2025-08-29 20:10:00
This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.
The case against humans in space
Elon Musk and Jeff Bezos are bitter rivals in the commercial space race, but they agree on one thing: Settling space is an existential imperative. Space is the place. The final frontier. It is our human destiny to transcend our home world and expand our civilization to extraterrestrial vistas.
This belief has been mainstream for decades, but its rise has been positively meteoric in this new gilded age of astropreneurs.
But as visions of giant orbital stations and Martian cities dance in our heads, a case against human space colonization has found its footing in a number of recent books, from doubts about the practical feasibility of off-Earth communities, to realism about the harsh environment of space and the enormous tax it would exact on the human body. Read the full story.
—Becky Ferreira
This story is from our new print edition, which is all about the future of security. Subscribe here to catch future copies when they land.
This American nuclear company could help India’s thorium dream
For just the second time in nearly two decades, the United States has granted an export license to an American company planning to sell nuclear technology to India, MIT Technology Review has learned.
The decision to greenlight Clean Core Thorium Energy’s license is a major step toward closer cooperation between the two countries on atomic energy and marks a milestone in the development of thorium as an alternative to uranium for fueling nuclear reactors. Read more about why it’s such a big deal.
—Alexander C. Kaufman
RFK Jr’s plan to improve America’s diet is missing the point
A lot of Americans don’t eat well. And they’re paying for it with their health. A diet high in sugar, sodium, and saturated fat can increase the risk of problems like diabetes, heart disease, and kidney disease, to name a few. And those are among the leading causes of death in the US.
This is hardly news. But this week Robert F Kennedy Jr., who heads the US Department of Health and Human Services, floated a new solution to the problem: teaching medical students more about the role of nutrition in health could help turn things around.
It certainly sounds like a good idea. If more Americans ate a healthier diet, we could expect to see a decrease in those diseases.
But this framing of America’s health crisis is overly simplistic, especially given that plenty of the administration’s other actions have directly undermined health in multiple ways—including by canceling a vital nutrition education program. And at any rate, there are other, more effective ways to tackle the chronic-disease crisis. Read the full story.
—Jessica Hamzelou
This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.
The must-reads
I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.
1 RFK Jr’s deputy has been chosen to be the new acting head of the CDC
Jim O’Neill is likely to greenlight his boss’s federal vaccine policy plans. (WP $)
+ The future of the department looks decidedly precarious. (The Atlantic $)
+ Everything you need to know about Jim O’Neill, the longevity enthusiast who is now RFK Jr.’s right-hand man. (MIT Technology Review)
2 A man killed his mother and himself after conversing with ChatGPT
The chatbot encouraged Stein-Erik Soelberg’s paranoia while repeatedly assuring him he was sane. (WSJ $)
+ An AI chatbot told a user how to kill himself—but the company doesn’t want to “censor” it. (MIT Technology Review)
3 China is cracking down on excess competition in its AI sector
The country is hellbent on avoiding wasteful investment. (Bloomberg $)
+ China is laser-focused on engineering, not so much on litigating. (Wired $)
+ China built hundreds of AI data centers to catch the AI boom. Now many stand unused. (MIT Technology Review)
4 The EU should be prepared to walk away from a US trade deal
Its competition commissioner worries Trump may act on his threats to target the bloc. (FT $)
+ The French President had a similar warning for his ministers. (Politico)
5 xAI has released a new Grok agentic coding model
At a significantly lower price than its rivals. (Reuters)
+ This no-code website builder has been valued at $2 billion. (TechCrunch)
+ The second wave of AI coding is here. (MIT Technology Review)
6 A US mail change has thrown online businesses into turmoil
All package deliveries are due to face duties from this week. (Insider $)
7 A former DOGE official is running America’s biggest MDMA company
And Antonio Gracias is not the only member of the department with ties to the psychedelics industry. (The Guardian)
+ Other DOGE workers are joining Trump’s new National Design Studio. (Wired $)
+ The FDA said no to the use of MDMA as a therapy last year. (MIT Technology Review)
8 How chatbots fake having personalities
They have no persistent self—despite what they may tell you. (Ars Technica)
+ What is AI? (MIT Technology Review)
9 The future of podcasting is murky
Hundreds of shows have folded. The medium is in desperate need of an archive. (NY Mag $)
+ The race to save our online lives from a digital dark age. (MIT Technology Review)
10 Do we even know what we want to watch anymore?
We’re so reliant on algorithms, it’s hard to know. (New Yorker $)
Quote of the day
“We’re scared for ourselves and for the country.”
