Kaiser Permanente Claims Sample: Fill & Download for Free

Consult with people who are covered by both plans. Claims experience is important. Examine sample policies with similar costs. You are talking about two of the major CA insurers. They may be about the same.Think about the differences that matter to you. Beware of cheap high deductible policies. $4000-$5000 usually is a meaningful amount of pocket money.

*** Morgellons = Pseudomedical diagnosis, Risks = Nocebo ***This article is part of a series on Alternative and pseudo‑medicine(General information= Fringe medicine and science)Quora required LINK: Morgellons - Wikipedia .“””” Morgellons (/mɔːrˈɡɛlənz/) is the informal name of a self-diagnosed, scientificallyunsubstantiated skin condition. Individuals claiming to have Morgellons typically exhibit sores, which they believe “contain” some sort of fibrous material.Morgellons is poorly characterized, but the general medical consensus is that it is a form of delusional parasitosis.The sores are typically the result of compulsive scratching, and the fibers, when analysed, were consistently found to have originated from clothings and other textiles.Mary Leitao, a mother who rejected the medical diagnosis of her son's delusional parasitosis, named the supposed disease in 2002. She revived it from a letter written by a physician in the mid-17th century.Leitao and others involved in her Morgellons Research Foundation successfully lobbied members of the U.S. Congress and the U.S. Centers for Disease Control and Prevention (CDC) to investigate the condition in 2006.CDC researchers issued the results of their multi-year study in January 2012, indicating that no disease organisms were present in people with so-called "Morgellons", that the fibers were likely cotton, and concluded that the condition was "similar to more commonly recognized conditions such as delusional infestation".Medical description ~ Morgellons is poorly understood but the general medical consensus is that it is a form of delusional parasitosis in which individuals have some form of actual skin condition that they believe contains some kind of fibers.Society and cultureMary Leitao and the MRF In 2001, according to Leitao, her then two-year-old son developed sores under his lip and began to complain of "bugs".Leitao says she examined the sores with her son's toy microscope and discovered red, blue, black, and white fibers.She states that she took her son to see at least eight different doctors who were unable to find any disease, allergy, or anything unusual about her son's described symptoms. Fred Heldrich, a Johns Hopkins pediatrician with a reputation "for solving mystery cases", examined Leitao's son.Heldrich found nothing abnormal about the boy's skin, wrote to the referring physician that "Leitao would benefit from a psychiatric evaluation and support", and registered his worry about Leitao's "use" of her son.Leitao last consulted an unnamed Johns Hopkins infectious disease specialist who, after reviewing her son's records refused to see him, suggesting Leitao herself might have "Munchausen's by proxy, a psychiatric syndrome in which a parent pretends a child is sick or makes him sick to get attention from the medical system".According to Leitao, several medical professionals she sought out shared this opinion of a potential psychological disorder:[Leitao] said she long ago grew accustomed to being doubted by doctors whenever she sought help for her son, who is now 7 and still suffering from recurring lesions. "They suggested that maybe I was neurotic," Leitao said. "They said they were not interested in seeing him because I had Munchausen Syndrome by Proxy".Leitao says that her son developed more sores, and more fibers continued to poke out of them. She and her husband, Edward Leitao, an internist with South Allegheny Internal Medicine in Pennsylvania, felt their son had "something unknown".She chose the name Morgellons disease (with a hard g) from a description of an illness in the medical case-history essay,A Letter to a Friend (c. 1656, pub. 1690) by Sir Thomas Browne, where the physician describes several medical conditions in his experience, including "that endemial distemper of children in Languedoc, called the morgellons, wherein they critically break out with harsh hairs on their backs".There is no suggestion that the symptoms described by Browne are linked to the alleged modern cases.Leitao started the Morgellons Research Foundation (MRF) informally in 2002 and as an official non-profit in 2004.The MRF states on its website that its purpose is to raise awareness and funding for research into the proposed condition, described by the organization as a "poorly understood illness, which can be disfiguring and disabling".Leitao stated that she initially hoped to receive information from scientists or physicians who might understand the problem, but instead, thousands of others contacted her describing their sores and fibers, as well as neurological symptoms, fatigue, muscle and joint pain, and other symptoms.The MRF claimed to have received self-identified reports of Morgellons from all 50 US states and 15 other countries, including Canada, the UK, Australia, and the Netherlands, and states that it has been contacted by over 12,000 families.In 2012 the