[lesuorac]

All you have to do is take an initial cost hit where you have multiple support staff review a case as a calibration phase and generate cohorts of say 3 reviews where 2 have the desired denial rate and 1 doesn't. Determine the performance of each cohort by how much in agreement they are and then rotate out whose in training over time and you'll achieve a target denial rate.

There will always be people who "try to do their best" and actually read the case and decide accordingly. But you can drown them out with malleable people who come to understand if they deny 100 cases today then they're getting a cash bonus for alignment (with the other guy mashing deny 100 times).

Technology solves technological problems. It does not solve societal ones.

[rglullis]

I am not disagreeing, and I am not arguing for AI.

I am just saying that the perverse incentives already exist and that in this case AI-assisted evaluation (which defers to a human when uncertain) is not going to make it any better, but it is not going to make it any worse.

[ToucanLoucan]

Actually it may, even if only slightly. Because now as the GP says, the humans know the only cases they're going to get are the ones the AI suspects are not worthy. They will look more skeptically.

I totally agree that the injustices at play here are already long baked in and this is not the harbinger of doom, medical billing already sucks immense amounts of ass and this isn't changing it much? But it is changing it and worse, it's infusing the credibility of automation, even in a small way, into a system. "Our decisions are better because a computer made them" which doesn't deal at all with how we don't fully understand how these systems work or what their reasoning is for any particular claim.

Insofar as we must have profit-generating investment funds masquerading as healthcare providers, I don't think it's asking a ton that they be made to continue employing people to handle claims, and customer service for that matter. They're already some of the most profitable corporations on the planet, are costs really needing cutting here?

[rglullis]

>"Our decisions are better because a computer made them"

This is the root of the problem, and it is (relatively) easy to solve: make any decision taken by the computer directly attributed to the CEO. Let them have some Skin in The Game, it should be more than enough to align the risk and the rewards.