Monday Morning Update 10/21/24

Top News

A US Senate subcommittee report finds that UnitedHealthcare, Humana, and CVS disproportionately denied prior authorization PA requests for post-acute care in their Medicare Advantage patients, often by using AI-driven tools.

• UnitedHealth’s denial rate doubled between 2020 and 2022 as the company  implemented “Machine Assisted Prior Authorization” and “[Healthcare Economics] Auto Authorization model.”
• CVS saved $660 million in one year by denying inpatient admissions. It tested and then abandoned a predictive model that was too generous in approving cases.
• Humana coached its reviewers in how to explain denials to the ordering providers. The Subcommittee was not able to assess the company’s use of technology to deny PA requests, but notes that Humana has been a NaviHealth customer for years.

The report recommends that CMS audit denials, especially for targeted services, and expand its regulation of utilization management committees to ensure that predictive technologies don’t exert undue influence on human reviewers who might be pressured to “rubber-stamp the recommendations of algorithms and artificial intelligence.”

HIStalk Announcements and Requests

Most poll respondents don’t sneak looks at their phones during meetings except to check email or texts.

New poll to your right or here: What is the worst HR action you have experienced in the past two years? “Worst” in this case means whatever one you found to be most disappointing. I ran this poll three years ago and being laid off was the top answer, probably because it was peak COVID.

Most respondents to my one-off poll said that they would not listen to a NotebookLM-created podcast of the week’s top news. I was going to create another one for this week, but I found it frustrating that the “hosts” mispronounced HIPAA as “HYPE-uh.” The Google team has cranked out a lot of improvements to NotebookLM, so maybe they will add the ability to create a pronunciation guide. 

A Reader’s Notes from Nashville Health Care Council’s Sessions Conference

Toby Cosgrove (interviewed by Bill Frist)

• Cosgrove was unemployed for a period after his residency.
• He made a point about letting clinicians practice at the top of their license and pushing administrative burden down the chain by talking about his experience serving in Vietnam. He led a 100-bed field hospital there with a total of two physicians, 15 nurses, and an army of service members who took care of everything that didn’t require true clinical expertise.
• He’s a proponent of AI scribes and sees AI playing a larger role in clinical care in the coming years.
• At Cleveland Clinic, they started an initiative to find and follow up with the first 1,000 coronary bypass patients to assess their wellbeing and outcomes. It took hiring private detectives to track down some of the patients. They maintained this culture of review and continuous improvement until they made bypass a very safe procedure.
• He says that one of the top issues in healthcare is the explosion of knowledge and data and our inability to stay on top of it all.
• Provider burnout and the shortage of providers came up numerous times during the conference. Apparently one-third of nephrology residency slots go unfilled each year.

David Feinberg, Oracle Health

• He says that innovation hasn’t come to healthcare as much as other industries because we’ve skipped steps in the tech process. For example, with Meaningful Use, we paid people to use software, but didn’t evaluate whether the software is helpful.
• He advocated for a nutrition label of sorts for AI that tells you how the system was trained, and which data points it uses.
• He said that when Oracle was buying Cerner, Oracle made several decisions that made him question the success of the deal, so he felt incentivized to leave within a year to redeem his golden parachute. He even told his wife he was out within a year. But he says he stayed the course because those decisions were reversed and because Larry Ellison has allowed the Cerner team to be the healthcare experts while the Oracle team are the tech experts.
• He says that they applied previously created software and solutions to create the Clinical Digital Assistant and a new patient intake product. For the latter, they borrowed from work that Oracle has done in developing inmate intake systems for prisons.
• CDA has 70 customers using it since its June launch.
• He said a new EHR that is rooted in AI is coming, with more details to be shared at the Oracle Health Summit in a few days in Nashville. He says it’s ready for ambulatory and will be ready for inpatient sometime next year.

A Reader’s Notes from Vanderbilt’s Health AI Sessions

Brad Malin, professor of biomedical informatics, biostatistics, and computer science

• There is a real risk of LLMs, including GPT-4, divulging training data through a carefully crafted prompt. Providers need to be cognizant of this if they are providing identifiable data for model training; there’s a reasonable chance it could be exposed.
• Research has shown that introducing a little synthetic data into the training set for an AI model can reduce model bias, but you can reach a point where too much synthetic data eliminates any benefits.

