We will refrain from commenting on the ongoing investigation and the apparent capture of the individual responsible for the assassination of UnitedHealth’s CEO. As we noted in our previous blog, this is an unwarranted crime, a tragic event. While the news continues to evolve, one thing remains clear: we have reached a tipping point. Consumers are angry, as highlighted in our first blog post. The anger is intensifying.
As illustrated in articles from the Wall Street Journal (WSJ) and CNBC (quoted below), the word “anger” is repeatedly used. In fact, even those who condemn the crime seem to express empathy for the issues surrounding insurance companies.
The suspect, Mr. Luigi Mangione, commented during his court appearance: “It’s completely out of touch and an insult to the intelligence of the American people and their lived experience!”
Here are three WSJ headlines that shed light on the situation:
- Manhunt for UnitedHealthcare CEO Killer Faces Unexpected Obstacle: Sympathy for the Gunman
- Death Threats Against Health Insurers Highlight Long-Simmering Anger Against the Industry
- Following the UnitedHealthcare CEO Killing, Companies Bolster Security and Try to Address Americans’ Anger
Reports also indicate that a “manifesto” was found with the suspect.
This Time It Could Be Different
As we write this blog, CNN reports that Amazon is pulling merchandise emblazoned with the phrase “Delay, Deny, Defend” for violating company rules. What makes this moment potentially different is how communication has evolved over the last two decades. We no longer receive news solely from traditional networks or even 24-hour cable channels. Instead, we’re inundated with information from an unlimited number of news sources, social media platforms, and private/public sites—all accessible directly on our phones.
CNN quoted UnitedHealth Group’s Facebook page in their coverage:
The killing has generated mixed reactions online. A post expressing sadness over the death of UnitedHealthcare CEO Brian Thompson received 62,000 reactions, of which 57,000 were laughing emojis. UnitedHealth Group is the parent company of UnitedHealthcare, the division Thompson led.
Industry discussions, especially on platforms like LinkedIn, often fall into one of three camps, though all share a sense of trauma:
- Those expecting companies to intensify security for their executives and facilities. A key example will be the J.P. Morgan healthcare conference in San Francisco next month.
- Those who simply want the situation to fade and return to normalcy.
- Those frustrated by working within a system they believe is fundamentally broken but unsure of any viable alternatives.
Every adult in America has encountered frustration—either personally or through family members—when dealing with insurance companies, particularly beyond routine maintenance. Those with chronic conditions like cancer or other complex illnesses face even greater hurdles.
“Limitations on access to care due to claims denials have absolutely been a source of frustration for a long time,” said Kaye Pestaina, director of the Program on Patient and Consumer Protections at KFF.
The WSJ and AP report that the bullets used in the killing of UnitedHealthcare’s CEO on December 4, 2024, carried the words “Delay, Deny, Depose,” further emphasizing the message behind the act.
Is the ACA Making the Problem Worse?
As we’ve speculated, if the motive for the murder stems from a sense of personal injury, it likely originates from frustrations with a commercial insurance plan, rather than with Medicaid or Medicare—though those systems have their own issues. The alleged perpetrator is likely enrolled in a commercial plan.
Consumers have long been dissatisfied with healthcare, particularly with insurance companies. Some of this dissatisfaction can be traced back to the Affordable Care Act (ACA), passed in 2010, which has led to higher premiums, larger deductibles, and fewer benefits for many. Despite increased federal spending, healthcare costs have grown by about $2 trillion per year since 2011, with no corresponding improvement in American health. In fact, mortality rates for Americans aged 25–64 have increased.
Did AI Play a Role?
I recently reviewed a 54-page report issued by the U.S. Senate’s Permanent Subcommittee on Investigations (October 17, 2024), summarized below. This report, and my summary, must also be considered alongside a letter from the American Medical Association (AMA), which is linked below.
AI in healthcare, especially within the context of Medicare Advantage plans, presents both opportunities and risks. On the one hand, AI-powered systems, such as “Machine-Assisted Prior Authorization” (MAP), can speed up the approval process for medical services, ensuring quicker decisions and timely care. AI could help allocate resources efficiently, reduce operational costs, and alleviate clinician burnout.
However, AI also carries significant risks. Some Medicare Advantage insurers have reportedly used AI algorithms to flag and deny high-cost post-acute care requests, focusing on financial outcomes rather than patient health. This practice leads to increased rejection rates for services like skilled nursing facility care, even when it is medically necessary. AI systems, while efficient, can lack the nuanced human judgment needed for complex healthcare decisions, potentially compromising patient care.
Additionally, the Journal of the American Medical Association recently published a letter titled Denial—Artificial Intelligence Tools and Health Insurance Coverage Decisions, which highlights the challenges AI introduces in healthcare decision-making. Three key points are:
- AI Utilization Review: Insurance reviews, ripe for AI solutions due to their complexity and volume, have not always yielded positive results. The application of AI to these tasks can go awry when humans do not intervene to prevent errors.
- Improved Prediction Claims: AI algorithms could theoretically offer more accurate predictions by analyzing vast datasets. However, claims about AI improving prediction accuracy are often overstated.
- Efficiency vs. Accuracy: AI can expedite decisions by analyzing millions of datapoints quickly, but this may not always result in better outcomes for patients, particularly when compared to decisions made by humans after thorough review.
The Consumer’s Role
For years, we’ve advocated for a healthcare system centered around the consumer. In fact, I’ve used this principle as part of the logo for one of the healthcare service companies I helped take public. However, with the benefit of experience, it’s become clear that the correct structure should place the consumer at the apex of the pyramid. To achieve this, consumers must have access to—and control over—their healthcare data. This shift could eventually transform healthcare data from being fragmented for billing efficiency into a consumer-driven repository of wellness data.
-Noel J. Guillama, Chairman
About HealthScoreAI™
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.
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. 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.