December 18, 2024 • 13 mins
What drives a person to commit an unimaginable act? With the shocking and tragic murder of UnitedHealthcare's CEO dominating headlines, we shift the lens to probe deeper into the healthcare industry's brewing tensions. As AI reshapes denial management, we wonder: Is technology fueling discontent among healthcare professionals & the public? Did UnitedHealthcare's use of an AI claims evaluator, which denied 90% of claims without human intervention, drive us towards this contentious intersection of technology and patient care?
The conversation doesn't end there. We tackle the pressing issue of workplace violence that has gained momentum since the onset of the COVID pandemic, questioning its role in this incident. As AI continues to gain a foothold in healthcare, we ponder its impact on denial rates and the broader industry ramifications. Join us for a thoughtful exploration of these urgent topics and the future path of denial management in healthcare. This episode is a must-listen for those seeking to understand the shifting dynamics at play in today's healthcare landscape.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Aaron (00:00):
Hi there, folks.
Before we get started, I dowant to give you a little bit of
a disclaimer.
What we're going to talk abouttoday is a bit of a tragedy that
occurred just very recently.
As you may have heard if not,you've probably been under a
rock the CEO of UnitedHealthcarewas murdered in the streets of
New York just prior to ashareholder conference.
(00:22):
Just prior to a shareholderconference.
While we're going to be talkingabout that today, we're not
going to really focus on theaction itself, but maybe some of
the things that have led up toit and some of the more
sensitive subjects around claimsdenials.
So if this isn't the sort ofconversation you're looking for,
maybe skip today's episode.
(00:43):
All right, let's get with it.
Well, hey there, jason.
How are you doing today?
Aaron, I'm well.
How are you.
Jason (01:00):
I'm doing okay A little tired, but I'm doing okay.
That's okay.
You know it's near Christmas.
It's nothing but positivity inthe air, or at least you want it
to be, but yeah good season.
Aaron (01:11):
Yeah, it is.
So.
You know, for our regularlisteners, typically, jason and
I, if you've been listening fora while we'll talk about the
latest headlines and some.
Ai has been a big topic andthat sort of thing, and today we
kind of want to go a slightlymore serious tone.
The CEO of UnitedHealthcare wasgunned down in the streets
(01:34):
fairly recently and I know thetopic has been talked to death
by everybody.
No pun intended, but I don'treally want to focus on the
murder itself.
I think today what I want totalk about is more the business
aspect of it.
A lot of that talk online hasrevealed a lot of frustration by
(01:55):
clinicians, by the businessside of healthcare, with the way
that healthcare denials havebeen.
So, jason, this is a touchysubject, obviously, so I want to
handle it with a little bit ofcare.
What have you seen from our ownclient base and maybe what
(02:18):
comments you've read online?
Is some of this underlyingangst around?
Why?
Maybe this assassin did what hedid At the time we recorded
this?
They believe they got the guy,so we will kind of know his
motives, but the online worldhas been abuzz with this for the
last week.
Jason (02:39):
Yeah, definitely caught us all off guard, didn't it?
And now you get videos.
It's so easy nowadays to seesuch an event, an unfortunate
incident.
We heard a lot of the reasoningbeing related to denials, for
(03:07):
example, and those in industryknow where united stands on that
.
And then there's the aicomponent in terms of the
platform that they use, whichyou've had that type of episode
for us in the past before aswell, and ai is going to be more
prominent of of an item in ourindustry and into another thing.
That kind of popped in my headas I saw it was.
(03:28):
We talked a lot in our industryright after COVID, for example,
about workplace violence, right,and just especially for
clinicians.
Well, this time, obviously itwasn't a clinician, it wasn't
necessarily in a workplace, butit's still within our industry
at a healthcare conferencetaking place and we all go to
conferences and that sort ofthing.
And so those are the threeitems that I kind of took away
(03:50):
in terms of things that I reador underlying tone that may
impact us.
You get the denials componentthat may have, and of course,
we're all speculating, right,but you know, denial management
has always been a thorn in ourindustry.
Now we have AI as somethingthat we're not used to, so it'll
be interesting how thosecomponents come to light over
(04:11):
the next couple of weeks, butthat's definitely been the theme
I keep picking up on.
