Volume 38

For those in the United States, I trust everyone had an amazing Thanksgiving with few arguments about politics and healthcare. (Did you hear about Donald Trump and Barack Obama? They’re back to fighting about the Affordable Care Act!) 

I missed turkey and stuffing this year since I was teaching at ESCP Business School in London. My students and I discussed the complexities of the U.S. healthcare system and the differences between it and European systems. 

Unsurprisingly, my 72 French students had similar views of the U.S. healthcare system as my U.S. MBA students: it’s a mess. 

But fear not, there are brilliant innovators and thinkers entering the market soon! 

Now onto this week’s newsletter. And once again, AI continues to be in the news. The question is: Can Americans be convinced these tools are trustworthy?

With that, open the link to see our top healthcare news from the last two weeks.

In the Shadows of Doubt: AI's Trust Struggles in Healthcare Unveiled

A recent survey of more than 28,000 consumers globally found 45% of respondents are less comfortable with using artificial intelligence (AI) for medical advice than using it in other sectors. Regarding healthcare, more than 80% of respondents want human advice. Sixty percent want personal interactions for appointments and scheduling. In contrast, 73% of consumers are comfortable using AI to track orders for goods. (How else would Cyber Monday work?!) More than half of healthcare workers, 56%, surveyed also expressed caution about AI use.

So What’s The Big Deal?  I once had an advisor tell me, “Adam, your most important currency during a crisis and with patients, is trust.” She wasn’t wrong. Trust is a critical component in healthcare, whether the messenger is a doctor, nurse, or an AI bot. If the messenger is not trusted, the message will be questioned. For AI to gain traction, developers must establish trust with the end users. Addressing these concerns is crucial for successfully integrating AI into the healthcare sector and aligning it with consumer and industry expectations.

Your BIG Thoughts: Consumers were once skeptical of buying goods online and look at us now! How can commercial interests facilitate trust in AI? 

ChatGPT Sparks Alarm with 100 Health Disinformation Blogs

Wondering why trust in AI is low? Australian researchers discovered generative AI, specifically ChatGPT, could rapidly generate substantial amounts of health misinformation about vaccines and vaping. In just 65 minutes, ChatGPT produced 102 blog articles containing more than 17,000 words of disinformation, accompanied by 20 realistic images and one deep-fake video.

So What’s The Big Deal? ChatGPT cannot be used as a source. People should not use generative AI platforms to answer questions about their health. And for providers, we could see a future where AI chatbots or services like ChatGPT are held to liability standards if patients are given inaccurate information or remedies. 

Your BIG Thoughts: What is a bigger threat at this point: Self-diagnosis by WebMD or ChatGPT misinformation? 

A Call for AI Standards in Healthcare

Leadership instability at OpenAI, the creator of ChatGPT, has prompted calls for standards in the use of generative AI in healthcare. Additionally, Microsoft's involvement in deploying generative AI in healthcare has raised questions about the company’s control of data and its commercial ambitions. The issues: transparency, biased outputs, incorrect conclusions, error-prone decision-making, and a lack of consensus regarding safety measures and performance metrics. Health AI experts emphasize the need for independent entities to ensure safety, quality, and equity, highlighting the current absence of this type of oversight.

So What’s The Big Deal? AI still has a lot of buzz, but there’s a long way to go. Regulatory guardrails are needed. Pricing, access, accuracy, innovation, and transparency will continue to be issues in AI models until those rules exist. The lack of a clear regulatory framework adds complexity, leaving the industry at a crossroads between innovation and the need for standards to ensure safety and equity. 

Your BIG Thoughts: Lawmakers and regulators must strike a delicate balance between ensuring AI's safety and fostering innovation. How can policymakers ensure AI is trustworthy and reliable without eroding research and experimentation? 

Patients Envision AI Will Improve Access and Affordability

And now for the good news: While consumers may not fully trust AI for diagnosis, they do see some upside. Specifically, 53% believe generative AI can improve access to healthcare. Consumers also believe it could reduce wait times, and 46% say it could make healthcare more affordable. AI users, of course, are already convinced. Nearly three-quarters, 71%, of current generative AI users believe the tool could revolutionize healthcare delivery. Specifically, 69% say it could improve access issues, while 63% believe it could lower individual healthcare costs.

So What’s The Big Deal? As people hear more about AI and experience it, adoption and trust may grow. However, the term “AI” is overly broad and does not describe the real power and potential of alternative forms of intelligence. That said, there is potential to leverage technologies for healthcare delivery, improved access, and reduced costs.

Your BIG Thoughts: What are the tools out there right now that could improve access and affordability? What new use cases are you excited to see in 2024? 

 AI Bias in Healthcare Models under Scrutiny

A study by researchers at Brown University, Mass General Hospital, and other institutions has revealed that AI systems, specifically text-to-image generators, predominantly depict surgeons as white men. The study tested three prominent systems, with some demonstrating greater diversity, but … most depicted a surgeon as a white man.

So What’s The Big Deal?  Once again, this study is a reminder that AI is a garbage in/garbage out system that, if we are not careful, will reinforce bias and exacerbate healthcare disparities. Technologists must address these problems. Now.

Your BIG Thoughts: Talk to us about solutions. Who are the innovators tackling the problem of bias in AI?

