An AI guide through health care's red-tape maze

Zoom out: AI promoters say the technology will reinvent health care in two main ways.

• They foresee AI supercharging medical research and diagnosis — a process that's already underway.
• They also predict the arrival of individualized medical care delivered by autonomous AI doctors.

That second vision remains hypothetical, thanks to the technology's unreliability, complexity and cost.

• But in the meantime, AI optimists promise it will help us all deal with the headaches of getting and paying for health care in today's maze-like medical system.
• "AI models will soon serve as autonomous personal assistants who carry out specific tasks on our behalf like coordinating medical care," OpenAI CEO Sam Altman wrote last month.

State of play: Early adopters are already using off-the-shelf generative AI as a personal health care assistant.

• Shasta Kearns Moore tells Axios that she uses ChatGPT to help with what she calls "navigating the high seas" of caring for her two children.
• Kearns Moore, the author of Medical Motherhood, a newsletter for people raising disabled and neurodivergent children, says she uses ChatGPT to simplify complicated test results, as well as medical and insurance forms.
• She tells Axios that she used it to "politely write an email asking for a doctor's involvement when I didn't trust another doctor to provide quality care to a disabled person," and to help her compose complaint letters.
• "It's great for families like mine who don't have the spoons to be fighting battles on two fronts," she said.

Between the lines: ChatGPT's terms of service say that it's not intended for medical advice, but the burgeoning medical AI field has fully embraced OpenAI's API.

• Othman Laraki, CEO of Color Health, tells Axios that when someone gets diagnosed with cancer today they can be forced to wait weeks or even months to see an oncologist for the first time.
• Color uses GPT-4o to help doctors and patients cut through some of that health care red tape.
• For example, Color's co-pilot gives primary care physicians access to complex genetics, family history and lifestyle data that can help them assess cancer risk levels without having to refer a patient to a specialist.
• Color focuses on the co-pilot approach rather than building an autonomous agent. "We're not trying to teach it how to be a doctor," he says.

The biggest obstacle to creating an effective medical assistant is finding a clean data set to train models, says Eli Ben-Joseph, co-founder and CEO of Regard, a startup that uses AI to analyze patient data for doctors.

• "An AI system is only as good as the data that you feed it," Ben-Joseph told Axios. "And health care, as a whole, is notorious for having pretty bad data." It's poorly organized, messy and some percentage is still in paper form, Ben-Joseph said.
• Laraki says the other challenge with data is that there's often no consensus on even the most basic health questions, like the right age for a woman to get her first mammogram.
• The data also changes all the time, says Ben-Joseph: "Every year, your insurance plan changes a bit."

Even so, both CEOs believe that in the future, autonomous agents could help navigate finding a doctor and coordinating insurance coverage, and also provide care to some degree.

Reality check: Kearns Moore says that while ChatGPT is not a full solution to the health coverage maze, it's the "next best thing."

• "Is this better than a knowledgable and skilled human case worker who wants to help navigate you through the system? Absolutely not," Kearns Moore writes in her blog. "But it is very helpful for learning more about the system, just in case you don't have one of those."

Our thought bubble: As AI agents take over work on both sides of the health coverage game, acting on behalf of both patients and providers, the process of getting and paying for care could become an even more opaque and confusing bot versus bot interaction.