Aaron (04:18):
Independent physician associations play a crucial role
in delivering qualityhealthcare while allowing
physicians to maintain theirautonomy.
At Strategic HealthcarePartners, we manage the full
spectrum of IPA services,including managed care,
contracting, practiceenhancements and member
education.
Our goal is to empowerphysicians to secure their
current and future patientsthrough an organization governed
(04:40):
by physicians for physicians,whether you're part of a
(05:04):
statewide IPA.
A of AI.
On UHC's recent implementationof a new AI claims evaluator and
something like 90% of itsdenials were denied by the AI
and then never actually reviewedby a human.
So I can certainly see thatthere's a lot of concerns and
obviously it is very clear thatI'm a huge fan of AI.
(05:28):
I see a lot of potentialbenefit with it, particularly in
the healthcare realm.
But do you think that thesetechnologies are potentially a
little too premature to be putinto such a place where people's
lives are literally at stakePeople's lives are literally at
stake, Especially with somethingthat's such a complex process
and workflow and documentmanagement.
Jason (05:47):
right.
We all know that with denialsthere's a lot of hoops it's
going through systematically toget to the system in which UHC
is probably utilizing.
That it does, to your point,kind of feels a little early
right.
To that extent there's too manyfilters in place.
Whatever the case may be, Ifully agree with you.
It almost feels like maybe theyjumped the gun a little bit, or
(06:09):
some organizations have.
Aaron (06:10):
It is interesting and I think it's very clear,
particularly those of us whohave been in the AI world for
the last couple of years,because that's really when it's
taken off.
It's only been around two years.
It's still a very new, emergingtechnology.
Ai makes mistakes, it makes alot of mistakes, and responsible
use of AI requires a humanbeing.
(06:30):
Just like you and I weretalking about earlier today.
Jason requires a human being tocome in behind it, clean up,
make sure those mistakes areremoved and that the information
is verified.
It's that trust but verify thatseemed to be missing here with
UHC.
So let's not focus too muchhere on UHC.
That seem to be missing herewith UHC.
So let's not focus too muchhere on UHC.
Seeing a lot of the commentsonline about the vitriol kind of
(06:51):
almost a brothers in arms youknow there's no atheists in
foxholes People who just a fewweeks ago, were tearing each
other apart over which of theirfavorite candidate was going to
win the presidency are suddenlyunited in their dislike of the
healthcare system in the UnitedStates.
(07:11):
Do you think this has sparked,potentially, a conversation
nationwide in that regard?
What do you think might be someof the outcomes from this,
aside from what will undoubtedlybe a very traumatic murder
trial, oh, you can't help butthink it can do anything.
Jason (07:29):
But that right At least part of the conversation.
Whatever is truly proven and ifit is denials, for example,
that we keep thinking it isyou've got to think that's going
to jump to the forefront ofconversations come next year,
post-january 20th, and how thatbecomes more of a health care
discussion than it has in thepast, and you hate that such an
(07:49):
incident occurs.
Hopefully you know.
Some of the good I can come outof is just conversations on how
to improve a flawed process anda flawed system.
Aaron (07:58):
I saw somewhere at which I kind of had to laugh to myself
about how how the approvalrating of insurance companies
has taken a huge hit in the lastweek, where they've always kind
(08:19):
of been low bar kind ofCongress level of approval here.
But they've taken a real hit aspeople start to kind of talk
about this and start comparingnotes in very frank and honest
ways online.
And I saw, though, that of thepayers that exist out there, the
(08:40):
number one most liked and it'slike by 85 percent, it's not
even close is the VA, which is,of course, a government-run
healthcare system.
I have to wonder if people likeme are going to be taking
notice of that and going well,okay, if the VA can be run with
an 85% satisfaction level andthese other guys are running in
(09:03):
the single digits of approvallevel, Boy, that that certainly
changes the conversation,doesn't it?
Jason (09:11):
Something's up.
Right, you almost wish you canpick and choose.
Okay, I like this off the menu,I like that off the menu in
terms of different providersettings and ownership and
entities that manage thosefacilities, and voila, we put
together the perfect recipe forhealthcare system, or at least a
setting that we can go to.
But yeah, that's it is mind.