Morgellons Research Foundation closed down and directed future inquiries to Oklahoma State University.Media coverage ~ In May 2006, a CBS news segment on Morgellons aired in Southern California.The same day, the Los Angeles County Department of Health services issued a statement saying, "No credible medical or public health association has verified the existence or diagnosis of 'Morgellons Disease'", and "at this time there is no reason for individuals to panic over unsubstantiated reports of this disease".In June and July 2006 there were segments on CNN, ABC's Good Morning America,and NBC's The Today Show. In August 2006, a segment of the ABC show Medical Mysteries was devoted to the subject.Morgellons was featured on ABC's Nightline on January 16, 2008, and as the cover story of the January 20, 2008, issue of the Washington Post.The first article to propose Morgellons as a new disease in a scientific journal was a review article co-authored by members of the MRF and published in 2006 by the American Journal of Clinical Dermatology.A 2006 article in the San Francisco Chronicle reported, "There have been no clinical studies" of Morgellons disease.A New Scientist article in 2007 also covered the phenomenon, noting that people are reporting similar symptoms in Europe and Australia.In an article published in the Los Angeles Times on April 22, 2010, singer-songwriter Joni Mitchell claimed to have the condition.On June 13, 2011, the Australian Broadcasting Corporation's Radio National broadcast The Mystery of Morgellons with guests including Mayo Clinic Professor Mark Davis.CDC investigation ~ Following a mailing campaign coordinated by the Morgellons Research Foundation, in which self-described sufferers clicked on the foundation website and sent thousands of form letters to members of Congress, a Centers for Disease Control and Prevention (CDC) task force first met in June 2006.By August 2006, the task force consisted of 12 people, including two pathologists, a toxicologist, an ethicist, a mental health expert, and specialists in infectious, parasitic, environmental and chronic diseases.In June 2007, the CDC opened a website relating to Morgellons, CDC Study of an Unexplained Dermopathy, and by November 2007, the CDC opened an investigation into the condition.Kaiser Permanente, a health-care consortium in Northern California, was chosen to assist with the investigation, which involved skin biopsies from affected people and characterization of foreign material such as fibers or threads obtained from people to determine their potential source.The U.S. Armed Forces Institute of Pathology and the American Academy of Dermatology assisted with pathology.In January 2012, the CDC released the results of the study.Their conclusions were that 59% of subjects showed cognitive deficits and 63% had evidence of clinically significant symptoms. 50% had drugs in their systems, and 78% reported exposure to solvents (potential skin irritants). No parasites or mycobacteria were detected in the samples collected from any patients. Most materials collected from participants' skin were composed of cellulose, likely of cotton origin.Internet and media influence ~ People usually self-diagnose Morgellons based on information from the Internet and find support and confirmation in online communities of people with similar illness beliefs.In 2006, Waddell and Burke reported the influence of the Internet on people self-diagnosed of Morgellons: "physicians are becoming more and more challenged by the many persons who attempt self-diagnosis on-line. In many cases, these attempts are well-intentioned, yet wrong, and a person's belief in some of these oftentimes unscientific sites online may preclude their trust in the evidence-based approaches and treatment recommendations of their physician."Dermatologist Caroline Koblenzer specifically faults the Morgellons Research Foundation (MRF) website for misleading people: "Clearly, as more and more of our patients discover this site (MRF), there will be an ever greater waste of valuable time and resources on fruitless research into fibers, fluffs, irrelevant bacteria, and innocuous worms and insects."Vila-Rodriguez states that the Internet promotes the spreading and supporting of "bizarre" disease beliefs, because "a belief is not considered delusional if it is accepted by other members of an individual’s culture or subculture".The Los Angeles Times, in an article on Morgellons, notes that "[t]he recent upsurge in symptoms can be traced directly to the Internet, following the naming of the disease by Mary Leitao, a Pennsylvania mother".Robert Bartholomew, a sociologist who has studied the Morgellons phenomenon, states that the "World Wide Web has become the incubator for mass delusion and it (Morgellons) seems to be a socially transmitted disease over the Internet."According to this hypothesis, people with delusions of parasitosis and other psychological disorders become convinced they have "Morgellons" after reading Internet accounts of others with similar symptoms.This is known as mass psychogenic illness, where physical symptoms without an organic cause spread to multiple people within the same community or social group.A 2005 Popular Mechanics article stated that Morgellons symptoms are well-known and characterized in