15 ms·
There is another real-world version of this in the US healthcare system, where doctor offices are using domain-specific LLMs to craft multi-page medical approva
by crmd 2y ago
There is another real-world version of this in the US healthcare system, where doctor offices are using domain-specific LLMs to craft multi-page medical approval requests for procedures that cover every known loophole insurer’s use to deny, which are then being reviewed by ML-powered algorithms at the insurance company looking for any way to deny and delay the claim approval.
In other words we have a bona fide AI arms race between doctors and insurers with patient outcomes and profits in play. Wild stuff and nothing I could have ever imagined would be an applied use of ML research from earlier in my career.
- lfmunoz4 2y ago[flagged]
- DonHopkins 2y ago[flagged]
- deleted 2y ago[deleted]
- dpflan 2y agoInteresting. Do you have any examples to share?
- mancharface1 2y agoAgree. I'd love to see an example of this, or read more about it.
- starkparker 2y agoThis piqued my interest too. I found a few adjacent papers but couldn't find a source that made as comprehensive of a claim. The closest were: - "In constant battle with insurers, doctors reach for a cudgel: AI" from NYT (via Salt Lake Tribune), 2024 July, which is mostly on doctors using law-compliant LLMs to draft prior authorizations and has a passing one-graf mention of insurers likely doing the same: https://www.sltrib.com/news/nation-world/2024/07/11/constant-battle-with-insurers/ https://www.sltrib.com/news/nation-world/2024/07/11/constant... - "The AI arms race over your medical bill" from Politico, 2024 Jan., summarizing LLM use in coding, billing, and fraud prevention: https://www.politico.com/newsletters/future-pulse/2024/01/05/the-ai-arms-race-over-your-medical-bill-00133883 https://www.politico.com/newsletters/future-pulse/2024/01/05..., linking to https://www.politico.com/news/2023/12/31/ai-medical-expenses-00132557 https://www.politico.com/news/2023/12/31/ai-medical-expenses... and https://govciomedia.com/how-health-tech-leaders-use-ai-to-combat-fraud-2/ https://govciomedia.com/how-health-tech-leaders-use-ai-to-co... Aside from that: "Large Language Models to Help Appeal Denied Radiotherapy Services" from JCO Clinical Cancer Information, 2024 Sept. (abstract only; full-text paywalled) https://pubmed.ncbi.nlm.nih.gov/39250740/ https://pubmed.ncbi.nlm.nih.gov/39250740/ "The potential of large language models in the insurance sector", 2024 Feb. (commercial white paper), largely focused on "fraud detection" in claims: https://www.milliman.com/en/insight/potential-of-large-language-models-insurance-sector https://www.milliman.com/en/insight/potential-of-large-langu... "IQVIA NLP Risk Adjustment Solution (undated commercial white paper), marketing pitch on using AI to improve coding accuracy and reduce chart review times: https://www.iqvia.com/-/media/iqvia/pdfs/library/fact-sheets/iqvia-natural-language-processing-risk-adjustment-solution.pdf https://www.iqvia.com/-/media/iqvia/pdfs/library/fact-sheets...
- z3c0 2y agoIt will take me some time to dig up with all the noise around AI, but this reminds me of a paper published around 2018 or so that explored the possibility of two such AI forming an accidental trust by optimizing around each other. For example, if the denying AI used frequency of denied claims as a heuristic for success, and the AI drafting claims used the claim amount for the same, then the two bots may unknowingly strike a deal where the AI drafting claims lets smaller claims get frequently denied to increase the odds of larger claims. Note: not saying these metrics are what would be used, just giving examples of antithetical heuristics that could play together.
- asdf147 2y agoWow, that sounds very interesting, do you have some link to that paper?
- z3c0 2y agoI'm on the hunt, but no luck. I've tried a myriad of search terms to dig it up, but none are able to surface the paper through all the vaporware and blog pieces on competitive AI.
- 0_____0 2y agoI feel that this sort of autonomous agent co-optimization may happen more often over time as humans step farther away from the loop, and lead to some pretty weird outcomes with nobody around to go "wait what the f---- are we doing?"
- z3c0 2y agoAgreed, and I'm even further worried about the plausible deniability these situations would create.
- jiggawatts 2y agoIt’s so bizarre to me that this uniquely US phenomenon of for-profit-middlemen inserted into the healthcare system has resulted in an adverserial relationship between the sick person and the “healthcare provider”. I put that air quotes because insurance companies don’t actually provide health care. They provide insurance. That’s a financial product, not a medical one.
- superq 2y agoTrue! Really, it's a three-way relationship: customer - insurer: the govt (or, far more rarely, the employer) is the customer insurer - recipient: the recipient is you. You're really just a necessary but unwelcome side-effect.
