HIMSSCast

HIMSSCast: Payers and providers gird for an escalating AI prior auth arms race (brought to you by SuperDial)

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0:00 | 18:38

As health plans expand their use of artificial intelligence for utilization review, hospitals and health systems are adopting AI tools of their own – for documentation, coding automation, denial prediction and more – in an effort to level the playing field. But in an era of aspiration toward value-based reimbursement and of consumer-focused price transparency efforts, could this arms race be cooled for the good of all? Instead of a battle with leading-edge technologies on both sides, can payers and providers find common ground and instead use AI for the greater good – even, just maybe, for their patients and plan members? We speak with Michelle Mello, professor of health policy at Stanford School of Medicine, about those questions and others.