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Nine days after a Russian-speaking ransomware syndicate took down the biggest US health care payment processor, pharmacies, health care providers, and patients were still scrambling to fill prescriptions for medicines, many of which are lifesaving.

On Thursday, UnitedHealth Group accused a notorious ransomware gang known both as AlphV and Black Cat of hacking its subsidiary Optum. Optum provides a nationwide network called Change Healthcare, which allows health care providers to manage customer payments and insurance claims. With no easy way for pharmacies to calculate what costs were covered by insurance companies, many had to turn to alternative services or offline methods.

The most serious incident of its kind

Optum first disclosed on February 21 that its services were down as a result of a “cyber security issue.” Its service has been hamstrung ever since. Shortly before this post went live on Ars, Optum said it had restored Change Healthcare services.

Enlarge / A nursing home resident is pushed along a corridor by a nurse. (credit: Getty | Marijan Murat )

Health insurance companies cannot use algorithms or artificial intelligence to determine care or deny coverage to members on Medicare Advantage plans, the Centers for Medicare & Medicaid Services (CMS) clarified in a memo sent to all Medicare Advantage insurers .

The memo—formatted like an FAQ on Medicare Advantage (MA) plan rules—comes just months after patients filed lawsuits claiming that UnitedHealth and Humana have been using a deeply flawed, AI-powered tool to deny care to elderly patients on MA plans. The lawsuits, which seek class-action status, center on the same AI tool, called nH Predict, used by both insurers and developed by NaviHealth, a UnitedHealth subsidiary.

According to the lawsuits, nH Predict produces draconian estimates for how long a patient will need post-acute care in facilities like skilled nursing homes and rehabilitation centers after an acute injury, illness, or event, like a fall or a stroke. And NaviHealth employees face discipline for deviating from the estimates, even though they often don't match prescribing physicians' recommendations or Medicare coverage rules. For instance, while MA plans typically provide up to 100 days of covered care in a nursing home after a three-day hospital stay, using nH Predict, patients on UnitedHealth's MA plan rarely stay in nursing homes for more than 14 days before receiving payment denials, the lawsuits allege.

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It started with a Google search for prescription medications I might get online.

Almost immediately, ads from telehealth companies began chasing me around the Internet, promising access to drugs to make me prettier, skinnier, happier, and hornier. Several of these companies sell anti-aging creams. While decidedly pro-aging, I don’t love the visible effects of my sun-soaked youth. “Sure,” I thought. “Why not?”

Within the hour I had joined the millions of Americans who get prescription drugs from providers in cyberspace.

Enlarge / Moderna CEO Stephane Bancel during a Bloomberg Television interview on the closing day of the World Economic Forum in Davos, Switzerland, on May 26, 2022. (credit: Getty | Jason Alden )

The CEOs of more than 300 publicly traded health care companies collectively raked in $4 billion last year as Americans struggled under high inflation, according to an analysis by Stat News .

Topping the income chart is the CEO of Moderna, the company that developed one of the leading COVID-19 vaccines in the world—with significant support from US taxpayers and federal scientists.

Moderna's Stéphane Bancel made $398 million in 2022, which equaled the total pay for the next six highest-paid CEOs in the biotech and pharma sector, according to Stat's analysis. It also put Bancel near the top of the income inequality chart, showing Bancel's compensation was 2,435 times more than the median salary of Moderna employees last year.

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The Advanced Research Projects Agency for Health (Arpa-H), a research support agency within the United States Department of Health and Human Services, said today that it is launching an initiative to find and help fund the development of cybersecurity technologies that can specifically improve defenses for digital infrastructure in US health care. Dubbed the Digital Health Security project, also known as Digiheals, the effort will allow researchers and technologists to submit proposals beginning today through September 7 for cybersecurity tools geared specifically to health care systems, hospitals and clinics, and health-related devices.

