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A.M.BestTV: ‘First Monday’: ACA Program Change Hampers Insurers

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A.M.BestTV: ‘First Monday’: ACA Program Change Hampers Insurers OLDWICK, N.J.--(BUSINESS WIRE)--This third of four “First Monday” episodes examines the U.S. health insurance industry, as A.M. Best Senior Financial Analyst Doniella Pliss explores how a budget change that leaves the collectability of risk corridor payments uncertain is impacting U.S. health insurers. Click on http://www.ambest.com/v.asp?v=fmhealth415 to view the video program. The last episode in this series of “First Monday’s” will focus on the industry-wide wave of mergers and acquisitions. Reported by Business Wire 18 hours ago.

To Sign or Not to Sign

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That is not the question

Across the US, people are lining up for or against Barack Obama's agreement with Iran to prevent it from ever producing nuclear weapons, should it decide to do so. Some feel he is wasting his time trying to make any kind of deal with Iran.

And they should know. They know that Obama has been wasting his time for the past six years trying to make deals with them -- and I mean the Republicans. They should know because they have behaved the same way they now characterize Iran as behaving -- that they will never go along with anything Obama wants to do.

This is a classic case of projection, of unconsciously displacing their own intransigent stance against Obama onto Teheran. It is as if being consistently paranoid about their own president gives them special insight that Iranian leaders are not to be trusted. They remain certain that Iran will undermine and break any agreement this president makes.

Some also say that Obama is "giving away the store" to Iran. They sense it because they experienced his excessive accommodations both to big "Pharma" and Health Insurance Companies in order to pass Obamacare.

But the reason they know for sure that Iran will continue to pursue nuclear weapons is because they know the same thing about themselves -- that they will never rest until they destroy Obamacare. So Republicans continue to do everything in their power to undermine Obama, redirecting their attention to his current treaty initiative. Their unconscious self-knowledge reinforces their views of Iran, because they have relentlessly opposed Obama's efforts to unite the United States -- whether to fix health care, to reverse climate change, or to raise the minimum wage. They know that Iran will do whatever it takes because they do whatever it takes. Their special insight into the relentless danger posed by Iran comes from looking at themselves in the mirror.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 17 hours ago.

Health Solutions Sandbox™: Breakthrough Program to Accelerate Value-Based Reimbursement through OMSiH, in Collaboration with AEGIS.net, Inc. & Center of Health Engagement

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One Million Solutions in Health™ (OMSiH), in Collaboration with AEGIS.net, Inc. (AEGIS) and the Center of Health Engagement (CHE) announce a groundbreaking initiative to fast-track interoperability for value-based health care

Boston, MA (PRWEB) April 08, 2015

One Million Solutions in Health (OMSiH), AEGIS and the Center of Health Engagement (CHE) will be launching a breakthrough program to create an interoperable ‘sandbox’ at HIMSS 2015, the premiere event for health care transformation through health information technology (HIT). The Health Solutions Sandbox™ is a platform where organizations can securely place their data and be assured that conformance and standards in HL7 are being met. This will be transformative, as HIMSS has traditionally been the launchpad for catalyzing such innovations into the worldwide HIT community.

This paradigm-changing initiative will integrate different data sets, from different sources, providing an unbiased and meaningful way to look for patterns and trends that influence health care outcomes. Focused on interoperability, the Health Solutions Sandbox will provide the ability for unrelated information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. This ‘sandbox’ will be a game-changer for the broader HIT community, as it will allow access for analytics development and dataflow architecture in a collaborative, non-competitive and free-flowing open source environment.

Importantly, through HIT interoperability, this Health Solutions Sandbox will allow all parties to merge previously unrelated data to identify barriers that curtail the health care system’s ability to generate better health outcomes. As a first-of-its-kind initiative, the ‘sandbox’ will provide a foundation for correlating and initiating solutions in value-based reimbursement models.

At the AEGIS Booth, #3486 on the main exhibitor floor, Brett Johnson, Ph.D., Executive Vice President of One Million Solutions in Health, and Cyndy Nayer, CEO of the Center of Health Engagement, will be discussing this unique opportunity to work with public and private tools, HIT architecture and software applications. The vision for the Health Solutions Sandbox is to both meet the goals of value-based reimbursement and to provide true patient-centric changes in health care.

Executives in the C-Suite in Health Systems, ACOs, Public Health Services, and Health Insurance Exchanges, along with the senior executives in the Biotech and Pharmaceutical industries, are struggling to identify how to answer a growing list of requirements that meet the new value-based reimbursement and data sharing protocols in the United States under the Affordable Care Act (ACA).

The key to these problems is finding solutions that can add true value into health care, along with better patient and system outcomes.

Dr. Johnson stated that OMSiH is “acting on the unmet need to combine datasets of patient behaviors and engagement, practice patterns, diagnostic test results and the use of medical devices and health services. The foundation for this solution is interoperability. Combining this data must be done in a way that is standardized, consistent, secure and reliable.”

The launch of this groundbreaking initiative to create a Health Solutions Sandbox is critical, given the historic announcement from the HHS (United States Department of Health & Human Services), which provides clear goals and timelines for shifting Medicare reimbursements from volume to value. To meet the goals of value-based health care as defined by the HHS [Better, Smarter, Healthier], the ‘sandbox’ will also provide the open source forum to develop HIT and payment solutions, while driving towards superior health outcomes.

“Value in health care can only truly be found when we combine unrelated datasets in meaningful and actionable ways to understand the patient and system behaviors, which will then result in the betterment of our world and the health of every individual,” declared Dawn Van Dam, President & CEO of One Million Solutions in Health, as part of this far-reaching announcement. “We are blessed, additionally, to welcome Cyndy Nayer, CEO of the Center of Health Engagement, to this collaboration in the strategic effort to cut the time to get to better outcomes for everyone, but particularly for patients.”

Nayer, who has been named one of six national thought leaders in health innovation by EY (Ernst & Young), is a critical player in this landmark initiative. The Health Solutions Sandbox is a unique opportunity to combine the technical expertise of OMSiH, with CHE’s prowess for identifying and engaging vulnerable populations—typically those who are not adherent to treatment or who are struggling with health-related lifestyle management issues.

BEGINNING A NEW CHAPTER IN HIT AND INTEROPERABILITY

“When I met Brett and OMSiH several months ago in Boston, we began a journey of bringing technology squarely to the center of value-based designs. We identified the early opportunities to accelerate engagement throughout the system and reduce safety incidents, from rewards to patients and consumers for engaging in better health choices, through administrative hurdles and on to how best to re-engineer the reimbursement to providers and systems for quality outcomes,” Cyndy Nayer affirmed.

Nayer explained that under the umbrella of the non-profit One Million Solutions in Health, “we have a non-competitive environment in which to model various data sets and solutions. The possibilities range from being able to show earlier indicators of poor outcomes to identifying the economic rationale for including non-clinical services to help individuals overcome barriers to care. This last piece, the recognition that financial, behavioral and social factors can derail the best of clinical care, has been highlighted by the Institute of Medicine, and it has been a primary inclusion in the value-based designs that have been most successful, whether insurance plan coverage or payment reimbursement.”

Mario Hyland, Senior Vice President and Founder of AEGIS (Twitter @Interopguy), has been a key navigator in the OMSiH vision. “Our objective is to help our clients achieve their goals by transforming business needs into technical results. Through multiple discussions with the team, we see an aligned vision of conformance and standards testing, and an integrated Ecosystem (AEGIS Infrastructure as a Service – IaaS), that will ensure the various stakeholders can get to their respective goals quicker, and with peace of mind. Our goal is to help our clients succeed, and for that reason, we have established this collaboration. Given the importance of this initiative, we would like to have a large flow of interested individuals and organizations talk with Brett and Cyndy at the AEGIS booth during HIMSS to identify data sets for the Health Solutions Sandbox and be transformed by these ambitious ideas.”

This project, a part of One Million Solutions in Health, is offering this groundbreaking opportunity for health plans, health systems, patient associations, clinical care organizations, public health, IT developers and other stakeholders to combine their data in one safe, secure and HIPAA-compliant environment, thereby enriching the knowledge and possibilities for all. This is all part of the growing efforts of One Million Solutions in Health, founded by Dawn Van Dam, an expert in transforming life sciences and health care discoveries into commercial success. She understands the critical need for an objective oversight at the intersection of health care, bio-genomics, health IT, and payment reform in order to truly transform the system.

