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?

http://www.nytimes.com/2011/10/06/us/stanford-hospital-patient-data-breach-is-detailed.html?ref=health

A medical data breach at stanford hospital: 20K emegency room patients, and 3+ other such incidents are discussed.

-> 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)? Yes -> Can you be a member of HPN and have gov't sponsored insurance eg Medicare, Medi-Cal? Yes for Medicare. I can follow up on Medi-Cal if you like?

Thank you Anthony! In regards to the Medi-Cal question, I think I'm all set, knowing there is infact a set of members who are operating under the particular incentives/constraints associated with gov't provided insurance.

There are two related issues, to which I think there is still a general confusion about on this forum:

1. PayDelay - what payment is being measured here?

patient ->  vendor ? patient's insurance -> vendor ? HPN headquarters -> vendor ? something else?

2. Here, Igor and others came to the conclusion that HPN was an HMO and IDN untill 2005, after which it continued only as an IDN. http://www.heritagehealthprize.com/c/hhp/forums/t/381/daysinhospital-outside-of-hpn-heritage-network-idn-leakage-issues Is this correct?

Is there some kind of financial intermediary in this "Delivery Netwok"? eg a centralized finance dept at HPN headquarters that then pays indv hospitals/pcp's that belong to this network.

I realize these are not easy questions and appreciate any guidance you could provide.

Have passed these questions onto HPN. Will respond as soon as I get an answer.