—An anonymous CDC worker tells the New York Times about the mood inside the agency following the firing of their new director Susan Monarez.
One more thing
How a tiny Pacific Island became the global capital of cybercrime
Tokelau, a string of three isolated atolls strung out across the Pacific, is so remote that it was the last place on Earth to be connected to the telephone—only in 1997. Just three years later, the islands received a fax with an unlikely business proposal that would change everything.
It was from an early internet entrepreneur from Amsterdam, named Joost Zuurbier. He wanted to manage Tokelau’s country-code top-level domain, or ccTLD—the short string of characters that is tacked onto the end of a URL—in exchange for money.
In the succeeding years, tiny Tokelau became an unlikely internet giant—but not in the way it may have hoped. Until recently, its .tk domain had more users than any other country’s: a staggering 25 million—but the vast majority were spammers, phishers, and cybercriminals.
Now the territory is desperately trying to clean up .tk. Its international standing, and even its sovereignty, may depend on it. Read the full story.
—Jacob Judah
We can still have nice things
A place for comfort, fun and distraction to brighten up your day. (Got any ideas? Drop me a line or skeet ’em at me.)
+ Scientists are using yeast to help save the bees.
+ How to become super productive 
+ Why North American mammoths were genetic freaks of nature.
+ I love Seal’s steadfast refusal to explain his lyrics to Kiss from a Rose.
2025-08-29 17:56:45
For just the second time in nearly two decades, the United States has granted an export license to an American company planning to sell nuclear technology to India, MIT Technology Review has learned. The decision to greenlight Clean Core Thorium Energy’s license is a major step toward closer cooperation between the two countries on atomic energy and marks a milestone in the development of thorium as an alternative to uranium for fueling nuclear reactors.
Starting from the issuance last week, the thorium fuel produced by the Chicago-based company can be shipped to reactors in India, where it could be loaded into the cores of existing reactors. Once Clean Core receives final approval from Indian regulators, it will become one of the first American companies to sell nuclear technology to India, just as the world’s most populous nation has started relaxing strict rules that have long kept the US private sector from entering its atomic power industry.
“This license marks a turning point, not just for Clean Core but for the US-India civil nuclear partnership,” says Mehul Shah, the company’s chief executive and founder. “It places thorium at the center of the global energy transformation.”
Thorium has long been seen as a good alternative to uranium because it’s more abundant, produces both smaller amounts of long-lived radioactive waste and fewer byproducts with centuries-long half-lives, and reduces the risk that materials from the fuel cycle will be diverted into weapons manufacturing.
But at least some uranium fuel is needed to make thorium atoms split, making it an imperfect replacement. It’s also less well suited for use in the light-water reactors that power the vast majority of commercial nuclear plants worldwide. And in any case, the complex, highly regulated nuclear industry is extremely resistant to change.
For India, which has scant uranium reserves but abundant deposits of thorium, the latter metal has been part of a long-term strategy for reducing dependence on imported fuels. The nation started negotiating a nuclear export treaty with the US in the early 2000s, and a 123 Agreement—a special, Senate-approved treaty the US requires with another country before sending it any civilian nuclear products—was approved in 2008.
While most thorium advocates have envisioned new reactors designed to run on this fuel, which would mean rebuilding the nuclear industry from the ground up, Shah and his team took a different approach. Clean Core created a new type of fuel that blends thorium with a more concentrated type of uranium called HALEU (high-assay low-enriched uranium). This blended fuel can be used in India’s pressurized heavy-water reactors, which make up the bulk of the country’s existing fleet and many of the new units under development now.
Thorium isn’t a fissile material itself, meaning its atoms aren’t inherently unstable enough for an extra neutron to easily split the nuclei and release energy. But the metal has what’s known as “fertile properties,” meaning it can absorb neutrons and transform into the fissile material uranium-233. Uranium-233 produces fewer long-lived radioactive isotopes than the uranium-235 that makes up the fissionable part of traditional fuel pellets. Most commercial reactors run on low-enriched uranium, which is about 5% U-235. When the fuel is spent, roughly 95% of the energy potential is left in the metal. And what remains is a highly toxic cocktail of long-lived radioactive isotopes such as cesium-137 and plutonium-239, which keep the waste dangerous for tens of thousands of years. Another concern is that the plutonium could be extracted for use in weapons.
