Now Machines Decide If Your Care Will Be Reimbursed

  1. Can a machine look at all the pertinent data, properly structured, and run some rules to see if the case fits the prescribed procedure and either extreme — those that are outright rejects, and those that are outright matches?
  2. Can a machine convert all the contracts, pathways and guidelines into a structured representation, perhaps an ontology, to then do step 1 much better, essentially closing the gap between outright rejects and outright matches?
  3. Can a machine look at all the historical cases and start to infer these rules as well as patterns in human judgment calls to further adjudicate every case in step 2 with varying degrees of confidence?
  4. Can a machine convert all electronic health data to a structured format to further improve confidences in step 3? This includes text, images.
  5. Can a machine start to look at comprehensive personal and family health history to further improve the confidences in step 3?



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Praful Krishna

Praful Krishna

AI, Product, Strategy, Digital Transformation