Not too familiar with the practices in healthcare of but a couple or articles have caught my eye, now that I've started this competition:
http://www.businessweek.com/ap/financialnews/D9NAR60G1.htm: Califronia has succesfully sued Quest Diagnostics for $200M+ for a scheme where doctors received kickbacks for recommending patients to Quest clinics. Especially important seemed to be de-frauding of patients using Medi-Cal.
http://www.boston.com/Boston/whitecoatnotes/2011/09/state-penalize-hospitals-that-readmit-too-many-patients/orkMrIXGmideu0PkL3CgHL/index.html Massachusetts Medicare plans to dock "the pay of hospitals that readmit high numbers of patients within 30 days of discharge" A follow up letter to the editor argued, this will encourage hospitals to keep patients longer the first time around.
From my very limited knowledge though, it seems these are the type of issues that HPN was built to avoid, and also the type of issues we're getting offered a reward to try to solve. I'm curious if anyone understands:
-> Does being a member of HPN mean you usually referred to an in-network provider of say lab testing (unless obviosuly it is some specialty unavailable)?
-> Can you be a member of HPN and have gov't sponsored insurance eg Medicare, Medi-Cal? Here's the datamining part: if so, can we somehow identify this trait ( I'm thinking some standard PayDelay from such a giant admin system) and is this trait predictive of DIH, LOS, etc?