WellPoint Hires IBM's 'Jeopardy!'-Playing Computer System, Watson - WSJ.com

Watson, the “Jeopardy!”-playing computer system, is getting a job.

WellPoint Inc. and International Business Machines Corp. are set to announce a deal on Monday for the health insurer to use the Watson technology, the first time the high-profile project will result in a commercial application.

WellPoint said it plans to use Watson’s data-crunching to help suggest treatment options and diagnoses to doctors. It is part of a far broader push in the health industry to incorporate computerized guidance into care, as doctors and hospitals adopt electronic medical records and other digital tools that can record, track and check their work.

Wellpoint Expands Primary Care Payments

The expansion includes raised payments and payments for currently unreimbursed services such as creating patient care plans.  They also unveiled a shared-savings program, up to 30% and plans to invest in staffing and data sharing in exchange for measures such as participating in monitoring programs and offering 24 hour access. Wellpoint plans to invest $1 billion.  They hope to achieve savings of up to 20% from improved health and reduced use of costlier services (ER visits).

Wellpoint companies include Anthem Blue Cross & Blue Shield in Virginia.  Wellpoint is taking a business risk by pursuing this investment.  Since providers tend to contract with several insurers competitors may take advantage of the program without making a similar investment or taking on similar risk of loss.  This free rider problem may have discouraged insurance companies from aggressively pursuing cost-savings–at least until now.

IBM's Watson computer goes from "Jeopardy" champ to health care expert

Back in February, IBM’s Watson computer defeated two previous “Jeopardy” winners over the course of a three day match. It was a historical accomplishment for the system’s designers, who have programmed Watson to “understand” language as humans speak it. 

And now Watson has a new job in the health care sector:

IBM is partnering with WellPoint, a large health insurance plan provider with around 34 million subscribers, to bring Watson technology to the health care sector, the companies said Monday. 

The goal is for Watson to help medical professionals diagnose and sort out treatment options for complicated health issues.

Health care professionals hope that Watson’s processing ability to analyze 200 million pages of data and provide a response in less than three seconds with help improve Health IT over time, decreasing that critical window between the onset of medical symptoms and treatment. WellPoint says they plan to begin using Watson technology in small clinical tests beginning in 2012.

Health Insurers Value Profits Over People: Fresh Evidence

If Americans were to eavesdrop on behind the scenes talk of big health insurers, such as UnitedHealth, WellPoint, and Aetna, they would gain a better understanding of why premiums continue to rise, while the number of people with medical coverage continues to fall.   These three companies have announced their quarterly earnings in the past few days, and have earned a combined $2.51 billion from April through the end of June, much more than analysts expected.  On a per share basis, their earnings were up more than 17% on average compared with the second quarter of 2010.  These big for-profit health insurers have exceeded analyst’s expectations for several quarters in a row now.  So why do health insurer’s profits continue to grow, even as the country struggles to recover from the recession, and one out six Americans remains without coverage?  The answer is simple: health insurers value profits over people.

One of the secrets to maintaining these results is what insurers have defined “medical management”, which translates into the euphemism of denying claims and coverage.   The fewer claims they pay and the more procedures they refuse to pay for, the more money the investors have leftover to put in their pockets.

Another trick to sustaining this impressive rise in earnings is the greater responsibility and cost of sharing from policyholders. More and more companies’ policyholders are enrolled in plans that require greater cost sharing, thus policyholders pay more out of pocket than ever, while their insurers are paying much less.

These tactics, and many others, are used as excuses to evade what’s really going on here. We’re simply unable to get the care we need because of the outrageous deductibles of today’s health plans.   “WellPoint and Aetna and other insurers have demonstrated repeatedly that while they will do all they can to avoid sacrificing profitability for membership, they are quite willing to sacrifice their members—and the American public—for profits.”

Kantor & Kantor is an advocate for clients whose insurance companies have failed, or refused to pay claims, arising out of Disability, Health, Life, Long Term Care and other liability insurance claims.  We help people get medical care and treatment when it has been unfairly denied by their insurance company.  It’s unfortunate that health insurers are maximizing profit at our expense and sacrificing the health of its members.  If your health insurance claim has been denied, call us. WE CAN HELP.


