The Secret Life of a QUANT

Whatsa  "Quant" ?

It sounds like a new previously undiscovered subatomic particle somewhere between a quark, a string, a lepton,a boson,a prion,mesons and baryons.

Well, a quant is none of that. While those fundamental particles are essential to matter and energy and some are theoretical, the "Quant" is a far more threatening player in health care and the financial world. On one hand quants offer great hope for some, and for others they are a barrier to obtaining health care.


Quants are the math wizards and computer programmers in the engine room of our global financial system who designed the financial products that almost crashed Wall st.

The Quants arrived quietly some time ago in  health care. The similarities between the crash of the global financial system and current health care systems is frightening.

Quants are sometimes known as "Algos".

Barbara Duck, who writes at The Medical Quack:

     Attack of the Killer Algorithms – “Algo Duping 101″

     In health care this is well underway with the Affordable Care Act,
     Accountable Care Organizations, Outcome Studies, Preferred Practice Pattern;  all have been developed by "Quants".

Here’s a selection of videos that offer a lot of information, which I call “Algo Duping”. Barbara Duck has written several posts on the Medical Quack about this topic and here’s a group of MUST SEE videos if you want to understand what is happening in the world. The general public does not like math, is afraid of it, etc. but banks and corporations are not and they use it against us.

First off let’s hear from Charlie Siefe, Who Wrote the Book, “Proofiness, The Dark Arts of Mathematical Deception.


 Physicians, too are afraid of the math, although trained in scientific methodology. One cannot defend against something one does not know about. For most, statistical probability and algorithms fall into that category.

Health insurers have been big on algos, that is how they separated the sick,(read expensive) and infirm from the healthy (read inexpensive) beneficiaries.

How will they work around the Affordable Care Act ?  When there is challenge their is opportunity (to make a profit). The  Affordable Care Act's initial thrust is to eliminate pre-existing conditions as a reason for non insurability.  This flies in the face of previous algo's.

The first law of algo's is: "If the first algo fails, another algo will appear"

The second algo will disavow the original algo as "obsolete and not suited to the changes in health finance".

Jobs in quants are fluorishing in health care with enterprises attempting to game the system.

There is a continuing tension between quants and quals (those who emphasize quality, regardless of cost ).

As in the financial world risk is a key metric for a health algorithm. Population health is a field in which quants are essential.



Is this occurring in health reform? This is a documentary called “Quants, the Alchemists of Wall Street” and they make the math and formulas that move money. Banks and companies use these all the time and the one interview tells you that yes they are smart and talks about their attitudes as they literally have the CEOs by the balls, as they don’t understand their own business models that they pay royally for the Quants to write. In this video you see the software designer who created the software for the big mortgage scam. It’s not his fault but rather how it was used and abused. He makes one very good quote at the end, “You Can Do Anything With Software”

There is a saying amongst quants (read statisticians) “You Can Do Anything With Software” and also points out the software models and the real world do clash

Challenges of Interoperability in Healthcare

Although regional  health information exchanges were promoted and funded early in 2004-2006 by then appointed David Brailer MD and the Office of the National Coordinator for Information (by George Bush), progress has been slow due to a number of factors.


At the recent 2013 AHIMA meeting, interoperability was a topic discussed by Steve Bonney, VP of Business Development and Strategy at BayScribe.

 In this video interview. Steve discusses the challenges of getting structured data in healthcare and how you can use good technology to get the healthcare data without disrupting the physician workflow. Steve also discusses some of the benefits of having interoperable data in healthcare. Then,we ask him if Meaningful Use is going to make structured, interoperable data a reality.

Despite the increased acceptance of EHR many providers, and hospitals are reticent to 'buy in' to connectivity based upon costs and an unknown ROI. On the other hand there are many large outstanding and credible health institutions that have built networks between their hospitals and providers.

Perhaps the addition of the Affordable Care Act, it's mandates and looming deadlines have diverted manpower and financial  resources from health information exchanges, making it a lower priority with unknown results financially from the Affordable Care Act. Providers and hospitals are clearly challenged with developing Accountable Care Organizations, EHRs, Health Information Exchanges, and the possible change in reimbursement paradigm.