Enriched up to 20%, HALEU allows reactors to extract more of the available energy and thus reduce the volume of waste. Clean Core’s fuel goes further: The HALEU provides the initial spark to ignite fertile thorium and triggers a reaction that can burn much hotter and utilize the vast majority of the material in the core, as a study published last year in the journal Nuclear Engineering and Design showed.
“Thorium provides attributes needed to achieve higher burnups,” says Koroush Shirvan, an MIT professor of nuclear science and engineering who helped design Clean Core’s fuel assemblies. “It is enabling technology to go to higher burnups, which reduces your spent fuel volume, increases your fuel efficiency, and reduces the amount of uranium that you need.”
Compared with traditional uranium fuel, Clean Core says, its fuel reduces waste by more than 85% while avoiding the most problematic isotopes produced during fission. “The result is a safer, more sustainable cycle that reframes nuclear power not as a source of millennia-long liabilities but as a pathway to cleaner energy and a viable future fuel supply,” says Milan Shah, Clean Core’s chief operating officer and Mehul’s son.
Pressurized heavy-water reactors are particularly well suited to thorium because heavy water—a version of H2O that has an extra neutron on the hydrogen atom—absorbs fewer neutrons during the fission process, increasing efficiency by allowing more neutrons to be captured by the thorium.
There are 46 so-called PHWRs operating worldwide: 17 in Canada, 19 in India, three each in Argentina and South Korea, and two each in China and Romania, according to data from the International Atomic Energy Agency. In 1954, India set out a three-stage development plan for nuclear power that involved eventually phasing thorium into the fuel cycle for its fleet.
Yet in the 56 years since India built its first commercial nuclear plant, its state-controlled industry has remained relatively shut off to the private sector and the rest of the world. When the US signed the 123 Agreement with India in 2008, the moment heralded an era in which the subcontinent could become a testing ground for new American reactor designs.
In 2010, however, India passed the Civil Liability for Nuclear Damage Act. The legislation was based on what lawmakers saw as legal shortcomings in the wake of the 1984 Bhopal chemical factory disaster, when a subsidiary of the American industrial giant Dow Chemical avoided major payouts to the victims of a catastrophe that killed thousands. Under this law, responsibility for an accident at an Indian nuclear plant would fall on suppliers. The statute effectively killed any exports to India, since few companies could shoulder that burden. Only Russia’s state-owned Rosatom charged ahead with exporting reactors to India.
But things are changing. In a joint statement issued after a February 2025 summit, Prime Minister Narendra Modi and President Donald Trump “announced their commitment to fully realise the US-India 123 Civil Nuclear Agreement by moving forward with plans to work together to build US-designed nuclear reactors in India through large scale localisation and possible technology transfer.”
In March 2025, US federal officials gave the nuclear developer Holtec International an export license to sell Indian companies its as-yet-unbuilt small modular reactors, which are based on the light-water reactor design used in the US. In April, the Indian government suggested it would reform the nuclear liability law to relax rules on foreign companies in hopes of drawing more overseas developers. Last month, a top minister confirmed that the Modi administration would overhaul the law.
“For India, the thing they need to do is get another international vendor in the marketplace,” says Chris Gadomski, the chief nuclear analyst at the consultancy BloombergNEF.
But Shah sees larger potential for Clean Core. Unlike Holtec, whose export license was endorsed by the two Mumbai-based industrial giants Larsen & Toubro and Tata Consulting Engineers, Clean Core had its permit approved by two of India’s atomic regulators and its main state-owned nuclear company. By focusing on fuel rather than new reactors, Clean Core could become a vendor to the majority of the existing plants already operating in India.
Its technology diverges not only from that of other US nuclear companies but also from the approach used in China. Last year, China made waves by bringing its first thorium-fueled reactor online. This enabled it to establish a new foothold in a technology the US had invented and then abandoned, and it gave Beijing another leg up in atomic energy.
