At Becker's Fall Payer Issues Roundtable, industry leaders explored how AI can transform managed care organizations by promoting health equity and enhancing patient outcomes.
Trey Sutten, Co-founder and CEO and Kim Webb, Vice President of Health Strategy both at Siftwell were joined by Erin Henderson Moore, President and CEO of Fidelis Care New Jersey and Gary Rosenfeld, Director of Medicaid Product & Strategy at United Concordia Dental.
The panel focused on actionable steps for AI adoption, such as establishing governance frameworks, fostering cross-functional dialogue, and concentrating on actionable insights to improve healthcare accessibility.
Below are the three key takeaways from their discussion.
1. AI is a tool that can augment and enhance managed care operations, but it must be implemented with a focus on addressing bias and ensuring data quality.
Leaders concurred that AI is a crucial tool for creating more equitable access to healthcare by allowing for a more holistic examination of data. Ms. Webb underscored the importance of addressing health-related social needs and to forge stronger community partnerships to tackle these issues. In this context, AI facilitates a more refined analysis of data sets to identify and mitigate existing biases.
The panelists stressed the necessity of human oversight in AI processes to ensure ethical applications and to view AI as a supplement and complement to traditional care models, with human involvement at key points to focus on what they do best—delivering exceptional member care— allowing AI to identify and address high-risk individuals effectively.
"AI is just a tool," stated Ms. Henderson Moore. "Organizations have abundant data on everything. We can probably predict your strengths and weaknesses before you're even aware of them. But what do we do next? We must work together to determine where we can utilize our traditional managed care tools and where we can innovate and think differently."
Mr. Rosenfeld also noted the reluctance, particularly among dental practices, to adopt AI more fully. He pointed to a slow adoption process within organizations, partly due to skepticism about data quality and a lack of expertise among healthcare teams. His organization has concentrated on establishing an AI committee and a super user group to ensure proper governance and quality control during implementation.
"It helps us set boundaries on what AI can and cannot be used for," said Mr. Rosenfeld. "You want that governance model in place because we've all experienced data breaches and similar challenges. It's crucial to establish these guardrails to ensure accountability and functionality."
2. Leveraging AI and data analytics can help identify key challenges and opportunities when organizations work cross-functionally.
A central question that emerged during the discussion was how data can be leveraged to aid people effectively. According to Ms. Henderson Moore, the answer lies in integrating AI into an existing ecosystem, allowing various departments across an organization to benefit.
This integration can ultimately lead to a better understanding of the patient population, providing a more focused look at how patients access their health plans, communicate with providers, and which services are most needed in communities.
"We've been so focused on providers that sometimes we've overlooked our members," Ms. Henderson Moore remarked. "I think it's a really exciting opportunity, and the data has been instrumental in helping us reach this point. We're even re-evaluating our internal data with the member in mind, which has proven beneficial."
Engaging partners within a provider network is also crucial to maximizing the benefits of data and AI. Some organizations may have departments that have already integrated AI, yet much of the organization remains unaware. Raising awareness about integration and having involved discussions are essential for identifying and overcoming challenges related to access, equity, and profitability.
"Start having those conversations. It's here, it's coming, and it's not going anywhere," Ms. Webb said. "Engage in dialogue to start envisioning what this integration means for your team. Educate yourself so that you're prepared to embrace it. And when the time comes to make decisions, you can make informed choices."
3. Integrating data and technology across the healthcare ecosystem can help address health equity and social determinants of health.
Panelists emphasized the critical role of AI in enhancing patient journeys, especially for underserved populations, by anticipating healthcare needs and optimizing resource allocation.
In the realm of dental care, Mr. Rosenfeld highlighted that 93% of individuals living in poverty have unmet dental needs. He also pointed out that people of color are three times more likely to have never visited a dentist, leading to increased reliance on emergency departments and creating service bottlenecks for other healthcare providers. Although AI in the dental sector is still in its infancy, he acknowledged its significance and the necessity of adopting AI as a tool to foster meaningful improvements in health equity and patient care, addressing issues related to access, administrative burdens, and insurance barriers.
"How can you use technology to predict who might not be able to attend appointments, and what interventions can you implement to mitigate that?" Mr. Rosenfeld asked. "Alleviating administrative burdens, streamlining the claims process, and overcoming transportation barriers — these are all areas we're exploring, and I believe there's potential to drive better outcomes."