Artificial Intelligence Podcast: ChatGPT, Claude, Midjourney and all other AI Tools

Can AI Build Your New Doctor with Max Rispler

• Jonathan Green : Artificial Intelligence Expert and Author of ChatGPT Profits • Episode 366

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Welcome to the Artificial Intelligence Podcast with Jonathan Green! In this episode, we delve into the transformative potential of AI within the healthcare and insurance sectors alongside our insightful guest, Max Rispler. Max is an industry innovator, driving change with data analytics to enhance health outcomes and reshape the insurance landscape.

Max highlights the burgeoning integration of AI in insurance, particularly in proactive care management and cost containment strategies. From utilizing risk scores to manage health proactively to integrating AI with electronic health records for personalized healthcare navigation, Max illustrates how AI is not just a tool but a partner in improving healthcare efficiency and accessibility.

Notable Quotes:

  • "AI is starting to really focus on how we’re utilizing data to then focus on care management." - [Max Rispler]
  • "AI is truly starting to change the landscape. It's really exciting as we start to see what the future holds." - [Max Rispler]
  • "From a billing perspective, generally speaking, a lot of the carriers don't look at claims until it reaches a certain threshold." - [Max Rispler]

Jonathan and Max also discuss the potential of AI to demystify healthcare billing and pricing transparency, with AI poised to bridge the knowledge gap and empower consumers with clearer, more accurate healthcare cost insights.

Connect with Max Rispler:

Through his active presence on LinkedIn, Max continues to educate and influence both industry leaders and the general public about AI’s role in healthcare. If you're intrigued by AI's potential to revolutionize health and insurance, this episode is a must-listen! Don't miss out on this illuminating discussion about the future of healthcare with AI at its helm. 

For more episodes and insights, stay tuned to the Artificial Intelligence Podcast.

