Medicare's new payment model is built for AI. Most of the tech world has no idea

bbrandonb about 4 hours ago 26 commentsRead Article on techcrunch.com

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brandonb•about 3 hours ago

I run a YC startup that was accepted to Medicare ACCESS.

Historically, insurance has paid for activity: time spent in visits, RVUs generated, and minutes logged. This was a reasonable starting point, but the flaw is that there's no strong incentives to be efficient.

ACCESS is explicitly a "deflationary" approach. Medicare has set the payment rates high enough to be viable for startups, but low enough that you have to use software (including AI) to deliver a large part of your program.

So Medicare has basically created economic incentives to reward software without prescribing the exact shape of the programs. I thought it was a really interesting approach and builds on 15 years of lessons from CMMI (Medicare's innovation group).

caycep•about 2 hours ago

I would maybe modify this to say - there is a strong incentive to be efficient - you only make so much money per encounter, DRG visit to the hospital, etc. So the pressure from "management" on a lot of us clinicians is to see more people per day, make each hospital visit as short as possible, etc. Medicaid providers now see something like 50-60 patients a day because the per-patient visit is relatively low. But there isn't as much incentive for outcomes. I think CMS has tried it in the past, but with varying success. Whether this new mousetrap will work, who knows.

brandonb•about 2 hours ago

The existing CPT codes (roughly) pay proportionately to physician time (RVUs). So I wouldn't say there's an an incentive toward delivering care efficiently, but rather hospital management wants to maximize billable hours.

ineedasername•about 2 hours ago

>rewards health outcomes rather than required activities… earn the full amount only when patients meet measurable health goals, like lower blood pressure or reduced pain

They’ll just start cherry picking their patients, finding ways to squeeze out the people just that little bit lower on the prognosis curve. Or at least that will be the risk in a setup like that.

throwway120385•about 2 hours ago

One might argue that that's the goal. There's the approach we've taken of trying to help people, and then there's the approach some people want, which is to treat every problem as if it is an entirely individual problem and treatment has to be earned by trying to will yourself out of the problem.

myhf•about 2 hours ago

Billing Medicare for services that never get performed is a particularly offensive kind of fraud. I hope these criminals get a harsh sentence.

lazyasciiart•about 1 hour ago

I think this is less offensive than the kind of scheme where a hospital billed for doing actual heart surgery on patients who didn’t have heart problems. https://www.sfgate.com/health/article/REDDING-Settlement-in-...

gowld•about 1 hour ago

The worst one in history was elected to the Senate.

https://en.wikipedia.org/wiki/Rick_Scott

swe_dima•about 3 hours ago

Is it basically about giving as much data as possible to insurance companies?

brandonb•about 2 hours ago

Medicare is a government-run insurance program, so this is one of the few cases where a private insurance company wouldn't receive data.

(There is such a thing as Medicare advantage, where a patient can choose to put their Medicare dollars toward private insurance, but it's not part of the initial launch of this program.)

bonsai_spool•about 3 hours ago

It seems that TechCrunch, not a strong source of news since around 2014/15, is now just sending out AI text:

First the title: "Medicare's new payment model is built for AI. Most of the tech world has no idea", classic AI tell. The by-line is by the editor-in-chief.

Em-dashes everywhere, including in this quote, somewhat unusually: “The best solution wins, which, in regulated industries like healthcare — that’s not been the case.”

Oddly-short paragraphs: "That payment structure is the real news."

Rule of threes: "Pair Team launched in 2019 with a specific kind of patient in mind: people managing chronic conditions who were also dealing with unstable housing, too little food, or lack of transportation"

This whole paragraph: "There are real risks. Participants are feeding extraordinarily sensitive patient data — intimate conversations about housing and diseases and mental illness — into a federal infrastructure with a documented history of breaches, including exposed Social Security numbers. For the vulnerable populations ACCESS is designed to serve, that's not an impractical concern."

---

I haven't opened a TC article in years and I think I'll return to that practice.

I think there's an ongoing conversation about whether we should accept all LLM-generated text without commentary.

I write this comment because I have some sympathy for a Show HN with AI-assisted writing, but I will not spend time enriching TechCrunch's use of machine-generated text anymore than I would scroll through an ad block at the end of any other article.

brandonb•about 2 hours ago

Isn't the first em dash taken from an interview that the writer did with the subject over Zoom? I think using an em dash to punctuate a broken or partial sentence like that is pretty standard journalistic practice when you don't want to modify the original quotation (e.g, denote a paraphrase with brackets), and definitely not an AI tell.

The other uses are honestly pretty standard rhetorical patterns; they do not seem especially AI-flavored to me.

AndrewKemendo•about 3 hours ago

>The company's premise was that you can't improve health outcomes without addressing the full context of someone's life

They are absolutely correct about this mathematically, you can’t solve problems you don’t have data for

The question is what organization would I trust with the full context of my life. None. Zero.

**future headline: Consumer warning: The panopticon(tm) product is embedded into your care plan, insurance is only available for panopticon subscribers.

spwa4•about 3 hours ago

> The first call that shifted his thinking was with a 67-year-old woman living out of her car, managing PTSD and congestive heart failure. She spoke with Flora for over an hour. "It was both incredible and depressing," Batlivala told me. "Flora was probably the only 'person' she'd talked to in weeks about her situation." Now, hourlong conversations with Flora are routine. "That's the companionship piece," he said. "And it turns out that is truly an intervention."

People don't seem to realize that this is both coming and that before long people will be defending AI "persons" because of this reason (OpenAI is already complaining about people doing this). Nobody's going to deliver this level of care using humans. It's not going to happen.

A lot of people needing care are deeply isolated and will be of the opinion that AI changes that.

esseph•24 minutes ago

Every psychologist and therapist I have talked to about using LLMs in place of personal interactions (just discussion about this topic) have all said roughly the same thing:

Any attempt to use LLMs as a substitute for personal interaction is playing an incredibly dangerous game that will probably make them a lot of money, while hurting a lot of people.

d0liver•about 2 hours ago

Gross .