Bass, Berry & Sims attorney Lindsey Fetzer discussed the challenges for health insurance plans in using artificial intelligence tools and the difficulty of regulating their use in healthcare.

People at healthcare companies trying to implement AI solutions, and the lawyers and regulators trying to give them guidance, are all struggling to keep up with the technology’s rapid pace of development. A consensus is starting to form around the idea that AI tools can help make coverage determinations about care, but the tools shouldn’t be the only basis for those decisions; there still should be human review to make the final determination, Lindsey said.

Patients and healthcare organizations alike can benefit greatly from properly governed AI uses, Lindsey said. AI can reduce administrative expenses, redirecting those savings toward supplemental benefits for health plan members, and improve care by reducing paperwork burdens on clinicians and assist them in considering social determinants of health and health equity issues, she added.

Building trust in AI tools requires health plans to consider all the potential impacts of that tool.

“[Medicare Advantage] organizations or any organization developing an AI strategy needs to think through what the corporate governance of AI looks like, what the strategy is, and how to teach that strategy so that humans understand it,” Lindsey said. “All companies should be careful not to roll out a tool until they understand what that tool is and have some comfort around whether the information used to train the tool creates negative biases or other negative outcomes.”

The full article, “With Proper Use, Artificial Intelligence Improves Health Plan Operations,” was published by Health Payer Intelligence on March 5 and is available online.