Connect with Jonathan Green

Could AI build your new docker? Let's find out with today's special guest, Max Rispler. Welcome to the Artificial Intelligence Podcast, where we make AI simple, practical, and accessible for small business owners and leaders. Forget the complicated T talk or expensive consultants. This is where you'll learn how to implement AI strategies that are easy to understand and can make a big impact for your business. The Artificial Intelligence Podcast is brought to you by fraction, a IO, the trusted partner for AI Digital transformation. At fraction a IO, we help small and medium sized businesses boost revenue by eliminating time wasting non-revenue generating tasks that frustrate your team. With our custom AI bots, tools and automations, we make it easy to shift your team's focus to the task. That matter most. Driving growth and results, we guide you through a smooth, seamless transition to ai, ensuring you avoid policy mistakes and invest in the tools that truly deliver value. Don't get left behind. Let fraction aio help you. Stay ahead in today's AI driven world. Learn more. Get started. Fraction aio.com. Now Max, I'm excited to have you here because we're seeing a lot of innovations with AI in the news, but so often what we see is like what's interesting or what's cool? And yeah, AI video is interesting, but how's it gonna make my life any better? But healthcare is really important. America's the country we spend the most on healthcare, and yet we have the worst outcomes. Is AI gonna make a difference? And is AI gonna change the insurance world for the better or for the worse? What do you think? It's a great question. Ai, it's so early to tell, but there's some amazing innovations that are happening within the insurance industry and already the technology's continuing to get better, what's happening? Two different pieces that actually we've been utilizing in our day-to-day. One in the data analytics side, so the ability for the data analytics to be focused on health outcomes. So taking in all of the different pieces from what's happening with individuals throughout their health journey, and then being able to risk score them on a one to five basis, take that risk score ability from there, and then be able to figure out what opportunities are there to get ahead and be proactive on care management and cost containment and structure it away. So there's. Great education engagement for that individual to then start bringing them back down the risk score from a five to a four to a three and such. And so a great example is diabetes, right? So diabetes is one of the biggest pieces everybody talks about GLP ones and health management and coaching. Lifestyle medicine or functional medicine has been a big piece in this. And so a lot of the analytics tools are how can we focus on diabetes as, for example, a comorbidity of structuring away a lifestyle management to help them live a healthier lifestyle and then start to pull back off of either medications whether that's GLP ones or even coming off diabetic medications as a whole, once they get their diet and exercise and sleep and other pieces corrected. AI is starting to really focus on how are we utilizing that data that we're getting in a way to then focus on care management. And then also what's interesting too is we actually ran across a company recently that is doing AI on electronic health records. And so there are so many different, what we call point solutions. Point solutions are care management programs within whether you're working with an independent third party administrator or you're working directly with a carrier. Whether that's a Blue Cross carrier, an Anthem carrier, Cigna or UnitedHealthcare or such, but it's hard When you're going through your health journey, you ultimately don't know where you should go because there's so many resources and it could be overwhelming at times. The cool thing about this piece with the analytics is it's actually attaching to your electronic health records on the backend, and then the AI tool is able to show. What are the different ways that individual from a medication management or from a medical management, and then what are the resources, like gaps in care, what should they be thinking about? And then if it's supported with a nurse team or a pharmacy team, they're actually then on the back end, I. Reaching out to these individuals, either texting or calling them, and then helping them navigate the healthcare landscape too. So working with them to make sure that they're going to low cost providers that are going to do everything encompassing to make sure that their care is well taken co taken care of throughout their healthcare journey. So AI is truly starting to change the landscape. It's really exciting as we start to see what the future. One of the things that's interesting to me is like depending upon which insurance company you have and which plan you're on your bill from, like a hospital is completely different and hospitals don't show you the price in advance. Everywhere else you go to a restaurant. If there's no prices on the menu, you know it's gonna be rough one, right? So you go to the hospital, and I know this is a common discussion, and it's like with AI's knowledge of big data. Do you think we're gonna get to a point where the ai, you could just ask your ai like, Hey, what's this gonna cost me? Because already we see a lot of people self diagnosing this is why everyone has some type of mental health disease now on TikTok and everyone. First it was WebMD. Oh my gosh, I've self-diagnosed with myself with cancer like seven times now. AI does it. And of course ai, if you ask it the right way, I say, yeah, it sounds like you have it right, because it always wants to give the result you're looking for. So do you think there's a positive outcome there where people can a little better calibrate. Make that informed decision.'cause even though the hospital doesn't wanna tell you the AI has seen enough people's bills to then know that information. Yeah, it's a great question. There's a ton of bill mismanagement and that also comes from directly the hospital systems. So what they'll do is sometimes they'll double charge, sometimes they'll add in different. Different pieces to the bill that are incorrect or even they'll upcharge because they know that they can