Medicare's new payment model is built for AI. Most of the tech world has no idea

The payment model is not "built for AI"; it's incentivized to drive costs down for chronically ill patients (and likely other high utilizers), which matters because a small number of patients (and end-of-life care) represents the bulk of costs. That means automation, ideal for SaaS.

Remember: this is just v1. In theory Medicare Access will learn to weed out the bad actors and get better at focusing on progress that matters and can't be faked, and the AI companies will get better at reaching more people.

This kind of work is profoundly unrewarding: hand-holding chronic patients and sorting out medical and personal logistics is no one's calling.

Right now Pair Team has 3 engineering positions (~170K), but 14 for case workers that get to work from home for ~$50K (outside the bay area).

I could see them pivoting to social services, with health care being just one aspect.

(As a reminder, the homeless problem is driven by mental health issues blocking people from adapting economically, for which social services cannot keep up. I'd love to see a program offering free phones for daily AI discussions that surface some cheap partial solutions.)

I run a YC startup that was accepted to Medicare ACCESS.

Historically, insurance has paid for activity: time spent in visits, RVUs generated, and minutes logged. This was a reasonable starting point, but the flaw is that there's no strong incentives to be efficient.

ACCESS is explicitly a "deflationary" approach. Medicare has set the payment rates high enough to be viable for startups, but low enough that you have to use software (including AI) to deliver a large part of your program.

So Medicare has basically created economic incentives to reward software without prescribing the exact shape of the programs. I thought it was a really interesting approach and builds on 15 years of lessons from CMMI (Medicare's innovation group).

>rewards health outcomes rather than required activities… earn the full amount only when patients meet measurable health goals, like lower blood pressure or reduced pain

They’ll just start cherry picking their patients, finding ways to squeeze out the people just that little bit lower on the prognosis curve. Or at least that will be the risk in a setup like that.

Billing Medicare for services that never get performed is a particularly offensive kind of fraud. I hope these criminals get a harsh sentence.

Recent podcast episode with CMS explains how ACCESS works in practice https://open.spotify.com/episode/720DvvkFd73BwXiXlOOte1?si=b...

Is it basically about giving as much data as possible to insurance companies?

>The company's premise was that you can't improve health outcomes without addressing the full context of someone's life

They are absolutely correct about this mathematically, you can’t solve problems you don’t have data for

The question is what organization would I trust with the full context of my life. None. Zero.

**future headline: Consumer warning: The panopticon(tm) product is embedded into your care plan, insurance is only available for panopticon subscribers.

It seems that TechCrunch, not a strong source of news since around 2014/15, is now just sending out AI text:

First the title: "Medicare's new payment model is built for AI. Most of the tech world has no idea", classic AI tell. The by-line is by the editor-in-chief.

Em-dashes everywhere, including in this quote, somewhat unusually: “The best solution wins, which, in regulated industries like healthcare — that’s not been the case.”

Oddly-short paragraphs: "That payment structure is the real news."

Rule of threes: "Pair Team launched in 2019 with a specific kind of patient in mind: people managing chronic conditions who were also dealing with unstable housing, too little food, or lack of transportation"

This whole paragraph: "There are real risks. Participants are feeding extraordinarily sensitive patient data — intimate conversations about housing and diseases and mental illness — into a federal infrastructure with a documented history of breaches, including exposed Social Security numbers. For the vulnerable populations ACCESS is designed to serve, that's not an impractical concern."

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I haven't opened a TC article in years and I think I'll return to that practice.

I think there's an ongoing conversation about whether we should accept all LLM-generated text without commentary.

I write this comment because I have some sympathy for a Show HN with AI-assisted writing, but I will not spend time enriching TechCrunch's use of machine-generated text anymore than I would scroll through an ad block at the end of any other article.

(Just for the sake of comparison, here's something by the same writer from a few years ago - https://techcrunch.com/2022/11/16/boompop-gains-traction-by-...

You can see more examples here, too https://techcrunch.com/author/connie-loizos/page/16/ )

> The first call that shifted his thinking was with a 67-year-old woman living out of her car, managing PTSD and congestive heart failure. She spoke with Flora for over an hour. "It was both incredible and depressing," Batlivala told me. "Flora was probably the only 'person' she'd talked to in weeks about her situation." Now, hourlong conversations with Flora are routine. "That's the companionship piece," he said. "And it turns out that is truly an intervention."

People don't seem to realize that this is both coming and that before long people will be defending AI "persons" because of this reason (OpenAI is already complaining about people doing this). Nobody's going to deliver this level of care using humans. It's not going to happen.

A lot of people needing care are deeply isolated and will be of the opinion that AI changes that.

Gross .