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.
Guest: Jason Crosby, VP Network Integration & Strategic Planning
Jason currently serves as the Vice President of Strategic Planning & Network Integration for Strategic Healthcare Partners (SHP) of Savannah, GA, with whom he has been employed for 13 years. With SHP, he oversees the Clinically Integrated Network activity, as well as the Business Development and Strategic Planning function.
Prior to joining SHP, Jason served as Finance Director for Georgia Emergency Associates, Decision Support Manager at Memorial Health, and as a Finance Lead with Gulfstream Aerospace.
Guest: Aaron Higgins, Data Manager & IT Strategist
Aaron Higgins has worked with SHP since 2019 as the Data Manager and all around Quality Payment Program expert. In 2021, his role expanded to include IT Strategy to help SHP navigate the changing IT landscape in a post-COVID workplace.
Prior to working at SHP, Aaron worked in various private practices starting in 2008, where he typically held dual roles as both the Health IT Administrator and Meaningful Use/PQRS Manager, and in 2015 he moved to the Savannah area to oversee the Quality Payment Program for a private practice.
Every year, since coming to SHP, Aaron has provided a webinar series updating QPP eligible practices on the proposed & final rule changes coming to QPP (recordings of which can be found on the SHP website).
Transcript
Speaker 1:
Hi there, folks. Before we get started, I do want to give you a little bit of a disclaimer. What we’re going to talk about today 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 UnitedHealthcare was murdered in the streets of New York just prior to a shareholder conference. Just prior to a shareholder conference. While we’re going to be talking about that today, we’re not going to really focus on the action itself, but maybe some of the things that have led up to it and some of the more sensitive subjects around claims denials. So if this isn’t the sort of conversation you’re looking for, maybe skip today’s episode. All right, let’s get with it. Well, hey there, jason. How are you doing today? Aaron, I’m well. How are you.
Speaker 2:
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 in the air, or at least you want it to be, but yeah good season.
Speaker 1:
Yeah, it is. So. You know, for our regular listeners, typically, jason and I, if you’ve been listening for a while we’ll talk about the latest headlines and some. Ai has been a big topic and that sort of thing, and today we kind of want to go a slightly more serious tone.
Speaker 1:
The CEO of UnitedHealthcare was gunned down in the streets fairly recently and I know the topic has been talked to death by everybody. No pun intended, but I don’t really want to focus on the murder itself. I think today what I want to talk about is more the business aspect of it. A lot of that talk online has revealed a lot of frustration by clinicians, by the business side of healthcare, with the way that healthcare denials have been. So, jason, this is a touchy subject, obviously, so I want to handle it with a little bit of care. What have you seen from our own client base and maybe what comments you’ve read online? Is some of this underlying angst around? Why? Maybe this assassin did what he did At the time we recorded this? They believe they got the guy, so we will kind of know his motives, but the online world has been abuzz with this for the last week.
Speaker 2:
Yeah, definitely caught us all off guard, didn’t it? And now you get videos. It’s so easy nowadays to see such an event, an unfortunate incident. We heard a lot of the reasoning being related to denials, for example, and those in industry know where united stands on that. And then there’s the ai component in terms of the platform that they use, which you’ve had that type of episode for us in the past before as well, and ai is going to be more prominent of of an item in our industry and into another thing. That kind of popped in my head as I saw it was.
Speaker 2:
We talked a lot in our industry right after COVID, for example, about workplace violence, right, and just especially for clinicians. Well, this time, obviously it wasn’t a clinician, it wasn’t necessarily in a workplace, but it’s still within our industry at a healthcare conference taking place and we all go to conferences and that sort of thing. And so those are the three items that I kind of took away in terms of things that I read or underlying tone that may impact us. You get the denials component that may have, and of course, we’re all speculating, right, but you know, denial management has always been a thorn in our industry. Now we have AI as something that we’re not used to, so it’ll be interesting how those components come to light over the next couple of weeks, but that’s definitely been the theme I keep picking up on.
Speaker 1:
Independent physician associations play a crucial role in delivering quality healthcare while allowing physicians to maintain their autonomy. At Strategic Healthcare Partners, we manage the full spectrum of IPA services, including managed care, contracting, practice enhancements and member education. Our goal is to empower physicians to secure their current and future patients through an organization governed by physicians for physicians, whether you’re part of a statewide IPA. A of AI. On UHC’s recent implementation of a new AI claims evaluator and something like 90% of its denials were denied by the AI and then never actually reviewed by a human. So I can certainly see that there’s a lot of concerns and obviously it is very clear that I’m a huge fan of AI. I see a lot of potential benefit with it, particularly in the healthcare realm. But do you think that these technologies are potentially a little too premature to be put into such a place where people’s lives are literally at stake People’s lives are literally at stake, Especially with something that’s such a complex process and workflow and document management.