12 Career Tips for 12: Recruiters Tell You How To Be a Rock Star! (Part I)

Each week, StartWire News features insider tips from recruiting directors and talent acquisition pros. As we look ahead to 2012, we’re encouraged by the uptick in hiring – and we want to share some of the best of the best with you so that you can land the job you want – fast! 

Get to know the whole company – not just the job you’re applying for

I always say a career is like a puzzle; you have to look at the whole picture. Whether you are looking to go into finance, marketing, product design or sales, be open minded and take into account the whole experience - think about what it is you can take away from a particular role. Understand the many pieces of the company and be willing to learn about new things that might be the right fit for you. You’re not going to know enough unless you are open and aggressive learner.

Nancy Hickey 
Senior Vice President, Chief Administrative Officer for Steelcase Inc.

Why you shouldn’t get discouraged if the phone doesn’t ring

When a job seeker applies for any job they should remember that being qualified doesn’t necessarily mean the same thing as being the most qualified.  So the assumption by a job seeker that they are entitled to an interview just because they meet the qualifications is a tough thing to swallow at any level.  

The fact is that even if recruiters wanted to interview all 1,000 qualified job seekers that apply to their job, they can’t always do so.  And even if they did, they’re only able to hire one of these people.

It’s why connecting outside of the application process is so important for both job seekers and recruiters.  It’s why having a visible and living profile that showcases your expertise and engagement with industry peers is much more powerful than is sometimes thought.

Chris Hoyt
Talent Engagement & Marketing Leader at PepsiCo.

Your chances of getting hired go way up if you get a referral.

Use social media to network and make professional connections. Build relationships with people who work in the industry you are interested in working. Once you build those relationships, ask for professional advice.  They can perhaps lead to referrals and references.

On average, one of out every 33 candidates is going to get hired from an online source—such as a job board or a career site. If you are referred, your odds go up to one  in four. Those are better odds. 

Shanil Kaderali
Manager of Talent Programs at WellPoint

If at first you don’t get hired, try, try again.

Understand that whenever you are applying to an organization that is highly desirable, people tend to get discouraged if they don’t get the first job they go for. We may get 400 or 500 applicants for one job. There could be 10 top people in the field. If you are passionate about the organization continue to look at the organization.

The first time I applied for a recruiter job with Taylor Made – I came in third. Then four years later, I’m leading global recruiting.

Michael Jordan got cut from his high school varsity team and ended up becoming one of the best players of all time. You shouldn’t discourage easily. I find that the lessons I learned on the playing field have guided me to this point in his career: Hard work pays off, you accomplishes far more working with teammates, and a good coach is critical to deliver successful end results!

Steve Bonomo
Head of Global Talent Acquisition for Adidas

Be humble

Occasionally, people aren’t humble enough. People say “I meet all the criteria for the job.” A lot of candidates have come in from our process and people have walked away saying “That’s the smartest person we’ve interviewed for this job but they come out of the interview saying ‘let’s not hire them.’ We like to see people who feel like they have something to learn from us, too.  I’m not going to ask you to rewire yourself.  You want people who can sell themselves, but people who can be themselves, too.

Miles Parroco
Director of Recruiting, Eventbrite

Ask for the job

Research each company you want to work for.   If you are socially connected (personally or professionally via social media) with someone from the company, if appropriate, query those associates about the culture.    Ask relative questions about the job and the company.   

Interviewing is getting to know one another.  During the interview process, instead of answering questions with one word, tell a story about how you positively responded to a situation.  Before you leave the interview, ask what the next steps are in the process.  In the best-case scenario: Ask for the job.

Wanda Callahan,
Director of Recruiting, Harris Interactive

Learning to Be Lean

Should employers be required to pay health insurance for all children of employees to be examined for obesity?

As one of the many outgrowths of the sweeping federal health care law, health insurers and employers must now pay the cost of screening children for obesity and providing them with appropriate counseling.