- wat10000 2y agoOnce AI is able to replace patients, the industry is really going to take off.
- egypturnash 2y agoDeath panels.
- olddustytrail 2y agoWhat about them?
- thephyber 2y agoThe political boogeyman was that government bureaucrats would be the members of “death panels” if we went full socialized healthcare industry, but in practice we already have death panels in health insurance claims adjusters and (less maliciously) doctors on transplant review boards.
- _DeadFred_ 2y agoMy mother beat cancer. Insurance paid for follow up testing every 2 years. I tried to convince her to pay out of pocket and do it every year but she said 'they know best'. My mom did not beat cancer the second time when it came back and too much time elapsed between screenings. I know 'pro status quo' people will say online anecdotes are all lies and not relevant, but there are a heck of a lot of people with a lot of animosity to the current system and it's 'for profit death panels'. I think it would be easier to swallow if it were societal chosen death panels over failed doctors (that can't make it so they go work for the insurance company) or random AIs doing the decision making.
- fallingknife 2y agoThe year is 2035. To cut costs, both insurance companies and providers removed the human from the loop long ago setting off an adversarial process between the LLMs on both sides. Medical insurance claims are now written in an ever changing format that resembles no human language. United Healthcare has just announced a $10 billion project including a multi gigawatt data center to train its own foundational model to keep ahead in the arms race. UNH stock is up 5% on the announcement.
- khana 2y ago[dead]
- YurgenJurgensen 2y agoThe naïveté of I Have no Mouth and I Must Scream is that it would be something as pedestrian as nuclear war that the globe-spanning hate machine would be built to manage. Now we know what AM would really have been built to do.
- starkparker 2y agolmfao: https://www.reddit.com/r/healthIT/comments/1eblbk1/comment/lf4cvi6/ https://www.reddit.com/r/healthIT/comments/1eblbk1/comment/l...
- crakenzak 2y agoInteresting! Source?
- CoastalCoder 2y agoWhat really grinds my gears is the CO2 emissions and power-grid load that's being used for this stupid arms race. I realize that there's no magic solution to perverse systems like this, but it really bothers me nonetheless.
- jnwatson 2y agoInference uses hardly any compute. You should be complaining about computer games for real compute use.
- ranger_danger 2y agoI'm pretty sure they meant emissions/load from inference and/or training TIMES all the current LLM users on the Earth...
- ethbr1 2y agoYes, but you've got to balance that against the equivalent human processing time. Meatbags are notoriously carbon-intensive to feed.
- tsimionescu 2y agoHumans use tiny amounts of energy compared to even a smartphone. And they consume the vast majority of that energy regardless of whether they're lounging in bed or pouring over medical records.
- jlebar 2y agoA human burns say 2000 kcal / day. That's about 2.3kW hours / day. An iPhone 16 pro battery appears to have about 18 watt hours. So approximately 100x less then a human uses.
- tsimionescu 2y ago
- dataviz1000 2y agoInteresting. My next door neighbor ten years ago was a lawyer a couple years out of law school. He discovered that he could pour through hundreds of medical charts a day and find cases where the doctor under billed the insurance company. He would then sue the insurance company, settle, and split the profits with the doctor. More or less he was mining the charts. He would sometimes pull up next door with a half dozen tote boxes overflowing with medical records. He would say "hey, dataviz1000, can you help me get these into the house?" He once asked me if I wanted a new job helping him go through all the charts. I don't get involved with illegal activities and I was earning more not breaking the law elsewhere. He did hire a young woman who graduated law school and was still working on passing the bar. Since they have married and started a family. Yes, HIPAA laws got broken! Yes, this guy made 10s of millions in a few short years. There are no good guys in this story. Probably would make a good start up using LLM and bringing the process into compliance with HIPAA. There is probably several billion dollars in insurance companies that have been under billed.
- ec109685 2y agoAre you sure it was illegal? HIPPA carves out this exception for using your health records: “To pay doctors and hospitals for your health care and to help run their businesses”
- dataviz1000 2y agoWith HIPAA you have to track and store the information every person who touches or reads the medical chart. The issue was more to do with random people reading medical charts. It isn't difficult to bring the process into compliance. I offered to make an app which would have been easy because there was a predefined workflow that can be diagrammed on a sequence chart in about 10 steps. There were a couple interactions between the lawyer and the doctor. Then a step where the insurance company is notified. Then a lawsuit filed if not paid. At one point, I was researching how to store data in HIPAA compliance in the cloud. It was about 2 years later when AWS provided HIPAA compliant EC2 instances. I offered to build the app for $10,000. Having random people pour over private medical charts and undocumented and haphazard communication between the lawyers, insurance company, and doctors through email and text messages was a mess.
