Thursday, November 16, 2023
HomeHealth CareHow Medicaid Administrators Are Pondering About AI

How Medicaid Administrators Are Pondering About AI


Throughout an Oct. 25 Nationwide Academy of Drugs Workshop on Generative AI and Massive Language Fashions in Well being and Drugs, Christopher Chen, M.D., M.B.A., medical director for Medicaid on the Washington State Well being Care Authority (HCA), spoke in regards to the potential and threat of generative AI within the Medicaid house.  

Chen helps information scientific coverage and technique on the company, and helps initiatives in well being data know-how, telehealth, high quality, and well being fairness. He additionally serves as chair for the Nationwide Medicaid Medical Administrators Community.

Chen started by noting that a few of HCA’s well being IT priorities contain getting IT sources to individuals who’ve been historically unnoticed of digital modernization. In a kind of initiatives, HCA is partnering with Epic on offering a state-option EHR for suppliers that had been unnoticed of HITECH funding, together with behavioral well being suppliers, rural suppliers, and tribal suppliers. “We’re additionally engaged on creating a group data trade to help useful resource referral for health-related social wants, in addition to built-in eligibility,” he stated. “It was seen as a very essential social determinants play for us in making an attempt to get to a 20-minute on-line utility for Medicaid, SNAP, money and meals help and childcare advantages for shoppers.”

 “Once I take into consideration generative AI, there are many thrilling prospects to supply shoppers culturally attuned and tailor-made schooling, and assist navigating and accessing what is usually a actually advanced system of advantages,” Chen stated. “There was a New York Occasions article that described how troublesome it’s to be poor in America and the way a lot of an administrative burden we impose on our sufferers. For states, there is a vital potential to make authorities extra environment friendly, and to entry alternate sources of unstructured information to develop actually significant insights on high quality of care and use new instruments to fight myths and disinformation.”

 “However after I take into consideration the dangers of generative AI, it is just a little bit overwhelming,” he added.  “Medicaid shoppers are sometimes not represented in these information units that algorithms are educated on. On account of boundaries in accessing care, a few of their suppliers are nonetheless on paper. And moreover, regulatory concerns that disproportionately have an effect on the inhabitants that we serve are actually have a stronger affect akin to tribal sovereignty over information and privateness concerns round SUD information.”

For instance, he stated, there are significant dangers to privateness for shoppers who’ve a decrease degree of well being literacy, and likewise lack actual or significant controls of their private information. “One other concern that I’ve is how is that this going to have an effect on our capacity to behave as stewards of public {dollars}? Medicaid medical administrators actually take critically our position to be stewards of public sources and cling to requirements of evidence-based medication. We have seen the rising prevalence of assertions of medical necessity on the premise of actual or not-real research. And that is a priority.”

Chen stated he additionally is anxious that their standing as public entities signifies that Medicaid businesses will not be capable to make the most of the potential of AI. “I feel that there is an inherent rigidity between the character of our work as a public company, and the transparency that is required, and the black field in a few of the algorithms in synthetic intelligence, which aren’t auditable or explainable,” he defined. “And the best threat of generative AI that I see is that we simply do not deploy this in a approach that meaningfully improves well being outcomes for marginalized populations. Historical past is crammed with cases the place know-how would not profit all equally. I feel there’s usually an assumption {that a} rising tide lifts all boats with out recognizing that some boats are floating on the high and a few boats are on the backside of the ocean. And the way will we deliberately deal with disparities?”So how is the HCA planning round AI? “We’re very early in our journey, however on the Well being Care Authority we now have established a man-made intelligence ethics committee,” Chen stated. “This work is led by our chief information officer, Vishal Chaudhry. The scope of our work is targeted on our position as a regulator, purchaser and payer, placing our shoppers on the heart of our work and complementing quite a lot of different efforts in healthcare. This committee is sponsored by our information governance and oversight committee and is tasked with creating and sustaining an AI ethics framework. We have been inviting consultants to return converse to our group. We have been trying on the AI Invoice of Rights, the NIST requirements and specializing in the moral concerns round equitability, transparency, accountability, compliance, trustworthiness and equity. Our committee is chartered to develop synthetic intelligence experience in order that the company can create clear and constant guidelines for its use, superior well being fairness and respect tribal sovereignty when it is relevant.”

 Most of their experiences up to now are with predictive AI, however they’ve seen some rising use circumstances for generative AI. “Our committee additionally works actually intently with our state Workplace of the Chief Data Officer. I simply wish to advocate for us as a group to work to resolve the large issues that drive disparities in our well being outcomes. We have had many, many inventions and know-how throughout the business over the previous couple of years and but as a rustic, our life expectations have been reducing on account of crises and behavioral well being and substance use. How will we goal these instruments to resolve these large issues? We have to actually meaningfully partaking sufferers in these sorts of conversations.”





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