Early project ideas and outcomes are expected in the following areas:

●    Immunization as an indicator of early success in treatment and outcomes for adults and children.
●    Diabetes as a community health cost that can be better managed by expanding the knowledge of non-clinical influences in lifestyle, social influences, engagement and choice of care.
●    Integration of depression and behavioral health indicators for a more robust and targeted delivery of services to patients.

MEET US AT HIMSS this April 14th and 15th in Chicago, Illinois

The team, in bringing forward the Health Solutions Sandbox, is asking interested C-Suite executives to BOOK APPOINTMENTS HERE

Get in on the ground floor to discuss the opportunity to join this ground-breaking initiative. Providing a ‘sandbox’ for interoperability has been discussed and imagined in many quarters, but it has not been implemented in such a comprehensive and cross-functional way -- until now.

About One Million Solutions in Health

Shaping Health Care by Sharing Solutions™: To transform the face of health care and life sciences around the world, One Million Solutions in Health™ (OMSiH) is a global movement working to stimulate ideas, innovation and solutions by connecting people and sharing high-value, innovative science.

Inspired by a mutual conviction that all people around the globe deserve better health, we have crafted a number of platforms and programs that leverage collective knowledge, and the willingness to collaborate, for the purpose of accelerating the adoption of solutions that improve our health and well-being. Through a disciplined, scientific process, we work with Subject Matter Experts to evaluate and then validate new technological innovations.

Mission: To Connect, Learn + Share, Innovate and Collaborate to improve health care delivery, accelerate life sciences research and share patient and consumer-focused ideas and solutions.

About Center of Health Engagement

The Center of Health Engagement is a solution-focused agency accelerating the best of value-based designs for improved health and economic outcomes. We are in relentless pursuit of solutions that deliver better health, wealth and performance, building value and quality for families, business and communities. http://www.CenterofHealthEngagement.com

About AEGIS.net, Inc.

AEGIS.net, Inc. (AEGIS) is a certified small business and premier provider of Information Technology consulting services to Federal Civilian, Defense, and Commercial sector clients. AEGIS is a quality process driven organization, rated Maturity Level 3 in both CMMI-DEV v1.3 and CMMI-SVC+SSD v1.3 as well as ISO 9001:2008 certified. We provide technical and subject matter expertise in the areas of comprehensive systems and business process analyses; information technology modernization and transformation; and financial, health care, regulatory compliance, logistics, and human resource systems.

Contact information:

Dawn Van Dam
President and CEO
One Million Solutions in Health
416-402-8274
dawn(at)vandam(at)onemillionsolutionsinhealth(dot)org
http://www.onemillionsolutionsinhealth.org Reported by PRWeb 18 hours ago.

Officer Charged With Murdering Walter Scott Has Been Fired

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The city of North Charleston will be covering the health insurance for the pregnant wife of the police officer who was caught on tape shooting an unarmed driver. Reported by ABCNews.com 17 hours ago.

South Carolina official vows body cams for police after fatal shooting video of Walter Scott

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The officer has been fired, but the town will continue to pay for his health insurance because his wife is eight-month's pregnant. Reported by nola.com 16 hours ago.

Tennessee Senator Assumes A Vasectomy Is Harder To Get Than An Abortion

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During a debate Tuesday night, Tennessee state Sen. Todd Gardenhire (R) told state legislators that it's harder for men to get vasectomies than for women to get abortions. He knows, he said, from personal experience.

Gardenhire, however, acknowledged he only has experience with one of the procedures, though it is not the one he proposes making laws about. "Men go through a lot more stringent process for a vasectomy than women, I assume, go through for an abortion,” Gardenhire told the Senate Judiciary Committee.

“Having personal experience in that field and also having one reversed I want to promise you that when ... you start talking to a doctor about them whacking on you down there, you want to wait a while and think about it,” he said.

Gardenhire's life experience was shared during debate over a bill that would require a 48-hour waiting period for women seeking an abortion in Tennessee.

Gardenhire’s comment came after state Sen. Sara Kyle (D) argued that increased regulations on abortions should also be extended to vasectomies.

“Here you’re putting all this burden on a woman. Why don’t we put these same standards on a man who wants to have a vasectomy?” Kyle asked.

A call to Gardenhire's office was not immediately returned.

Last week after the Senate Commerce and Labor Committee rejected a plan to expand Medicaid to some 280,000 state residents, Gardenhire, a member of the panel who voted with the majority, called an activist “asshole” after he was asked if he would give up his own state-subsidized health insurance.

Gardenhire, in a video of the incident, turned around and said something along the lines of "Not giving it up, asshole" or, perhaps, "Why don't you give it up, asshole?"

Odd as Gardenhire's argument may be, it does include one element that in a fundamental way gives up the game. The Nashville Scene picked up Gardenhire's accidental admission that he doesn't actually understand the process he is insisting on regulating:
That's right, in the middle of a debate over abortion, a state senator said "I assume."

Maybe we shouldn't just assume stuff when deciding to enact legislation?

*Watch Gardenhire’s comment about vasectomies and abortions above, and his run-in with a constituent below.*-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 15 hours ago.

Ben Carson Wades Into Hostile Territory at Al Sharpton Event

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Ben Carson, the black Republican and potential presidential candidate who once told Barack Obama his health-insurance plan was the worst U.S. policy since slavery, was an unlikely guest speaker Wednesday at Al Sharpton's National Action Network.Appearing in Manhattan at the... Reported by Newsmax 12 hours ago.

Ige taps Linda Chu Takeyama to lead Hawaii Labor Department

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Hawaii Gov. David Ige said Wednesday he has nominated Linda Chu Takayama, an attorney and executive director of Honolulu Mayor Kirk Caldwell’s Office of Economic Development, to lead the state Department of Labor and Industrial Relations. Chu Takayama, a former deputy director of the state Department of Commerce and Consumer Affairs and a former state insurance commissioner, also maintains a private law practice that specializes in regulator and government affairs, health insurance and corporate… Reported by bizjournals 10 hours ago.

Rand Paul's Political Views Make Perfect Sense When You Look At His Medical Background

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The doctor is in. The senator is out.

Rand Paul, the ophthalmologist and Republican senator from Kentucky, officially launched his presidential campaign on Tuesday, complete with a little rebranding. Paul's Twitter handle had previously been “@SenRandPaul.” That old profile is gone. Now, his handle is “@RandPaul” and the official name on the account is “Dr. Rand Paul.” Paul’s campaign website refers to him throughout as Dr. Paul and the official campaign biography focuses on his work as a physician -- including a history of performing surgery at deep discounts, or at no charge, for people without the ability to pay for it.

Playing up Paul’s medical background has several benefits. As my colleague Scott Conroy has observed, it burnishes Paul’s image as an outsider -- somebody who's not a politician at heart, who will challenge the Washington establishment and the way it normally conducts business. Paul often refers to himself as a "country doctor," as a way to sand down whatever sheen of elitism the title might convey -- and, perhaps, to conjure up nostalgic images of the bygone America that ignites conservative enthusiasm.

But the “doctor” honorific has one other purpose as well. It lends Paul an aura of compassion, something that most physicians have and that Paul, a libertarian who has advocated reducing government spending on the poor and elderly, could desperately use. It’s no coincidence that the campaign bio notes, in bold, near the end, “A large part of *Rand’s daily work as an ophthalmologist was dedicated to preserving the vision of our seniors*.”

Paul’s charitable work seems to be genuine and, for the people who benefit from it, of real life-changing value. But if you’re looking for insights into Paul’s policy priorities -- and what his presidency would actually mean for people in need -- you need to be careful about how you interpret his professional history.

The fact that he’s a doctor tells you something. The fact that he’s an ophthalmologist tells you more.

That’s because the medical profession has a well-known, well-documented divide when it comes to politics. On one end are specialists. Think orthopedists, anesthesiologists, plastic surgeons, radiologists and, yes, ophthalmologists. They tend to be conservative and support Republicans, whether you measure this by self-described political affiliation or by campaign contributions.

On the other end of the spectrum are general practitioners -- pediatricians, family doctors and internists. Psychiatrists usually fall into this category, as do many oncologists and obstetricians. They tend to be liberal and support Democrats. (Greg Dworkin, a pediatrician who writes for Daily Kos, had a great write-up on this recently.)

The split makes sense if you understand the very different work these doctors perform -- and the money they get paid for it. Specialists' clinical interactions tend to be episodic: A surgeon called in to remove a gall bladder, repair a ligament or install a stent is probably meeting his or her patient for the first time -- and may have little contact, or even none at all, with that patient once the procedure and rehabilitation are over. Such encounters may reinforce a more individualistic, atomistic view of one's relationship with patients and one's role in society.

