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Soundbites, and Tachyons, quick takes….
Rethinking Emergency Care: 911 Diversion and Value-Based Initiatives
You know, smarter prior auth, high cost drug controls, ER diversion programs. There's so much that can be done with smarter 911 triage. Like if you think about it, I think we're going to a future where if you call 911, an ambulance will not show up. Right? Why would it? It gets diverted either via telemedicine or to another service that's lower cost. Because even that ambulance ride has a bill. Yeah, a very big one. So I think a lot of plans are really investing in 911 diversion and ER diversion. Because decreasing ER visits, hospitalizations, and readmissions is always the top spear for any value-based care initiative. It doesn't matter what... So I'm seeing a lot of focus there, a lot of focus on very strong provider alignment.
The Crisis and Cost of Aging and Dying in America
I've been at a few kind of aging and dying innovation companies in the last five to six years. And I think on the macro, when the government looks at Medicare and Medicaid budget, and then we pair that with aging population and sicker population, when we're in a world of trouble, we're already at the breaking point. I think to your point, you know, there is a lack of funding, a lack of infrastructure and a lack of policy and regulatory focus on aging and then dying. It's really expensive to die. You know, some estimates have said northwards of about three hundred thousand dollars. Who has that saved up for that?
Why AI Governance Frameworks Matter in Healthcare
Yeah, I would love to jump on this idea of you know, AI governance and the opportunity for health plans to establish frameworks. I do see that as a tailwind and an opportunity, you know, really building cross-functional AI governance sports. Plans definitely have the opportunity and the urgency to establish committees, which includes legal, clinical, actuarial, and compliance leaders to oversee AI vendor use and deployment. and i think health plans can take a page from what's happening in the provider space with hospitals and providers that are doing the same thing a lot of my colleagues are chief medical information officers they have backgrounds in clinical informatics and at various hospitals you're also now seeing the kind of construction formulation of these ai governance boards because the the practice of safe and responsible ai definitely is a shared enterprise I think the second thing is really establishing vendor procurement standards, requiring all AI vendors to provide documentation on training data, bias testing, and especially post-deployment monitoring plans. As we think about kind of the core framework problems that AI poses, it's very important to understand how do we explain what bias in training data is? How do we explain efficacy and safety and privacy and liability? So there's a really big impetus now to be able to establish these frameworks.
How Health Plans Can Systematically Assess AI Solutions
15 years in this space and kind of seeing the silos within a health plan of completely different departments, different focus points, but they're all trying to tackle the same exact challenges. And I was privileged enough to listen to the HCSE team talk at length about their approach to assessing AI. And you'll have individual siloed teams call it risk adjustment, call it payment integrity. AI is popping up all over the place. And what they were finding is a lot of vendors were showing a fairly shiny solution. And then there wasn't as much due diligence on the overall impact, the security, a lot of components around leveraging it. And to your point, like what problem are you really trying to solve? And so HCSC took it as a use case approach. So every single use case that comes through and they're looking at potentially acquiring or building an AI internally, there was an entire AI task force that was assigned to review it. I just found that as an interesting approach. I think a lot of health plans and providers across the country could leverage to try to mitigate some of that risk because It's just the ability for a solution to come in and to not actually solve your problem, and then all the risks that are associated with it, I just found really interesting.
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