So, there’s this guy named Bob Herman who spends his days digging into health insurance, government programs, hospitals, doctors, and all that jazz. He’s got this newsletter called Health Care Inc., and you can hit him up on Signal at bobjherman.09. Recently, in sunny San Diego, Optum, which is part of UnitedHealth Group, is cooking up a new way to figure out how sick Medicare patients are. And get this, they’re using artificial intelligence to do it instead of just relying on what the doctors jot down in their notes.
Ken Cohen, a doc and big shot at Optum, spilled the beans at a conference hosted by America’s Physician Groups. He mentioned teaming up with the Duke-Margolis Institute for Health Policy to whip up this fancy new Medicare risk coding system using AI. Why? Well, UnitedHealth and Optum have a lot riding on this new coding system. Turns out, the whole company is under the microscope for possible fraud related to Medicare Advantage. Yikes. The Wall Street Journal just dropped this bombshell, adding to the mess with civil investigations on their billing and coding practices, not to mention an antitrust probe.
Now, you may be wondering, what’s the big deal with all this AI stuff? Who knows, but it seems like Optum and UnitedHealth are pretty invested in making sure they’ve got their bases covered when it comes to coding Medicare patients. It’s like they’re trying to stay one step ahead of the game, especially with all these investigations breathing down their necks. But hey, can’t blame them for trying to play it safe, right?
Alright, so Optum, the brainiacs at UnitedHealth, are diving headfirst into the world of artificial intelligence to suss out how sick Medicare patients really are. Instead of relying on what the doctors scribble in their notes, they’re letting AI work its magic. Ken Cohen spilled the beans at this conference, teaming up with the Duke-Margolis Institute for Health Policy to make this happen. UnitedHealth and Optum are sweating bullets over these investigations, so it’s no surprise they’re going all-in on this new coding system. Let’s see if AI can save the day for them.
