AI Corner
Over the holidays, someone tipped me off to the podcast ALL-IN, where I found long interviews with Alex Karp of Palantir, Jared Kushner, Vivek Ramaswamy, and more (this blog uses Chat GPT to compare RFK Jr and DJT views on healthcare.)
Palantir, a software/AI company focused on government services, has seen its stock nearly double (to a market cap of $170B) since just before the election.
Palantir hasn't had much focus in healthcare, but it's starting to, and Palantir has a big contract with the UK NHS.
I asked Chat GPT about potential impacts of companies like Palantir in healthcare, rolling in topics like DOGE and MOLDX.
- Note that Chat GPT responses can't actually predict healthcare evolution; Chat GPT just takes existing fact patterns and creates extrapolations. (The original full chat is here.)
- Palantir and Healthcare
- Palantir and NHS in UK
- Palantir and Healthcare and DOGE?
- Palantir and MolDx?
- MolDx vs Publicly-reported Medicare waste
- Wrapping Up: How might DOGE view MolDx?
- Wrapping Up: Greatest potential, greatest hurdles?
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#1
How could Palantir technology improve health care? Focus on real impacts, avoid generalistic claims. Is there any adoption (sales) of Palantir in US healthcare today?
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Palantir Technologies has developed data integration and analytics platforms that have been applied in various sectors, including healthcare.In the United States, Palantir's technology has been utilized by organizations such as the National Institutes of Health (NIH) to support both fundamental and translational research. Link.
By consolidating disparate data sources, Palantir's platforms can enhance decision-making processes, streamline operations, and improve patient outcomes. For instance, during the COVID-19 pandemic, Palantir's technology was employed to manage vaccine distribution, ensuring efficient allocation and delivery.
In the United Kingdom, Palantir's data platform has been adopted by the National Health Service (NHS) to improve efficiency and productivity across trusts. As of November 2024, 87 acute NHS trusts and 28 integrated care boards have signed up to use the Federated Data Platform.Some trusts have reported significant improvements, such as a 37% reduction in the number of days patients remained in hospital after they were ready to go home. Link.
While specific sales figures and detailed adoption metrics in U.S. healthcare are not publicly disclosed, Palantir's involvement with institutions like the NIH indicates a presence in the sector.The company's focus on data integration and analytics aligns with the increasing emphasis on leveraging technology to enhance healthcare delivery and outcomes.
https://www.ft.com/content/9efae6c4-c039-49b9-bbe6-dcac575cb4a5?
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#2
What is publicly known about Palantir and the UK NHS?
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Palantir Technologies, a U.S.-based data analytics firm, has established a significant presence within the UK's National Health Service (NHS) through several key engagements:
COVID-19 Response Initiatives:
Initial Involvement: In March 2020, during the early stages of the COVID-19 pandemic, Palantir began collaborating with the NHS to develop a data platform aimed at managing the crisis. This initial engagement was secured through a nominal £1 contract, arranged without a competitive process.
Subsequent Contracts: Following the initial collaboration, Palantir secured additional contracts with the NHS, including a £23 million agreement in December 2020, also awarded without competition. These contracts facilitated the development and expansion of data management systems to support the NHS's pandemic response.
Federated Data Platform (FDP):
Contract Award: In November 2023, NHS England awarded Palantir a £330 million contract to develop and manage the Federated Data Platform (FDP). This platform is designed to integrate data from various NHS trusts and systems, enhancing efficiency and patient care across the health service.
Adoption and Implementation: As of November 2024, 87 acute NHS trusts and 28 integrated care boards have adopted the FDP. The platform consolidates data on bed availability, waiting lists, and medical supplies, among other metrics, to improve operational efficiency. Some trusts have reported significant benefits, such as a 37% reduction in patient hospital days post-adoption.
Controversies and Concerns:
Privacy and Data Security: Palantir's involvement with the NHS has sparked concerns among privacy advocates and medical professionals, primarily due to the company's background in defense and intelligence sectors. Critics have expressed apprehension about the handling of sensitive patient data by a firm with such affiliations.