Among physicians, specialists and surgeons have the highest incomes and, according to a Rand Corp. study, are the most likely to face a malpractice claim. Not surprisingly, they gravitate to the party that puts a high priority on lowering taxes for the wealthy, reducing malpractice liability and generally pushing the government out of health care.

Ophthalmologists in particular are also fond of talking
about LASIK surgery, something they perform on a cash-only basis, as proof that health care would be cheaper without government interference.

Generalists, on the other hand, don’t deal with body parts. They deal with whole bodies. And inevitably, that approach forces them to consider how patients live. It’s the generalists who end up asking about conditions at home, who see connections between lifestyle and health, and who think about the ways in which economic insecurity affects long-term health. (Pediatricians are frequently the first ones to pick up signs of developmental delays and mental health problems, both of which can be products of struggles at home.)

Overall, these doctors have lower incomes than specialists and surgeons -- and are less likely to file malpractice claims. Their kindred spirits are the politicians who put a high priority on making health insurance more easily available and helping people pay for basic needs like food and shelter -- even if that means higher taxes and, yes, bigger government.

These trends probably reflect a great deal of self-selection. Medical students who care more about making money and operating free of government interference are more likely to pursue surgical training. Those who care more about improving general health, particularly among the poor, gravitate to fields like pediatrics. Choices about medical careers tend to go hand in hand with other variables that correlate with political affiliation, such as gender. Men (who are more likely to vote Republican) still dominate the surgical fields, while women (who are more likely to vote Democratic) make up the majority of primary care doctors.

You’ll find plenty of exceptions to these crude categories. But Rand Paul is not one of them. His medical profile lines up perfectly with his ideological profile -- not to mention with the policies he’s proposed. As Dylan Matthews has noted at Vox, the budget proposals that Paul has endorsed are more extreme than anything else you’ll see in this presidential campaign. They would effectively dismantle Medicaid, Medicare and the Affordable Care Act, among others -- forcing literally millions to lose health insurance and endure economic hardship. The vast majority of these people would be elderly or poor or both.

As a surgeon doing charity work, Paul could help a few of these people. The rest would be on their own.-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 10 hours ago.

WellCare Gives $50,000 Grant to Morehouse School of Medicine Initiative to Advance Health Equity for Minorities, Low-Income, Aged and Disabled

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WellCare Health Plans, Inc. (NYSE: WCG) and the Health Equity Leadership & Exchange Network (HELEN), an initiative lead by Morehouse School of Medicine, the National REACH Coalition, and the National Collaborative for Health Equity, announced today that WellCare gave a $50,000 grant to further HELEN’s efforts to advance health equity in Georgia and throughout the nation.

TAMPA, Fla. and ATLANTA (PRWEB) April 09, 2015

WellCare Health Plans, Inc. (NYSE: WCG) and the Health Equity Leadership & Exchange Network (HELEN), an initiative lead by Morehouse School of Medicine, the National REACH Coalition, and the National Collaborative for Health Equity, announced today that WellCare gave a $50,000 grant to further HELEN’s efforts to advance health equity in Georgia and throughout the nation. The grant will be used to support HELEN’s efforts to facilitate national discussions to address the impact health disparities are having on quality measurements, and the influence this has on care for minorities, those who are low-income, and the aged and disabled.

HELEN was established in 2014 to bolster leadership and the exchange of ideas and information among communities of color and other vulnerable populations relative to the advancement of health equity in laws, policies and programs.

“The HELEN initiative is increasing the number of sustainable campaigns that play a role in offering community education and mobilization to help achieve the highest level of health for all people, said Daniel E. Dawes, executive director, Government Relations, Health Policy and External Affairs, Morehouse School of Medicine, and HELEN’s co-principal investigator. “WellCare’s thought leadership and monetary investment will support our efforts to drive measureable, impactful change.”

“Health equity is about focusing societal efforts on addressing avoidable inequities in areas including education, employment status, income level, gender and ethnicity,” said Brian Smedley, co-founder and executive director, National Collaborative for Health Equity, and HELEN’s co-principal investigator. “It will take extensive collaboration between business, government and civil society to address the systematic differences in the health status of vulnerable populations in this country.”

“One of HELEN’s focus areas is the analysis of policies and the implementation of these policies, which has a direct bearing on health equity in under-resourced communities,” said Charmaine Ruddock, chair of the National REACH Coalition. “We are looking to advance a community engagement model of environmental, programmatic and infrastructural change at the local, state and national levels.”

“WellCare is committed to partnering with our government customers, providers, thought leaders and communities to find innovative solutions to remove barriers to care for the low-income children and families, the aged, and the blind and disabled members we serve,” said Dr. Steve Goldberg, WellCare’s chief medical officer. “We look forward to working with the Morehouse School of Medicine and other HELEN participants to address an issue that directly impacts the nearly 70 million Americans who receive Medicaid benefits.”

The HELEN initiative includes members of various organizations, coalitions and associations committed to the elimination of health disparities. To learn more about HELEN go to http://www.healthequitynetwork.org.

About WellCare Health Plans, Inc.
WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4.1 million members nationwide as of Dec. 31, 2014. For more information about WellCare, please visit the company's website at http://www.wellcare.com or view the company’s videos at https://www.youtube.com/user/WellCareHealthPlan.

About HELEN
The Health Equity Leadership & Exchange Network (HELEN) is a collaborative effort between the National REACH Coalition, Morehouse School of Medicine, and the National Collaborative for Health Equity. The national network was designed to bolster leadership and the exchange of ideas and information among communities of color and other vulnerable populations relative to the advancement of health equity in laws, policies and programs. The HELEN initiative will strengthen health equity leadership and increase the number of sustainable campaigns that play an important role in offering community education and mobilization. HELEN, which will include members of various organizations, coalitions and associations committed to the elimination of health disparities, will serve as a national forum for health equity champions to share information about timely, relevant and pressing policy issues impacting health equity. Reported by PRWeb 1 day ago.

Big Cloud Analytics Releases Real-Time Healthcare Analytics for The Internet Of Things (IoT)

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Big Cloud Analytics, Inc. (BCA), leading provider of predictive analytics technology today announced it will deliver a real-time analytic solution that predicts the churn risk for Medicare and individual health insurance plan participants with up to 83 percent accuracy.

San Jose, Calif. (PRWEB) April 09, 2015

Big Cloud Analytics, Inc. (BCA), leading provider of predictive analytics technology today announced it will deliver a real-time analytic solution that predicts the churn risk for Medicare and individual health insurance plan participants with up to 83 percent accuracy.

The solution is powered by COVALENCETM, a patent pending customer intelligence engine from BCA that runs natively on the Intel® Internet of Things (IoT) Gateway and leverages equations from BCA’s Chief Scientist, Dr. V Kumar, the most published data scientist in the field of marketing.

“With Intel, we are providing healthcare churn analytics to the Internet of Things,” states J Patrick Bewley, CEO of Big Cloud Analytics. “The Intel® IoT Gateway provides a powerful compute platform for the deployment of our COVALENCETM Customer Intelligence Engine. This solution enables customers to deploy analytics at the edge, with an easy path to scale up, a robust and flexible security infrastructure, remote manageability and a unique ability to mesh public and private cloud computing environments.”

“The ability for healthcare insurers to perform analytics at the edge of their network enables real-time customer intelligence that can be used in the moment to shape business outcomes,” said Ed Hill, Director of Healthcare IoT, Intel Corporation. “The Intel® IoT Gateway provides a foundational platform that empowers organizations to easily implement edge analytics in a safer and more secure way.”

Intel is a trademark of Intel Corporation in the United States and other countries.

About Big Cloud Analytics
Big Cloud Analytics leads the market in real-time predictive analytics technology for the Internet of Things (IoT). Recognized in 2014 by CIO Review as one of the Top 100 most promising companies in Big Data globally, the Company provides technology enabled real-time marketing predictions based on world-renowned science from the top marketing scholar in the world and BCA’s proprietary COVALENCETM modeling approach. Big Cloud serves the Healthcare, Financial Services and Retail.

Big Cloud Analytics and COVALENCE are trademarks of Big Cloud Analytics, Inc.

### Reported by PRWeb 1 day ago.

Devil's Bargain: A Former Medellin Cartel Official Has Been A DEA Informant For 27 Years. Now He Wants Out.

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Carlos Toro, seen at his Miami home in 1982, has been on both sides of the drug war, first as a Medellín cartel member and later as a confidential DEA informant. (Photo courtesy of Carlos Toro)“You're lying to me," the man said. Carlos Toro took a gulp of wine and tried to maintain his composure. For years, he had dreaded hearing those words.

