Well being insurers are starting to undertake AI to help prior authorization selections. However is that this a very good factor? Consultants weighed in throughout a panel dialogue held by KFF on Thursday.

One panelist mentioned she has some questions on using AI in prior authorization, including that there must be extra transparency on this matter and the way usually prior authorization requests utilizing AI are overturned.

“I believe as we see using AI improve, one query we’ve is: What’s the knowledge that goes into these algorithms? What knowledge are these algorithms based mostly on? Is that this essentially the most present knowledge? Do these algorithms include outdated research that will not replicate one of the best medical data we’ve right this moment? How usually are they up to date? Are they inspired to refuse care, a minimum of on the major stage?” mentioned Anna Schwamlein Howard, director of coverage improvement on the American Most cancers Society's Most cancers Motion Community.

Nevertheless, there was elevated scrutiny lately on using AI in healthcare, which is an effective factor, in line with Kaye Pestaina, vice chairman and director of the affected person and client safety program at KFF. She famous that there was a Senate listening to final week on AI in healthcare.

One other panelist reiterated the necessity for transparency in terms of AI in prior authorization. Nevertheless, he famous that AI and newer applied sciences even have the potential to enhance and pace up the prior authorization course of.

“We're speaking about most cancers, it takes over 4 weeks to get to an oncologist or radiation oncologist right this moment, and I hate to assume that a few of that delay is because of folks having to take care of prior authorization . So any discount within the latency interval for treating folks is vital. And I believe so long as you could have the transparency and you may perceive what these algorithms are doing, I believe it may be a vital enchancment within the course of total. I wouldn't be afraid of it, mentioned Dr. Troyen Brennan, adjunct professor of well being coverage and administration at Harvard TH Chan College of Public Well being. Brennan can also be a former director at CVS Caremark and Aetna.

Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Most cancers Middle, mentioned she welcomes “our new pc overlords with some caveats.”

“We all know that knowledge units are deeply flawed and, for instance, marginalized populations are more likely to be undocumented or lacking key components of their EMR notes that may create limitations and subsequently might expertise denials disproportionately ,” Chino mentioned. “Then you could have educated a machine based mostly on a knowledge set that’s primarily racist. I believe in the end that's what we’ve to battle in opposition to.”

How will using AI in prior authorization influence affected person belief? Schwamlein Howard famous that the typical affected person doesn't take into consideration this.

“They concentrate on getting higher,” she mentioned.

Photograph: Piotrekswat, Getty Pictures