UHG reports losses after cyberattack, providers warm up to AI

April 24, 2024 - The major health insurer UnitedHealth Group has not yet issued a formal breach notification, prompting more scrutiny of its response to the Change Healthcare cyberattack.

So far, UnitedHealth Group reported that the breach involved files containing personal health information, but there is no evidence of malicious actors accessing full medical histories. The payer has 60 days from the time of the breach's discovery to report it.

Providers are growing more accustomed to artificial intelligence (AI). A survey from Wolters Kluwer Health found that many providers changed their minds about AI in the last year. However, providers still voiced some concerns about the technology.

The National Institutes of Health and the National Science Foundation are funding research around how environmental and climate changes in oceans and the Great Lakes affects human health. Specifically, the research will focus on the effects of microplastics and nanoplastics.

A study published in Health Affairs found that health systems with higher rates of telehealth utilization had better outcomes. These health systems saw rates of drug adherence for certain medications and a decline in non-COVID-19 emergency department visits. However, one important metric was slightly higher for these health systems compared to those with lower rates of telehealth use.

Kyle Murphy:

Hello, and welcome to Healthcare Strategies | Headlines. Today's episode:

UnitedHealth Group faces HIPAA compliance scrutiny

Providers are warming up to AI

NIH and NSF team up to study ocean's impact on human health

High telehealth use impacts care, access, and cost

Kelsey Waddill:

Wow.

Kyle Murphy:

Welcome back, listeners. This is Kyle Murphy, vice president of editorial at Xtelligent Healthcare, and I am joined as always by seeing what, multimedia manager? Whatever you, managing editor, Kelsey Waddill.

Kelsey Waddill:

Whatever. Hello.

Kyle Murphy:

You ascended through the ranks so quickly. It's hard to keep track of what your current title is.

Kelsey Waddill:

I don't know what my title is.

Kyle Murphy:

He who controls the technology controls the company.

Kelsey Waddill:

Wow. I'll just join ranks with AI, and soon we'll control the world.

Kyle Murphy:

Oh, yes. Always be--

Kelsey Waddill:

Like in Mission: Impossible - Dead Reckoning.

Kyle Murphy:

I watched that. That was quite interesting.

Kelsey Waddill:

Yeah. I predicted that it was going to be about AI because everything's about AI in 2024, speaking of which....

Kyle Murphy:

Except for our first headline.

Kelsey Waddill:

Oh, yeah.

Kyle Murphy:

UnitedHealth Group has not yet issued a formal breach notification following a cyber attack. Yes, listeners, this cyber attack is still going on apparently. It just doesn't end.

Kelsey Waddill:

Never ends.

Kyle Murphy:

It's the gift that keeps on giving.

Kelsey Waddill:

Yeah.

Kyle Murphy:

As they continue to review the impacted data, a process that is expected to take several months--whenever I see several, I assume seven, but in this particular case, it's seven or more. So let's--

Kelsey Waddill:

Yeah. I think it's going to be much more than seven. Seven years maybe.

Kyle Murphy:

Yeah. We'll do a postmortem then and finally realize what happened.

Under HIPAA, entities have 60 days from a breach's discovery to report it. UHG's preliminary findings indicate the breach involved files containing personal and health information significant enough to potentially affect a large portion of the United States population. But there's no evidence of full medical histories or doctor charts being exfiltrated. That's important in terms of what we know as protected health information. Notably, screenshots from the breach appeared on the dark web, but we're only visible for a week, seven days, with no subsequent data releases reported. Only seven days guys, it's cool.

Kelsey Waddill:

Several days.

Kyle Murphy:

Several days. The Office for Civil Rights, OCR has opened an investigation and issued FAQs focusing on compliance with HIPAA rules in the wake of the incident. UHG and Change Healthcare must issue breach notifications if applicable and UHG has offered to manage these notifications for its customers. Amidst all of this, UHG reported a significant first quarter net loss of $1.4 billion.

Kelsey Waddill:

Wow.

Kyle Murphy:

The revenue saw a substantial increase. So I guess it didn't really hurt. Attributed to growth across the services despite the attacks financial impact. Yes, that's what happens when you run a massive company.

Kelsey Waddill:

It's called premiums.

Kyle Murphy:

So Kelsey, what are your thoughts on UHG's handling of the cyber attack? I know we've done a lot of talking about it with experts across the industry, but do you think their response has been adequate?

Kelsey Waddill:

I think that there's been a lot of criticism about the response for good reason. We were talking earlier today even about the lack of acknowledgement of the role that consolidation played in this and the repercussions from UHG. There hasn't been a significant amount of conversation on what role that played, but from the outside looking in, it's pretty clear that the repercussions were serious given, you know....