It was February 2011, and Toro, who was then 61, had come to this upscale steakhouse in Madrid expecting a casual meal between two friends with business to discuss. His companion was a South American diplomat and high-level cocaine trafficker eager to break into the European drug market, where a kilo purchased for less than $1,000 wholesale back home could sell for more than $40,000 on the street. Toro was a onetime top official in the Colombia-based Medellín cartel, which dominated the global cocaine market in the 1970s and '80s.

In his sharply tailored blazer and slacks, a shock of thinning, gray hair atop his head, Toro certainly looked the part of a high-rolling cartel boss. He made up for his short and slightly sagging frame with a confident, easygoing charm. He had offered to facilitate a partnership with a Spanish airline employee who could supposedly transport drugs between South America and Europe aboard commercial planes.

Over the previous two years, Toro and the diplomat had shared many dinners like this one. They had exchanged intimate details about their personal lives, and Toro had even met the man's young son. Everything Toro told him, though, had been a lie.

For well over two decades, Toro had been a confidential informant for the U.S. Drug Enforcement Administration -- and a very effective one at that. But now the diplomat had stumbled across a piece of incriminating evidence: Toro's airline contact wasn't real. When the diplomat analyzed their email correspondence, he discovered that the messages from Toro and the airline employee originated from the same IP address. If the airline contact really was a Spaniard living in Barcelona, why did he appear to be with Toro in the United States, sending emails from Toro's computer?

"What are you talking about?" Toro replied, trying to sound confused. The man stood up. "Who are you working for?" he snarled. "Are you working for the DEA?"

The restaurant seemed to come to a standstill, and Toro began to panic. Feigning outrage at the accusation, he stormed off to the bathroom and frantically called the U.S. embassy, hoping to reach his DEA handler.

But before Toro could get his supervisor on the line, someone grabbed his jacket collar. Toro turned and swung at his assailant's face. It was the diplomat, and the blow sent him staggering backwards to the floor. Just then, another patron walked in, preventing a brawl. Toro's target picked himself up, and they awkwardly returned to their table.

The diplomat demanded to see Toro's cell phone. Knowing his call log would show his recent attempt to contact the DEA, Toro refused, challenging his companion to turn over his phone instead. When he did, Toro grabbed both phones, slammed them on the tile floor and stomped them to pieces. "I don't trust you. I don't want to work with you. You doubted me. I don't have to do this. I came all the way from the United States to help you," he shouted. "This is outrageous."

Every customer and employee in the establishment was now following the commotion. People stood up, craning their necks to watch the drama unfold. Servers hurried over to defuse the situation. The diplomat, who had no desire for a spectacle, finally left the restaurant.

Toro apologized to the manager, paid the bill, cleaned up the shattered cell phones and headed for the exit. But before he reached the street, he hesitated. What would happen when he walked out the door? Was he about to be gunned down by a drive-by assassin -- or worse, tossed into a car trunk and taken off to be tortured?

Toro took a deep breath. It was after 1 a.m., and the lingering smell of grilled meat was now infused with the acrid odor of cleaning supplies. He pushed through the doors and found the diplomat waiting for him on a metal bench outside.

For a moment, Toro wondered if the diplomat was planning to pull the trigger himself. But his tantrum had apparently been effective. The man seemed almost apologetic, acknowledging that he may have overreacted. Perhaps the airline contact was actually the DEA snitch, he suggested.

Toro bid the diplomat a cold good-night and walked swiftly to his hotel, making sure he wasn't being followed. When he made contact with his DEA handler, he was ordered to extract immediately. Toro got on the first flight out of Madrid. Within a few hours, he had arrived safely in Lisbon.
Soon, he'd be back in the U.S., awaiting his next assignment.Confidential informants are the lifeblood of the DEA, and Toro is what agents would characterize as a "good asset." He has served the DEA for 27 years. His intelligence-gathering has helped take down arms dealers, money launderers and narcotraffickers across the globe, including legendary figures such as Medellín cartel kingpin Carlos Lehder and Panamanian dictator Manuel Noriega. Toro testified against Noriega in federal court. And in 2010, the DEA, citing his contributions to those cases, gave him an award for lifetime achievement. He is one of the most productive DEA assets ever to come forward and tell his story.

Toro's escapades in narcotrafficking often sound fantastical. This is, after all, a man who regularly lies for a living. But Toro spoke to The Huffington Post extensively over the course of several months. He provided numerous documents to support his account, including emails, photos and DEA incident reports detailing the Madrid episode and others. The following story has been based largely on those sources. (The DEA denied repeated requests for comment and typically does not speak publicly about specific informants.)

For Toro, going public in this manner comes with obvious risks. But he feels that he has no other choice. Now 65, he has grown tired of facing down dangerous criminals. He is no longer in good health, too old to square off with would-be assassins or make quick getaways down darkened streets. He wants to retire and live out his remaining years with his family in the United States -- his wife of 35 years, Mariana; their son and daughter; a grandson. (The name of Toro's wife has been changed to protect her identity.)

The DEA, however, has a different idea. For the last five years, the agency has issued Toro a temporary immigration document that requires him to assist in active investigations. If he stops snitching, however, his immigration status will lapse. That could mean deportation to Colombia, Toro's country of birth, where he fears he'd be assassinated by the former cartel associates he once helped put behind bars.

In 2012, Alejandro Bernal Madrigal, a former member of the Medellín cartel, was murdered in Colombia just a month after returning home. He had served time in a U.S. prison for trafficking cocaine, but had bargained down his sentence in exchange for testimony against a top cartel financier. Colombian authorities believe it was a revenge killing.

To avoid a similar fate, Toro has asked the DEA to help him obtain U.S. citizenship or legal permanent residence, allowing him to avoid deportation and access the federal benefits he's paid into over the course of his life. But he said the DEA has refused to change the terms of their arrangement. For years, Toro told himself that this was a partnership of equals. Now, he's come to realize that despite his record of success and years of risking his life, to the DEA he is merely a useful idiot.

Toro's situation conforms to the experience of many other DEA informants, according to criminal justice experts and former agents. There are an estimated 4,000 such operatives working for the agency at any given time, according to a 2005 report by the Department of Justice. "Sources make you or break you," said Finn Selander, a former DEA special agent and a member of Law Enforcement Against Prohibition, which opposes the war on drugs. "They are everything for an agent's career."

According to former undercover agent Michael Levine, agents come under enormous pressure to obtain results, and they lean on their sources heavily. "Agents are only interested in one thing, and that is numbers: What can you do for me? Who can you get for me? What kind of headlines can you get? What kind of cases? How far can I go with you?" said Levine, who spent 25 years with the DEA.

When a DEA agent has leverage over an informant, Selander said, "for lack of a more politically correct way of saying it, you've got that person by the balls." He added that agents often view their sources as "dirtbags" and have no qualms about exploiting them.
It's a situation in which the government holds all the cards, said Alexandra Natapoff, a professor at Loyola Law School and an expert on informants in the criminal justice system. "If you've committed a crime, then you're on your own," she said. Agents may benefit greatly from a source's information, but there are no legal protections for the informants themselves. In dealings with the federal government, Natapoff said, "those individuals often fare very badly."

Toro was on his cell phone when he opened the door to his Washington, D.C., hotel room on an overcast January afternoon and ushered me in. "DEA," he whispered loudly, pointing to his phone. He placed it on the desk and switched on the speaker, as if to show me there was actually someone on the other end.

When he finished the call, Toro extended his hand, flashing a disarming smile. He had flown in earlier that morning to tell me his life story in person. He was dressed in a blue zip-up sweater and skinny jeans -- an outfit he jokingly referred to as his "drug dealer clothes." Over the next three-and-a-half hours, he paced the slate gray carpet almost maniacally as he painted a detailed portrait of his life. He spoke quickly and assuredly, often without pause -- a regular habit of his. It was easy to see how he had made a career out of getting people to trust him.

Toro was born in 1949 in the city of Armenia, in the heart of the coffee-growing Andes region of Colombia. His family was wealthy. His father had been a pioneer in the broadcasting business, founding one of the nation's first private radio stations.

As a child, Toro recalled, he developed a close relationship with a family friend named Carlos Lehder. They were born just days apart, but shared little in terms of personality. Lehder was a rebellious youth who would go on to become one of the most powerful members of the Medellín cartel. Toro was personable and loyal but always more reserved, a trait he said was a function of his Christian upbringing. As a child, Lehder lived with Toro's family for a few months. In the mid-1960s, however, he left for the United States with his mother.

