Once again, a major healthcare development pushes our planned blog topics to the back burner. UnitedHealth Group (UNH) CEO Andrew Witty has announced his resignation, and the company has suspended its annual financial forecast, as reported by multiple media outlets (sources listed below).
We’ve frequently said that healthcare in America is not just broken—it’s decaying, and today’s news only reinforces that view.
A Sudden Departure Amid Mounting Pressure
In our previous blog, we examined The Wall Street Journal’s (WSJ) reporting on how UNH has been leveraging AI—particularly in ways that suggest it may be used to deny medical claims. While I have no direct proof, the numbers disclosed by UNH themselves raise serious questions. (See our last blog for the analysis.)
Today’s resignation adds another layer of complexity to what is already a tumultuous time for UNH.
A Day That Changed Healthcare Forever
On December 4, 2024, UNH’s insurance division CEO Brian R. Thompson was assassinated—a tragic and horrifying event. At the time, I wrote that this would be a historic moment in U.S. healthcare, and I believe that now more than ever.
As CNBC noted in coverage of Witty’s resignation:
“Witty oversaw a tumultuous year for the company, which grappled with government investigations, a historic cyberattack, higher-than-expected medical costs, and the torrent of public blowback after the murder of UnitedHealthcare CEO Brian Thompson.”
While Mr. Witty cited “personal reasons” for his departure, the cumulative pressure on UNH over the past year—from rising medical costs to public scrutiny—can’t be ignored.
The Real Financial Strain: Medical Loss Ratios
Much of this turmoil boils down to something technical yet critical: medical loss ratios (MLR)—the percentage of premiums spent on actual medical care. As a giant in both insurance and healthcare delivery (UNH is also the largest employer of doctors in the U.S.), the company has a unique ability to pay itself. That setup allows it to legally adjust how MLRs are calculated.
But here’s the bottom line: medical utilization has surged post-COVID, which has dramatically impacted UNH’s margins. They made enormous profits during the pandemic (we covered this in previous blogs), but now, the pendulum is swinging the other way.
And while Witty earned a total compensation package of $26.3 million in 2024, shareholders have lost nearly 50% of their investment since December 4.
“The System Is Flawed” – We Agree
Following Thompson’s death, Witty was quoted saying the U.S. healthcare system is “flawed” and in need of reform.
We couldn’t agree more.
But we believe the only true path to reform lies not with government agencies, corporate employers, or insurance companies. It lies with the consumer.
The system costs $5.3 trillion annually, and in this zero-sum game, one company’s cost is another’s revenue. This dynamic makes systemic reform nearly impossible unless patients themselves become empowered participants in their care.
We once hoped that Electronic Health Records (EHRs) would empower patients with better access to data. Instead, EHRs have largely become billing tools, optimized for documenting complexity—not improving care.
A CFO’s Words: Investors vs. Patients
In comments reported by Fierce Healthcare, UNH CFO John Hemsley told investors:
“The company has taken significant steps to get its arms around this utilization problem… Having that baseline makes it easier to predict performance and puts the company on the path to return to its growth trajectory in 2026.”
If you’re an investor, that may sound reassuring.
If you’re a patient, it should concern you.
This means the company is actively working to control medical usage, which likely translates into tighter claim reviews and more denials, especially in cost-sensitive areas like Medicare Advantage—a segment where they receive fixed payments per patient.
It’s no coincidence that UNH is also under investigation for allegedly inflating diagnosis codes to maximize reimbursement. The tension between cost containment and patient care is as visible as ever.
The Role—and Risks—of AI
UNH is one of the most advanced users of AI in healthcare. It’s been accused of using AI to deny claims, and while this is still being investigated, The Wall Street Journal revealed that over 90% of UNH’s claims are auto-adjudicated.
Let that sink in: software is making decisions on billions of medical claims every year.
Given UNH’s size, the implications are enormous. AI is clearly playing a growing role in shaping what care is approved—and what is denied.
The Consumer’s Next Move: Use AI for Empowerment
If insurance companies are using AI to protect their bottom line, consumers must use AI to protect their health and rights.
We believe that now is the time for consumers to:
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Aggregate their medical records and make sense of their data
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Understand drug interactions and treatment risks
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Use AI to file appeals when claims are denied
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Stay informed and proactive in managing their healthcare
Denials are not going away—they’re likely to increase. But the same technology being used against patients can also be used by patients, if given the tools.
This is the real “AI arms race” in healthcare. And it’s one that consumers must win—because no one else is going to fight for them.
About HealthScoreAI ™
Healthcare is at a tipping point, and HealthScoreAI (HSAI) 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 exceeded $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 system of 500 EHRs, 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. With over 850 million medical claims denied annually in the U.S., HSAI intends on giving Consumers practical tools to respond to denial of care by insurers. We aim to bridge the gaps in healthcare access and outcomes. By monetizing de-identified data, HealthScoreAI seeks to share revenue with Consumers, potentially creating a new $100 billion market value 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 tech savvy 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.
Noel J. Guillama-Alvarez
https://www.linkedin.com/in/nguillama/
+1-561-904-9477, Ext 355
https://www.cnbc.com/2025/05/13/unitedhealth-group-ceo-andrew-witty-steps-down.html
https://www.wsj.com/health/healthcare/unitedhealth-names-new-ceo-suspends-2025-guidance-ed8244a1
https://finance.yahoo.com/news/unitedhealthcare-sued-shareholders-over-reaction-131646117.html