Everyone in health insurance is talking about data. In the Year of our Lord 2025, AI is the big bright mysterious star on the horizon steering these conversations, but the conversation about data in health insurance is far from new.
There is no doubt that good people want to use data for good purposes. They want to measure the quality of healthcare being delivered and the cost of various services. With this knowledge, they believe they will be able to create an omniscient, all-knowing god that shares their enlightened values. This god I shall call “The Algorithm”.
The Algorithm is a mythical input-output information system that takes as variables all medical and financial information about a patient, all cost and quality information about all providers, and dictates a morally and economically optimal way of caring for and paying claims on behalf of that patient.
Trillions of dollars have been invested in the divine undertaking of creating The Algorithm. Our nation’s Mission-Oriented-Product-Managers have spent countless hours on echo-y Zoom calls explaining The Algorithm to the gentiles, their sermons recorded and transcribed and subject to your organization’s Mutual NDA.
Departments and sub-departments of universities have established prestigious programs for those pure and untainted by clinical experience to study the teachings of healthcare administration. Such monks are permitted to read the informatics scrolls under the academic use license.
Agencies and sub-agencies of government have laid the legal framework for measuring and codifying the regulations, guidelines, and oversight boards that will sanction the holy Algorithm in all the courts of the land.
Fairness will be not only quantified, efficiency will be not only optimized. Fairness and efficiency will be codified, enforced, and proselytized. The Algorithm will be all-powerful. Those who challenge The Algorithm will be punished, and not only in the context of a particular sin. The suffering of non-believers will be eternal: they will be kicked out of network, refused future service, bound to non-competes.
In order to ensure people have privacy, all information will be shared securely and compliantly with The Algorithm. This data is the blood of the Algorithm and its circulation through the corpus shall pass through veins and artery networks called things like Clearinghouses and Qualified Health Information Networks to deliver x12 and HL7 data packets to The Algorithm’s appropriate organs for processing. Your applications shall drink from this blood, the holy blood of The Algorithm.
Nourishing The Algorithm’s data needs is a pious job, and requires sacrifice. Those deigned with an EHR login and appropriate, Algorithm-sanctioned credentials shall enter the raw data into the portals to ensure The Algorithm can achieve Care Everywhere.
The Algorithm will make all decisions for the faithful. The pious will be saved from implicit bias. Instrumental preachers will guard against experimental procedures. The Algorithm’s eternal perfection will save all souls who focus on adhering to its commanding guidelines and best practices. Residents will obtain these Commandments through their forty day-and-night shifts at Mount Sinai.
Just as mortals cannot look within the Ark of the Covenant, mere humans are not able to understand The Algorithm. The “Mystery of The Algorithm” shall guide your approach to understanding the word of the Plan Document, the sacredness of the Medical Guidelines, and anything else that affects your ability to take care of yourself or others.
Buy Repentance or Beg Forgiveness
The Algorithm knows you are not perfect. By nature, You are Flawed, as is every other human being. The Algorithm has solutions for you in the form of indulgences. The purgatory of the administrative denial? Optum Insight. The purgatory of your primary care not understanding your insurance? One Medical is discounted with Amazon Prime.
The Algorithm shall know everything, including your sins. Confession shall happen Peer to Peer, behind a veil (or certified mail). Forgiveness of debts for you and for many is possible through The Algorithm’s financial aid policies. Pray to Saint Mary. Pray to Saint Joseph. Pray to Saint Peter, Saint Angus, Saint Francis, or Saint Jude. Each is canonized by their Miracle Cures. You may wander the desert for 120 days before the Ascension of your hospital debt to collections.
Do we really believe in this God, The Algorithm?
I wholly fear it, this brave new holy spirit. Fortunately, I am not alone.
“And thus be confident of entering into heaven through many tribulations rather than through the false security of peace.” - Thesis 95, Martin Luther 1517