{"id":4621,"date":"2024-12-10T09:00:29","date_gmt":"2024-12-10T09:00:29","guid":{"rendered":"https:\/\/pwer.com\/?p=4621"},"modified":"2024-12-11T17:55:16","modified_gmt":"2024-12-11T17:55:16","slug":"the-consumer-of-healthcare-2025-unitedhealth-ceo-assassinated-consumers-are-angry-and-the-role-of-ai","status":"publish","type":"post","link":"https:\/\/pwer.com\/?p=4621","title":{"rendered":"The Consumer of Healthcare 2025: UnitedHealth CEO Assassinated, Consumers Are Angry, and the Role of AI"},"content":{"rendered":"

Assassination of UnitedHealthcare CEO Brian Thompson<\/strong><\/p>\n

I delayed discussing the tragic news of the assassination of UnitedHealthcare CEO Brian Thompson on December 4th, 2024\u2014a day healthcare may never forget\u2014until more information emerged, and I could gather my thoughts.<\/p>\n

The reports are varied, and I won\u2019t repeat them in detail. However, there are disturbing elements emerging. A bullet left by the assailant could either signal a motive or be a disguise for something else. The message found on three 9mm shell casings reads: \u201cDelay, Deny, and Depose.\u201d<\/em><\/p>\n

The healthcare industry has reacted with shock, and new safety measures are being put into place\u2014more on that later. What we\u2019ve also witnessed is a tidal wave of anger from consumers, with millions of criticisms directed at healthcare practices, especially related to the high costs of insurance and issues with claim denials. Some reports and lawsuits allege that UnitedHealthcare has been using Artificial Intelligence (AI) to deny claims. More on that later as well.<\/p>\n

It\u2019s important to note that most claims denials occur within commercial insurance, rather than Medicaid or Medicare. Medicare is relatively liberal in its referral procedures, except in extreme cases. Medicare Advantage (MA) plans, on the other hand, experience more delays and denials, though they are also aware of the potential long-term costs of delayed care. I have personal experience with that in my family right now, and we will discuss that shortly.<\/p>\n

News outlets have taken notice of the issues within the healthcare insurance industry. Forbes recently ran a headline, \u201cUnitedHealthcare denies more claims than other insurers\u2014angering patients and health systems\u201d<\/em> (see the graph below from another source). CNN\u2019s headline was \u201cKilling of UnitedHealthcare CEO prompts flurry of stories on social media over denied insurance claims.\u201d<\/em><\/p>\n

\"\"<\/p>\n

There is no excuse for this crime. It is inexcusable. Period.<\/p>\n

My Point of View on Healthcare<\/strong><\/p>\n

I\u2019ve held an insurance license in Florida since I entered the healthcare field, and it is still active today. This education and experience have given me invaluable insight into the numbers behind healthcare. More relevantly, I\u2019ve operated as a Third Party Administrator (handling claims), helped set up Medicare HMOs, and operated 40 medical centers serving over 100,000 patients. Over the years, I\u2019ve also worked with 14 insurance companies, some of which were shared or full-risk partners. However, UnitedHealthcare was never a partner in Florida, as they were not a dominant player in the state nor particularly receptive to partnerships.<\/p>\n

Additionally, I hold 30 patents, primarily in the use of technology within healthcare, and I\u2019ve built three separate healthcare technology platforms. On the technology side, we did use Change Healthcare (now owned by UnitedHealthcare\u2019s parent company) in our EHR platform, as it was a necessary tool in the industry. Though I\u2019ve never been a client or partner of UnitedHealthcare, I hold no bias against them.<\/p>\n

During our operations in South Florida, most of our administrative centers were fortified, and some medical centers, particularly in Miami, had armed security. While the threat of violence was always present, it never escalated. Since we live in Florida, we also allowed team members to be armed, provided they followed both legal and company regulations. Fortunately, no serious incidents occurred. Having attended hundreds of investor presentations across the country, I\u2019ve been to the hotel where this murder occurred numerous times. I understand the environment, as I\u2019ve frequently traveled alone.<\/p>\n