Daniel Fabbri, assistant professor of biomedical informatics and computer science

• VUMC spends $5-10 million per year on chart abstraction. Reliant upon expensive abstraction staff and requires lots of time and manual review.
• Asked the question, “Can we build a system that allows non-technical users to attain 90% faster abstraction for a range of medical research tasks with human-level accuracy?”
• First tried a not-so-technical approach: crowdsourcing the work through a group of medical students. This was still slow and resource-intensive.
• Tried ChatGPT as a way to analyze and extract the pertinent data points; it was “okay”.
• Ultimately created a new tool called BRIM that has reduced abstraction time for cancer research from 5 minutes per note to 15 seconds. All Vanderbilt staff, faculty, and students can use the tool with IRB approval. They also achieved 80% time reduction in mental health case review with human-like accuracy, and they recently won an ARPA-H funding award.
• One key decision they made was to introduce a design requirement that every BRIM-generated data point must include the raw text from the source note, so that a human can quickly see where the LLM abstracted the information from and can easily verify accurate selection of pertinent information.

Jesse Spencer-Smith, director and chief data scientist for the Data Science Institute

• Gave a very helpful overview of what a transformer in AI actually is.
• He says that giving AI greater context (e.g., more input data or a longer conversation history) reduces hallucinations.
• He says that we are seeing small (“small” meaning lighter weight and with fewer parameters) open-source AI models that have similar performance to ChatGPT, which will open up AI to function on small devices such as smartphones).

Webinars

October 24 (Thursday) noon ET. “Preparing for HTI-2 Compliance: What EHR and Health IT Vendors Need to Know.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Tyler Higgins, senior director of product management, DrFirst. Failure to meet ASTP’s mandatory HTI-2 certification  and compliance standards could impose financial consequences on clients. The presenters will discuss the content and timelines of this key policy update, which includes NCPDP Script upgrades, mandatory support for electronic prior authorization, and real-time prescription benefit. They will offer insight into the impact on “Base EHR” qualifications and provide practical advice on aligning development roadmaps with these changes.

Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

CVS Health fires CEO Karen Lynch and promotes David Joyner, who runs its CVS Caremark pharmacy benefits management business, to replace her. The company also reduces guidance due to increased medical costs, sending CVS shares down more than 5% on Friday.

Cigna has reportedly restarts merger discussions with rival insurer Humana. The companies had ended those negotiations last year after failing to agree on terms.

Sales

• MaineGeneral Health chooses Sectra’s hosted enterprising enterprising solution.
• GaHIN migrates to InterSystems HealthShare.

People

Michael Raymer (Simulations Plus) joins Vitalchat Telehealth as CEO.

Providence CIO/EVP B. J. Moore announces his resignation.

Announcements and Implementations

Artera announces new AI co-pilots: Staff (translation, predictive text for patient inquiries, message shortening, and conversation summaries that can be saved to the EHR) and Insights (no-show reports).

Zoom announces Workplace for Clinicians, a paid offering that includes visit transcription with AI-generated clinical notes and displaying EHR data as a visit prep summary.

The Coalition for Health AI (CHAI) publishes draft frameworks of how it will certify independent quality assurance labs and standardize their test results into what it compares to a nutrition label for AI product performance and safety.

Privacy and Security

Axis Health System alerts patients and employees that ransomware hackers have posted their data to the dark web after the health system declined to pay a $1.7 million ransom.

Sponsor Updates

• Revuud team members join Reynolds Baptist Church volunteers in their Hurricane Helene clean-up efforts in Asheville, NC.
• Wolters Kluwer Health adds AI search, robust analytics, and insights to the latest edition of its UpToDate Enterprise Edition.
• Nordic and BeeKeeperAI partner to accelerate AI-driven clinical decision support at the point of care.
• The EClinicalWorks Image AI Assistant saves York Primary Care (ME) over an hour per day on managing incoming faxes.
• Greater Houston Healthconnect will connect charitable clinics across Texas at no cost using technology and services from InterSystems and J2 Interactive.
• Netsmart and WellSky and exhibit at the National Association for Home Care and Hospice Conference and Expo October 20-22 in Tampa, FL.
• Health Data Movers posts a new episode of its “QuickHITs” podcast, “Healthcare Innovation and Informatics with Dr. Nitu Kashyap.”
• Nordic releases a new “Designing for Health” podcast, “Interview with Bryan Vartabedian, MD.”
• QGenda receives Authority to Operate certification from the Indian Health Service.
• Waystar publishes a new case study, “AnMed Health’s way forward.”

Blog Posts

• Innovation in Care Coordination: Bridging Gaps for Better Patient Outcomes (Netsmart)
• Get More Value Out of Your EMR With the ServiceNow Platform (Optimum Healthcare IT)
• Implementing a Healthcare Workforce Management System: 5 Common Challenges and Practical Solutions | Part 2 (QGenda)
• From Complexity to Simplicity: One Clinic’s Journey to Corepoint (Rhapsody)
• How Predictive Scheduling Technology is Maximizing Efficiency and Improving Patient Care (SnapCare)
• Meaningful Innovation Starts with Collaboration (Surescripts)
• Community Champions: How West Feliciana Parish Hospital Is Improving Community Health (TruBridge)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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