the context of other disorders, and that "widespread reports of the strange fibers date back" only a few years to when the MRF first described them on the Internet.The Dallas Observer writes that Morgellons may be memetically spread via the Internet and mass media, and "if this is the case, then Morgellons is one in a long line of weird diseases that have swept through populations, only to disappear without a trace once public concern subsides".The article draws parallels to several media-spread mass delusions.In 2008, The Washington Post reported that Internet discussions about Morgellons include many conspiracy theories about the cause, including biological warfare, nanotechnology, chemtrails and extraterrestrial life.The Atlantic says it "even received pop-culture attention" when it was featured on Criminal Minds, adding that some people have linked Morgellons "to another illness viewed skeptically by most doctors, chronic Lyme disease"”””, Morgellons -Wikipedia .

There’s a huge need for big data in healthcare due to rising costs in nations like the United States. The advantages of adopting and applying such in the healthcare has been to potentially said to reduce US healthcare expenditure.Below are some areas where big data is being applied in the healthcare:1) Patients Predictions For An Improved StaffingFor our first example of big data in healthcare, we will look at one classic problem that any shift manager faces: how many people do I put on staff at any given time period? If you put on too many workers, you run the risk of having unnecessary labor costs add up. Too few workers, you can have poor customer service outcomes – which can be fatal for patients in that industry.Big data is helping to solve this problem, at least at a few hospitals in Paris. A Forbes article details how four hospitals which are part of the Assistance Publique-Hôpitaux de Paris have been using data from a variety of sources to come up with daily and hourly predictions of how many patients are expected to be at each hospital.One of they key data sets is 10 years’ worth of hospital admissions records, which data scientists crunched using “time series analysis” techniques. These analyses allowed the researchers to see relevant patterns in admission rates. Then, they could use machine learning to find the most accurate algorithms that predicted future admissions trends.Summing up the product of all this work, Forbes states: “The result is a web browser-based interface designed to be used by doctors, nurses and hospital administration staff – untrained in data science – to forecast visit and admission rates for the next 15 days. Extra staff can be drafted in when high numbers of visitors are expected, leading to reduced waiting times for patients and better quality of care.”2) Electronic Health Records (EHRs)It’s the most widespread application of big data in medicine. Every patient has his own digital record which includes demographics, medical history, allergies, laboratory test results etc. Records are shared via secure information systems and are available for providers from both public and private sector. Every record is comprised of one modifiable file, which means that doctors can implement changes over time with no paperwork and no danger of data replication.EHRs can also trigger warnings and reminders when a patient should get a new lab test or track prescriptions to see if a patient has been following doctors’ orders.Although EHR are a great idea, many countries still struggle to fully implement them. U.S. has made a major leap with 94% of hospitals adopting EHRs according to this HITECH research, but the EU still lags behind. However, an ambitious directive drafted by European Commission is supposed to change it: by 2020 centralized European health record system should become a reality.Kaiser Permanente is leading the way in the U.S., and could provide a model for the EU to follow. They’ve fully implemented a system called HealthConnect that shares data across all of their facilities and makes it easier to use EHRs. A McKinsey report on big data healthcare states that “The integrated system has improved outcomes in cardiovascular disease and achieved an estimated $1 billion in savings from reduced office visits and lab tests.”3) Real-Time AlertingOther examples of big data analytics in healthcare share one crucial functionality – real-time alerting. In hospitals, Clinical Decision Support (CDS) software analyzes medical data on the spot, providing health practitioners with advice as they make prescriptive decisions.However, doctors want patients to stay away from hospitals to avoid costly in-house treatments. Personal analytics devices, already trending as business intelligence buzzwords in 2016, have the potential to become part of a new strategy. Wearables will collect patients’ health data continuously and send this data to the cloud.Additionally, this information will be accessed to the database on the state of health of the general public, which will allow doctors to compare this data in socioeconomic context and modify the delivery strategies accordingly. Institutions and care managers will use sophisticated tools to monitor this massive data stream and react every time the results will be disturbing.For example, if a patient’s