(09:31):
I mean just how drastic thosedifferences are, isn't it Cause,
yeah, each of them are going toget slammed satisfaction rise
in some capacity.
But you're right, there aresome in which they're very much
praised, and to see the VApraise like that was kind of a
shocker to me.
Aaron (09:47):
Yeah, no doubt.
So to wrap this up, this is aquick conversation.
After all, it's certainly thedeath of the CEO Brian.
It's a terrible individualhuman tragedy, but in those sort
of moments I think those canbecome touchstones within a
society, particularly as one isseemingly fractured, as we are,
(10:10):
that a whole bunch of people whoagain previously were
disagreeing are now suddenlyagreeing that, okay, something
is horrifically broken here andit needs to be fixed.
So I guess my hope for 2025 isthat this has now sparked a new
conversation about how can we beaddressing health care and
(10:30):
satisfaction with care in thefuture.
Jason (10:34):
Yeah, I think we all share that sentiment.
Hopefully we go into 25 alittle refreshed and look for
positivity and some good changethat we can make.
Aaron (10:42):
Okay, folks, this was a slightly heavier than usual
episode.
I appreciate you sticking withus, and next week, when we come
back, we're going to have alittle bit of Christmas cheer to
share with you.
So thanks for checking in withus and, jason, thanks for
talking about this topic.
Jason (10:59):
Thanks Aaron, Thanks everybody, have a great day.
Aaron (11:03):
Alrighty folks, that's a wrap on this episode of Beyond
the Stethoscope VitalConversations with SHP.
I'm Aaron Higgins and I'm Jason.
Jason (11:11):
Crosby.
This show is brought to you byStrategic Healthcare Partners.
Our executive producers areMike Scribner and John Crew.
Who probably by now deservemedals and our editor is Nyla
Wiebe, who polishes ourramblings into something
listenable and shout out toJeremy Miller, our social media
manager, with Boost by Design,keeping us trendy and
(11:33):
meme-worthy.
Aaron (11:34):
And let us not forget our toiling robot transcriber, who
catches about 90% of what we sayand that other 10% it's tweaked
by Jason, a real-life human,allegedly.
Jason (11:47):
Wait, here's proof, right in this episode.
You can dig through our podcastarchive at shplccom slash
podcast Pretty clever Check outall the episodes and even learn
about what SHP can do for you.
Aaron (12:01):
And while you're at it, find us on Facebook and LinkedIn
, Drop us a comment, ask aquestion or just let us know if
you made it to the end of thisepisode without zoning out.
Jason (12:10):
thanks for hanging out with us.
We'll see you next week, sametime, same place.
Bye for now, later Gator.
Hi there, folks.
Before we get started, I dowant to give you a little bit of
a disclaimer.
What we're going to talk abouttoday is a bit of a tragedy that
occurred just very recently.
As you may have heard if not,you've probably been under a
rock the CEO of UnitedHealthcarewas murdered in the streets of
New York just prior to ashareholder conference.
(00:22):
Just prior to a shareholderconference.
While we're going to be talkingabout that today, we're not
going to really focus on theaction itself, but maybe some of
the things that have led up toit and some of the more
sensitive subjects around claimsdenials.
So if this isn't the sort ofconversation you're looking for,
maybe skip today's episode.
(00:43):
All right, let's get with it.
Well, hey there, jason.
How are you doing today?
Aaron, I'm well.
How are you.
Jason (01:00):
I'm doing okay A little tired, but I'm doing okay.
That's okay.
You know it's near Christmas.
It's nothing but positivity inthe air, or at least you want it
to be, but yeah good season.
Aaron (01:11):
Yeah, it is.
So.
You know, for our regularlisteners, typically, jason and
I, if you've been listening fora while we'll talk about the
latest headlines and some.
Ai has been a big topic andthat sort of thing, and today we
kind of want to go a slightlymore serious tone.
The CEO of UnitedHealthcare wasgunned down in the streets
(01:34):
fairly recently and I know thetopic has been talked to death
by everybody.
No pun intended, but I don'treally want to focus on the
murder itself.
I think today what I want totalk about is more the business
aspect of it.
A lot of that talk online hasrevealed a lot of frustration by
(01:55):
clinicians, by the businessside of healthcare, with the way
that healthcare denials havebeen.
