I work in this space. I agree with the gist of what you’re getting at; the catch is that it’s mostly just feeding the beast rather than breaking the dynamic.
With LLMs, the problem is that they’re neither objective nor consistent, so the insurance companies are just going to increase their headcounts and hire more people to contest submitted claims. Deterministic output would change the picture in a big way, but I’m not seeing much appetite for that in the market for some reason.
There’s a lot more potential for disruption in the form of advanced monitoring that can automatically flag and document complications in an objective way (which is my professional wheelhouse, for the sake of disclosure), but even then I expect payors to mostly pass the increased reimbursement rates on to their enrollees.
A single-payor model is the biggest real cure for what ails our system, and I think I speak for a lot of us in the industry when I say that we’d happily lose our jobs to see that happen for the greater good.
so the insurance companies are just going to increase their headcounts and hire more people to contest submitted claims.
And this is where things get dicey. Insurance companies hire more people and invest more into AL tools to deny claims, while hospitals try to spend more money on coders and invest is AI solutions to code as accurately as possible so they can bill as much as possible. All the while wondering where law of diminishing returns kicks in…
I work in this space. I agree with the gist of what you’re getting at; the catch is that it’s mostly just feeding the beast rather than breaking the dynamic.
With LLMs, the problem is that they’re neither objective nor consistent, so the insurance companies are just going to increase their headcounts and hire more people to contest submitted claims. Deterministic output would change the picture in a big way, but I’m not seeing much appetite for that in the market for some reason.
There’s a lot more potential for disruption in the form of advanced monitoring that can automatically flag and document complications in an objective way (which is my professional wheelhouse, for the sake of disclosure), but even then I expect payors to mostly pass the increased reimbursement rates on to their enrollees.
A single-payor model is the biggest real cure for what ails our system, and I think I speak for a lot of us in the industry when I say that we’d happily lose our jobs to see that happen for the greater good.
And this is where things get dicey. Insurance companies hire more people and invest more into AL tools to deny claims, while hospitals try to spend more money on coders and invest is AI solutions to code as accurately as possible so they can bill as much as possible. All the while wondering where law of diminishing returns kicks in…