STAT's 'Denied by AI' series is a Pulitzer finalist

In just the latest in a dizzying array of awards and acknowledgements, my colleagues Casey Ross and Bob Herman's 4-part series on a health plan using AI to deny beneficiaries medial care has been named a Pulitzer finalist.

The series reveals how UnitedHealthcare, the nation's largest health insurer, has been using unregulated and unvalidated algorithms in their Medicare Advantage plans to cut off payment for necessary rehab care for patients. The algorithm was developed and owned by a UnitedHealth Group company NaviHealth. Nearly 31 million Americans rely on Medicare Advantage plans for their medical needs.

Casey and Bob's reporting was cited in a class action lawsuit against UnitedHealth and its subsidiary NaviHealth. And the Centers for Medicare and Medicaid Services has since warned health plans not to use algorithms as the sole criteria in making coverage decisions for patients. Revisit the investigative series and its impact here.

Virtual care

Telehealth policy enters familiar holding pattern

Congress seems likely to opt for a short-term extension of telehealth flexibilities instead of finding a permanent fix, despite years of pressure from virtual care advocates arguing that the pandemic has netted more than enough data supporting its long-term use. Citing several sources familiar with the congressional talks, my colleagues Mario Aguilar and Rachel Cohrs Zhang report that short-term extensions are much less costly than permanent ones. They cited a Congressional Budget Office estimate that pegged the cost of a two-year extension at around $4 billion; that figure hasn't been released publicly yet.

The House Ways & Means Committee is slated to mark up one such two-year extension bill tomorrow, and we'll be closely watching its progress. Read more on the policy landscape here.

standards

On tap this week: ONC takes up cancer data exchange

Elsewhere in Washington, the federal government's top health data office (the Office of the National Coordinator for Health IT) is convening a two-day summit on Wednesday and Thursday examining standards intended to make sharing cancer data more seamless, including for meeting milestones for the White House's Cancer Moonshot. The virtual gathering is slated to draw in researchers, clinicians, regulators, standard-setting groups, and EHR vendors.

First opinions

The case for virtual-second care

An intriguing take made its way to STAT's First Opinion desk late last week: A call for a "virtual-second" care model instead of one that shuffles patients through virtual exams before an in-person visit. As a flurry of telehealth businesses fizzle — including Walmart's and Optum's — it could be time for telehealth providers to embrace in-person care as a means for building longer-term relationships with patients instead of transactional, one-off-video calls, Deepak Sirdeshmukh argues. Read the opinion piece and let me know what you think.

the market

Deals, layoffs and new business strategies

Some tidbits that caught my eye this week:

Kaiser Permanente is signing up to deploy Innovaccer's AI technology in Washington state, potentially influencing the care of 650,000 members. Innovaccer is also reportedly in talks to raise $250 million.
Covid testmaker Cue Health is slashing hundreds of jobs as the sales of its test kits plummet.
Direct-to-consumer telehealth company Ro appears to be trying a new tactic with its "Ro Operating System," a tech platform and suite of products aimed at providers. Among offerings: A patient app for users to message providers, a monitoring app clinicians can use to log treatments and review lab results, and a pharmacy app.

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What we're reading

The teens making friends with chatbots, The Verge
Who gets sued when AI harms patients? Forbes
How a YC-backed medical records startup build its founding team, Tech Crunch

Thanks for reading! More on Thursday - Mohana

Mohana Ravindranath is a Bay Area correspondent covering health tech at STAT and has made it her mission to separate out hype from reality in health care.