The underground fungus that is United Healthcare
There are many networks in the US healthcare ecosystem: educational institutions, medical journals, social ties, provider networks, hospital systems to name a few that are easy for anyone to grasp. Many of them are branded, even household names like Blue Cross, Virtua, Harvard, the AMA. And we interact with the US healthcare ecosystem through additional networks we don’t always think about: payments. Anyone who has paid a copay or fee for a medical service with a check, a credit card or a debit card knows there is a banking system that allows funds from your bank or your credit card to reach your doctor’s office. That banking system is part of a larger payments ecosystem.
I am reminded of Wohlleben’s “Woodwide Web” of mycelium in the soil of the forest, connecting the roots of trees beneath our feet for miles and miles, this massive fungus signals trees to make adaptations in response to threats, like wildfires; it provides nutrients to the trees; and in exchange, it takes a portion of the sugars the trees generate through photosynthesis.
Like the mycelium beneath the trees and the forest floor, the medical payments ecosystem is vast, essential, symbiotic, and nearly invisible. That is, until something goes wrong.
United Healthcare has a recently-acquired payments subsidiary, Change Healthcare, that handles “14 billion clinical, financial, and operational transactions annually.” Thanks to laws regarding disclosures of data breaches, and journalism serving the public interest, we know about a ransomware attack this United Healthcare unit sustained that for months has affected millions of patients who are trying to pay their bills. The ripple effects of such a hack are huge, lasting, expensive, and even deadly.
This unit handles data of about 50% of Americans, and 94% of all US hospitals have been disrupted by the attack. (Go ahead, read it twice. I did.) It is the conduit for millions of payments to US medical providers. When a network has a node that becomes a hub that handles so much of the load… that is even greater cause for concern. My wife, a data privacy & policy nerd, enlightened me about this situation, and in our discussion one night inspired me to diagram the system so we could both understand it better. And here is an abbizzo* visualizing the US healthcare payments biz.
Stocks-and-flow schematic of how patient transactions for care are handled, highlighting funding layer (insurers) payments layer (banks) clinical layer (healthcare systems) and the hidden HC business layer (eg United Healthcare/Change HC)
Note: BSCA and UCSF are merely examples of insurers and healthcare systems. United Healthcare’s Change unit, however, is very specific.
* “Abbizzo” is my term for a rough, imperfect sketch (abozzo in Italian) + biz (for business) It’s also my consulting brand. See this and more at www.abbizzo.com.
https://www.nationalforests.org/blog/underground-mycorrhizal-network