For more than a decade, health care providers in the United States and around the world have been plagued by criminal cyberattacks, particularly ransomware attacks , that take advantage of medical facilities’ high-stakes work to attempt to extort big payouts. Efforts in recent years to crack down on and deter cybercriminal actors have made some limited progress, but health care attacks still occur regularly , disrupting vital services and endangering patients.

Health and Human Service’s research agency Arpa-H doesn’t specifically focus on cybersecurity innovation. The agency has programs running, for example, to spur advances in osteoarthritis treatment and medical imaging for cancer removal. But Digiheals program manager and longtime security researcher Andrew Carney says there is a dire need to make progress on digital defense tools for health care that are both effective and usable for medical facilities in practice.

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On average, patients with chronic illnesses follow their prescribed treatments about 50 percent of the time. That’s a problem. If drugs aren’t taken regularly, on time, and in the right doses, the treatment may not work, and the person’s condition can worsen.

The issue isn’t that people are unwilling to take their prescriptions. It’s that some drugs, like HIV medications, require unwavering commitment . And essential medicines, like insulin , can be brutally expensive. Plus, the Covid pandemic illustrated the difficulties of delivering perishable follow-up vaccine shots to regions with no cold chain . “Are we really squeezing all the utility out of those drugs and vaccines?” asks Kevin McHugh, a bioengineer at Rice University. “The answer is, in general, no . And sometimes we’re missing out on a lot.”

For example, the injectable drug bevacizumab can be used to treat macular degeneration, a leading cause of blindness. But even though it’s effective, dosing adherence is notoriously low . “People hate getting injections into their eyes,” McHugh says. “And I don’t blame them at all—that’s terrible.”

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When it comes to artificial intelligence, the hype, hope, and foreboding are suddenly everywhere. But the turbulent tech has long caused waves in health care: from IBM Watson's failed foray into health care (and the long-held hope that AI tools may one day beat doctors at detecting cancer on medical images) to the realized problems of algorithmic racial biases .

But, behind the public fray of fanfare and failures, there's a chaotic reality of rollouts that has largely gone untold. For years, health care systems and hospitals have grappled with inefficient and, in some cases, doomed attempts to adopt AI tools, according to a new study led by researchers at Duke University. The study, posted online as a pre-print, pulls back the curtain on these messy implementations while also mining for lessons learned. Amid the eye-opening revelations from 89 professionals involved in the rollouts at 11 health care organizations—including Duke Health, Mayo Clinic, and Kaiser Permanente—the authors assemble a practical framework that health systems can follow as they try to roll out new AI tools.

And new AI tools keep coming. Just last week, a study in JAMA Internal Medicine found that ChatGPT (version 3.5) decisively bested doctors at providing high-quality, empathetic answers to medical questions people posted on the subreddit r/AskDocs . The superior responses—as subjectively judged by a panel of three physicians with relevant medical expertise—suggest an AI chatbot such as ChatGPT could one day help doctors tackle the growing burden of responding to medical messages sent through online patient portals.

Enlarge / An AI-generated image of a pixel art hospital with empty windows. (credit: Benj Edwards / Midjourney)

On Monday, Microsoft and Epic Systems announced that they are bringing OpenAI's GPT-4 AI language model into health care for use in drafting message responses from health care workers to patients and for use in analyzing medical records while looking for trends.

Epic Systems is one of America's largest health care software companies. Its electronic health records (EHR) software (such as MyChart) is reportedly used in over 29 percent of acute hospitals in the United States, and over 305 million patients have an electronic record in Epic worldwide. Tangentially, Epic's history of using predictive algorithms in health care has attracted some criticism in the past.

In Monday's announcement, Microsoft mentions two specific ways Epic will use its Azure OpenAI Service , which provides API access to OpenAI's large language models (LLMs), such as GPT-3 and GPT-4. In layperson's terms, it means that companies can hire Microsoft to provide generative AI services for them using Microsoft's Azure cloud platform.