Kyle Murphy:

That healthcare has shut down for a lot of people?

Kelsey Waddill:

Right, yeah. Across multiple sectors of the industry as well, including even from providers to pharmacy to all these other usually siloed areas of the healthcare industry.

Providers are warming up to artificial intelligence. Physicians are changing their tune a little bit on generative AI. According to a survey commissioned by Wolters Kluwer Health, over two-thirds of the provider respondents in a recent survey, all of whom worked in large hospitals or large health systems, agreed that they were more likely to believe that using generative AI in health would be advantageous compared to the year before the survey.

Kyle Murphy:

You ever write notes? Typing stinks.

Kelsey Waddill:

Four in 10 participants were so optimistic that they would be ready to use AI for interactions with patients at the point of care by the end of 2024. More than half of the participants said that generative AI can help search medical literature, summarize EHR data and save 20 percent or more on car insurance... No. 20 percent or more of their time spent in finding and evaluating data for clinical decision-making, which is, as we all know, a key part of clinician burnout. Additionally, most respondents agree that AI can support care coordination and interactions with patients, but providers still harbored some concerns about the technology. So it wasn't all rosy didn't receive a full A+. Primarily they wanted to know about the content source. Most of the participants--

Kyle Murphy:

Don't we all?

Kelsey Waddill:

Yeah, don't we all? Most of the participants agreed that ensuring that medical professionals were involved in the tools training was essential to their AI tool selection process. Makes sense.

Kyle Murphy:

Makes sense.

Kelsey Waddill:

Yeah. Vendor name also made a difference with 76 percent of participants stating that they were more likely to use an AI solution from an established vendor.

Kyle Murphy:

Not just Bob down the street.

Kelsey Waddill:

Apparently not. Which sucks for Bob.

Kyle Murphy:

He's out of work again. Keep working, Bob.

Kelsey Waddill:

Just got to keep building things, that's all. Obviously Kyle, getting providers on board is key to AI adoption. So what do you think about the shift and what it says about the future of AI in hospitals and large health systems?

Kyle Murphy:

I wonder if some of the phobia, some of the fear around AI is just like you haven't used it, and when you use it and you realize how non-threatening it actually is. You can do certain tasks very, very well, particularly when fed information that it just needs to format, recontextualize, all that type of jazz. But it clearly can't do these other things or with a higher level of certainty. So it's not going to replace people with significant training and knowledge, it's not going to do that.

But for summarizing some notes, I mean, come on. Come on. No one gets hurt from that. It's all documentation and who knows, when it comes to clinical documentation for claims purposes, who's to say you couldn't train the thing to actually generate notes in such a way that there's much more compliant or adheres to contract rules so that claims don't get rejected or don't go into the adjudication process. So maybe it just streamlines everything because people are suddenly speaking the same language. So I think it's a big one. We know that documentation is a time suck. We know about "piyama," pajama time, so hopefully this goes a long way towards addressing that. And we're not talking about AI replacing clinical decision-making. We're talking about AI taking care of this manual labor that is taking away from clinical decision-making in actual patient interactions.

Kelsey Waddill:

Right. We just need more AI-wareness.

Kyle Murphy:

AI awareness. Yeah, I'm going to start that campaign.

Speaking of awareness and research, so the National Institutes of Health (NIH) and the National Science Foundation (NSF) are funding four new centers for ocean and human health. No, this is not Water World. You don't get to just live in the ocean.

Kelsey Waddill:

Darn.

Kyle Murphy:

No. So they also renewing support for two existing centers, but we can dream. We can dream. Water parks for everybody.

The initiative which involves a $42 million investment over five years aims to investigate the health impacts of environmental and climate changes in oceans and the Great Lakes, don't leave out the Great Lakes.

Kelsey Waddill:

Interesting.

Kyle Murphy:

They're lakes too.

Kelsey Waddill:

Yep. They're water too.

Kyle Murphy:

Yeah. Well, they got some salt in them, I think that's why.

A significant focus of the research is on how microplastics--you've heard about those plastics--and nanoplastics--even smaller than the microplastics--in these waters affect human health. Who'd 'a' thunk it? The stuff that you drunk would go into your system and make you unwell. Couldn't believe it. As these contaminants enter the human food chain--that sounds really weird, are humans on the food chain?--through seafood consumption and carry other pollutants like mercury, lead....

This research is crucial and explores the broader implications of ocean pollution on public health. Wow. Potentially guiding future pollution reduction efforts and public health policies.

Individuals can do more. Use a water bottle and you can save the environment. I don't know who generates the plastic, but once we figure that out, we might be onto something.

So Kelsey, we often talk about the environment in the healthcare world when we talk about the areas where people live, their neighborhoods, communities, things like that. But what are your thoughts on extending this kind of coverage, this reach to talk about the substance that covers nearly 70 percent of the Earth?