blood pressure increases alarmingly, the system will send an alert in real time to the doctor who will then take action to reach the patient and administer measures to lower the pressure.Another example is that of Asthmapolis, which has started to use inhalers with GPS-enabled trackers in order to identify asthma trends both on an individual level and looking at larger populations. This data is being used in conjunction with data from the CDC in order to develop better treatment plans for asthmatics.4) Enhancing Patient EngagementMany consumers – and hence, potential patients – already have an interest in smart devices that record every step they take, their heart rates, sleeping habits, etc., on a permanent basis. All this vital information can be coupled with other trackable data to identify potential health risks lurking. A chronic insomnia and an elevated heart rate can signal a risk for future heart disease for instance. Patients are directly involved in the monitoring of their own health, and incentives from health insurances can push them to lead a healthy lifestyle (e.g.: giving money back to people using smart watches).Another way to do so comes with new wearables under development, tracking specific health trends and relaying them to the cloud where physicians can monitor them. Patients suffering from asthma or blood pressure could benefit from it, and become a bit more independent and reduce unnecessary visits to the doctor.5) Prevent Opioid Abuse In The USOur fourth example of big data healthcare is tackling a serious problem in the US. Here’s a sobering fact: as of this year, overdoses from misused opioids have caused more accidental deaths in the U.S. than road accidents, which were previously the most common cause of accidental death.Analytics expert Bernard Marr writes about the problem in a Forbes article. The situation has gotten so dire that Canada has declared opioid abuse to be a “national health crisis,” and President Obama earmarked $1.1 billion dollars for developing solutions to the issue while he was in office.Once again, an application of big data analytics in healthcare might be the answer everyone is looking for: data scientists at Blue Cross Blue Shield have started working with analytics experts at Fuzzy Logix to tackle the problem. Using years of insurance and pharmacy data, Fuzzy Logix analysts have been able to identify 742 risk factors that predict with a high degree of accuracy whether someone is at risk for abusing opioids.As Blue Cross Blue Shield data scientist Brandon Cosley states in the Forbes piece: “It’s not like one thing – ‘he went to the doctor too much’ – is predictive … it’s like ‘well you hit a threshold of going to the doctor and you have certain types of conditions and you go to more than one doctor and live in a certain zip code…’ Those things add up.”To be fair, reaching out to people identified as “high risk” and preventing them from developing a drug issue is a delicate undertaking. However, this project still offers a lot of hope towards mitigating an issue which is destroying the lives of many people and costing the system a lot of money.6) Using Health Data For Informed Strategic PlanningThe use of big data in healthcare allows for strategic planning thanks to better insights into people’s motivations. Care mangers can analyze check-up results among people in different demographic groups and identify what factors discourage people from taking up treatment.University of Florida made use of Google Maps and free public health data to prepare heat maps targeted at multiple issues, such as population growth and chronic diseases. Subsequently, academics compared this data with the availability of medical services in most heated areas. The insights gleaned from this allowed them to review their delivery strategy and add more care units to most problematic areas.7) Big Data Might Just Cure CancerAnother interesting example of the use of big data in healthcare is the Cancer Moonshot program. Before the end of his second term, President Obama came up with this program that had the goal of accomplishing 10 years’ worth of progress towards curing cancer in half that time.Medical researchers can use large amounts of data on treatment plans and recovery rates of cancer patients in order to find trends and treatments that have the highest rates of success in the real world. For example, researchers can examine tumor samples in biobanks that are linked up with patient treatment records. Using this data, researchers can see things like how certain mutations and cancer proteins interact with different treatments and find trends that will lead to better patient outcomes.This data can also lead to unexpected benefits, such as finding that Desipramine, which is an anti-depressant, has the ability to help cure certain types of lung cancer.However, in order to make these kinds of insights more available, patient databases from different institutions such as hospitals, universities, and nonprofits need to be linked up. Then, for example, researchers could access patient biopsy reports from other institutions. Another potential use case would be genetically sequencing cancer tissue samples from clinical trial patients and making these data available to the wider cancer database.But, there are a lot