Toro also traveled to the U.S. in 1967 to attend high school in Hartford, Connecticut, where he could learn English and get an American education. He attended Emerson College in Boston, and during the summers toured with Campus Crusade for Christ and interned for Pat Robertson and the Christian Broadcasting Network. He eventually left school to join CBN and travel the world as a cameraman, before moving to New York in the mid-1970s.

Back in the U.S., Lehder took every opportunity to try to lure his friend away from the straight-and-narrow lifestyle. Toro recalled meeting with Lehder on several occasions, including at two separate parties at the Waldorf Astoria hotel in New York. In 1978, as America’s cocaine binge was in full swing, he visited Lehder in the hotel's presidential suite.

"He's got 20 prostitutes, there's a kilo of cocaine on the center table, and a bunch of friends and everybody is having a party," Toro said. "We were there for three days, I don't even know."

Lehder explained to Toro his grand vision for a new Colombia, controlled by the cartel and its ever-expanding cocaine empire. Lehder was on top of the world, making $2 million a week and entertaining foreign dignitaries, prime ministers and presidents. He'd even bought an island in the Bahamas, which the cartel would soon be using as a staging ground for cocaine shipments into the States.

Toro visited the Caribbean compound a few times a year in the late '70s and described it as an enclave overflowing with sex and drugs, guarded by a small army of men with Uzi submachine guns and packs of attack dogs. Each time he'd go, Lehder would insist that Toro join the cartel, but Toro remained wary of his friend's criminal enterprises.

In 1980, Toro married Mariana, a Colombian-American born and raised in Miami. Their first child was born in 1981. Shortly thereafter, the family moved from New York to Tamarac, Florida, where Toro managed a janitorial services company. Yet he couldn't deny that he was drawn to the perks of working for the cartel.

One day in 1983, Alvaro Triana, another childhood friend then in charge of the cartel's finances in Florida, showed up with an offer from Lehder. "You will never, never be exposed to the drugs. You'll never touch the drugs. We need you as a PR man. You're the perfect person to do public relations," Toro recalled being told by Triana, a bulbous man with a mop of curly red hair and a fondness for whiskey. "We're having problems finding landing strips to refuel our airplanes, recruiting pilots, training pilots, buying airplanes, repairing airplanes."

The offer would bring Toro a fortune -- and all, he convinced himself, without having to get his hands dirty. Still, Toro didn't want to tell his wife he was getting involved in the cocaine trade that was then terrorizing large swaths of South Florida. Instead, he claimed that they were setting up a scheme to sell contraband luxury French goods, like perfume and lingerie. He said they would have both legal and physical protection, and that they would be moved into a brand-new, villa-style home in Boca Raton and given whatever kind of car they wanted to drive. Toro took a sabbatical from his cleaning business, and within a few weeks, he was working for the cartel.

Over the next few years, Toro's role in the organization expanded. He coordinated logistics for cocaine smuggling operations, arranging flight paths, cutting deals with foreign leaders and paying pilots and couriers. (Years later, he described his responsibilities and the internal workings of the Medellín cartel in a 2000 interview with PBS's "Frontline.")

Throughout the mid-'80s, Toro regularly saw $10 million a week flow through the attic of his home. He also purchased a .38-caliber revolver, which he carried under his jacket.

One day while Toro was out, Mariana unzipped one of the army-green duffel bags lying on the attic floor. It was full of rubber-banded rolls of hundred-dollar bills -- a total of $1.2 million in cash. Mariana had suspected her husband was involved in something more serious than selling stolen Chanel No. 5. When she confronted him, he promised the work was only temporary.

Toro claims the situation left him desensitized to wealth. He was being paid handsomely and everything he could want was at his fingertips, so he never felt the need to save. He had planned to retire after a couple of years but never put money aside, unwisely assuming it would always be available to him.

Respect for the chain of command was a central tenet of the Medellín cartel. So in 1985, when Toro found out that Triana wasn't paying pilots on time, he was faced with a hard decision: go over Triana’s head or risk losing key links in their supply chain. Toro decided to make sure the pilots were paid immediately. He contacted the cartel's financial backers in Colombia, who gave him $7 million to distribute. It was the latest episode in an already escalating feud between Toro and Triana, and perhaps Toro should have known better. Triana was volatile, insecure and impulsive -- not the sort of man you wanted to antagonize.

The next afternoon, Triana showed up at Toro's house looking disheveled and cradling a nearly empty bottle of whiskey. "Come out, you son of a bitch," Toro remembered Triana yelling from his front yard. Triana continued to hurl insults at Toro as they took the argument down the street to Triana's house. In the living room, Triana sank into a recliner and gave Toro an ultimatum: He had 24 hours to leave the Boca Raton house and return the cartel's property.

Toro accused Triana of stealing the money meant for the pilots and threatened to go to the cartel bosses with the allegation. Triana exploded. "I'm gonna kill you!" he screamed, reaching down and pulling an Uzi from beneath his armchair. Toro grabbed his revolver and fired three times, hitting Triana in the chin and the groin and sending him slumping to the floor. The third shot hit the ceiling. "I don't know how I did it," Toro recalled. "I wasn't looking."

Triana was alive and conscious but losing blood fast. The hospital was out of the question: Triana was living in the U.S. under a fake identity. Taking him to the emergency room would have put the entire Florida-based cartel operation in jeopardy. Toro called a former business partner and asked him to send over his son, a medical student. The young man dressed Triana's wounds and gave him a morphine injection, while Toro tracked down a cartel pilot to fly Triana back to Colombia for more extensive treatment. In the middle of the night, Triana was loaded onto a small plane and secreted out of the country.
Toro called Lehder to tell him what had happened, expecting that his old friend would understand. "You shot one of my men?" Toro remembered Lehder saying. "You're dead."

As a DEA informant, Toro (center, in the 1980s) gathered intelligence that helped take down such legendary figures as cartel kingpin Carlos Lehder (left) and Panamanian dictator Manuel Noriega (right). (Lehder and Noriega photos: AP; Toro photo courtesy of Carlos Toro)
Toro and his family fled back to Tamarac. One morning a few months later, the cartel apparently caught up with him. In a parking lot a few miles from his house, police discovered the body of a young woman, a small-time cocaine dealer Toro had known, in the trunk of a car. She had been stabbed more than 15 times, and her head had been cut off. Toro said he believes she was killed by a cartel hit man and dumped near his house to frame him.

Police arrested Toro for the murder, but with no real evidence to link him to the girl's death, the charges were dismissed. During his 12-hour interrogation, however, Toro let slip that he'd helped the Medellín cartel buy fuel for its planes. That gave the local district attorney a charge that could stick: conspiracy to traffic cocaine. If convicted, Toro would face a 15-year mandatory minimum prison sentence.

Convincing a jury of his innocence seemed like a long shot. Toro had in fact been a party to a massive criminal enterprise. It didn't help that the drug violence sweeping Florida had made many people suspicious of Colombians. An innocent Colombian stood little chance in front of a Florida jury at that time. A guilty one with a taped confession had even less.

Toro's lawyer brokered an alternative: Toro could become an informant for the DEA. If he provided substantial assistance to the agency within 90 days, he could plead no contest to the conspiracy charge and remain a free man, with his criminal record sealed.

If Toro didn't already have a price on his head, he knew that working for the feds would surely earn him one. But 15 years in prison would have meant losing his family, including his two young children. It also didn't hurt that the deal would allow him to exact revenge on his former cartel associates who had turned their backs on him.

Toro's first order of business was to begin identifying cartel assets -- account numbers, stash houses, residences, banks and other properties that had been used to facilitate their drug operation. His handler was Michael McManus, a young, ambitious DEA special agent cutting his teeth in the drug war then raging in Florida. Toro was productive, and when his three months of service were up, he could have walked away from the DEA for good. In hindsight, he should have. Instead, he made a decision that would define the rest of his life.

"Deep inside, I felt that the more I contributed to the DEA, the more the government would appreciate what I do, and I could re-establish my life as a private citizen," Toro said, taking a break from his patrolling of the hotel room to sit on the bed across from me. "I knew I screwed up, and I felt the need to atone and pay back, and to this day I feel that way."

Toro agreed to expand his role with the DEA and became drawn, almost obsessively, to the work. Going undercover provided many of the same things that had led him to join the cartel: an adrenaline rush, a lavish lifestyle, a feeling of importance.

"It's fun to be a drug dealer with a permit -- to be a drug dealer legally," Toro said. "I leave my humble apartment in Miami to go the next day and sleep at the presidential suite in Paris in a Hyatt, and I go and rent a car that costs me $800 a day to drive around Paris, and I have a watch that is a $5,000 Rolex."