But scaling that technology will require building out a whole new kind of reactor. That comes at a cost. A recent Johns Hopkins University study found that China’s success in building nuclear reactors stemmed in large part from standardization and repetition of successful designs, virtually all of which have been light-water reactors. Using thorium in existing heavy-water reactors lowers the bar for popularizing the fuel, according to the younger Shah.
“We think ours is the path of least resistance,” Milan Shah says. “Maybe not being completely revolutionary in the way you look at nuclear today, but incredibly evolutionary to progress humanity forward.”
The company has plans to go beyond pressurized heavy-water reactors. Within two years, the elder Shah says, Clean Core plans to design a version of its fuel that could work in the light-water reactors that make up the entire US fleet of 94. But it’s not a simple conversion. For starters, there’s the size: While the PHWR fuel rods are about 50 centimeters in length, the rods that go into light-water reactors are roughly four meters long. Then there’s the history of challenges with light water’s absorption of neutrons that could otherwise be captured to induce fission in the thorium.
For Anil Kakodkar, the former chairman of India’s Atomic Energy Commission and a mentor to Shah, popularizing thorium could help rectify one of the darker chapters in his country’s nuclear development. In 1974, India became the first country since the signing of the first global Treaty on the Non-Proliferation of Nuclear Weapons to successfully test an atomic weapon. New Delhi was never a signatory to the pact. But the milestone prompted neighboring Pakistan to develop its own weapons.
In response, President Jimmy Carter tried to demonstrate Washington’s commitment to reversing the Cold War arms race by sacrificing the first US effort to commercialize nuclear waste recycling, since the technology to separate plutonium and other radioisotopes from uranium in spent fuel was widely seen as a potential new source of weapons-grade material. By running its own reactors on thorium, Kakodkar says, India can chart a new path for newcomer nations that want to harness the power of the atom without stoking fears that nuclear weapons capability will spread.
“The proliferation concerns will be dismissed to a significant extent, allowing more rapid growth of nuclear power in emerging countries,” he says. “That will be a good thing for the world at large.”
Alexander C. Kaufman is a reporter who has covered energy, climate change, pollution, business, and geopolitics for more than a decade.
2025-08-29 17:00:00
A lot of Americans don’t eat well. And they’re paying for it with their health. A diet high in sugar, sodium, and saturated fat can increase the risk of problems like diabetes, heart disease, and kidney disease, to name a few. And those are among the leading causes of death in the US.
This is hardly news. But this week Robert F Kennedy Jr., who heads the US Department of Health and Human Services, floated a new solution to the problem. Kennedy and education secretary Linda McMahon think that teaching medical students more about the role of nutrition in health could help turn things around.
“I’m working with Linda on forcing medical schools … to put nutrition into medical school education,” Kennedy said during a cabinet meeting on August 26. The next day, HHS released a statement calling for “increased nutrition education” for medical students.
“We can reverse the chronic-disease epidemic simply by changing our diets and lifestyles,” Kennedy said in an accompanying video statement. “But to do that, we need nutrition to be a basic part of every doctor’s training.”
It certainly sounds like a good idea. If more Americans ate a healthier diet, we could expect to see a decrease in those diseases. But this framing of America’s health crisis is overly simplistic, especially given that plenty of the administration’s other actions have directly undermined health in multiple ways—including by canceling a vital nutrition education program.
At any rate, there are other, more effective ways to tackle the chronic-disease crisis.
The biggest killers, heart disease and stroke, are responsible for more than a third of deaths, according to the US Centers for Disease Control and Prevention. A healthy diet can reduce your risk of developing those conditions. And it makes total sense to educate the future doctors of America about nutrition.
Medical bodies are on board with the idea, too. “The importance of nutrition in medical education is increasingly clear, and we support expanded, evidence-based instruction to better equip physicians to prevent and manage chronic disease and improve patient outcomes,” David H. Aizuss, chair of the American Medical Association’s board of trustees, said in a statement.
But it’s not as though medical students aren’t getting any nutrition education. And that training has increased in the last five years, according to surveys carried out by the American Association of Medical Colleges.
Kennedy has referred to a 2021 survey suggesting that medical students in the US get only around one hour of nutrition education per year. But the AAMC argues that nutrition education increasingly happens through “integrated experiences” rather than stand-alone lectures.
