“Just because everybody hates it doesn’t mean it’s not good!” This is the wisdom imparted by the supercriminal “Gru” in the animated film Despicable Me. It is a rather empathetic response to Gru’s elderly assistant’s invention of a jam that has every type of berry infused into it, but tastes awful. This seems to be a good time for similarly nonsensical platitudes (for you kids out there, a platitude is a meaningless or prosaic statement designed to quell social, emotional, or cognitive unease.) I think we can all agree that we are experiencing an interesting moment in time when everyone, everywhere, tends to hate or complain about everything. So maybe watch a clever cartoon where they make light of all the dark things? Weird that this wisdom can be directly applied to this week’s news about healthcare data. If you are skeptical, check out the One Thoughtful Paragraph below.
Proof that everyone is complaining about everything, even in health information policy:
- Three in four U.S. adults believe AI technology in healthcare is moving too fast before fully understanding the risks to patients, according to Pew Research data outlined by AIPRM’s “AI Statistics 2024.”
- Epic executive David de Young told Politico that Epic’s AI tool for streamlining prior authorizations in health systems is being held up by the lack of national infrastructure for health plans and hospital systems to communicate.
- UnitedHealth Group requested that the lawsuit alleging that an AI algorithm inappropriately denied MA beneficiaries’ care be dismissed because the plaintiffs did not first exhaust the administrative appeal process.
The villain Gru, the lead character in the Despicable Me movie, has Mommy issues. When Gru was a little boy, he excitedly announced: “Mom, someday I’m going to the moon!” His mother responded that it was too late, NASA was no longer sending monkeys to the moon. Rather than wallowing in the negativity, Gru decided to change his plan and steal the moon instead. This brings us to MedPAC’s analysis of the risk adjustment process to determine payments for Medicare Advantage plans. Monkeys may or may not be involved in risk adjustment, but there is a serious controversy about whether plans are stealing money from the government to boost their own revenues. This week, one current and three former MedPAC commissioners co-authored a blog post (published in Health Affairs) to explain that there is a basic misunderstanding of how stealing the moon works. They recommend a more holistic approach to the risk adjustment process that connects to actual business and clinical operations so we can all best determine how much to pay MA plans. This would be different from the current approach which forces plans to use fee-for-service data (that mind-numbingly reflects relative value units paid to clinicians and diagnosis-related groups paid to hospitals) to determine how to adjust payments according to the health risk that consumers post to health plans, despite the fact that plans are paid on a per-member, per-month base capitation rate. In short, there are completely different incentives between FFS and MA that drive how this data is collected and tracked, which makes about as much sense as sending monkeys to the moon again when we know that isn’t going to be helpful. As Gru wisely tells his adoptive children: “Life is just like that sometimes. We’re hoping for a unicorn, and we get a goat.”