Over the next few years, Toro contributed intelligence to investigations that would eventually lead to the arrests and extraditions of Lehder in 1987 and Triana in 1988, as well as a number of other cartel members and their allies in the U.S., the Caribbean and Latin America. As rumors of Toro's involvement in these cases trickled back to Colombia, he became a pariah in his country of birth, and his relatives received death threats. Toro, Mariana and their children spent almost two years in the Witness Protection Program, living in the U.S. under assumed identities, moving from city to city to prevent possible exposure. Tired of the constant upheaval, Toro and his family voluntarily left the program in 1988, against the advice of his supervisors.

When not pursuing cases, Toro took a number of civilian jobs to supplement his wife's income as a medical assistant. Over the years, he scanned mail for the U.S. Postal Service, sold appliances at Sears, handled credit and collections for Microsoft, worked as a repo man for Ford and translated for Immigration and Customs Enforcement.

The lure of his DEA gigs -- for which he was paid only minimally -- always superseded his other commitments, however, and his family suffered as a result. "Financial instability defined our lives," Toro's son, now 30, told The Huffington Post.
Mariana said that the DEA knew it had effective control over her husband and didn't hesitate to take advantage of it. "Carlos would find a job and he gets into the rhythm of having regular employment, and then the DEA would entice him with this thing that by his nature he likes," Mariana said. "In my mind he likes that adrenaline, that dual persona -- that persona that lies within him. He doesn't want to be the 9-to-5 and the boring life and the mundane -- he doesn't want that. A lot of times he took the jobs for that reason, because he got bored."

By 2006, the adrenaline rush was starting to wear off. Toro was 56 years old, and he'd spent the past two decades at the beck and call of the DEA. With an eye on retirement, he took a job in Costa Rica as a credit and collections manager with Hewlett Packard. He and Mariana traveled there together. He saw the two-and-a-half year contract as a chance to finally step away from DEA work and ease their money troubles.

Less than a year later, however, Toro flew to Chicago to attend a work conference. As he went through passport control at O'Hare International Airport, security stopped him and took him to a room for a secondary inspection. With the passage of the Patriot Act, any known member of a drug cartel was classified as a terrorist. Toro's criminal record had been unsealed, and he had been declared inadmissible -- never again permitted back into the country.

"The agent told me I had two choices," Toro recalled. "You leave the country today under your own will to the country of origin, to Costa Rica -- you pay for your ticket -- or we have to take you into custody and you'll go through deportation hearings and you'll be shipped to Colombia. I knew I couldn't go to Colombia, because I'd be dead."

Distraught, Toro returned to Costa Rica. When his contract with Hewlett Packard expired in 2009, he was given 30 days to vacate the country. Now he was a man without a home. Toro still couldn't believe he was being locked out of the U.S., a nation he'd lived in and served for so long.

The DEA finally offered him a lifeline, asking him to gather intelligence on a drug-trafficking scheme in South America. Toro dusted off his second identity as a drug trafficker and moved to a new base in Peru.

"I thought, 'If I go back to DEA, this will be solved. I'll be able to come back to the United States very soon,'" Toro said. "It sounded so simple that after working for a few months they would reverse the inadmissibility or that they would make an exception, because it didn't make sense that I wouldn't be admitted to a country that I worked for."

But relief came only when one of Toro's targets summoned him to an important meeting in the U.S., forcing the DEA to devise a solution. In 2010, Toro re-entered the country for the first time in nearly four years with an I-512 form that granted him legal status for a year, contingent upon his continued service to the federal government. (Toro provided a copy of his most recent I-512 forms to The Huffington Post.) He moved back in with his wife, where he could be close to his son and grandson.
Now, the DEA's control over Toro was complete. Every three months, the Department of Homeland Security would conduct an audit to make sure he was still active in an investigation, and the DEA would assess his productivity annually before sponsoring him for another year. If the agency determined he was no longer valuable, his immigration status would be revoked and he could be deported to Colombia.This type of exploitation is standard practice in the DEA and other law enforcement agencies, according to former agents and criminal justice experts. An informant's immigration status is particularly easy to take advantage of. "The leverage the immigration status gives the government is immense," said Loyola Law’s Natapoff, "so we have seen in recent years more stories coming to light of the government using that leverage in ways that really do hang informants out to dry."

Levine, the former undercover DEA agent, said it's extremely common for informants like Toro to feel that they've been abused by the process, sometimes rightly and sometimes wrongly. But he also suggested that Toro was foolish to assume any amount of hard work and dedication could earn him special treatment. "Once you get caught up in that world, you're on your own. The rule is that there are no rules," he said. "That's a dirty, wormy, rat-eat-rat world."

In March 2014, Toro finally had a wake-up call. Then 64, he was told by an oncologist in Miami that he needed immediate surgery to remove a baseball-sized tumor from his prostate -- a $5,000 procedure. Toro had no savings, no benefits and no health insurance. “I told the DEA, and they said, 'Sorry, we can't help you.' I was dying and they didn't care," Toro said. He claimed that a DEA contact even told him at one point to "stop whining."

Toro turned to McManus, the man who had first brought him to the DEA nearly 30 years earlier. Propelled in part by the successful cases he'd worked with Toro, McManus had moved up the ranks of the agency, eventually becoming chief of operations for Mexico and Central America before retiring in 2004. In one of the highlights of his career, he took down George Jung, the drug trafficker portrayed by Johnny Depp in the 2001 film "Blow." He is now a highly sought-after public speaker and an unofficial spokesman for the DEA.
When Toro reached out to him, McManus lent him the $5,000. McManus denied requests for comment.

Today, Toro lives with his wife in a small one-bedroom apartment. Mariana supports both of them on her modest salary as an administrator at a medical supply company. Without legal status, Toro can't get a job or health insurance. He has no pension and no way to contribute to the rent. When his driver's license expires later this year, he has no way to legally renew it.

"Many people got promoted because of what my husband did," Mariana said. "What did Carlos get out of it? What did my family get out of it?"

In 2010, the U.S. government gave Toro a "lifetime achievement" award and a check for $80,000 -- about $3,000 for each year of work. It was the only significant money he ever made as an informant. But what Toro really wants is a permanent resolution to his immigration problems and an end to his DEA servitude.

With the government's support, Toro could secure a visa or green card. That would allow him to eventually apply for Medicare and retire in the U.S. with the Social Security benefits he has earned over his years as a civilian employee.

In effect, he is asking the DEA to do the right thing. But while Toro claimed he's been treated well by some agents over the years, Natapoff said the overall relationship between the DEA and its informants is not based on fairness. "The whole world of informant use is built on fuzzy ethics, the toleration of hypocrisy, inequitable treatment and often coercion," she said. "So that is a tricky world to ask people to do the right thing."

Toro said the DEA recently warned him against going public with his story and claimed the agency would get him a visa, eventually. But the agency's process could take years, and he would still be required to work as an informant. At his age and with his health continuing to decline, he said he can't continue to wait indefinitely or jet around the globe chasing bad guys. He simply wants out of the devil's bargain he made with the DEA some three decades ago.
"I am not denying that I was at fault by working for the cartel," Toro said. “I feel not that I deserve a medal, not that I should be compensated with money ... but that I should be recognized only as a human being who has made a huge mistake, and that I made it up over and over and over."
Video editing by Christine Conetta.-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 19 hours ago.

Cambia Welcomes Chip Parkinson as President of OmedaRx

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Chip Parkinson as President of OmedaRx will focus on positioning Cambia's pharmacy operations for continuing strategic growth

Portland, Oregon (PRWEB) April 09, 2015

Cambia Health Solutions announced Chip Parkinson as President of OmedaRx. In this role, Chip will focus on positioning of Cambia’s pharmacy operations for continuing strategic growth. Chip’s role will directly contribute to Cambia’s mission to transform the consumer health care experience to one that is person-focused.

Chip brings more than 18 years of experience in leading and building strategic pharmacy and health care growth businesses. Most recently, Chip served as General Manager of the urology division of Myriad Genetics, a business unit dedicated to improving health outcomes for men with prostate cancer based upon personalized risk assessment. Chip grew the division from early stages to one that enjoys a leading market share in the prognostic and tailored treatment sector for urology patients. Previously, Chip spent more than 15 years with Pfizer Inc., including leadership roles over the southwest region and the state of Massachusetts.