On the one hand health information exchanges could reduce costs, however achieving both ends....interoperable EHRs and the Affordable Care Act may take longer to achieve than originally antcipated.

Nevertheless the sum of the parts should be greater than the whole, and the transformation cannot be complete without each paradigm suceeding. Each part has it's proponents.

In my next blog posting, we'll discuss 'BIG DATA' and analytics...the promises and disappointments to come.

Chao: 30%-40% of ACA Website's Back End Yet To Be Completed

The News is not Good, despite reassurances from Sebelius and Obama

Those parts of the system include accounting and payment systems such as the delivery of federal subsidies (Hattem [1], "RegWatch," The Hill, 11/19). According to Politico, many of the back-end systems Chao referenced were not scheduled to come online until December, when insurers would need to begin finalizing coverage that would start Jan. 1 (Meyers, Politico, 11/20).

Panel Cites Recent McKinsey Analysis, Criticizes Chao

When asked during the hearing about a recently released risk-assessment document from McKinsey, which stated that a number of federal officials were made aware of problems with HealthCare.gov in April, Chao said he was "aware that some document was being prepared" but he had not read it, The Hill's "RegWatch" reports (Hattem [2], "RegWatch," The Hill, 11/19).

Republican subcommittee members criticized Chao for not reading the document -- which was publicly released Monday by the House Energy and Commerce Committee -- saying it proves at least some officials were aware of the website's problems well ahead of its launch (Jackson, USA Today, 11/19).

Meanwhile, Rep. Steve Scalise (R-La.) called on President Obama to fire those who were aware of potential problems with the website but did not make the issues known. He said, "This report says absolutely they knew, and they didn't tell the president."

Democrats sought to downplay the significance of the document, criticizing their Republican colleagues for not sharing the information before releasing it to the public just hours before the hearing (Hattem [2], "RegWatch," The Hill, 11/19).

In a letter, Democrats on the House Energy and Commerce Committee accused the GOP of selectively leaking documents "without appropriate context, without the benefit of witness testimony to provide additional information, and in this latest case, without providing Democratic members timely access" (USA Today, 11/19).

Obama Briefed on Website Problems

Meanwhile, White House press secretary Jay Carney on Tuesday said that Obama was told about the problems identified by McKinsey but was assured that the issues were being addressed,

Sebelius Says Nov. 30 Not a 'Magic' Date

In related news, HHS Secretary Kathleen Sebelius on Tuesday during appearances in Orlando and Miami said HHS' self-imposed Nov. 30 deadline to have HealthCare.gov fixed is "not a magic go, no go date," AP/Yahoo! News reports.

Sebelius said, "We have some very specific things we know we need to complete by the 30th and that punch list is getting knocked out every week." However, she added, "We recognize that there will still be periodic spikes, glitches, whatever that people will experience" (Kennedy, AP/Yahoo News, 11/19). 

Whose Data is it Anyway?

 

There used to be a controversy regarding who owns the medical record, you or your doctor/hospital? It became a growing conflict at EMRs and HIT developed. Paper was king, you copied it, faxed it, spindled it. burned it, and shredded it when it was no longer needed.

The conclusion in the past several  years shiftted; the patient owns his data, not the medical software.  The most recent iteration is that the software is separate from data fields and/or EMR information.

In a paper world it would look like this:   If you want your data, copy it, and the new copy is yours !

That seemed fairly clear cut in clinical encounters.

This TEDMED  video illuminates other challenges regarding medical data used in clinical situations encountered in Clinical Trials.

Amy Abernethy at TEDMED 2013

Should patients be able to share and/or donate their ‘data’ just like blood donors give to a blood bank. 

Can we develop software to support these options? Let the patient control how much, who, and where the data should be sent. Make permissions rescindible

Blood drives,,info-drives,, the infomobile,

Information networking is critical from the patient perspective.

Give our Data a Second Life

 

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