THE DENIAL MACHINE : TECHNOLOGY BECOMES THE PRIORITY, WHO PAYS THE PRICE?

The controversy surrounding the use of algorithms and denial/restriction of healthcare coverage.

UnitedHealthcare and its parent company, UnitedHealth Group, have faced scrutiny over the use of technology and organizational policies in Medicare Advantage coverage decisions.

A 2024 Senate investigation examined UnitedHealthcare, Humana and CVS and found that the insurers increasingly denied requests for post-acute care as they expanded their use of technology in coverage decisions. The investigation reported that the three companies collectively denied about one-quarter of post-acute-care requests in 2022. THE DECISION-MAKING PROBLEM Speed does not necessarily mean good judgment. When an algorithm says NO, does anyone stop to ask WHY? Who had the power to make decisions?

UnitedHealthcare / senior management (High level of power) : Set policies, incentives and systems

Employees (Limited organizational power) : Had to operate within those policies

Doctors (Professional influence, but limited organizational power): Could challenge decisions but didn't control the insurance system

Patients (Least organizational power) : Were affected by decisions but had the least organizational power

WHO HAD THE POWER TO MAKE DECISIONS?

The problem can be understood as a combination of organizational power, technology and decision-making processes.

UnitedHealthcare's senior management had the greatest ability to establish the systems through which decisions were made, meaning they may fail to recognize the ethical consequences of their decisions. The organization made decisions that prioritized investment in technology and cost-control systems rather than investing in the human judgment needed to make sure those systems were producing appropriate outcomes.

Employees and healthcare providers operated within those systems, while patients were largely on the receiving end of the decisions. WHAT COULD HAVE BEEN DONE DIFFERENTLY? Those with the greatest authority had the greatest ability to shape the system, while patients, who were most directly affected by the decisions, had the least power to influence it. Based on Buchanan, D. A. and Huczynski, A. A. (2019) Using System 1 and 2 - Slow down important decisions and question automated or intuitive conclusions.

- Consider the human consequences, not just organizational goals. - Give lower-level employees and affected stakeholders meaningful opportunities to challenge decisions. - Decision-making: Don't assume that investing more in a system automatically makes it better. - Oversight: Important decisions need mechanisms for review and accountability.

VERDICT: THE SYSTEM FAILED BEFORE THE INDIVIDUAL DID.

The biggest failure was not simply that individual decisions may have been wrong. It was that the organizational system gave greater power to those designing and controlling the decision-making process than to those experiencing its consequences. UnitedHealthcare's case shows that effective decision-making requires more than speed and efficiency. Organizations must also provide human oversight, encourage questioning and ensure that those affected by decisions are not forgotten in the pursuit of organizational goals.