“We are excited to welcome Chip to the OmedaRx team and Cambia family,” said Cambia Direct Health Solutions Division President Dudley Slater. “Chip brings a demonstrated track record of leading and driving business growth opportunities in a consumer-focused health care setting, in alignment with our own mission to transform the health care system to one that is sustainable and centered around the consumer.”

Chip will collaborate with teams across Cambia to position pharmacy operations and products competitively moving forward.

“I’m ready to lead OmedaRx to success in pharmacy operations with an emphasis on consumer’s needs, including cost and safety,” said Chip Parkinson. “I look forward to working with a strong and dynamic team that wants to make meaningful changes in health care to benefit others. That’s what I’ve worked to achieve in health care throughout my career.”

About Cambia
Cambia Health Solutions, headquartered in Portland, Oregon, is a nonprofit total health solutions company dedicated to transforming health care by creating a person-focused and economically sustainable system. Cambia’s growing family of companies range from software and mobile applications, health care marketplaces, non-traditional health care delivery models, health insurance, life insurance, pharmacy benefit management, wellness and overall consumer engagement. Through bold thinking and innovative technology, we are delivering solutions that make quality health care more available, affordable and personally relevant for everyone. To learn more, visit cambiahealth.com or twitter.com/cambia. Reported by PRWeb 19 hours ago.

SpendWell Announces Strategic Alignment with HealthCare Executive Group

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HCEG accelerates health care transformation by supporting consumer and retail movements with leading health care e-commerce solution provider

Portland, Oregon (PRWEB) April 09, 2015

SpendWell HealthTM, the leading health care e-commerce solution, has signed on to sponsor the HealthCare Executive Group (HCEG), a nationwide network of select executives and thought leaders. Previously the Managed Care Executive Group, the recently relaunched HCEG has expanded its charter to provide a comprehensive focus on the industry as a whole, allowing sponsor organizations like SpendWell the opportunity to collectively navigate the tactical and strategic issues facing the industry by providing a platform that promotes health care innovation and positive industry transformation.

SpendWell is a nationwide online marketplace that enables consumers who have health insurance with a deductible to shop for and purchase quality routine health care services while viewing their out-of-pocket cost share, consumer reviews and actual “buy now” prices from providers. Putting consumers directly in touch with a comprehensive catalog of routine health providers creates an actionable consumer shopping culture and an engaged community of health consumers (locally and nationally), sharing experiences and best practices needed for a trusted health care e-commerce experience. The Advisory Board Company recently estimated the market size for shoppable health procedures at $700 billion.

“We are excited to welcome SpendWell Health to the HCEG community,” notes Tom Carleton, HCEG Chairman of the Board. “Their e-commerce solution addresses 8 out of 10 critical industry issues identified by our members in our HCEG Top 10 List, a keystone for industry-wide analysis developed through an extensive collaborative process amongst HCEG members.”
HCEG’s Top 10 provides extensive insight into the industry, encouraging continuous and evolving dialogue on the main issues and concerns facing health care, while promoting industry-wide transformation. SpendWell’s unique marketplace, dedicated to transforming how people shop and pay for health care, aligns directly with HCEG’s drive toward innovation by combining e-commerce, consumerism and real-time services (e.g., eligibility and claims adjudication).

“We continually scan the industry for organizations committed to resolving systemic health care improvement barriers and promoting innovation through thought leadership,” said Marcee Chmait, President of SpendWell. “HCEG stood out due to their focus on health care consumerism initiatives and the interoperability needed to better activate and enable consumers, whose cost share continues to increase, to achieve better health status and health value.”

As high-deductible health plan adoption continues to grow, consumers bear more responsibility for their health care costs. Out-of-pocket expenses for insured patients are expected to grow to $420 billion in 2015, yet 66% of Americans are consistently surprised by their medical bills. SpendWell empowers shoppers with real-time price information with the ability to purchase health care services upfront.

Shopping with SpendWell is simple. Consumers search for health care providers and services, determine their out-of-pocket costs for services and pay online for selected services prior to their appointment. After the patient’s appointment, providers simply click to verify services and SpendWell releases the patient’s payment.

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About HealthCare Executive Group
The HealthCare Executive Group is a national network of select health care executives and thought leaders, who navigate the tactical and strategic issues facing organizations today and provide a platform that promotes health care innovation and the development of life-long relationships. Originally the Managed Care Executive Group (MCEG), the HealthCare Executive Group (HCEG) was founded in 1988 by health care executives looking for a forum where the open exchange of ideas, opportunities for collaboration and transformational dialogue could freely ensue. For more information about the HealthCare Executive Group, visit HCEG.org.

About SpendWell
SpendWellTM is an online marketplace where employees with high-deductible health plans can shop and buy health care services directly from providers. With clear pricing on everything from routine wellness exams and preventive care to screenings and urgent care, employees will be able to maximize the health care dollars they have to spend. And caring for direct-pay patients will give providers more time to focus on people, not paperwork. SpendWell is a wholly owned subsidiary of Cambia Health Solutions, Inc. Learn more at CambiaHealth.com. For more information about SpendWell, visit SpendWellHealth.com. Reported by PRWeb 19 hours ago.

Why the Private Health Insurance Industry Has to Go

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The private health insurance industry in the U.S. has had a long run since shifting to medical underwriting and a for-profit status in the early 1960s. It finds itself increasingly dependent on the government as the costs and prices of health care have continued upward since the 1980s. Its many perks from government include tax exemptions for employer-sponsored insurance (ESI), privatized Medicare and Medicaid programs, and longstanding over-payments to Medicare Advantage programs. The Affordable Care Act (ACA) has added to these perks since 2010 with subsidized premiums through the exchanges, a "risk corridor system" to protect insurers from losses, and allowing automatic self-renewal for 2015 plans. (1)

Incremental attempts to contain health care costs and reform the system since the 1990s have built upon our current multi-payer financing system. After five years' experience with the ACA, we now know that insurers themselves are a major barrier to achieving the kind of access to affordable care that our population so desperately needs.

Here are some of the major reasons why private health insurers warrant no further bailout by government and taxpayers.

*1. Continued discrimination against the sick.*

Despite the supposed consumer protections in the ACA, a 2014 letter from more than 300 patient advocacy groups to the Secretary of Health and Human Services described continuing ways that insurers still discriminate against the sick, including benefit designs that limit access, high cost-sharing, restrictive drug formularies, inadequate provider networks, and deceptive marketing practices. (2)

A recent study by Kaiser Family Foundation found that only one-third of households with incomes between 100 percent and 250 percent of poverty have enough liquid assets to pay their deductibles, while only about one-half can meet out-of-pocket limits. (3) As other examples, Wellpoint developed an algorithm to search its database for patients with breast cancer with an intent to cancel their policies (4), while many insurers place all drugs used to treat such complex diseases as cancer, multiple sclerosis and HIV in the highest drug formulary cost-sharing tiers, thereby reducing insurers' costs but making the drugs unaffordable for many patients. (5)

*2. Fragmentation, inefficiency, and exorbitant administrative overhead.*

There are some 1,300 private insurers still trying to maximize their income by avoiding the costs of sicker patients. Their administrative overhead is more than five times higher than that of the single-payer program in two Canadian provinces (6); the overhead of private Medicare Advantage plans averages 19 percent vs. the 1.5 percent for traditional Medicare. (7) Although the ACA set limits of 20 percent for overhead in the individual market and 15 percent in large-group markets, a recent study has found that those requirements had no effect on insurers' overhead spending over the first three years of the ACA. (8)

*3. Increasing costs for less coverage*

The ACA provided insurers with four levels of coverage -- the so-called "metals" -- with actuarial values (what insurers pay vs. what patients pay) ranging from 60 percent (bronze) 70 percent (silver) to 80 percent (gold) and 90 percent (platinum). Not content with those levels of coverage, the industry through its trade group, America's Health Insurance Programs (AHIP), has been lobbying hard for copper plans with only 50 percent actuarial value. (9)

Silver plans have been the most popular on the exchanges, so that patients are left with almost one-third of their costs, plus the cost-sharing that was required to get and maintain their policies. All this has led to an epidemic of underinsurance, whether the plans are purchased through the ACA exchanges or through the private insurance markets. The ACA has made the mistake of focusing on raising the numbers of Americans with "insurance", but has not been effective in containing prices or costs of health care, with the result that an increasing proportion of these costs are shifted to patients and families. One-half of bronze plans in seven large U.S. cities requireenrollees to pay the deductible (often $5,000) before covering a doctor's visit. (10)