UnitedHealth Accused of Using Algorithm to Cut Payments for Rehab Care

Here’s another way to reduce patient trust in AI: Use it for purposes that are clearly unethical. UnitedHealth Group, the largest health insurance company in the United States, allegedly pressured medical staff to use a computer algorithm to deny rehabilitation care for seriously ill patients. Despite saying the algorithm is merely a guide, internal documents suggest the insurance company intended to use the tool to cut off payments. The strategy, outlined by  UnitedHealth subsidiary NaviHealth, includes stringent performance goals to reduce nursing home care costs for Medicare Advantage patients.

So What’s The Big Deal? This story raises concerns about patient care and the ethics of prioritizing profits. It should make every provider, family member, and patient mad. United Healthcare’s strategy is simple: Collect revenues from taxpayers and beneficiaries, promise to pay for a service, create an algorithm that prevents that service, and erect barriers to fight the service prevention. It’s frankly exploitative for all stakeholders. I’ve written about this problem in a MedPage article. Regulation and oversight are desperately needed.

Your BIG Thoughts: What is the right punishment to fit this crime? In other words: What should the federal government do to prevent this type of exploitation from ever happening again? 

Medical Practices Struggle with Mounting Regulatory Burdens

According to the Medical Group Management Association (MGMA) annual regulatory burden report, 90% of medical practices surveyed reported increased regulatory burdens over the past year. The key pain points include prior authorization, audits, appeals, the Medicare Quality Payment Program (QPP), and surprise billing requirements. Prior authorization emerged as the most burdensome, with 89% of respondents expressing significant challenges that led to delays in patient care and the need for additional staffing.

So What’s The Big Deal? These costs affect patient care. In the United States, administrative costs far eclipse any other nation. Take for example, prior authorizations. From a direct cost perspective, the practice continues to put unnecessary burdens on physicians that divert clinical hours away from patients. Other indirect costs and redundant processes also must be streamlined and standardized. AI may help alleviate the situation, but, as our previous stories show, we must be careful. 

Your BIG Thoughts: These findings also shed light on the strain imposed by audits, appeals, and value-based payment initiatives. How can policymakers address these issues and create a more sustainable and patient-centric healthcare landscape?

Amazon's One Medical Join Forces with HTA for Healthcare Transformation

Through a partnership with the Health Transformation Alliance (HTA), One Medical will become the virtual and in-person primary care provider for major companies like Coca-Cola, Boeing, and JPMorgan. This news, combined with the company’s recent partnership with Hackensack Meridian Medical Center, means Amazon’s One Medical is scaling quickly. HTA's members collectively manage care for more than 4 million individuals who collectively spend about $27 billion on healthcare each year. This collaboration aims to leverage digital health tools and primary care services to address inefficiencies and costs within the healthcare system.

So What’s The Big Deal?  Amazon. Amazon is a big deal and, each day is becoming a bigger deal in healthcare. This new alliance also may shift payer costs and could benefit employers. Indeed, it demonstrates how companies can work with Amazon to provide accessible and convenient healthcare services for employees and address the need to control costs.

Your BIG Thoughts: If consumers are worried AI may depersonalize healthcare, why don’t they have the same worries about Amazon? What if, anything, does that say about building trust in unconventional healthcare tools? 

U.S. Leads in Deferred Healthcare Costs Among Wealthy Nations

The latest Commonwealth Fund survey underscores significant disparities in healthcare utilization and access in the United States, particularly concerning income levels. When compared to nine other wealthy nations, the U.S. stands out for having the highest percentage of respondents, especially those with lower incomes, reporting skipping medical care due to cost-related reasons. The income-based gaps extend to decisions on dental and mental healthcare, revealing a concerning pattern of deferred care in the U.S. population.

So What’s The Big Deal? If you were in one of my classes, you would learn this isn’t a surprise. The cost of healthcare continues to be a barrier for patients seeking care (whether they need it or not).   The survey reveals a systemic issue – financial barriers disproportionately affect those with lower incomes, creating disparities, especially in areas like dental and mental healthcare. Healthcare leaders must urgently develop solutions to ensure equitable access, mitigate financial obstacles, and foster more inclusive healthcare.

The Senate Wants to Take a Swipe at PE

U.S. Sens. Elizabeth Warren and Richard Blumenthal have raised concerns regarding U.S. Anesthesiology Partners (USAP), one of the nation’s largest anesthesiology practices, and potentially unfair business practices. In a letter addressed to USAP's CEO, the senators accuse the company of engaging in anticompetitive actions like imposing restrictive non-compete agreements on its physicians and controlling pricing. USAP also faces charges from the Federal Trade Commission about price collusion. The company vehemently denies those accusations.

So What’s The Big Deal: The roll-up strategy USAP used is similar to what has been deployed by other private equity-backed organizations. It is clear Washington is interested in private equity in healthcare and its potential impact on costs and access. The allegations of leveraging market power to inflate prices and imposing non-compete agreements on physicians could have legal and financial implications for USAP. Furthermore, the ongoing FTC lawsuit alleging price collusion is a serious matter and one other PE-backed healthcare groups should take as a sign of things to come.

Your BIG Thoughts: Are these moves all bark and no bite, or, in an election year, will progressives in Washington take on private equity in healthcare? 

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