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"Patients often fell into a higher-cost billing category after a secondary diagnosis, a condition identified in addition to the patient's primary reason for receiving care. This secondary diagnosis may be derived from single laboratory values, making it particularly well-suited for detection by AI tools. Approximately 70% of the additional costs, more than $650 million, were tied to secondary diagnoses."
So if these are true positives they're jist finding more stuff? How does that work with no treatment changes
Just guessing: people are being diagnosed with additional conditions because of AI, which changes the coding and that's what the visit is billed to the insurance under, but the patients don't have the time or money to pursue further treatments for these conditions (take the example they use, hemoglobin transfusion for treatment of anemia, takes hours per session and costs thousands which under a high deductible plan comes entirely out of pocket).
AI is being put to good use by doctors, its pattern recognition and relevant memory are identifying health issues doctors miss, and BCBS is trying to spin it as "look, they're not getting treatments for the diagnosed conditions, there's a disconnect and it's why we raised your insurance cost by 30%, someone has to stop this", when in reality the diagnoses is not bad (they would say that if they had evidence of that), but people working 2 jobs to survive don't have time or money to pursue testament before it's an emergency.
The tone of this Luke Chalker from BCBS is truly disgusting. “If patients are truly sicker, we'd expect to see more treatment,” said Luke Chalker, BCBSA’s senior vice president of product and data science. “For example, we're seeing significantly more anemia diagnoses at these hospitals without a corresponding increase in transfusions. The disconnect between diagnoses and treatment suggests that AI is identifying more billable conditions, not sicker patients.”
And David Merritt, BCBSA’s senior vice president of external affairs, is even more disgusting: "As families face higher healthcare costs, this research underscores the urgent need to better understand these AI tools and the role they may play in exacerbating the affordability crisis.”
It doesn't cross their mind that expensive time consuming treatment isn't being done because it's excessive and time consuming, must be doctors trying to scam the honorable insurance companies. Won't you think of the families?
The insurers racheted it one way to lower their costs previously, now the medical people are trying to push the system back the other way to increase their profits. This battle will continue using any and all tools until the system is changed. Nothing new here.