of obstacles in the way, including:Incompatible data systems. This is perhaps the biggest technical challenge, as making these data sets able to interface with each other is quite a feat.Patient confidentiality issues. There are differing laws state by state which govern what patient information can be released with or without consent, and all of these would have to be navigated.Simply put, institutions which have put a lot of time and money into developing their own cancer dataset may not be eager to share with others, even though it could lead to a cure much more quickly.However, as an article by Fast Company states, there are precedents to navigating these types of problems: “…the U.S. National Institutes of Health (NIH) has hooked up with a half-dozen hospitals and universities to form the Undiagnosed Disease Network, which pools data on super-rare conditions (like those with just a half-dozen sufferers), for which every patient record is a treasure to researchers.”Hopefully, Obama’s panel will be able to navigate the many roadblocks in the way and accelerate progress towards curing cancer using the strength of data analytics.Exclusive Bonus Content: Boost your healthcare business with Big Data Get our guide with 5 questions you can use to increase profits!8) Predictive Analytics In HealthcareWe have already recognized predictive analytics as one of the biggest business intelligence trend two years in a row, but the potential applications reach far beyond business and much further in the future. Optum Labs, an US research collaborative, has collected EHRs of over 30 million patients to create a database for predictive analytics tools that will improve the delivery of care.The goal of healthcare business intelligence is to help doctors make data-driven decisions within seconds and improve patients’ treatment. This is particularly useful in case of patients with complex medical histories, suffering from multiple conditions. New tools would also be able to predict, for example, who is at risk of diabetes, and thereby be advised to make use of additional screenings or weight management.9) Reduce Fraud And Enhance SecuritySome studies have shown that this particular industry is 200% more likely to experience data breaches than any other industry. The reason is simple: personal data is extremely valuable and profitable on the black markets. And any breach would have dramatic consequences. With that in mind, many organizations started to use analytics to help prevent security threats by identifying changes in network traffic, or any other behavior that reflects a cyber-attack. Of course, big data has inherent security issues and many think that using it will make the organizations more vulnerable than they already are. But advances in security such as encryption technology, firewalls, anti-virus software, etc, answer that need for more security, and the benefits brought largely overtake the risks.Likewise, it can help prevent fraud and inaccurate claims in a systemic, repeatable way. Analytics help streamline the processing of insurance claims, enabling patients to get better returns on their claims and caregivers are paid faster. For instance, the Centers for Medicare and Medicaid Services said they saved over $210.7 million in frauds in just a year.10) TelemedicineTelemedicine has been present on the market for over 40 years, but only today, with the arrival of online video conferences, smartphones, wireless devices, and wearables, has it been able to come into full bloom. The term refers to delivery of remote clinical services using technology.It is used for primary consultations and initial diagnosis, remote patient monitoring, and medical education for health professionals. Some more specific uses include telesurgery – doctors can perform operations with the use of robots and high-speed real-time data delivery without physically being in the same location with a patient.Clinicians use telemedicine to provide personalized treatment plans and prevent hospitalization or re-admission. Such use of healthcare data analytics can be linked to the use of predictive analytics as seen previously. It allows clinicians to predict acute medical events in advance and prevent deterioration of patient’s conditions.By keeping patients away from hospitals, telemedicine helps to reduce costs and improve the quality of service. Patients can avoid waiting lines and doctors don’t waste time for unnecessary consultations and paperwork. Telemedicine also improves the availability of care as patients’ state can be monitored and consulted anywhere and anytime.11) Integrating Big Data With Medical ImagingMedical imaging is vital and each year in the US about 600 million imaging procedures are performed. Analyzing and storing manually these images is expensive both in terms of time and money, as radiologists need to examine each image individually, while hospitals need to store them for several years.Medical imaging provider Carestream explains how big data analytics for healthcare could change the way images are read: algorithms developed analyzing hundreds of thousands of images could identify specific patterns in the pixels and convert it into a number to help the physician with the diagnosis. They even go further, saying that it could be possible