By Greg Shulas December
4, 2019
The recent public scrutiny of racially biased
algorithms at a UnitedHealth affiliate has been escalated on
Capitol Hill as two U.S. senators have launched an inquiry into the matter.
Their effort involves sending out letters to five health insurance
organizations — as well as the CMS — that include explicit
questions about how these payers are using algorithms in their operations.
Moreover, the lawmakers have asked the Federal
Trade Commission if it has any plans to undertake “an investigation”
into algorithms that “unfairly discriminate against members of protected
classes”— essentially saying that the FTC should be probing this matter, if it
has not already.
The five health insurance companies to receive
letters from U.S. Senators Cory A. Booker (D-N.J.) and Ron
Wyden (D-Ore.) are: UnitedHealth Group, Humana, Aetna, Cigna and
the Blue Cross Blue Shield Association, or BCBSA. No other payers
so far have received letters from the lawmakers about this topic.
The review follows a report in the
journal Science that concluded an algorithm created by
UnitedHealth affiliate OptumHealth — which helps refer
patients to critical care programs — inadvertently contained a bias against
African-American patients, as reported on by Health
Payer Specialist. The October Science article has already
sparked separate probes by the New York Department of Financial
Services and the state’s Department of Public Health.
At issue is the algorithm’s apparent use of
healthcare costs as a proxy for a patient’s true healthcare needs. Such an
approach would fail to take into account a minority patient's lack of equal
access to healthcare facilities in communities, as well as “low levels of
trust” in local health systems, the lawmakers noted. Experts have told Health
Payer Specialist that the OptumHealth matter is far from the only case
of less-than-neutral algorithms in the burgeoning world of healthcare
analytics.
Questions that the lawmakers posed to the
payers, among others, include:
·
What specific
decisions are these algorithms making?
·
How many people do
these algorithms impact?
·
What is [the payer]
doing to ensure that these algorithms are free from bias?
·
How often are audits
done to detect bias?
·
Do you compare
performance before and after algorithm implementation to ensure the algorithm
actually works and does not maintain or increase bias?
·
Do any of the
algorithms that [the payer] is currently utilizing include a bias that would
negatively affect certain patients relative to others?
·
Will [the payer]
commit to immediately halting the use of these algorithms where possible, until
such bias is eliminated? In cases where the algorithm cannot easily be halted,
will [the payer] commit to providing adequate resources to investigate and fix
the problem?
The senators acknowledge in their letter to
the FTC that UnitedHealth is seeking to actively address the issues exposed in
the algorithm. In a special Health Payer Specialist report Wednesday about the algorithm
matter, a UnitedHealth spokesperson told the publication that the organization
appreciated the work done by the Science researchers, and
noted that algorithm “was highly predictive of cost, which is what it was
designed to do.”
Both Booker and Wyden did note that algorithm
can serve an important role in healthcare delivery by removing human flaws and
prejudices from clinical processes. However, the senators stressed how the data
sets that the algorithms rely on are influenced by “historical and human
biases” and thus can’t be entirely trusted, according to their letter to
Cigna’s CEO.
“Technology holds great promise in addressing
these issues and improving population health. However, if it is not applied
thoughtfully and with acknowledgment of the risk for biases, it can also
exacerbate them,” the senators wrote to Cigna Chief Executive David
Cordani.
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