MEDICAL PRIVACY: Insurers Use of Data Worries Advocates
New York's Empire Blue Cross/Blue Shield says it has spotted potential problems -- such as overlooked test results -- with the medical care of about 120,000 members in its first year of using a computer system that reviews patients' medical records and claims, USA Today reports in a look at how insurers are taking a more proactive role in members' care. Although the attention may be reassuring to some patients, the program also raises debate about how involved insurers should be in medical care, and how much access they should have to private medical information. Programs like Empire's are made possible by the increasing use of electronic medical records and claims, but that increase has also fueled fears among privacy advocates about the use of the information that such systems make available. Some worry that, without limits on insurers' access to medical records, there is nothing to prevent health plans from using that information in ways that may not be in members' best interests.
Critics also worry that intervention by insurers may not be medically appropriate. As the result of its new program, Empire has contacted the physicians of about 4,000 members during the past year to suggest additional tests or changes in care. The insurer says there is "enormous value" in providing physicians with the information it uncovers, but others argue that medical directors at health plans are not in a position to "second-guess" the care provided by physicians (Appleby, 4/7).