Procurement Processes: The manner in which contracts were awarded to Palantir, particularly the initial £1 contract and subsequent non-competitive agreements, has been criticized for lack of transparency. Campaign groups and some NHS staff have called for greater openness in procurement to ensure fair competition and public trust.
In summary, Palantir's collaboration with the NHS has been instrumental in developing data integration platforms aimed at enhancing healthcare delivery. However, the partnership has also been accompanied by debates over data privacy, security, and procurement transparency.
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#2B
It seems Palantir might be more impactful on the United Kingdom national health service, which is an integrated system, in comparison to the highly fragmented system in the United States.
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That's a valid observation. The United Kingdom's National Health Service (NHS), as an integrated, publicly funded healthcare system, offers a more unified environment for deploying platforms like Palantir’s Federated Data Platform (FDP) compared to the fragmented healthcare system in the United States. Here's why Palantir might have a greater impact on the NHS:
1. Unified Data Infrastructure
- NHS Integration: The NHS operates as a single payer with centralized data systems. This enables platforms like Palantir’s FDP to integrate and analyze data across multiple trusts and care boards, providing actionable insights at a national scale.
- U.S. Fragmentation: The U.S. healthcare system comprises private insurers, federal programs (e.g., Medicare and Medicaid), and independent hospital networks. Integrating these siloed data sources is far more complex, limiting the potential impact of a centralized platform.
2. National Scale Projects
- In the UK, Palantir's work on initiatives like managing COVID-19 vaccine distribution and improving hospital workflows (e.g., reducing hospital stays by 37%) demonstrates the benefits of national-scale data coordination.
- In the U.S., Palantir has worked on smaller, more specific projects, like partnering with the National Institutes of Health (NIH). While impactful, these projects lack the system-wide reach possible in the UK.
3. Procurement and Adoption
- UK Centralization: The NHS has centralized authority to approve and implement technology like the FDP across its network. Once adopted, Palantir's tools can be scaled efficiently across all NHS trusts.
- U.S. Decentralization: In the U.S., each healthcare provider or payer must independently evaluate and adopt technology. This slows adoption and fragments potential impact.
4. Public Trust and Accountability
- Despite privacy controversies, the NHS provides a single point of accountability for data use. In contrast, U.S. patients interact with many entities, raising more questions about privacy, consent, and data security when large platforms like Palantir enter the picture.
Conclusion
Palantir's success with the NHS underscores the benefits of a centralized health system for implementing advanced data analytics. In the U.S., the fragmented system limits Palantir’s ability to replicate its NHS-level impact. However, targeted projects in research (e.g., NIH collaborations) or disease-specific programs (e.g., cancer genomics) still hold promise for meaningful contributions.
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#3 USA / HHS / DJT / DOGE
The 2025 Trump administration will use DOGE to improve government efficiency. How might DOGE make use of, or promote use of, Palantir in healthcare?
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The Department of Government Efficiency (DOGE), established by the 2025 Trump administration and led by Elon Musk and Vivek Ramaswamy, aims to enhance government operations and reduce expenditures. In the healthcare sector, DOGE may consider leveraging advanced data analytics platforms like Palantir's to achieve these objectives.
Potential Applications of Palantir in Healthcare:
Data Integration and Analysis: Palantir's platforms, such as Foundry, can consolidate disparate health data sources, enabling comprehensive analysis to inform policy decisions and improve patient outcomes. For instance, during the COVID-19 pandemic, Palantir's software facilitated data integration across multiple federal agencies, supporting effective pandemic management.
Operational Efficiency: By providing real-time insights into resource allocation, patient care, and administrative processes, Palantir's tools can help identify inefficiencies and areas for cost reduction within government-run healthcare programs.
Predictive Analytics: Utilizing artificial intelligence, Palantir's platforms can forecast healthcare trends, patient needs, and potential system bottlenecks, allowing for proactive measures to enhance service delivery and reduce costs.