“Medical schools understand the critical role that nutrition plays in preventing, managing, and treating chronic health conditions, and incorporate significant nutrition education across their required curricula,” Alison J. Whelan, AAMC’s chief academic officer, said in a statement.
That’s not to say there isn’t room for improvement. Gabby Headrick, a food systems dietician and associate director of food and nutrition policy at George Washington University’s Institute for Food Safety & Nutrition Security, thinks nutritionists could take a more prominent role in patient care, too.
But it’s somewhat galling for the administration to choose medical education as its focus given the recent cuts in federal funding that will affect health. For example, funding for the National Diabetes Prevention Program, which offers support and guidance to help thousands of people adopt healthy diets and exercise routines, was canceled by the Trump administration in March.
The focus on medical schools also overlooks one of the biggest factors behind poor nutrition in the US: access to healthy food. A recent survey by the Pew Research Center found that increased costs make it harder for most Americans to eat well. Twenty percent of the people surveyed acknowledged that their diets were not healthy.
“So many people know what a healthy diet is, and they know what should be on their plate every night,” says Headrick, who has researched this issue. “But the vast majority of folks just truly do not have the money or the time to get the food on the plate.”
The Supplemental Nutrition Assistance Program (SNAP) has been helping low-income Americans afford some of those healthier foods. It supported over 41 million people in 2024. But under the Trump administration’s tax and spending bill, the program is set to lose around $186 billion in funding over the next 10 years.
Kennedy’s focus is on education. And it just so happens that there is a nutrition education program in place—one that helps people of all ages learn not only what healthy foods are, but how to source them on a budget and use them to prepare meals.
SNAP-Ed, as it’s known, has already provided this support to millions of Americans. Under the Trump administration, it is set to be eliminated.
It is difficult to see how these actions are going to help people adopt healthier diets. What might be a better approach? I put the question to Headrick: If she were in charge, what policies would she enact?
“Universal health care,” she told me. Being able to access health care without risking financial hardship not only improves health outcomes and life expectancy; it also spares people from medical debt—something that affects around 40% of adults in the US, according to a recent survey.
And the Trump administration’s plans to cut federal health spending by about a trillion dollars over the next decade certainly aren’t going to help with that. All told, around 16 million people could lose their health insurance by 2034, according to estimates by the Congressional Budget Office.
“The evidence suggests that if we cut folks’ social benefit programs, such as access to health care and food, we are going to see detrimental impacts,” says Headrick. “And it’s going to cause an increased burden of preventable disease.”
This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.
2025-08-28 20:10:00
This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.
Google’s still not giving us the full picture on AI energy use
—Casey Crownhart
Google just announced that a typical query to its Gemini app uses about 0.24 watt-hours of electricity. That’s about the same as running a microwave for one second—something that feels insignificant. I run the microwave for many more seconds than that most days.
I welcome more openness from major AI players about their estimated energy use per query. But I’ve noticed that some folks are taking this number and using it to conclude that we don’t need to worry about AI’s energy demand. That’s not the right takeaway here. Let’s dig into why.
This article is from The Spark, MIT Technology Review’s weekly climate newsletter. To receive it in your inbox every Wednesday, sign up here.
+ If you’re interested in AI’s energy footprint, earlier this year, MIT Technology Review published Power Hungry: a comprehensive series on AI and energy.
The AI Hype Index: AI-designed antibiotics show promise
Separating AI reality from hyped-up fiction isn’t always easy. That’s why we’ve created the AI Hype Index—a simple, at-a-glance summary of everything you need to know about the state of the industry. Take a look at this month’s edition here.
The must-reads
I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.
