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Leveling the playing field: AI-assisted prior authorization can drive more equitable care

May 31, 2024
Artificial Intelligence Business Affairs

3. Personalized care pathways with AI-powered clinical insights:
AI and machine learning can go beyond analyzing medical records; they can consider SDOH factors that significantly impact health outcomes. For example, the technology can review a prior authorization request for a patient predisposed to heart disease and analyze their medical history, lab results, and genes to assess their risk. AI has the ability to go beyond the basics of analyzing data from wearable devices to understand a patient's lifestyle habits and recommend personalized improvements, while also considering social determinants of health, like access to healthy food, to suggest relevant resources.By analyzing vast amounts of data, AI and machine learning can even predict potential complications and recommend preventive measures. This allows physicians to create personalized treatment plans that address the medical and social aspects of heart disease prevention. This holistic approach ensures that treatment plans consider both the medical aspects and social realities that influence a patient's health journey.

Ensuring responsible AI implementation
While AI and machine learning technology offer potential benefits for promoting health equity, it's crucial to underscore the necessity of addressing algorithmic bias, maintaining clinical oversight, and securing patient data. Health plans must use diverse datasets and never employ AI technology to deny care.

By harnessing SDOH data and empowering physicians with intelligent tools, this technology can personalize care plans that address both medical conditions and social determinants of health. The future holds immense promise for improved patient outcomes–and a healthcare system where interventions are truly tailored to ALL patients' needs.

About the author: Dr. Mary Krebs serves as Medical Director of Primary Care at Cohere Health. In addition, she teaches residents and medical students at a family medicine residency program in Dayton, Ohio. She earned her medical degree from the Ohio State University College of Medicine in Columbus and completed a family medicine residency at Miami Valley Hospital in Dayton, Ohio. Previously, Dr. Krebs was in solo practice at a rural federally-qualified health center and co-ran Family Practice Associates, an independent rural practice.


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