Quick Takes: Interview with Dr. Bernie Steinbacher
In this conversation, Dr. Bernard Steinbacher, a Senior Medical Director at Lyric, offers a unique perspective on how artificial intelligence can help tackle healthcare fraud, waste, and abuse—three issues that often get lumped together but actually differ in subtle yet important ways. Fraud, as Dr. Steinbacher points out, involves deliberate wrongdoing. Waste and abuse, however, occupy murkier territory. Waste can come from unnecessary tests or procedures, while abuse lies somewhere between the two, often blending unintentional overuse of services with complexity in billing.
According to Dr. Steinbacher, AI already shows great promise in uncovering clear cases of fraud by identifying outliers and suspicious patterns. But when it comes to differentiating waste and abuse, the situation is trickier. Physicians may over-order tests not out of ill intent, but because of past experiences or defensive medicine practices. That’s where the human element becomes critical. While AI can highlight irregularities—like a provider billing far more often than peers—someone still needs to dig deeper. Understanding a doctor’s reasoning or unique patient population context often requires a person-to-person conversation, not just an algorithmic flag.
Empathy is key. Dr. Steinbacher stresses that meaningful investigations go beyond raw data. Considerations should include where a provider practices, the type of patients they see, and their personal history. By bringing empathy into these discussions, payers can help foster greater understanding and cooperation. Direct outreach, real conversations, and giving providers a voice are crucial steps.
Ultimately, while AI’s capabilities will continue to expand, Dr. Steinbacher believes human judgment and empathy will remain central. Health plans that strengthen their relationships with providers, use technology as an assistive tool rather than a blunt instrument, and maintain a respectful, collaborative approach will navigate fraud, waste, and abuse more effectively. In his view, integrating human insights and empathy with AI’s promise and capabilities is the best path forward.
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