Well being insurers are starting to undertake AI to help prior authorization choices. However is that this factor? Consultants weighed in throughout a panel dialogue held by KFF on Thursday.
One panelist stated she has some questions on the usage of AI in prior authorization, and added that there needs to be extra transparency on this matter and the way typically prior authorization requests utilizing AI are overturned.
“I believe that as we see the usage of AI improve, one query we’ve got is, what’s the info that’s going into these algorithms? What knowledge are these algorithms based mostly on? Are they essentially the most present knowledge? Do these algorithms embody previous research that will not mirror one of the best medical information that we’ve got proper now? How typically are they being up to date? Are they being inspired to disclaim care, at the very least on the first degree?” stated Anna Schwamlein Howard, principal of coverage growth on the American Most cancers Society Most cancers Motion Community.
Nonetheless, there has lately been extra scrutiny about the usage of AI in healthcare, which is an effective factor, in response to Kaye Pestaina, vp and director of the Program on Affected person and Client Safety at KFF. She famous that simply final week, there was a Senate listening to on AI in healthcare.
One other panelist echoed the necessity for transparency with regards to AI in prior authorization. Nonetheless, he famous that AI and newer applied sciences even have the chance to enhance and velocity up the prior authorization course of.
“We speak about most cancers, it takes over 4 weeks to get in to see an oncologist or radiation oncologist at present, and I hate to suppose that a part of that delay is the results of individuals having to take care of prior authorization. So any lower within the latency interval of getting individuals handled is a vital factor. And I believe so long as you’ve bought the transparency and you may perceive what these algorithms are doing, then I believe it’s doubtlessly an important enchancment general within the course of. I wouldn’t be afraid of it,” stated Dr. Troyen Brennan, adjunct professor of well being coverage and administration at Harvard T.H. Chan College of Public Well being. Brennan can also be a former govt at CVS Caremark and Aetna.
Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Most cancers Heart, stated that she welcomes “our new laptop overlords with some caveats.”
“We all know that datasets are very flawed and that for instance, marginalized populations are more likely to have undocumented stage or they could be lacking key components from their EMR notes that will result in limitations and due to this fact might disproportionately face denials,” Chino stated. “You then’ve skilled a machine based mostly on a dataset that’s basically racist. I believe that’s finally what we’ve got to combat towards.”
How will the usage of AI in prior authorization have an effect on affected person belief? Schwamlein Howard famous that the typical affected person isn’t serious about this.
“They’re specializing in getting higher,” she stated.
Picture: Piotrekswat, Getty Photos
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