Assassination of UnitedHealthcare CEO Brian Thompson
I delayed talking about the horrible and heartbreaking news of the assassination of the CEO of UnitedHealthcare on December 4th, 2024, a day healthcare may never forget, to wait for more information to emerge and to get my bearings.
The reports are all over the place, and I don’t need to repeat. The criminal left some bullet that could be a motive, or a disguise for another motive (there are other possible motives). The words placed on the three 9MM casing say “Delay, Deny and Depose”.
The healthcare industry has reacted with horror (and new safety measures, more to discuss later), and we have witnessed a deluge, literally millions of criticisms from consumers. Many people are seizing the moment to express frustration with the cost of insurance and the issues dealing with denying claims. Some reports and lawsuits claim Artificial Intelligence (AI) is use by UnitedHealthcare to deny claims (lots more on that later also). This has clearly caught the attention of politicians in Washington.
Most claims are denied in Commercial insurance, vs Medicaid and Medicare. Medicare has a very liberal referral procedure for most but the extremes situation. Medicare Advantage (MA) has more delays and denials, but MA plans also know what delayed care may mean, and usually does mean more expensive care later. I have personal experience with that in my family literally currently, and we will discuss that later also.
News organizations have taken to discuss the shortcomings of the healthcare insurance industry. Forbes just had a headline that said “UnitedHealthcare denies more claims than other insurers – angering patients and health systems” (see graph below from another source). CNN notes had this headline “Killing of UnitedHealthcare CEO prompts flurry of stories on social media over denied insurance claims”.
There is no excuse, no justifiableness to this crime. Period. Stop.
My point of view on healthcare
I have had an insurance license in Florida since I got into healthcare, it is active today. I needed to understand the numbers of healthcare, and that education and experience has “made all the difference”. Further and more relevant, I have operated Third Party Administrator (receiving and paying claims), helped set-up Medicare HMOs, operated 40 medical centers servicing more than 100,000 patients. I have also had 14 insurance companies as shared or full risk partners, never with UNH, just were not that big of player in Florida or that receptive to partnerships. I also have 30 patents in mostly the use of technology in healthcare and built 3 separate healthcare technology platforms. On that last part, we did use Change Healthcare (now owned by UnitedHealthcare parent) in our EHR platform, you kind of had to. I have never had UnitedHealthcare as a client or provider of insurance, so I have no bias against them.
Nearly all our South Florida based administrative operations were hardened, and or had armed security at some of our medical centers (Miami in particular). There was never an issue. We also since we live in Florida, allowed team members to be armed, if they were properly licensed and followed both legal and company regulations. Again, nothing serious ever happened. I have been to 100s of investor presentations in hotels all over the US and have been at the actual hotel of this murder too many times to count. I was in NYC 24 times the most in any one year in 1999 alone. 100s during my career. I also traveled alone, so I understand this environment.
UnitedHealthcare is a subsidiary of UnitedHealth Group Inc. UNH: NYSE. UNH is one of the largest companies in America with a market capitalization of $500 billion, revenue of about $375 billion and has about 4.7 million members and beneficiaries, about 3rd in the US, after Kaiser (non-profit) and Elevance (formerly Anthem). UNH employs more doctors than any organization in US via its Optum subsidiary, last I recall was about 40,000 physicians.
During our operations, we had to deal with a lot of referral denials and upset customers, the threat of violence was always there, but thank God, it never got serious. Our denial rate was very low, as we really tried to help our patients. I just checked and it was less than 3%, many times it was denied, to refer to another doctor(s) or diagnostic. As a full-risk provider, we had a financial as clearly moral incentive to keep our patients as healthy as possible.
2024 May Be The Year
We have been in our blogs, noting that healthcare is broken, it is getting worse and will for sure get really bad with 14,000 new baby-boomers transferring from commercial insurance to Medicare DAILY. That is a lot of people. My suspicion is that if there is a root driver for this assassination, it is most likely not Medicare Advantage, though not impossible (I am experiencing this for a family member right now). Because as I noted above, in MA the insurer has the financial risk if needed care is delayed. So that leaves most likely (not guaranteed) a commercial or employer-based plan administered by UNH.
The Consumer is Angry and Feed-Up, and AI can actually help, not hurt
We have seen a trend that has in our view reached a tipping point, in part because of the “80% who are dissatisfied with healthcare” more on that next time, and part of taking back control is having their data.
Most people can’t see and assume a broken system will continue this way. The horrible murder of Mr. Brian Thompson is inexcusable. We also believe it could be a warning that the consumer is done, trying to wait till it gets better. Immediately healthcare companies have increased security, most hospitals in my area have armed guards and metal detectors.
UnitedHealthcare Denies More Claims Than Other Insurers — Angering Patients And Health Systems
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.
Noel J. Guillama-Álvarez
Chairman of the Board
OXIO Health, Inc.
Innovator / Incubator / Accelerator / Platform
O. +1-561-904-9477 e355