So, jason, this is a touchysubject, obviously, so I want to
handle it with a little bit ofcare.
What have you seen from our ownclient base and maybe what
(02:18):
comments you've read online?
Is some of this underlyingangst around?
Why?
Maybe this assassin did what hedid At the time we recorded
this?
They believe they got the guy,so we will kind of know his
motives, but the online worldhas been abuzz with this for the
last week.
Jason (02:39):
Yeah, definitely caught us all off guard, didn't it?
And now you get videos.
It's so easy nowadays to seesuch an event, an unfortunate
incident.
We heard a lot of the reasoningbeing related to denials, for
(03:07):
example, and those in industryknow where united stands on that
.
And then there's the aicomponent in terms of the
platform that they use, whichyou've had that type of episode
for us in the past before aswell, and ai is going to be more
prominent of of an item in ourindustry and into another thing.
That kind of popped in my headas I saw it was.
(03:28):
We talked a lot in our industryright after COVID, for example,
about workplace violence, right,and just especially for
clinicians.
Well, this time, obviously itwasn't a clinician, it wasn't
necessarily in a workplace, butit's still within our industry
at a healthcare conferencetaking place and we all go to
conferences and that sort ofthing.
And so those are the threeitems that I kind of took away
(03:50):
in terms of things that I reador underlying tone that may
impact us.
You get the denials componentthat may have, and of course,
we're all speculating, right,but you know, denial management
has always been a thorn in ourindustry.
Now we have AI as somethingthat we're not used to, so it'll
be interesting how thosecomponents come to light over
(04:11):
the next couple of weeks, butthat's definitely been the theme
I keep picking up on.
Aaron (04:18):
Independent physician associations play a crucial role
in delivering qualityhealthcare while allowing
physicians to maintain theirautonomy.
At Strategic HealthcarePartners, we manage the full
spectrum of IPA services,including managed care,
contracting, practiceenhancements and member
education.
Our goal is to empowerphysicians to secure their
current and future patientsthrough an organization governed
(04:40):
by physicians for physicians,whether you're part of a
(05:04):
statewide IPA.
A of AI.
On UHC's recent implementationof a new AI claims evaluator and
something like 90% of itsdenials were denied by the AI
and then never actually reviewedby a human.
So I can certainly see thatthere's a lot of concerns and
obviously it is very clear thatI'm a huge fan of AI.
(05:28):
I see a lot of potentialbenefit with it, particularly in
the healthcare realm.
But do you think that thesetechnologies are potentially a
little too premature to be putinto such a place where people's
lives are literally at stakePeople's lives are literally at
stake, Especially with somethingthat's such a complex process
and workflow and documentmanagement.
Jason (05:47):
right.
We all know that with denialsthere's a lot of hoops it's
going through systematically toget to the system in which UHC
is probably utilizing.
That it does, to your point,kind of feels a little early
right.
To that extent there's too manyfilters in place.
Whatever the case may be, Ifully agree with you.
It almost feels like maybe theyjumped the gun a little bit, or
(06:09):
some organizations have.
Aaron (06:10):
It is interesting and I think it's very clear,
particularly those of us whohave been in the AI world for
the last couple of years,because that's really when it's
taken off.
It's only been around two years.
It's still a very new, emergingtechnology.
Ai makes mistakes, it makes alot of mistakes, and responsible
use of AI requires a humanbeing.
(06:30):
Just like you and I weretalking about earlier today.
Jason requires a human being tocome in behind it, clean up,
make sure those mistakes areremoved and that the information
is verified.
It's that trust but verify thatseemed to be missing here with
UHC.
So let's not focus too muchhere on UHC.
That seem to be missing herewith UHC.
So let's not focus too muchhere on UHC.
Seeing a lot of the commentsonline about the vitriol kind of
(06:51):
almost a brothers in arms youknow there's no atheists in
foxholes People who just a fewweeks ago, were tearing each
other apart over which of theirfavorite candidate was going to
win the presidency are suddenlyunited in their dislike of the
healthcare system in the UnitedStates.
(07:11):
Do you think this has sparked,potentially, a conversation
nationwide in that regard?
What do you think might be someof the outcomes from this,
aside from what will undoubtedlybe a very traumatic murder
trial, oh, you can't help butthink it can do anything.