squeak things by. From a carrier perspective, generally speaking, a lot of the carriers don't look at claims up above until it reaches a certain standpoint. So depending on the carrier, it could be 50,000, it could be 75,000, it could be a hundred thousand dollars before a carrier actually. Looks at that claim to tell that the, there are not pieces within that bill that are maybe an added zero here or double care here, or another aspect that is added in. So it's actually very interesting because AI will start to be able to manage a lot of that process for these carriers. Now, United Healthcare had a little bit of a problem earlier this year. I'm sure you are aware and many of your listeners are probably aware as well. But United Healthcare, they started to task what could AI do from the billing perspective, but then also care management. And it stepped in and it was denying claims. And also things were being balanced, billed, and other problems too, because the hospital systems were saying we're not getting our money that we ultimately wanted from a charge perspective. So then they're going direct and balance billing that member. So there is. Benefits to AI and what it can do, and hopefully in the future here, when AI is able to take also all the machine readable files, and so there are companies out there that are taking these machine readable files that are being posted by companies and then also the carriers. That information out there can start to navigate if I go to get a an orthopedic surgery for my knee or a scope or a shoulder surgery, this is what it's going to cost me. And then breaking down what that cost looks like, because I can know if I go to this hospital system versus this hospital system versus this outpatient facility, there's the three prices. And then being able to utilize that information. So if the bill comes back. Different than, it's okay. I was quoted as it was gonna be 50,000, it came back 55,000. Then I'm only gonna pay 50, and that 5,000 was overcharged. So there's an assumption that ais are objective because they're computers, but they're only as good as the data fed to them. As you've seen with certain different AI where companies put their thumbs on the scale and had a, like Google had a major incident last year where they were. Making some historically inaccurate pictures. That was a pretty big scandal, and it demonstrates, which is critical, which is that it's only as good as information's given, and you can see this if you start asking about certain health treatments that. The AI isn't objective. So there's this worry, and this is one of my concerns. It's if all of the data is coming from insurance companies and hospitals, that even when you ask a questions, it's kind like you ever visit one of those websites and it's you're like, which credit card should I get? And always recommends the one that gives them the biggest commission. Yep. And the same thing like you're prequalified doesn't mean anything. It's like you're not qual like it doesn't mean anything. It just means, yeah, we want you to submit a form, but we have no idea if we're gonna say yes or no. It doesn't affect it. In the same way. One of my, I wonder if there's a way that we could actually have an AI that actually is on behalf of the individual because they're made by these huge corporations. They're have massive expenses, and we've already seen that, certainly in healthcare as well. We've seen that like the more money a doctor gets from a certain pharmaceutical company, more likely they are to prescribe that, even if they're not intentionally like doing it or if they don't notice it. But statistics show that I'm friendly with this person. How do you think there's a path forward where AI can actually be objective? And it can actually be on the individual user's side because one of the challenges, like what's the right treatment? What's the best choice for me? I. Sometimes it's a better choice to not use your insurance. Sometimes better choice to use your insurance. Sometimes different carriers in network and out where it can be very challenging, right? It's a lot of, there's so much math in choosing your healthcare these days. It's so complicated. How can someone, or how can we get to a place where the AI is trying to give the best result for the individual rather than the best result for the company which has the larger budget? It's a great question, and that is where being objective with ai, it comes down to, you're right, the data and the information, but then also who is inputting that data information and then what is it ultimately the story that it tells. There's actually two different things going on right now. There's a sures program with UnitedHealthcare, and then Aetna has a simple pay program, which is very cool because they're using a lot of the information that they have from machine readable files, but then also using some of the AI technology and then being able to say if I go to, let's say these five specialists throughout a city. They're going to all be different copays. So you're removing all the different pieces of what's my co-insurance? What's my copay gonna be? How much is this gonna cost me? And it's simplifying it to just a straight copay. If you go here, it's $50 here, it's$75 here, it's a hundred dollars. And they're trying to steer, obviously, to the lower cost provider, but it's trying to take away some of the confusion of the healthcare system overall. And then AI from being objective. It will end up being more objective because as it continues to learn and has additional information, as long as it's one of those pieces, it's a third party and it's not carrier owned, or it's not pharmacy benefit manager owned, or some of these others. That's a big piece where it has to be independent in the standpoint of we've got good actors on the backend. Making sure that information that it's receiving is helpful for both us as consumers, but then also for our health outcomes as well. I. So like I've heard about this where you go to the pharmacist, once you show them your insurance card, they can't tell you that it would be cheaper for you if you didn't use your insurance because let's say your copay is $10, sometimes it's a medicine, especially if it's something that is no long, it's I guess over 25 years and you can get the generic. Do you think AI could fill in