Tip of the iceberg of their plotting, it's clearly the way they would like it all to work, not just with opiods:

How your health information is sold and turned into ‘risk scores’

Information used to gauge opioid overdose risk is unregulated and used without patient consent.

By Mohana Ravindranath @ Poltico.com, 02/03/2019 06:56 AM EST

Companies are starting to sell “risk scores” to doctors, insurers and hospitals to identify patients at risk of opioid addiction or overdose, without patient consent and with little regulation of the kinds of personal information used to create the scores.

While the data collection is aimed at helping doctors make more informed decisions on prescribing opioids, it could also lead to blacklisting of some patients and keep them from getting the drugs they need, according to patient advocates.

Over the past year, powerful companies such as LexisNexis have begun hoovering up the data from insurance claims, digital health records, housing records, and even information about a patient’s friends, family and roommates, without telling the patient they are accessing the information, and creating risk scores for health care providers and insurers. Health insurance giant Cigna and UnitedHealth's Optum are also using risk scores.

There’s no guarantee of the accuracy of the algorithms and “really no protection” against their use, said Sharona Hoffman, a professor of bioethics at Case Western Reserve University. Overestimating risk might lead health systems to focus their energy on the wrong patients; a low risk score might cause a patient to fall through the cracks [....]

I already had an inkling about this dealing with Optum Rx under United insurance, the responses from them when they turn down a prescription. Except here's the problem: they are incredibly inaccurate! They say: patient hasn't tried the protocol medicine first! When patient has, for years! This is no human you or the doctor are arguing with, and no one to turn to. It costs money to have humans deal with problems. The point is to get you to give up if you are risky and will cost them money.

Along these lines, one doctor told me this: they purposely program prescriptions to allow renewal right at the exact time it runs out, hoping the patient cannot get the refill in time and will skip a few days. In the skipping of a few days by many patients is a slim profit margin. He has learned to beat the system by writing prescriptions a different way, but it doesn't always work. As a patient, if you don't have a doctor this understanding, there is basically no recourse. You complain about it at CVS, you can't talk to a pharmacist-they are worked like cogs and don't talk to customer-you talk to the cashier kid who is trained to say it's the doctor's problem. Most doctors will say it's the insurer's problem. The insurer don't talk to you, as Optum RX is the entity that handles their prescriptions. Optum RX is robots. There must be some humans working there but I haven't found them yet.

Once again, the point is to get you to give up and just live with your illness with improper care, to not be so expensive and individual, to be a cog of predictable costs.

Just like it is the point of the adjuster involved in any claim you make of any other kind of insurance to accept less than you were expecting.

Some examples of the nightmares:

Patients Suffer When Health Care Behemoths Quarrel Over Contracts

By Barbara Feder-Ostroff @ Kaiser Health News-Feb 1, 2019

[....] Anthem Blue Cross of California, one of the state’s largest health insurers, is battling with Sutter Health over how much it should pay to care for tens of thousands of its enrollees in Northern California. Sutter operates 24 hospitals in the region and lists about 5,000 doctors in its network.

“It’s not the peace of mind I thought I was buying to have the entire Sutter network — which is the biggest game in Northern California — be out-of-network,” said Lerman, whose family is insured through his wife’s job as a California State University professor [....]

when insurers and providers fail to reach an agreement on time, it can force patients to pay higher prices for care that is no longer covered by their health plans. At the least, it can cause considerable anxiety.

“It is a game of chicken, and at the end of the day somebody blinks and they come to an agreement,” said Wendell Potter, a former senior executive at health insurance giant Cigna who became a critic of the industry and a strong proponent of sweeping health care reform. “The big losers in this are patients, because there’s a period of uncertainty and angst and a real possibility that the physicians and hospitals you want to go to are no longer in-network.” [....]

As large hospital systems merge with competitors and snap up medical practices, “it’s much more difficult for insurers to say, ‘OK, we’re letting you go,’” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

In western Pennsylvania, nearly 50,000 people with Medicare managed-care plans from Highmark Health will lose in-network access to University of Pittsburgh Medical Center hospitals and doctors starting July 1, because of a slow-moving divorce between the two regional health giants.

Among those patients is Judy Hays, a 75-year-old retired office manager from the Pittsburgh suburb of Crescent Township who relies on UPMC’s physicians and hospitals to treat a rare form of leukemia. Now, she plans to change doctors mid-treatment because she wants to keep her insurance, which she said has paid for her expensive medications. “It’s very tough. These people have been taking care of me for the last nine years. I can’t have any interruption in my care,” Hays told Kaiser Health News. “I’m very angry about it.”

In Georgia, WellStar Health System, with 11 hospitals and numerous medical offices, plans to stop accepting Anthem’s individual policyholders as in-network patients on Feb. 4, amid a contract dispute between the two companies [....]

Sutter has quarreled with other insurers, including Blue Shield of California in a dispute that affected about 270,000 consumers before the two sides reached a deal that took effect in February 2015.

Sutter’s market dominance in California and its high prices for inpatient care have long drawn criticism. One patient reported that Sutter charged $1,555 for a 10-minute ER visit to treat a cut finger, including $55 for a gel bandage and $487 for a tetanus shot.

Last year, state Attorney General Xavier Becerra sued the giant health system, alleging it had illegally overcharged patients and drove out competition in California. Sutter has contended that Becerra overstepped his authority and that limiting Sutter’s ability to negotiate with insurers will harm consumers [....]

The ugly truth is that a certain kind of dissatisfaction is global, and it's probably because of "them", the money driven merchants of medicine

See QB4.

To what extent do you agree or disagree with the following statement. – The healthcare system in my country is overstretched.

 on Ipsos poll huge health care survery of: 23,249 online adults aged 16-64 across 28 countries May 25 – June 8, 2018, 

PDF here

https://www.ipsos.com/sites/default/files/ct/news/documents/2018-07/global_views_on_healthcare_2018_-_graphic_report_0.pdf

Question QB4 is on page 33.

Overall world: 53% agree overstretched.

Contra my own beliefs, Great Britain is #1, 85% agree overstretched. Hungary # 2. Sweden is # 3, 74% believe overstretched.France #6, 70% think overstretched

Only countries where a third or less thought their system was overstretched: Belgium, Poland, South Korea and Japan. Japan has incredible numbers, everything hunky dory there. Don't know why, haven't looked into it.