Considerations for Implementation:
Privacy and Security: The use of Palantir's technology in healthcare would necessitate stringent safeguards to protect sensitive patient data, addressing concerns related to privacy and data security.
Interagency Collaboration: Effective deployment would require coordination among various government health agencies to ensure seamless data sharing and integration.
Cost-Benefit Analysis: DOGE would need to assess the financial implications of adopting Palantir's solutions, weighing the initial investment against potential long-term savings and efficiency gains.
In summary, DOGE could explore the utilization of Palantir's data analytics platforms to enhance efficiency within government healthcare services, provided that considerations regarding privacy, collaboration, and cost are thoroughly addressed.
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#4
How could the Medicare Moldx program and Palantir (and perhaps DOGE) bring assets together to improve US healthcare?
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Integrating the Medicare MolDX Program, Palantir's data analytics platform, and the Department of Government Efficiency (DOGE) could significantly enhance U.S. healthcare by streamlining molecular diagnostic test evaluations, improving data integration, and promoting efficient healthcare delivery. Here's how these entities could collaborate:
1. Enhancing Molecular Diagnostic Evaluations with Palantir's Data Integration
MolDX Program Overview: Established by Palmetto GBA in 2011, the MolDX Program identifies and establishes coverage and reimbursement for molecular diagnostic tests. It ensures that such tests meet Medicare's "reasonable and necessary" criteria by evaluating their analytical and clinical validity, as well as clinical utility.
Palantir's Role: Palantir's Foundry platform excels in integrating diverse data sources, enabling comprehensive analysis. By consolidating clinical trial data, patient outcomes, and real-world evidence, Palantir can assist MolDX in making more informed and timely coverage determinations for molecular diagnostics.
2. Streamlining Data Integration and Analysis
Data Silos Challenge: Healthcare data often exists in isolated systems, hindering comprehensive analysis and decision-making.
Palantir's Solution: Palantir's data integration capabilities can unify disparate data sources, providing a holistic view of patient information. This integration supports better clinical decisions, personalized medicine approaches, and efficient resource allocation.
3. Promoting Efficiency through DOGE Initiatives
DOGE's Mandate: The Department of Government Efficiency aims to enhance operational efficiency across government agencies, including healthcare services.
Collaborative Efforts: DOGE can facilitate the adoption of Palantir's platform within Medicare and other healthcare programs to streamline processes, reduce administrative burdens, and improve patient care outcomes.
4. Ensuring Data Security and Compliance
Privacy Concerns: Handling sensitive healthcare data necessitates stringent security measures to protect patient privacy.
Palantir's Compliance: Palantir's platforms are designed with robust security protocols to ensure compliance with healthcare regulations, safeguarding data integrity and confidentiality.
Conclusion
By leveraging Palantir's advanced data integration and analytics capabilities, the MolDX Program can enhance its evaluation processes for molecular diagnostics. With support from DOGE, this collaboration can lead to more efficient healthcare delivery, improved patient outcomes, and optimized resource utilization within the U.S. healthcare system.
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#5
The Office of the Inspector General for Health and Human Services recently released a report indicating that Medicare paid up to $1 billion in erroneous molecular test claims over a one- to two-year period, primarily under code 81408. These payments were halted and did not occur within the MolDx program.
Similarly, a recent JAMA article suggested that several hundred million dollars in excessive Medicare claims may have been paid for certain nonspecific molecular microbiology codes. Once again, such payments were identified and stopped by the MolDx system.
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Recent reports have highlighted significant improper payments by Medicare for molecular diagnostic tests, particularly under CPT code 81408, which is designated for complex genetic tests associated with rare diseases. An audit by the Office of Inspector General (OIG) revealed that, between 2018 and 2021, Medicare paid approximately $888 million for over 450,000 tests billed under this code. Given that these rare diseases typically manifest in childhood, such extensive testing within the predominantly senior Medicare population raises concerns about the appropriateness of these payments.