that gap where it can actually give you their recommendation? Before you go there to say, oh, this is it. This is my copay. What's the right choice? We're actually get that information. Yeah. No, that's a great question. We're actually seeing that happen right now. So what's very cool is we've got these independent PBMs, is what we call 'em, independent fire receipt benefit managers. There are three PBMs that own the majority of the market share Over 90%. You've got CVS, you've got Optum, and you've got Express Scripts. And those three, ultimately they do a good job in certain standpoints, but they really control the formularies and they control the pricing and then the rebates that come back to them as an organization. And also they're owned by the large health carriers. And those dollars end up being cycled back into the system. Ultimately, these independent PBMs, whether they're a fiduciary responsibility to the plan or they're independent in the standpoint of they wanna make sure to find the lowest cost medication at the best price for employees, is that they're utilizing GoodRx, they're utilizing Mark Cuban cost plus drugs.com. They're utilizing other resources. So when you go and use your card at the pharmacy. You know that you're getting the best price because it's looking over 15 to 20 different resources and looking at what would the cost be if I went in direct pay? What if it was with GoodRx? What if it was with Mark Cuban cost plus drugs? And on. And it will do that all the point of sale. And then you'll be able to get that medication at the lowest price possible. And then also like GoodRx in certain standpoints for many years if it wasn't attached to the healthcare plan. Ultimately, if you use GoodRx, that money, those dollars, whether it was$15, where whether it's $35 or whatever for the medication, that's not going towards your deductible, that's not going towards your out-of-pocket Maximum because it's off the plan, right? With a lot of these different independent pharmacy benefit managers, that money is then captured and going towards your out-of-pocket Maximum and towards your deductible and such too. So those are a lot of key pieces of what we're seeing from a technology perspective. I actually don't know if that's AI on the backend. I would assume that the technology is there where it's probably doing some kind of consumption of the data and then being able to analyze and then spit out the lowest cost as an AI function. But I don't know on the backend from a technology perspective, but it's very cool. It's great that we're seeing a lot of that happen because it's truly in a positive way. Affecting members as we continue to see keep going forward. But that means also these larger pharmacy benefit managers are gonna have to start playing that same game and implementing a lot of these strategies that the independent pharmacy benefit managers have already implemented. So we're starting to see more and more attempts to put AI into healthcare, as in replacing doctors, replacing therapists, replacing pharmacists, and. There's always this story of oh, this AI looked at my scan and caught something the doctor missed. And it's like for every one of those, there's probably 10,000 where it made you think you had something you don't have. You never hear that story. And it, there was a similar thing going on 20 years ago. I remember everyone who was really rich would pay to get a full body scan once a year. It was like one person found something and. So my question is, what do you think about that shift in the market? Like I'm very interested in the idea of AI therapy.'cause it's like, to me it's all you're doing is creating you're so replacing one problem with a new one, which is oh, maybe you form a codependent relationship or an emotion relationship with a non, like someone who doesn't exist. It's an ai. So what do you think about that direction of the market? Because obviously using an AI therapist is cheaper than a human therapist, but do you think that's a good thing or a good direction? I. It is a hard question because I have mixed views and opinions. I actually come from, my dad was a doctor, my mom was a nurse. So I think ultimately the healthcare system with AI is only going to continue to advance what we can do from detection, management and also care management from a doctor and a hospital perspective. I. The doctors do truly care about their patients and want to do the right thing, and ultimately the billing comes from the backend on the large administrations, from the hospital systems, from many other pieces within the healthcare system. I think that. AI is only going to enhance what we're doing and enhance what the doctors are helping with. But there are also different pieces, like you mentioned, I think behavioral health because there's such a huge gap in care within the behavioral health world that ultimately AI could fill in a lot of those gaps as well. But going back to our earlier question, how do we make sure that it's independent? How do we make sure that. That that bot is not going to lead somebody down a path that they ultimately shouldn't go down. And it's the same with humans as well, right? Because we all have emotions, we all have feelings, we all have thoughts, we all want to maybe get something out of a conversation or such. So there are many different things we wanna make sure when we utilize AI for healthcare, that it is ultimately. In the best interest of the patient, in the best interest of people as individuals, and leading them down the right path from a healthcare journey perspective. And then working directly with the doctors and not replacing, but more advancing what they can do or enhancing their outcomes by making sure that data. Is readily available and that it's structuring in a way that it's easily readable and quickly approachable From a client perspective or from an patient perspective. You brought up something I think is really important. I used to work in education and when you realize what percentage of your tuition goes towards admin versus teachers, it's nightmare. It's like for every teacher there's 20 admin or depending on the ho. University or more, there's 20 people not involved in teaching that you're paying for in the backend and in healthcare. Yeah. When you think about the number of people that work at a hospital