Payment integrity has always rested on an unstated assumption: that we know what appropriate care looks like, and the job is just catching deviations from it. AI-driven review at scale is revealing something uncomfortable — that clinical appropriateness is far murkier, more contested, and more regionally variable than any policy document acknowledges. This talk draws on population health data and real-world AI deployment to argue that the industry is approaching an epistemological reckoning it is not yet equipped to have.
In partnership with Machinify
Darshak Sanghavi
Darshak Sanghavi, MD, is Chief Medical Officer of Machinify.
Recently, he was one of the first Program Managers at the Advanced Research Projects Agency for Health (ARPA-H), a new multibillion dollar U.S. agency that the President tasked with developing health programs “so bold no one else, not even the private sector, is willing to give them a chance.” Overseeing an investment portfolio of several hundred million dollars, his programs cover cures for rare genetic diseases, regenerative medicine, women’s health, organ transplantation, innovative payment and business models for prevention, and many other areas.
Prior, he was Global Chief Medical and Clinical Operating Officer for Babylon, the global end-to-end digital health care provider serving over a dozen countries and over 24 million people, with the mission of bringing “affordable and accessible health care to everyone on Earth.” He was a member of the senior leadership team taking the company public in 2021 and oversaw a team of 1500 in the company’s global operations in the United States, United Kingdom, and Rwanda with revenues exceeding $1B. He is the former Chief Medical Officer of UnitedHealthcare’s Medicare & Retirement, the largest U.S. commercial Medicare program with over $90B in annual revenue, where he directed major national clinical and affordability programs. Earlier, he was Chief Medical Officer at OptumLabs, the R&D hub of UnitedHealth Group, running a portfolio of industry-leading projects with dozens of academic, government, and industry partners.
Before then, he served in a senior role in the federal government, as the Director of Preventive and Population Health at the Center for Medicare and Medicaid Innovation, where he directed the development of large pilot programs aimed at improving the nation’s health care costs and quality. In this capacity, he was the architect of the Accountable Health Communities model, the Million Hearts Cardiovascular Risk Reduction model, and the Medicare Diabetes Prevention Program, impacting tens of millions of Medicare beneficiaries. He was a fellow and managing director of the non-partisan Brookings Institution, and chief of pediatric cardiology at UMass Medical School (where he still sees patients). He’s an award-winning medical educator, has worked around the world and published dozens of scientific papers on topics ranging from the molecular biology of cell death to tuberculosis transmission in Peruvian slums.
A frequent guest on NBC’s Today and past commentator for NPR’s All Things Considered, Dr. Sanghavi was a columnist with Slate, the New York Times, Boston Globe, and Washington Post. His best-seller, A Map of the Child: A Pediatrician’s Tour of the Body, was named a best health book of the year by the Wall Street Journal. He previously worked as a U.S. Indian Health Service pediatrician on a Navajo reservation.
Educated at Harvard and Johns Hopkins, he completed his residency in pediatrics and fellowship in pediatric cardiology at Boston Children’s Hospital.
