cross-posted from: https://lemmy.blahaj.zone/post/5472838
UnitedHealthcare, the largest health insurance company in the US, is allegedly using a deeply flawed AI algorithm to override doctors’ judgments and wrongfully deny critical health coverage to elderly patients. This has resulted in patients being kicked out of rehabilitation programs and care facilities far too early, forcing them to drain their life savings to obtain needed care that should be covered under their government-funded Medicare Advantage Plan.
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This is the future of AI. Not generated art, but using AI to crush people under the heel of capitalism.
It’s so short-sighted and wasteful! A friend of mine got a knee replacement, and then they “couldn’t find” a facility to do her rehab (at their cheap recompense probably) so they sent her home. A few days later she fell and ripped everything apart, necessitating another surgery and even longer rehab. There is no cost savings to be had with this kind of penny pinching. It will no doubt be eaten up by lawsuits.
It honestly feels like the metric has become the target here. By it’s nature, health insurance wants to collect as much in premiums as possible, and pay for as little healthcare as possible. I’ll bet that someone somewhere is assuming that in the long term every claim averages out to roughly equal and is tracking the denial rate instead of the actual amount paid out. If they’re doing that, then your friend’s experience makes sense because they spent more money total but the denial rate was higher than if they had just paid the claim outright.
It’s exacerbated by a labor shortage in healthcare. Rehab spots are hard to find.
if(true) {denyClaim()};//the 10% acceptance rate is really just network errors
This is the best summary I could come up with:
The investigation’s findings stem from internal documents and communications the outlet obtained, as well as interviews with former employees of NaviHealth, the UnitedHealth subsidiary that developed the AI algorithm called nH Predict.
The algorithm estimates how much post-acute care a patient on a Medicare Advantage Plan will need after an acute injury, illness, or event, like a fall or a stroke.
It’s unclear how nH Predict works exactly, but it reportedly estimates post-acute care by pulling information from a database containing medical cases from 6 million patients.
NaviHealth case managers plug in certain information about a given patient—including age, living situation, and physical functions—and the AI algorithm spits out estimates based on similar patients in the database.
But Lynch noted to Stat that the algorithm doesn’t account for many relevant factors in a patient’s health and recovery time, including comorbidities and things that occur during stays, like if they develop pneumonia while in the hospital or catch COVID-19 in a nursing home.
Since UnitedHealth acquired NaviHealth in 2020, former employees told Stat that the company’s focus shifted from patient advocacy to performance metrics and keeping post-acute care as short and lean as possible.
The original article contains 669 words, the summary contains 193 words. Saved 71%. I’m a bot and I’m open source!