*4. Gaming the ACA for profits more than service to patients*

There are many examples of this, starting with Medicare Advantage. Many insurers have been cited by the Centers for Medicare & Medicaid Services (CMS) for serious violations of Medicare's patient protection requirements, including inappropriate denial of coverage and failure to consider physicians' clinical information. (11) Humana, one of the largest Medicare Advantage insurers in the country, is facing scrutiny from the U.S. Department of Justice for its risk-adjustment practices, which "upcode" the severity of patients' illnesses in order to gain increased reimbursement, even as they lobby Congress for continued high over-payments. (12) Meanwhile, some insurers are marketing short-term plans that last less than 12 months, evading any of the ACA's requirements. (13)

*5. Private insurance has priced itself out of the market. *

Premiums keep going up at rates much higher than the cost of living, with little or no containment by regulators. As examples, MetroPlus, a popular new entrant on the New York exchange in 2014, has requested rate hikes of up to 28 percent in 2015 for some of its enrollees (14), while Florida Blue, the state's largest insurer, has announced an average rate increase of 17.8 percent for 2015. (15)

One can argue that the private insurance industry should be regarded as obsolete and not worth saving. However, the ACA has extended its life, including almost $2 trillion in federal subsidies over the next ten years (16) (if these subsidies survive a U.S. Supreme Court ruling on their legality in coming months). Insurers have focused on attracting enrollees with low premiums, high cost-sharing, and low levels of actual coverage. Large insurers such as Wellpoint (Anthem) and Humana expect to receive $5.5 billion in 2015 through the ACA's "risk corridor" provision that protects them from "losses." (17)

*6. As their business plan dictates, insurers are leaving unprofitable markets without regard for patients' needs. *

Private health insurers are all about making money, so they leave unprofitable markets regardless of the public's needs. A recent example is Blue Shield of California (which just lost its state tax-exempt status with a surplus of more than $4 billion), which withdrew from 250 zip codes in California throughout the state in 2014. (18, 19).

Based on the above, the time has come for us to replace private health insurers with a more efficient, not-for-profit single-payer financing system--national health insurance (NHI)--which could be enacted by passage of H. R. 676, Expanded and Improved Medicare for All.
_____
Read more at http://www.johngeymanmd.org.

*References: *
1. Geyman, JP. How Obamacare Is Unsustainable: Why We Need a Single Payer Solution for All Americans. Friday Harbor, WA, Copernicus Healthcare, 2015, p. 170.

2. Patient advocacy groups. Letter to Sylvia Burwell, Secretary of Health and Human Services, July 28, 2014.

3. Claxton, G, Rae, M, Panchal, N. Consumer assets and patient cost sharing. Kaiser Family Foundation, March 11, 2015.

4. Tillow, K. Health care law did not end discrimination against those with pre-existing conditions. Firedoglake, MyFDL, March 6, 2015.

5. Pearson, C. Exchange benefit designs increasingly place all medications for some conditions on specialty drug tier. Avalere, February 11, 2015.

6. Woolhandler, S, Campbell, T, Himmelstein, DU. Costs of health care administration in the United States and Canada. N Engl J Med 349: 768-775, 2003.

7. Healthcare-NOW! Single-Payer Activist Guide to the Affordable Care Act, 2013. p. 22. Available at www.healthcare-now.org

8. Day, B, Himmelstein, DU, Broder, M et al. The Affordable Care Act and medical loss ratios: No impact in first three years. Intl J Health Services 45 (1), 2015.

9. Andrews, M. Proposal to add skimpier "copper" plans to marketplace raises concerns. Kaiser Health News, July 1, 2014.

10. Appleby, J. Consumers beware: Not all health plans cover a doctor's visit before the deductible is met. Kaiser Health News, December 23, 2013.

11. Pear, R. U.S. finds many failures in Medicare health plans. New York Times, October 12, 2014.

12. Herman, B. CMS pitches 1.1 % boost to Medicare Advantage payments. Modern Healthcare, February 20, 2015.

13. Andrews, M. Short-term plans can skirt health law requirements. Kaiser Health News, October 28, 2013.

14. Hartocollis, A. Insurers on New York State's exchange seek significant rate increases. New York Times, July 2, 2014.

15. Galewitz, P. Florida's largest insurer is raising exchange rates average of 17.6 percent. Kaiser Health News, August 1, 2014.

16. Pear, R. Health law turns Obama and insurers into allies. New York Times, November 17, 2014.

17. Wayne, A. Insurers' Obamacare losses may reach $5.5 billion in 2015. Bloomberg News Businessweek, March 4, 2014.

18. Terhune, C. With billions in the bank, Blue Shield of California loses its tax-exempt status. Los Angeles Times, March 18, 2015.

19. Bartolone, P., Capital Public Radio. Insurance choices dwindle in rural California as Blue Shield pulls back. Kaiser Health News, January 30, 2015.

Adapted in part from my recently released book, How Obamacare Is Unsustainable: Why We Need a Single Payer Solution for All Americans.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 17 hours ago.

UNITE HERE Local 5 Expands Campaign with Case Studies of Municipalities That Transitioned to Self-Funded Health Insurance

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HONOLULU--(BUSINESS WIRE)--UNITE HERE Local 5 expands campaign with new examples of municipal employers that used self-funded health insurance to successfully manage costs; shares own experience with Kaiser Permanente. Reported by Business Wire 17 hours ago.

Elder care costs keep climbing; nursing home bill now $91K

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The annual "Cost of Care" report from Genworth Financial tracks the staggering rise in expenses for long-term care, a growing financial burden for families, governments and insurers like Genworth. The annual report from Genworth, which sells policies to cover long-term care, looks at costs for a variety of services, including adult daycare, and home health aides. [...] who pays the nursing-home bill? "A lot of people believe Medicare will step in and cover them, but that's just not true," said Bruce Chernoff, president and CEO of The Scan Foundation, a charitable organization. Often enough, people wind up spending their savings until the last $2,000, and at that point Medicaid, the government's health insurance for the poor, starts covering the bill. Reported by SeattlePI.com 17 hours ago.

Elder Care Costs Keep Rising; Nursing Home Bill Now $91,000

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Elder Care Costs Keep Rising; Nursing Home Bill Now $91,000 Filed under: Family Money, Personal Finance, Elder Care, Long Term Care Insurance, Retirement Living

*Dan Marschka/Intelligencer Journal via AP*

By MATTHEW CRAFT

NEW YORK -- The steep cost of caring for the elderly continues to climb. The median bill for a private room in a nursing home is now $91,250 a year, according to an industry survey out Thursday.

The annual "Cost of Care" report from Genworth Financial (GNW) tracks the staggering rise in expenses for long-term care, a growing financial burden for families, governments and insurers including Genworth. The cost of staying in a nursing home has increased 4 percent every year over the last five years, the report says. Last year, the median bill was $87,600.
Most people don't realize how expensive this care can be until a parent or family member needs it.

"Most people don't realize how expensive this care can be until a parent or family member needs it," said Joe Caldwell, director of long-term services at the National Council on Aging. "And then it's a real shock."

The annual report from Genworth, which sells policies to cover long-term care, looks at costs for a variety of services, including adult daycare, and home health aides. And it's nursing home bills that are rising at the fastest pace, double the rate of U.S. inflation over the last five years. One year in a nursing home now costs nearly as much as three years of tuition at a private college.

For its report, Genworth surveyed 15,000 nursing homes, assisted living facilities and other providers across the country in January and February. It found wide differences from state to state. In Oklahoma, for instance, the median cost for a year in a nursing home came out to $60,225. In Connecticut, it was $158,775. Alaska had the highest costs by far, with one year at $281,415.

So, who pays the nursing-home bill? "A lot of people believe Medicare will step in and cover them, but that's just not true," said Bruce Chernoff, president and CEO of The Scan Foundation, a charitable organization. Medicare will cover some short visits for recovery after a surgery, for instance, not long-term stays.

Often enough, people wind up spending their savings until the last $2,000, and at that point Medicaid, the government's health insurance for the poor, starts covering the bill.

Less-intensive care remains much cheaper than staying at a nursing home, according to Genworth's survey. One year in in an assisted-living facility runs $43,200. A year of visits from an agency's home health aides runs $45,760.

 

Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 17 hours ago.

CDC: Access to Healthcare Unchanged After ACA's First Year

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The Centers for Disease Control and Prevention (CDC) recently released early estimates of health insurance and access to healthcare from January through September 2014 that suggest Obamacare's impact on overall access to health-care coverage has been negligible. Reported by Newsmax 11 hours ago.

Poll: Did you get health insurance through Obamacare?

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Did you get health insurance through Obamacare?

 
 
 
 
 
 
 
  Reported by Delawareonline 8 hours ago.
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