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.)
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).
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.
(There is such a thing as Medicare advantage, where a patient can choose to put their Medicare dollars toward private insurance, but it's not part of the initial launch of this program.)
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.
Wouldn't this mean you'd rather interact with an AI, if it meant whatever you said was provably shown that it could never leak (though the medical conclusions would be documented in your HIPAA-protected record)?
But if it’s in someone else’s computer? thats gonna be a no from me dawg.
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 other uses are honestly pretty standard rhetorical patterns; they do not seem especially AI-flavored to me.
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.
Any attempt to use LLMs as a substitute for personal interaction is playing an incredibly dangerous game that will probably make them a lot of money, while hurting a lot of people.
Oh and taking sycophancy out of a model is easy. Just finetune out that they (have to) agree with everything. Plus every new model has less of it, or at least masks it better.
One step further would be robots that take people to the bathroom, clean them and other stuff. Having this done by humans is either extremely expensive or it will not be done properly.
Some people are horrified by the loss of human touch but for most old people human touch is a luxury they can't afford.
Look at all the "AI psychosis" problems with people going into a conversation loop that amplifies their worst thought patterns. Now consider the same where the person in this loop is already having delusions and other cognitive decline. It seems to me that it could spiral in the wrong direction quite easily.
It's quite difficult for human caretakers to navigate this space too. That is part of why it is so exhausting. You're constantly trying to make judgement calls and implicitly predict the unreliable response of the dementia sufferer.
I think there is a large uncanny valley between having some facsimile of human interaction in a short session and having some kind of trustworthy caretaker that can consistently respond in a way that promotes health and safety. I think it involves a lot of subjunctive interpretation and reasoning to navigate all the mixed up layers of fact, fantasy, and simply aphasic expression that come from dementia.
First: of course this is fixable.
Second: As opposed to the damage of no attention at all? Because you act as if the alternative is that a professional therapist will be helping the homeless, walking around in the cold. I've never once seen that happen.