Jason (07:29):
But that right At least part of the conversation.
Whatever is truly proven and ifit is denials, for example,
that we keep thinking it isyou've got to think that's going
to jump to the forefront ofconversations come next year,
post-january 20th, and how thatbecomes more of a health care
discussion than it has in thepast, and you hate that such an
(07:49):
incident occurs.
Hopefully you know.
Some of the good I can come outof is just conversations on how
to improve a flawed process anda flawed system.
Aaron (07:58):
I saw somewhere at which I kind of had to laugh to myself
about how how the approvalrating of insurance companies
has taken a huge hit in the lastweek, where they've always kind
(08:19):
of been low bar kind ofCongress level of approval here.
But they've taken a real hit aspeople start to kind of talk
about this and start comparingnotes in very frank and honest
ways online.
And I saw, though, that of thepayers that exist out there, the
(08:40):
number one most liked and it'slike by 85 percent, it's not
even close is the VA, which is,of course, a government-run
healthcare system.
I have to wonder if people likeme are going to be taking
notice of that and going well,okay, if the VA can be run with
an 85% satisfaction level andthese other guys are running in
(09:03):
the single digits of approvallevel, Boy, that that certainly
changes the conversation,doesn't it?
Jason (09:11):
Something's up.
Right, you almost wish you canpick and choose.
Okay, I like this off the menu,I like that off the menu in
terms of different providersettings and ownership and
entities that manage thosefacilities, and voila, we put
together the perfect recipe forhealthcare system, or at least a
setting that we can go to.
But yeah, that's it is mind.
(09:31):
I mean just how drastic thosedifferences are, isn't it Cause,
yeah, each of them are going toget slammed satisfaction rise
in some capacity.
But you're right, there aresome in which they're very much
praised, and to see the VApraise like that was kind of a
shocker to me.
Aaron (09:47):
Yeah, no doubt.
So to wrap this up, this is aquick conversation.
After all, it's certainly thedeath of the CEO Brian.
It's a terrible individualhuman tragedy, but in those sort
of moments I think those canbecome touchstones within a
society, particularly as one isseemingly fractured, as we are,
(10:10):
that a whole bunch of people whoagain previously were
disagreeing are now suddenlyagreeing that, okay, something
is horrifically broken here andit needs to be fixed.
So I guess my hope for 2025 isthat this has now sparked a new
conversation about how can we beaddressing health care and
(10:30):
satisfaction with care in thefuture.
Jason (10:34):
Yeah, I think we all share that sentiment.
Hopefully we go into 25 alittle refreshed and look for
positivity and some good changethat we can make.
Aaron (10:42):
Okay, folks, this was a slightly heavier than usual
episode.
I appreciate you sticking withus, and next week, when we come
back, we're going to have alittle bit of Christmas cheer to
share with you.
So thanks for checking in withus and, jason, thanks for
talking about this topic.
Jason (10:59):
Thanks Aaron, Thanks everybody, have a great day.
Aaron (11:03):
Alrighty folks, that's a wrap on this episode of Beyond
the Stethoscope VitalConversations with SHP.
I'm Aaron Higgins and I'm Jason.
Jason (11:11):
Crosby.
This show is brought to you byStrategic Healthcare Partners.
Our executive producers areMike Scribner and John Crew.
Who probably by now deservemedals and our editor is Nyla
Wiebe, who polishes ourramblings into something
listenable and shout out toJeremy Miller, our social media
manager, with Boost by Design,keeping us trendy and
(11:33):
meme-worthy.
Aaron (11:34):
And let us not forget our toiling robot transcriber, who
catches about 90% of what we sayand that other 10% it's tweaked
by Jason, a real-life human,allegedly.
Jason (11:47):
Wait, here's proof, right in this episode.
You can dig through our podcastarchive at shplccom slash
podcast Pretty clever Check outall the episodes and even learn
about what SHP can do for you.
Aaron (12:01):
And while you're at it, find us on Facebook and LinkedIn
, Drop us a comment, ask aquestion or just let us know if
you made it to the end of thisepisode without zoning out.
Jason (12:10):
thanks for hanging out with us.
We'll see you next week, sametime, same place.
Bye for now, later Gator.
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