Speaker 2:
right. We all know that with denials there’s a lot of hoops it’s going through systematically to get 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 many filters in place. Whatever the case may be, I fully agree with you. It almost feels like maybe they jumped the gun a little bit, or some organizations have.
Speaker 1:
It is interesting and I think it’s very clear, particularly those of us who have 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, emerging technology. Ai makes mistakes, it makes a lot of mistakes, and responsible use of AI requires a human being. Just like you and I were talking about earlier today. Jason requires a human being to come in behind it, clean up, make sure those mistakes are removed and that the information is verified.
Speaker 1:
It’s that trust but verify that seemed to be missing here with UHC. So let’s not focus too much here on UHC. That seem to be missing here with UHC. So let’s not focus too much here on UHC. Seeing a lot of the comments online about the vitriol kind of almost a brothers in arms you know there’s no atheists in foxholes People who just a few weeks ago, were tearing each other apart over which of their favorite candidate was going to win the presidency are suddenly united in their dislike of the healthcare system in the United States. Do you think this has sparked, potentially, a conversation nationwide in that regard? What do you think might be some of the outcomes from this, aside from what will undoubtedly be a very traumatic murder trial, oh, you can’t help but think it can do anything.
Speaker 2:
But that right At least part of the conversation. Whatever is truly proven and if it is denials, for example, that we keep thinking it is you’ve got to think that’s going to jump to the forefront of conversations come next year, post-january 20th, and how that becomes more of a health care discussion than it has in the past, and you hate that such an incident occurs. Hopefully you know. Some of the good I can come out of is just conversations on how to improve a flawed process and a flawed system.
Speaker 1:
I saw somewhere at which I kind of had to laugh to myself about how how the approval rating of insurance companies has taken a huge hit in the last week, where they’ve always kind of been low bar kind of Congress level of approval here. But they’ve taken a real hit as people start to kind of talk about this and start comparing notes in very frank and honest ways online. And I saw, though, that of the payers that exist out there, the number one most liked and it’s like 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 like me are going to be taking notice of that and going well, okay, if the VA can be run with an 85% satisfaction level and these other guys are running in the single digits of approval level, Boy, that that certainly changes the conversation, doesn’t it?
Speaker 2:
Something’s up. Right, you almost wish you can pick and choose. Okay, I like this off the menu, I like that off the menu in terms of different provider settings and ownership and entities that manage those facilities, and voila, we put together the perfect recipe for healthcare system, or at least a setting that we can go to. But yeah, that’s it is mind. I mean just how drastic those differences are, isn’t it Cause, yeah, each of them are going to get slammed satisfaction rise in some capacity. But you’re right, there are some in which they’re very much praised, and to see the VA praise like that was kind of a shocker to me.
Speaker 1:
Yeah, no doubt. So to wrap this up, this is a quick conversation. After all, it’s certainly the death of the CEO Brian. It’s a terrible individual human tragedy, but in those sort of moments I think those can become touchstones within a society, particularly as one is seemingly fractured, as we are, that a whole bunch of people who again previously were disagreeing are now suddenly agreeing that, okay, something is horrifically broken here and it needs to be fixed. So I guess my hope for 2025 is that this has now sparked a new conversation about how can we be addressing health care and satisfaction with care in the future.
Speaker 2:
Yeah, I think we all share that sentiment. Hopefully we go into 25 a little refreshed and look for positivity and some good change that we can make.
Speaker 1:
Okay, folks, this was a slightly heavier than usual episode. I appreciate you sticking with us, and next week, when we come back, we’re going to have a little bit of Christmas cheer to share with you. So thanks for checking in with us and, jason, thanks for talking about this topic.
Speaker 2:
Thanks Aaron, Thanks everybody, have a great day.
Speaker 1:
Alrighty folks, that’s a wrap on this episode of Beyond the Stethoscope Vital Conversations with SHP. I’m Aaron Higgins and I’m Jason.
Speaker 2:
Crosby. This show is brought to you by Strategic Healthcare Partners. Our executive producers are Mike Scribner and John Crewe. Who probably by now deserve medals and our editor is Nyla Weeb, who polishes our ramblings into something listenable and shout out to Jeremy Miller, our social media manager, with Boost by Design, keeping us trendy and meme-worthy.
Speaker 1:
And let us not forget our toiling robot transcriber, who catches about 90% of what we say and that other 10% it’s tweaked by Jason, a real-life human, allegedly.
Speaker 2:
Wait, here’s proof, right in this episode. You can dig through our podcast archive at shplccom slash podcast Pretty clever Check out all the episodes and even learn about what SHP can do for you.
Speaker 1:
And while you’re at it, find us on Facebook and LinkedIn, Drop us a comment, ask a question or just let us know if you made it to the end of this episode without zoning out.
Speaker 2:
Mr Poyme, thanks for hanging out with us. We’ll see you next week, same time, same place. Bye for now, later Gator.