1 The White House has fired the director of the CDC
But Susan Monarez is refusing to go quietly. (WP $)
+ Monarez is said to have clashed with RFK Jr over vaccine policy. (NYT $)
+ She was confirmed by the Senate to the position just last month. (The Guardian)
+ Vaccine consensus is splintering across the US. (Vox)
2 A Chinese hacking campaign hit at least 200 US organizations
Intelligence agencies say the breaches are among the most significant ever. (WP $)
+ AI-generated ransomware is on the rise. (Wired $)
3 Ukraine’s new Flamingo cruise missile took just months to build
Russia’s air defenses are weakening. Can this missile exploit the gaps? (Economist $)
+ 14 people were killed in an overnight bombardment of Kyiv. (BBC)
+ On the ground in Ukraine’s largest Starlink repair shop. (MIT Technology Review)
4 AI infrastructure spending is boosting the US economy
Companies are throwing so much money at AI hardware it’s lifting the real economy, not just the stock market. (NYT $)
+ How to fine-tune AI for prosperity. (MIT Technology Review)
5 OpenAI and Anthropic safety-tested each other’s AI
They found Claude is a lot more cautious than OpenAI’s mini models. (Engadget)
+ Sycophancy was a repeated issue among OpenAI’s models. (TechCrunch)
+ This benchmark used Reddit’s AITA to test how much AI models suck up to us. (MIT Technology Review)
6 Climate change exacerbated Europe’s deadly wildfires
And fires across the Mediterranean are likely to become more frequent and severe. (BBC)
+ What the collapse of a glacier can teach us. (New Yorker $)
+ How AI can help spot wildfires. (MIT Technology Review)
7 911 centers are using AI to answer calls
It’s helping to triage anything that isn’t urgent. (TechCrunch)
8 Wikipedia has compiled a list of AI writing tropes
But their presence still isn’t a dead giveaway a text has been written by AI. (Fast Company $)
+ AI-text detection tools are really easy to fool. (MIT Technology Review)
9 Melania Trump has launched the Presidential AI Challenge
But it’s not all that clear what the competition actually is. (NY Mag $)
10 Netflix’s algorithm-appeasing movies are bland and boring
But millions of people will watch them anyway. (The Guardian)
Quote of the day
“The more you buy, the more you grow.”
—Nvidia CEO Jensen Huang conveniently sees no end to the AI chip spending boom, Reuters reports.
Inside the strange limbo facing millions of IVF embryos
Millions of embryos created through IVF sit frozen in time, stored in cryopreservation tanks around the world, and the number is only growing.
At a basic level, an embryo is simply a tiny ball of a hundred or so cells. But unlike other types of body tissue, it holds the potential for life. Many argue that this endows embryos with a special moral status, one that requires special protections.
The problem is that no one can really agree on what that status is. What do these embryos mean to us? And who should be responsible for them? Read the full story.
—Jessica Hamzelou
We can still have nice things
A place for comfort, fun and distraction to brighten up your day. (Got any ideas? Drop me a line or skeet ’em at me.)
+ Wow, that is one seriously orange shark!
+ TikTok is a proven way to introduce younger generations to older music—and now it’s Radiohead’s turn.
+ Why we’re still going bananas for Donkey Kong after all these years
+ This photo perfectly captures the joy of letting loose at a wedding.
2025-08-28 19:00:00
2025-08-28 18:09:13
Over the past 20 years building advanced AI systems—from academic labs to enterprise deployments—I’ve witnessed AI’s waves of success rise and fall. My journey began during the “AI Winter,” when billions were invested in expert systems that ultimately underdelivered. Flash forward to today: large language models (LLMs) represent a quantum leap forward, but their prompt-based adoption is similarly overhyped, as it’s essentially a rule-based approach disguised in natural language.
At Ensemble, the leading revenue cycle management (RCM) company for hospitals, we focus on overcoming model limitations by investing in what we believe is the next step in AI evolution: grounding LLMs in facts and logic through neuro-symbolic AI. Our in-house AI incubator pairs elite AI researchers with health-care experts to develop agentic systems powered by a neuro-symbolic AI framework. This bridges LLMs’ intuitive power with the precision of symbolic representation and reasoning.
LLMs excel at understanding nuanced context, performing instinctive reasoning, and generating human-like interactions, making them ideal for agentic tools to then interpret intricate data and communicate effectively. Yet in a domain like health care where compliance, accuracy, and adherence to regulatory standards are non-negotiable—and where a wealth of structured resources like taxonomies, rules, and clinical guidelines define the landscape—symbolic AI is indispensable.
By fusing LLMs and reinforcement learning with structured knowledge bases and clinical logic, our hybrid architecture delivers more than just intelligent automation—it minimizes hallucinations, expands reasoning capabilities, and ensures every decision is grounded in established guidelines and enforceable guardrails.
