Becker's Healthcare October 5, 2023
The federal government will restrict how Medicare Advantage plans use predictive technology tools to make some coverage decisions, KFF Health News reported Oct. 5.
Several private insurance providers use a tool called nH Predict, which uses millions of medical records to match patients with similar diagnoses and characteristics. Based on the comparisons, the algorithm anticipates what kind of care a patient will need and for how long.
Providers and patient advocates in several states told KFF Health News they have noticed what they call a “suspicious coincidence”: the tool predicts a patient’s discharge date and their insurer cuts off coverage that day, even if the patient needs further treatment that Medicare would cover.
A naviHealth spokesperson told KFF Health...
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