that don't actually work in healthcare, do I see that as like an area where AI could really make a difference? And there's certain areas like insurance codes and all of those things cause delays where it's going back and forth and maintaining documents and files. If you can start to, I think that could be such a big opportunity if we could decrease the amount of hospital admin that would make. Such a benefit for the end user, which is a patient, but also it's like admins who makes the buying decisions, the last thing they wanna do is decrease their own salary. So it's like one of the challenges that sometimes the best use cases for AI are not to the benefit of the person who has the power to make that decision. So do you think that there's a possibility going forward that AI, instead of replacing doctors, replaces the admin? Yeah I do. I think that we're seeing it on the healthcare insurance and the brokerage side too, as well. We're using AI in more of the remedial day-to-day tasks, and like you said, I think that will continue to happen within the administration of these hospital systems. Hospitals are incredibly heavy from an administration perspective. Ultimately, the nurses, the doctors, the care, they want to work with the patients, they want to do the right thing and help people. Ultimately, that is their goal and that's why they went into healthcare. The. Problem ultimately always becomes is that because there's such a high overhead from an administration perspective, that's why we're seeing costs continue to rise at such a rapid rate. A great example is in Michigan right now, there are different insurance carriers that are renegotiating with the hospital systems. The hospital systems are asking. Astronomical increases because they lost money last year. The carriers also lost money too. And ultimately, if the hospital systems get their big increases, that'll get passed right on to the insurance carriers. Then carriers pass it right on to companies and companies pass it right on to their employees. So the hospital systems is definitely a piece where we really need to get that under control. We need to start taking away a lot of that administration. The back room work. That's done that these hospital salaries that are huge, astronomical, oftentimes even more than what the doctors and other patient care the forward facing individuals within hospitals are making. And so they're definitely creating their own worst nightmare from an overhead perspective. And then those costs continue to rise. So if we can start to really focus on what AI can do to start from a billing perspective, from a task perspective, from analyzing records. To then making sure that healthcare outcomes are correct and value-based care and other aspects, and keeping people out of the hospital system. Emergency room management and follow ups with people and other if we can really focus on a lot of these things from making sure the administration is as thin as possible, then we can focus on care management for individuals with the doctors and the nurses and. People within the hospital system that ultimately that's what they wanna do. They wanna care for patients and help people think. A lot of the shifts we've seen in healthcare over the past 20 and 30 years have been. Not to the benefit of the patient. So an example of this is that every doctor has to take notes while they're directing every patient they have to write in their laptop. And they started like maybe 12, 15 years ago, this LO post passed. And it's so for better, but it means you that the doctor doesn't look at you. So you see the doctor for eight minutes and six of it. There's hyping because they have to. So one of the cool things I've seen happen in the healthcare space is called passive listening or ambient listening, where the AI makes the notes for you. And I think that's a cool thing because it increases communication. Like I think with actually my helpfulness is that kind of like everyone who does dating apps complains about it and then it, they shift to human interaction, which is better, like human to human actual communication is a good thing. And I think we're gonna see that. As AI gets more believable, the only way you're talking to a real person is shaking their hand, and that I think is the good direction. I see a lot of companies that are like really interested in doing like phone calls and they're testing the hangup rate. They're like, yeah, if someone realizes an ai, the hangup rate's like a hundred percent. It's and it's like the foundation of your sales strategy. In my opinion, it's deception. You're pretending to be something you're not, and that's the wrong direction. Where I think the right direction is how can we use AI tools to allow us to spend more time doing human to human interaction? It's like one of the things I love about my work is that I can be working on an AI project. I was designing a new piece of software and AI was doing 90% of the work. I was doing the instructions while I was swimming with two of my daughters the other day. I get outta the pool. Send a new instruction, tell it, fix this, check that, go swim while a code it for tournament and come back and check on it. Like that to me is the good direction as opposed to this other direction, which is let's replace human interaction. And one of the common mistakes I see companies make is oh, I wanna replace social media with ai. And I'm like, great. Great idea. Let's put an AI in between you and your customer base so that way if something goes wrong, you won't find out about it for longer. The most important thing is your customers. You want your customers to tell you early that something is wrong, not later. And unfortunately, there's these two directions, which is replace human interaction with AI or you human direction to AI to increase human interaction. I'm in the second school and hopefully more people will shift in that direction. So I think like nobody, I don't think anyone gets. Into healthcare to become rich. Like I don't think that's their first thought, and it's a side benefit, which is great, but. They, it's very rare for someone to become a doctor who hates people. Like that's very challenging, right? It's like you don't become a dentist if you hate teeth. You gotta really like mouths. So that's something that I think it's lost. I think that's really