s likely to be quite a bit of cynicism about this. After all, why should anyone use a health plan site to rate doctors rather than an independent one, and for that matter is Wellpoint going to let its customers rate it? I can think of a few who won’t rate it so highly!

But beyond the cynicism, it’s clear that some form of ratings is coming fast. And plans might as well get into the game somehow, although given the lack of trust they have in the market, my guess is that an independent ratings company is more likely to succeed. And there are lots of those around. Perhaps the question is whether it’ll be a guide known best for restaurants like Yelp, a general health care site which allows ratings like Revolution or Vimo, or whether a specialist one that just rates doctors like RateMDs or CareSeek.

Quick add: On the panel at Connected Health, Henry DePhillips, ex MedDecision now with Medem says– consumers not going to
rate costs or quality—so that Wellpoint/Zagats are missing the point!

I’m at the Partners Connected Health conference. Yesterday’s entry got killed by an overheating crash—but having blown the dust out of my heatsink, hopefully my Gateway is OK now.

Later today 5 cool Health2.0 companies are going to be showing their goodies on a panel I’m running. (WeGo Health, Enhanced Medical Decisions, DNADirect, PatientsLikeMe, and Praxeon)

I also heard an earlier panel talk from a next generation RelayHealth/online visit type company called American Well (not an oil company) which looks pretty interesting — real time video conf with docs “on call”, apparently some health plan will run it out next year)

Right now I’m at a panel on PHRs. We’re starting to talk about data privacy and trust. Funnily enough open source advocate Fred Trotter has today taken a broad swipe at Microsoft in an article called HealthVault: No Commitments and a Sleeping Watchdog in which he says that there’s no actual audit function and that privacy advocate Deborah Peel has been snowed.

So I asked….James Mault from Microsoft essentially said that they’ve done the best they can so far with a multitude of interested parties and that this is a continual work in process. He did say “ability or third party audits are built into the system” and that “at the end o the day the consumer will tell us what they want”. He didn’t mention the open source issue, and no, I’m sure Microsoft wont show him the code!