UnitedHealthcare is a subsidiary of UnitedHealth Group Inc. (UNH: NYSE). UNH is one of the largest companies in the United States, with a market capitalization of $500 billion, revenues around $375 billion, and approximately 4.7 million members and beneficiaries, ranking third in the U.S. behind Kaiser (a non-profit) and Elevance (formerly Anthem). Through its Optum subsidiary, UnitedHealth employs more doctors than any other organization in the U.S., with around 40,000 physicians.<\/p>\n

During our operations, we often dealt with referral denials and frustrated customers, and while the threat of violence was always present, it never became a serious issue. Our denial rate was very low\u2014under 3%. Most denials were related to referrals for additional doctors or diagnostics, as we prioritized patient health. As a full-risk provider, we had both a financial and ethical incentive to keep our patients as healthy as possible.<\/p>\n

2024: A Pivotal Year<\/strong><\/p>\n

As we’ve noted in previous blogs, the healthcare system is broken and is worsening. It will undoubtedly get much worse with 14,000 new baby boomers transitioning from commercial insurance to Medicare every day<\/em>. This is a massive shift. My suspicion is that, if there is a root cause behind the assassination, it\u2019s likely tied to commercial or employer-based insurance administered by UnitedHealthcare\u2014though this is not certain. As I mentioned, Medicare Advantage (MA) plans do carry the financial risk if care is delayed, but commercial plans might offer a more plausible motive.<\/p>\n

The Consumer is Angry and Fed Up\u2014AI Can Help, Not Hurt<\/strong><\/p>\n

We\u2019ve reached a tipping point, as evidenced by the 80% of consumers dissatisfied with healthcare. This anger is leading many to take back control, and one of the ways to do so is through their data. Most consumers can\u2019t see or imagine that a broken system can be fixed. The assassination of Brian Thompson is a stark reminder that consumers are fed up with waiting for improvements. Healthcare companies have already responded by tightening security, with armed guards and metal detectors now appearing in most local hospitals.<\/p>\n

\"\"-Noel J. Guillama, Chairman<\/p>\n

About HealthScoreAI \u2122<\/strong><\/p>\n

Healthcare is at a tipping point, and HealthScoreAI is positioning to revolutionize the industry by giving consumers control over their health data and unlocking its immense value. U.S. healthcare annual spending has reached $5 trillion with little improvement in outcomes. Despite advances, technology has failed to reduce costs or improve care. Meanwhile, 3,000 exabytes of consumer health data remain trapped in fragmented USA systems, leaving consumers and doctors without a complete picture of care.<\/p>\n

HealthScoreAI seeks to provide a unique solution, acting as a data surrogate for consumers and offering an unbiased holistic view of their health. By monetizing de-identified data, HealthScoreAI seeks to share revenue with consumers, potentially creating a new $100 billion market opportunity. With near-universal EHR adoption in the USA, and advances in technology, now is the perfect time to capitalize on the data available, practical use of AI and the empowering of consumers, in particular the 13,000 baby boomers turning 65 every single day and entering the Medicare system for the first time.\u00a0 Our team, with deep healthcare and tech expertise, holds U.S. patents and a proven track record of scaling companies and leading them to IPO.<\/p>\n","protected":false},"excerpt":{"rendered":"

Assassination of UnitedHealthcare CEO Brian Thompson I delayed discussing the tragic news of the assassination of UnitedHealthcare CEO Brian Thompson on December 4th, 2024\u2014a day healthcare may never forget\u2014until more information emerged, and I could gather my thoughts. The reports are varied, and I won\u2019t repeat them in detail. However, there are disturbing elements emerging. A bullet left by the assailant could either signal a motive or be a disguise for something else. The message found on three 9mm shell casings reads: \u201cDelay, Deny, and Depose.\u201d The healthcare industry has […]<\/p>\n","protected":false},"author":6,"featured_media":4623,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4621","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/pwer.com\/wp-content\/uploads\/2024\/12\/Screenshot-2024-12-09-122137.png","_links":{"self":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/4621","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4621"}],"version-history":[{"count":2,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/4621\/revisions"}],"predecessor-version":[{"id":4624,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/4621\/revisions\/4624"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/media\/4623"}],"wp:attachment":[{"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4621"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}