that radiologists will no longer need to look at the images, but instead analyze the outcomes of the algorithms that will inevitably study and remember more images than they could in a lifetime. This would undoubtedly impact the role of radiologists, their education and required skillset.12) A Way To Prevent Unnecessary ER VisitsSaving time, money and energy using big data analytics for healthcare is necessary. What if we told you that over the course of 3 years, one woman visited the ER more than 900 times? That situation is a reality in Oakland, California, where a woman who suffers from mental illness and substance abuse went to a variety of local hospitals on an almost daily basis.This woman’s issues were exacerbated by the lack of shared medical records between local emergency rooms, increasing the cost to taxpayers and hospitals, and making it harder for this woman to get good care. As Tracy Schrider, who coordinates the care management program at Alta Bates Summit Medical Center in Oakland stated in a Kaiser Health News article:“Everybody meant well. But she was being referred to three different substance abuse clinics and two different mental health clinics, and she had two case management workers both working on housing. It was not only bad for the patient, it was also a waste of precious resources for both hospitals.”In order to prevent future situations like this from happening, Alameda county hospitals came together to create a program called PreManage ED, which shares patient records between emergency departments.This system lets ER staff know things like:If the patient they are treating has already had certain tests done at other hospitals, and what the results of those tests areIf the patient in question already has a case manager at another hospital, preventing unnecessary assignmentsWhat advice has already been given to the patient, so that a coherent message to the patient can be maintained by providersThis is another great example where the application of healthcare analytics is useful and needed. In the past, hospitals without PreManage ED would repeat tests over and over, and even if they could see that a test had been done at another hospital, they would have to go old school and request or send a long fax just to get the information they needed.How To Use Big Data In HealthcareAll in all, we’ve seen through these 12 examples of big data application in healthcare three main trends: the patients experience could improve dramatically, including quality of treatment and satisfaction; the overall health of the population should also be improved over time; and the general costs should be reduced. Let’s have a look now at a concrete example of how to use data analytics in healthcare, in a hospital for instance:**click to enlarge**This healthcare dashboard provides you with the overview needed as a hospital director or as a facility manager. Gathering in one central point all the data on every division of the hospital, the attendance, its nature, the costs incurred, etc., you have the big picture of your facility, which will be of a great help to run it smoothly.You can see here the most important metrics concerning various aspects: the number of patients that were welcomed in your facility, how long they stayed and where, how much it cost to treat them, and the average waiting time in emergency rooms. Such a holistic view helps top-management identify potential bottlenecks, spot trends and patterns over time, and in general assess the situation. This is key in order to make better-informed decisions that will improve the overall operations performance, with the goal of treating patients better and having the right staffing resources.Our List of 12 Big Data Examples In HealthcareThe industry is changing, and like any other, big data is starting to transform it – but there is still a lot of work to be done. The sector slowly adopts the new technologies that will push it into the future, helping it to make better-informed decisions, improving operations, etc. In a nutshell, here’s a short list of the examples we have gone over in this article. With healthcare data analytics, you can:Predict the daily patients income to tailor staffing accordinglyUse Electronic Health Records (EHRs)Use real-time alerting for instant careHelp in preventing opioid abuse in the USEnhance patient engagement in their own healthUse health data for a better-informed strategic planningResearch more extensively to cure cancerUse predictive analyticsReduce fraud and enhance data securityPractice telemedicineIntegrate medical imaging for an broader diagnosisPrevent unnecessary ER visitsExclusive Bonus Content: Boost your healthcare business with Big Data Get our guide with 5 questions you can use to increase profits!These 12 examples of big data in healthcare prove that the development of medical applications of data should be the apple in the eye of data science, as they have the potential to save money and most importantly, people’s lives. Already today it allows for early identification of illnesses of individual patients and socioeconomic groups and taking preventive actions because, as we all know, prevention is better than cure.12 Examples of Big Data In Healthcare That Can Save PeopleAn Introduction to Diagnosing Diseases with Patient Data