Companies collect, analyze prescription information

8/4/2008

WASHINGTON The next step in the switch from hand-written medical records to electronic health records is companies offering their service in collecting and analyzing patients’ prescription information and then helping insurance companies decide whether to offer clients insurance through their companies and determine price, according to the Washington Post.

Companies offering the service, such as Ingenix and Milliman IntelliScript, say they follow Health Insurance Portability and Accountability Act procedure and ask for patients’ authorization before giving their information to insurance companies.

The companies create patient profiles with information from pharmacy benefit managers’ prescription drug history databases. Ingenix has servers in the PBM data centers updating the drug files as frequently as once a day, John Stenson, senior vice president of consulting for Ingenix, told The Washington Post.

Once the analysis is completed, the companies provide the insurance companies with a score that determines whether a patient constitutes a high risk, for whom care will cost more, or a low risk.

One of the biggest problems seems to be multiple uses of a drug. A patient could be taking Prozac for menopausal hot flashes, but insurance companies might think she is using it for depression and won’t offer her a life-insurance policy even if her doctor explains the reason for the drug’s use.

But the biggest factor is patient confidentiality. Companies like Milliman and Ingenix do not have to obey HIPAA, even though they say they do. There is a health privacy proposal pending in Congress would expand federal officials' ability to regulate such “downstream” organizations, audit their activities and impose civil fines.

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