where I could see healthcare getting really good is you go, what if AI let you spend more time with each patient? It allows you to better load balance.'cause if you've all been to the doctor and you're waiting for two hours, and that's because there's always a surprise. I run a team of engineers and they'll give it schedule, and I go, is your time assuming there's no surprises. When's the last time you had a day with no surprises, where you found no bucks? That sounds, it's, it never happened. So why is your estimate like that? So there's the challenge and it's like interesting because like now to get a new doctor, you have to audition or you have to come right? When they're taking new patients and then they have the sign not taking new patients, we're Maxed out. And that's load balancing, right? And that's one of the really big challenges. So I could see AI. That's where I see the good thing was where it helps you to be more efficient so you can spend more time with your patients, which leads to better diagnosis, better experiences. So that's my hopefulness for the future. Do you think that's a possibility or am I, I. Add a touch. No, we're seeing that shift right now, and that's a big piece of what AI is allowing us to do. And I love you brought up that question because what we're seeing is that it's going back to what care was 20, 30 years ago. It's actually caring for the patient. That's why I. The doctors, the nurses, the other individuals in the healthcare realm got into healthcare, right? It's not to get rich, it's to take care of the patients, to see the patient. I remember when I was growing up, my dad used to talk about how he would spend 30, 40 minutes in a room with the patient talking through what their needs are, what the surgery's gonna look like, what the structure, what the recovery, right? Now it's or over a period of time it was five minutes in the room and then 45 minutes scribing notes because that was what they needed to do to really to protect themselves as doctors, but also from a hospital system and such, make sure they don't get sued or other aspects. And it was a lot of time spent on those. Remedial tasks, and it's amazing now that AI is allowing this. And this is also why if you've heard of Direct Primary Care DPC Direct Primary Care is starting to take off because what we're seeing is that people want to have that one-on-one working with the doctors. They want to have that handshake. They want to have that relationship. They want to be in there and feel like they're TA being taken care of. They want to have a. A conversation, ask questions about their healthcare and what's going on and they're using this or doing that or shifting here or there. And so having those 30, 45 even hour long conversations are important from a healthcare perspective.'cause then somebody can get a real holistic view of that individual. And AI scribing notes is a piece of this that is going to continue to allow doctors to start building their relationships with patients. And instead of maybe five minutes. Coming in, having a quick conversation and they're doing 30 minutes of notes. Now they can be with the patient for 25, 30 minutes, AI, scribes, everything. Then they go in and make sure that the AI actually scribed what their real notes were. Check everything, right?'cause we always need to wanna double check AI right now until it continues to keep advancing and structuring in a way that we don't need to always constantly double check it. But we get to that standpoint where we're having that one-on-one conversation again with our doctor for 20, 30 minutes, building that relationship and then having better health outcomes because of that. So AI is currently doing that. We've actually I'm in Michigan. There's a hospital system here locally that just started that last year, and so they have implemented it. Have not implemented with every single part of the organization. They are testing it with a couple different pieces, but they have seen tremendous value and benefits from doing it with those parts of the organization. And it's also gonna help from a cost perspective. We talk about overhead, right? If they had to pay individuals prior because of the, some of the doctors didn't even want to do their own notes. They would have to bring somebody in to ultimately write the notes, and that's, paying for administration and overhead. And now that they can use AI and they don't have to have somebody in there necessarily, it actually ends up being much better from administration cost, patient care perspective, building those relationships, and then ultimately the healthcare value that comes out of it. I think that's exactly the direction I was hoping that things would go in like that. There's a hopefulness for the future that we can use AI to make things better, to improve human interaction, improve. Outcomes and also to lower costs, which is a good thing for everyone. So this has me excited about the future of the possibility that insurance could get better instead of worse for once in our lives. So Max, for people who are interested in what you're doing, wanna learn more about your approach to AI and what your company's doing, where people could find you online and learn about the kind of amazing things you're working on. Yeah. I actually do a bunch on LinkedIn, so please feel free to look up my page on LinkedIn. Max Risler Max and then my last name, R-I-S-P-L-E-R. We do or actually I do a ton of posting, usually three to four times a week about different healthcare pieces that are prevalent, what's happening in the industry, how to structure different things, and it's just education, both for people in general, but then also executive leaders and what they can ultimately do to continue to keep helping their employees continue. Or wanna just engage, please feel free to reach out to me on LinkedIn. That's great. Yeah, your content on LinkedIn is exactly why I saw you and wanted to have you on the show. So I appreciate you coming here today for another amazing episode of the Artificial Intelligence podcast. Awesome. Thank you so much, Jonathan. Really appreciate you and taking the time. Thank you for listening to this week's episode of the Artificial Intelligence Podcast. Make sure to subscribe so you never miss another episode. 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