By Kenneth Young, CEO, Medecision
Artificial intelligence (AI) is creating a unique moment for healthcare. To put it plainly, we are at an inflection point. We must move our processes into the modern era. To do that, we must be intentional today about safety, security, interoperability, and compliance to ensure future confidence as the technology and the industry evolve.
Recently, I sat down with Maverick Health Policy founder and CEO Julie Barnes for a webinar to discuss “AI, Policy & the Future of Prior Authorization.” While prior authorization mandates like CMS-0057-F remain top-of-mind for many, they’re only the tip of the iceberg.
What’s exciting about this moment in time is the opportunity for innovation to improve how healthcare works, but only if we lay the right foundation.
Navigating policy in uncertain times
During our conversation, Julie expressed confidence that the regulatory landscape will continue to incentivize healthcare AI no matter what happens in political elections.
Healthcare technology has always been the ‘babies and puppies’ of public policy. Everyone loves it.
Although all parties favor modernizing healthcare technology, Julie and I both acknowledged that the current lack of cohesive federal and/or state guidance presents a difficult balancing act for healthcare organizations. Those who view AI strictly through a regulatory lens face considerable chaos.
For that reason, I believe the silver lining lies in approaching AI adoption from a broader perspective. Ongoing economic, demographic, and labor pressures make healthcare AI a question of “when,” not “if.” So, now is the time to look beyond APIs and other legislative mandates and set a firm AI foundation that unlocks greater value.
Strengthening your foundation to unlock opportunity
Yes, it is imperative to meet requirements like CMS-00057-F, because information flow requires data standards. But Medecision is also looking at AI as an opportunity to securely connect data and systems, make information more actionable, automate workflows, improve accuracy, and increase efficiencies.
Policymakers are no longer asking, “How do we fund healthcare?” Instead, they are focusing on “What do we pay for?” and “How can technology help?” In other words, AI is expected to challenge the status quo. Indeed, as Julie Yoo at a16z points out, “challenger” health plans and providers are already leveraging AI to lower costs, streamline operations and care delivery, and become more competitive.
Still, innovation is only as powerful as the foundation it’s built on. Safety, flexibility, and configurability are key, as is maintaining human-in-the-loop safeguards. As AI becomes more autonomous, a secure, governed approach within a connected ecosystem can give organizations new ways to innovate without compromising trust.
Just because regulatory uncertainty is prominent today doesn’t mean healthcare organizations lack a navigational path forward. Responsible innovation will always require intentionally building in safety, security, and compliance from the start. With that intentionality as a North Star, healthcare organizations can confidently embrace AI and other modern technologies to improve healthcare for everyone.