In contrast, the MolDX program, administered by Medicare Administrative Contractors (MACs), has demonstrated effective oversight in this domain. MolDX requires detailed test information, including unique identifiers known as DEX Z-Codes®, to assess the clinical validity and utility of molecular diagnostic tests before approving coverage. This rigorous evaluation process has been instrumental in preventing improper payments for unsupported or unnecessary tests.
Additionally, a recent article in JAMA highlighted concerns about excessive Medicare payments for nonspecific molecular microbiology codes, particularly related to urinary tract infection (UTI) testing. The article noted a surge in the use of multiplex molecular panels for diagnosing UTIs, leading to substantial Medicare expenditures. However, the MolDX program had previously identified this trend and implemented strict local coverage determinations (LCDs) to limit coverage for such tests, effectively curbing unnecessary spending.
These instances underscore the importance of robust oversight mechanisms like the MolDX program in ensuring that Medicare payments for molecular diagnostic tests are appropriate and justified. By requiring comprehensive test information and conducting thorough evaluations, MolDX helps maintain the integrity of Medicare expenditures and safeguards against improper payments.
Link.
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#6 Wrapping Up
Given these findings that the Moldx program, which operates in only 28 states, saves Medicare many hundreds of millions of dollars.... could this MolDx program come to the attention of the DOGE? What might DOGE propose as a result?
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The Molecular Diagnostic Services (MolDX) Program, currently operational in 28 states, has demonstrated significant success in preventing improper Medicare payments for molecular diagnostic tests. Given its effectiveness, the Department of Government Efficiency (DOGE), led by Elon Musk and Vivek Ramaswamy, may consider the following actions to enhance Medicare's efficiency nationwide:
1. Nationwide Expansion of MolDX
Proposal: Extend the MolDX program to all 50 states to ensure uniform oversight of molecular diagnostic test claims across the country.
Expected Outcome: A nationwide implementation could standardize test evaluations, reduce improper payments, and enhance the overall integrity of Medicare's billing processes.
2. Integration with Advanced Data Analytics
Proposal: Collaborate with data analytics platforms, such as Palantir, to enhance the MolDX program's capabilities in real-time data analysis and fraud detection.
Expected Outcome: Leveraging advanced analytics can improve the detection of billing anomalies, streamline claims processing, and facilitate data-driven policy decisions.
3. Policy Standardization and Best Practices Implementation
Proposal: Develop and enforce standardized policies and best practices for molecular diagnostic testing coverage and reimbursement, informed by the MolDX program's successful methodologies.
Expected Outcome: Standardization can lead to more consistent coverage determinations, reduce administrative burdens, and promote equitable access to necessary diagnostic services nationwide.
4. Stakeholder Engagement and Training
Proposal: Initiate comprehensive training programs for healthcare providers and Medicare Administrative Contractors (MACs) to ensure adherence to MolDX guidelines and proper billing practices.
Expected Outcome: Enhanced education can lead to improved compliance, reduced billing errors, and a decrease in the submission of improper claims.
Conclusion
By expanding the MolDX program nationwide and integrating advanced data analytics, DOGE can significantly enhance Medicare's efficiency, reduce improper payments, and ensure that resources are appropriately allocated to support patient care. Such initiatives align with DOGE's mission to streamline government operations and eliminate wasteful expenditures.
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#7
We've had a great discussion about Palantir, its promise in the UK NHS, the coming DOGE entity, and MolDx, which has great expertise in molecular pathology especially in Medicare but now somewhat also in commercial health plans. Bringing these themes all together, what could be some of the biggest victories of a novel (and right now purely hypothetical) collaboration between Palantir, DOGE, and MolDx? And what would be the greatest hurdles in the way?
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A purely speculative, and hypothetical, collaboration between Palantir, DOGE, and MolDX could achieve transformative results in U.S. healthcare, particularly in areas like data integration, cost containment, and the standardization of molecular diagnostics. However, the success of such an ambitious initiative would hinge on overcoming significant challenges. Below, I outline potential victories and hurdles:
Biggest Potential Victories
Nationwide Standardization of Molecular Diagnostics
- What Could Happen: MolDX, leveraging Palantir’s data analytics, could be expanded nationwide to create a unified framework for evaluating molecular diagnostics across Medicare and commercial health plans.