With about one in three children in the United States obese or overweight, according to government statistics, the need for such programs is clear. But, experts say, creating them will be challenging. Other than intensive hospital-based programs, few proven models exist for helping children and adolescents achieve and maintain a healthier weight, and researchers do not even fully understand the factors that contributed to the rapid rise in childhood obesity in recent years. “If this were easy, if there were clear outcomes for success, we would be investing in these,” said Dr. Samuel R. Nussbaum, the chief medical officer for WellPoint, one of the nation’s largest health insurers.

While there are many community efforts aimed at getting every child to eat better and exercise more, including Michelle Obama’s “Let’s Move” initiative, there is also growing demand for programs that help children who are already seriously overweight. WellPoint and the UnitedHealth Group, another large insurer, are experimenting with new approaches, and even Weight Watchers says it is working to develop a program for children and teenagers. Drug companies and medical device makers are also testing some products on children.

Adults have a difficult enough time losing weight, and the issues are even more complicated with children and teenagers, experts say. Children are still growing, and the goal of any program may be to help them grow into a healthier weight rather than to actually lose pounds. Experts also say that to be successful, programs need to focus on the family as a whole, changing what everybody eats and how much time they are all active, not sitting in front of a computer screen or television.

UnitedHealth’s pilot program, aimed at these family dynamics, was conducted in partnership with the YMCA of the USA and the YMCA of Greater Providence, R.I. The sessions at the Y, with young children or teenagers talking about their struggles with food and exercise, are intended to be a friendlier, more cost-effective alternative to hospital programs.

Accompanied by a parent, the children meet for 16 hourlong sessions, initially once a week. Led by a coordinator who has been trained at a Y or other community setting, the children and parents learn about what foods they should favor, why children may be overeating and how to balance what they eat with how active they are.

The early results of UnitedHealth’s efforts are promising, according to the insurer, which said that 84 percent of the 155 children and teenagers who completed the program had an average 3.5 percent reduction in weight after six months. Parents also lost weight, according to UnitedHealth. The insurer says it is expanding the program, even as it continues to study its longer-term impact.

Raytheon, a military contractor, started offering the sessions to its employees in Massachusetts and Rhode Island as part of a pilot program. “We are always seeking out innovative ways to help our employees and their families live healthy lifestyles,” Keith J. Peden, a Raytheon executive, said in a statement.

UnitedHealth is now working with Texas and Louisiana to offer a similar program this year for children enrolled in Medicaid under the insurer’s Medicaid plans.

Weight Watchers, which runs a weight-loss program for adults that involves group meetings as well as a Web-based program, had to abandon one approach after discovering children were regaining their weight after a year, with some even gaining more than they might have had they not participated.

Weight Watchers has not given up, however. Departing from the early program, it is now trying to develop ways of engaging the whole family to eat better. The new efforts focus less on counting “points” for foods.

WellPoint is trying a different approach, working through pediatricians. Because many pediatricians lack the background to help children who are overweight and have nowhere to refer them, WellPoint provided training to 100 doctors and linked them with dietitians in Virginia. The health plan pays for four visits to the doctor and four visits to the dietitian, whose sessions are aimed at improving the diet of the entire family.

WellPoint is already planning to expand its efforts to customers in California and Wisconsin this year as soon as it is able to identify dietitians who can work with the pediatricians.

Anthem Blue Cross uses bait and switch tactics

WellPoint’s Anthem Blue Cross has found yet another way to shift insurance risk from itself to its beneficiaries. Individuals who purchased or renewed their health plans did so while assuming in good faith that their costs and risk exposure would be set for another year. No. Anthem Blue Cross included in the fine print the condition that these were only one month renewals, allowing them to change the terms of the insurance contract repeatedly throughout the year.

“Bait and switch” is a despicable business practice, and the nation’s largest insurer, WellPoint, is not above it. At the current rate of insurer consolidation, WellPoint’s plans will likely be amongst only a few choices, if that, in the state health insurance exchanges to be established under the Affordable Care Act. And surely the other insurers will adopt the same despicable practices in order to remain competitive.