- rscho 2y agoWell, docs have seen this coming from miles away. I don't think anyone having substantial experience in clinical medicine is surprised by those developments, unfortunately. But it doesn't stop here. Insurance companies will be (are) building models to overcome legal barriers. Imagine: you're 20 and healthy, but located somewhere suggesting a higher risk of developing some chronic disease in the future ? Then no insurance covering this particular condition, for you specifically. A real-world application of the 'fuck you in particular' meme. This of course extends to all sorts of sensitive matters, such as your ethnicity, sexual preferences, etc. Now this is a really scary application of AI, but you won't hear those wanting AI regulation such as Musk complain about that, right?
- deleted 2y ago[deleted]
- ethbr1 2y agoThat's one reason (among many) the preexisting condition part of ACA is so important. Without it, health insurance companies would have every incentive to do what car insurance companies do -- buy profiles and records from third parties and use those to adjust rates and willingness to insure. E.g. the obvious step of buying genetic information from 23andme, because it isn't covered by HIPAA
- nradov 2y agoGINA prohibits health insurance companies from using genetics to deny coverage or set premiums. https://www.hhs.gov/hipaa/for-professionals/special-topics/genetic-information/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/g...
- ethbr1 2y agoI'd feel a lot better with customer-centric privacy protections around the collector and storer, a la HIPAA. Instead of regulating only some of the uses. HHS already had to administratively extend to cover gaps (we'll see how that goes, post-Chevron) and Congress attempted to repeal it for workplace purposes in 2017. And there's still the gray market question about 23andme -> Equifax-alike packaging it into a blended proprietary risk score -> insurance companies using that (of course 'without knowing that genetic information was included').
- deleted 2y ago[deleted]
- IG_Semmelweiss 2y agoThis is coming and there's a very simple fix. Make healthcare insurance be actual insurance: as in, not a gateway to treatment conditions that are entirely lifestyle driven. Once patients are responsible for the bill and the large middle layer admin crud is taken off the table, medical inflation almost disappears. Take this example of a for-profit facility vs non-profit hospitals [1] Ideally this happens once environmental factors are fixed or drastically reduced so diet and lack of time are "choice-driven" instead of "needs driven" as health determinants (you do have subsidies at the lowest end, but that cannot go on forever). https://www.openhealthpolicy.com/p/cash-providers-cheaper-surgery-center-oklahoma https://www.openhealthpolicy.com/p/cash-providers-cheaper-su...
- 6ix8igth 2y agoHow do you delineate between conditions that are "lifestyle driven" and not? When you develop a problem with your body it doesn't come with a receipt listing the cause. I've personally had postural issues that were for many years simply attributed to poor discipline. It later turned out that I have a connective tissue disorder that was destroying the joints in my body. All you I can see your proposition doing is giving insurures another reason to decline potentially legitimate claims. Your case would be more rational if you were arguing for no insurance at all.
- brigandish 2y agoMedical authorities make a list, and people applying for insurance answer lifestyle questions like "do you smoke?", "do you exercise?" etc and they have an initial exam. It's not that hard. In the example you've given you could sue the doctors for misdiagnosis, or if research showed that a condition had been mislabelled, people would receive compensation. It doesn't seem any more onerous than any of the other negotiations over conditions and treatments that go on in any medical industry and legislature anywhere in the world.
- 6ix8igth 2y agoOne can smoke and have a condition that is not caused by smoking, just like one can avoid exercising and have a condition that is not caused by insufficient exercise. You can't compile a list of facts about a person's life and use that to deterministicly attribute the cause of given conditions. Does having one vice deny a person for life from having coverage for any disease which my potentially be caused by that vice? How long must a person partake in this vice to be denied coverage for life (i.e. is it okay to smoke for a few years then quit?) Your example also has the problem of measuring the "lifestyle questions" being presented. How would you prove a person isn't exercising enough? If I know it will get me denied I'm not going to self report. We would need some sort of invasive "health audit" industry to insure compliance with insurance requirements. A physical exam at the start of insurance doesn't solve this, because like I said, the existing issues could have been caused by any number of problems. Your dismissal of my specific example is silly - I don't want to sue a doctor for misdiagnosing a relatively common issue. Connective tissue disorders are not that rare, and I'm far from unique. Do you want to live in a society where we have to fight tooth and nail to get basic care for problems on the basis that we might have caused them ourselves?
- vjk800 2y agoThe real fun starts when they start writing the insurance contracts that are only meant to be readable by ML algorithms. Imagine thousands (millions?) of contract pages written in practically incomprehensible language, designed by an ML algorithm to contain clever loopholes that are difficult to detect by an adversarial algorithm.