Ensemble’s agentic AI approach includes three core pillars:
1. High-fidelity data sets: By managing revenue operations for hundreds of hospitals nationwide, Ensemble has unparallelled access to one of the most robust administrative datasets in health care. The team has decades of data aggregation, cleansing, and harmonization efforts, providing an exceptional environment to develop advanced applications.
To power our agentic systems, we’ve harmonized more than 2 petabytes of longitudinal claims data, 80,000 denial audit letters, and 80 million annual transactions mapped to industry-leading outcomes. This data fuels our end-to-end intelligence engine, EIQ, providing structured, context-rich data pipelines spanning across the 600-plus steps of revenue operations.
2. Collaborative domain expertise: Partnering with revenue cycle domain experts at each step of innovation, our AI scientists benefit from direct collaboration with in-house RCM experts, clinical ontologists, and clinical data labeling teams. Together, they architect nuanced use cases that account for regulatory constraints, evolving payer-specific logic and the complexity of revenue cycle processes. Embedded end users provide post-deployment feedback for continuous improvement cycles, flagging friction points early and enabling rapid iteration.
This trilateral collaboration—AI scientists, health-care experts, and end users—creates unmatched contextual awareness that escalates to human judgement appropriately, resulting in a system mirroring decision-making of experienced operators, and with the speed, scale, and consistency of AI, all with human oversight.
3. Elite AI scientists drive differentiation: Ensemble’s incubator model for research and development is comprised of AI talent typically only found in big tech. Our scientists hold PhD and MS degrees from top AI/NLP institutions like Columbia University and Carnegie Mellon University, and bring decades of experience from FAANG companies [Facebook/Meta, Amazon, Apple, Netflix, Google/Alphabet] and AI startups. At Ensemble, they’re able to pursue cutting-edge research in areas like LLMs, reinforcement learning, and neuro-symbolic AI within a mission-driven environment.
The also have unparalleled access to vast amounts of private and sensitive health-care data they wouldn’t see at tech giants paired with compute and infrastructure that startups simply can’t afford. This unique environment equips our scientists with everything they need to test novel ideas and push the frontiers of AI research—while driving meaningful, real-world impact in health care and improving lives.
By pairing the brightest AI minds with the most powerful health-care resources, we’re successfully building, deploying, and scaling AI models that are delivering tangible results across hundreds of health systems. Here’s how we put it into action:
Supporting clinical reasoning: Ensemble deployed neuro-symbolic AI with fine-tuned LLMs to support clinical reasoning. Clinical guidelines are rewritten into proprietary symbolic language and reviewed by humans for accuracy. When a hospital is denied payment for appropriate clinical care, an LLM-based system parses the patient record to produce the same symbolic language describing the patient’s clinical journey, which is matched deterministically against the guidelines to find the right justification and the proper evidence from the patient’s record. An LLM then generates a denial appeal letter with clinical justification grounded in evidence. AI-enabled clinical appeal letters have already improved denial overturn rates by 15% or more across Ensemble’s clients.
Building on this success, Ensemble is piloting similar clinical reasoning capabilities for utilization management and clinical documentation improvement, by analyzing real-time records, flagging documentation gaps, and suggesting compliance enhancements to reduce denial or downgrade risks.
Accelerating accurate reimbursement: Ensemble is piloting a multi-agent reasoning model to manage the complex process of collecting accurate reimbursement from health insurers. With this approach, a complex and coordinated system of autonomous agents work together to interpret account details, retrieve required data from various systems, decide account-specific next actions, automate resolution, and escalate complex cases to humans.
This will help reduce payment delays and minimize administrative burden for hospitals and ultimately improve the financial experience for patients.
Improving patient engagement: Ensemble’s conversational AI agents handle inbound patient calls naturally, routing to human operators as required. Operator assistant agents deliver call transcriptions, surface relevant data, suggest next-best actions, and streamline follow-up routines. According to Ensemble client performance metrics, the combination of these AI capabilities has reduced patient call duration by 35%, increasing one-call resolution rates and improving patient satisfaction by 15%.
The AI path forward in health care demands rigor, responsibility, and real-world impact. By grounding LLMs in symbolic logic and pairing AI scientists with domain experts, Ensemble is successfully deploying scalable AI to improve the experience for health-care providers and the people they serve.
This content was produced by Ensemble. It was not written by MIT Technology Review’s editorial staff.