- Impact: This would drastically reduce improper payments (as seen with CPT code 81408 and nonspecific microbiology codes) and improve clinical validity, analytical validity, and utility evaluations.
- Why It Matters: A standardized system reduces variability, ensuring equitable patient access to high-quality tests and protecting Medicare from excessive spending.
Real-Time Fraud Detection
- What Could Happen: Palantir’s platforms, integrated into MolDX processes, could enable real-time analysis of claims to flag anomalies, prevent fraudulent billing, and identify improper claims before payments are made.
- Impact: Billions in improper payments could be avoided, improving Medicare’s financial stability and reinforcing public trust in the system.
- Why It Matters: Fraudulent or erroneous claims are a drain on taxpayer dollars and healthcare resources.
Precision Medicine Expansion
- What Could Happen: By combining Palantir’s data capabilities with MolDX’s expertise, the collaboration could accelerate the adoption of precision medicine, integrating molecular diagnostics with genomic, phenotypic, and clinical data.
- Impact: Improved outcomes through personalized treatments, better alignment of therapies with individual patient needs, and reduced healthcare costs through targeted interventions.
- Why It Matters: Precision medicine promises to revolutionize healthcare delivery but requires robust data and evaluation frameworks to scale effectively.
System-Wide Operational Efficiency
- What Could Happen: DOGE’s oversight could streamline the collaboration, removing bureaucratic hurdles and promoting efficiency in policy implementation.
- Impact: Faster rollout of programs like MolDX to all states, less administrative burden on providers, and quicker access to high-value diagnostics for patients.
- Why It Matters: Streamlined operations mean more timely and impactful care delivery.
Integration with Commercial Health Plans
- What Could Happen: MolDX’s methodologies, supported by Palantir, could be adapted for use by commercial health plans, ensuring a broader reach and consistent quality of diagnostics across all payer systems.
- Impact: Expansion beyond Medicare could lead to system-wide benefits, improving outcomes for millions more patients.
- Why It Matters: Aligning Medicare and commercial plan policies reduces redundancy and administrative burdens for laboratories and providers.
Greatest Hurdles
Data Privacy and Security Concerns
- The Challenge: Patient data is highly sensitive, and Palantir’s past associations with defense and intelligence work could spark concerns about privacy and misuse.
- What’s Needed: Robust security frameworks and transparent policies to reassure stakeholders and comply with regulations like HIPAA.
Interagency Collaboration
- The Challenge: Medicare, DOGE, and Palantir would need to coordinate effectively, overcoming bureaucratic inertia and interagency rivalries.
- What’s Needed: Clear governance structures and leadership to ensure alignment of goals and smooth execution.
Resistance from Stakeholders
- The Challenge: Laboratories, commercial payers, and healthcare providers may resist new frameworks due to increased administrative complexity or fear of reduced reimbursement.
- What’s Needed: Stakeholder engagement, education, and phased implementation to ease the transition and demonstrate value.
Regulatory and Legal Barriers
- The Challenge: Expanding MolDX and integrating Palantir into Medicare workflows may require new regulations or legal changes, which could face opposition.
- What’s Needed: Legislative support and proactive policy-making to clear legal hurdles and avoid prolonged delays.
Scalability
- The Challenge: Scaling MolDX’s processes and integrating Palantir’s technology nationwide would require significant investment and infrastructure changes.
- What’s Needed: Strategic planning and incremental implementation to ensure feasibility and minimize disruption.
Conclusion
A collaboration between Palantir, DOGE, and MolDX could represent a landmark initiative in U.S. healthcare, driving standardization, operational efficiency, and innovation in molecular diagnostics. However, its success would depend on addressing challenges related to data privacy, stakeholder engagement, and regulatory hurdles. With proper leadership and a clear vision, this collaboration could set new benchmarks for healthcare efficiency and effectiveness.