Kelsey Waddill:

It's about time that we talk about this substance that covers 70 percent of the earth.

Kyle Murphy:

Oh my God, yes. Yes.

Kelsey Waddill:

Well, and it's just in time for Earth Day, so....

Kyle Murphy:

Oh, that's true.

Kelsey Waddill:

I think obviously this is a good reminder that environmental health is part of health and human health.

Kyle Murphy:

Hold on. Are you implying that we're part of this ecosystem?

Kelsey Waddill:

This might be groundbreaking, but we do live in the ecosystem, which makes us a part of the ecosystem.

Kyle Murphy:

Oh, wow. That's genius right there.

Kelsey Waddill:

I know it took a while to get there, but we're there finally.

Kyle Murphy:

Just a reminder to everyone. Don't throw trash in the oceans. They're going to be watching now.

Kelsey Waddill:

Yeah. Keep your trash to yourself.

Kyle Murphy:

All right. Let's end this on a high note. Give me something.

Kelsey Waddill:

Speaking of high note, high telehealth use impacts care access and cost.

Health systems that rely more on telehealth are reaping some benefits. According to a study of the Medicare population that was published in Health Affairs. The study found that patients and health systems with the highest rate of telehealth utilization had 2.5 telemedicine visits per person annually. And that telehealth visits made up over a quarter of all visits. In contrast, for patients and health systems with lower rates of telehealth use, 9.5 percent of visits were conducted via telehealth, and that's less than one visit per patient in a year. Increased telehealth utilization in a health system appears to correlate with a higher number of patient outpatient visits.

Kyle Murphy:

Heard you could bill for that.

Kelsey Waddill:

Yeah. The researchers found that more than eight out of ten telemedicine visits were a substitute for an in-person visit. Outcomes were also better for high telehealth health systems. They saw better drug adherence for metformin and statins.

Kyle Murphy:

Love a good statin.

Kelsey Waddill:

Got to love statins. And they experienced a 14.4 percent decline in non-COVID-19 emergency department visits per 1,000 patients per year. Relative to low telehealth systems, that's a 2.7 percent drop.

Kyle Murphy:

Wow.

Kelsey Waddill:

So the report didn't give a full A+ for telehealth, however. There was no real difference in imaging services or laboratory tests per capita per year, and--perhaps more significantly to some of our audience--spending was slightly higher for high telehealth health systems, which saw a 1.6 percent relative increase in spending compared to low telehealth peers.

And Kyle, the report's goal was to influence telehealth policy and reimbursement in Medicare. How do you think we should evaluate this evidence? What do you think about the evidence about telehealth's benefits and costs and how should it impact policymakers' decisions?

Kyle Murphy:

It seems as if there are logical use cases for telehealth and talking about medications, ensuring drug adherence, medication management therapy and things like that make a lot of sense, where the in-person touch is more expensive and probably more inconvenient. And then there are other areas that have to be managed a little bit differently. That whole component about laboratory tests and imaging, that's a lot of on-site type of stuff. It stands to reason that there wouldn't be an effect there. But who's to know in the future whether testing could be somehow extended out into the neighborhood? I see a lot of Quest Diagnostics cars driving around. I don't know, but that's a whole different matter. But I would say-

Kelsey Waddill:

Yeah, what are they doing?

Kyle Murphy:

Yeah, what are they doing? What are they moving? I just know that their speed is monitored by GPS and they can't speed.

Kelsey Waddill:

Oh, wow.

Kyle Murphy:

I always race them. I always race them from the dead start.

But I think in general, telehealth has its role. It's not a replacement. It is very, very useful for certain quick exchanges, FaceTime and things like that where people need answers. And in-person care is obviously important for other reasons, and we're still waiting for things to level out. But I think the more you can keep people out of the hospital environment unnecessarily, especially the ED, the better we're all going to be. Because people who need that attention, those services are going to get them. So I think it's positive in general. We obviously have to talk about reimbursement and payment parity and all that jazz, but we'll get there. But clearly it works.

Kelsey Waddill:

Especially in healthcare.

Kyle Murphy:

Just like this podcast.

Kelsey Waddill:

Yeah, we work. Look at us.

Kyle Murphy:

Pretty much every week until I take a vacation, go to Washington DC.

Well, listeners, that's been Healthcare Strategies | Headlines. Thank you for joining us. Make sure to like, subscribe, follow.

Kelsey Waddill:

Yes.

Kyle Murphy:

Give us a look on YouTube at Healthcare Strategies.

Kelsey Waddill:

YouTube, we're there.

Kyle Murphy:

Take care.

Kelsey Waddill:

Bye.

Kyle Murphy:

Don't litter.