HATCo CEO Marc Harrison on the acquisition of Summa Health.

Artificial Intelligence

How Health Systems Are Approaching AI

The New England Journal of Medicine’s just-released NEJM AI publication is off to the races, with its February issue including a stellar breakdown of how academic medical centers are managing the influx of predictive models and AI tools.

Researchers identified three governance phenotypes for managing the AI deluge:

• Well-Defined Governance – health systems have explicit, comprehensive procedures for the evaluation of AI and predictive models.
• Emerging Governance – systems are in the process of adapting previously established approaches for things like EHRs to govern AI.
• Interpersonal Governance – a small team or single person is tasked with making decisions about model implementation without consistent evaluation requirements. 

Regardless of the phenotype, interviews with AI leadership at 13 academic medical centers revealed that chaotic implementations are hard to avoid, partly due to external factors like vague regulatory standards.

• Most AI decision makers were aware of how the FDA regulates software, but believed those rules were “broad and loose,” and many thought they only applied to EHRs and third party vendors rather than health systems.

AI governance teams report better adherence to new solutions that prioritize limiting clicks for providers when they’re implemented. Effective governance of prediction models requires a broader approach, yet streamlining workflows is still a primary consideration for most implementations. That’s leading to trouble down the road considering predictive models’ impact on patient care, health equity, and quality care.

The Takeaway

Even well-equipped academic medical centers are struggling to effectively identify and mitigate the countless potential pitfalls that come along with predictive AI implementation. Existing AI governance structures within healthcare orgs all seem to be in need of additional guidance, and more guardrails from both the industry and regulators might help turn AI ambitions into AI-improved outcomes.

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The Wire

• HCSC Picks Up Cigna’s Medicare Business: A few short weeks after it was revealed that Health Care Service Corporation was in talks to acquire Cigna’s Medicare business, that transaction is officially going through at a value of $3.3B. Cigna offers Medicare plans in 29 states, and last reported having just under 600k MA members (accounting for $7.9B in 2022 revenue). That marks a major expansion for HCSC, dramatically expanding its reach beyond the five states where it’s the parent of Blue Cross Blue Shield plans.

• Cohere Raises $50M: Cohere Health raised $50M in unlabeled equity funding, increasing its total funding to $106M as it looks to meet increasing demand for its intelligent prior authorization platform. Cohere’s AI-driven solutions support health plans beyond traditional utilization management programs, ultimately helping providers and patients get to ‘yes’ more quickly. The platform combines AI with real-time analytics to reportedly slash denials while allowing patients to access care five days faster.

• Are Unicorns Endangered? The latest Pitchbook data shows that the total number of digital health unicorns valued at over $1B is starting to fall off, with only behavioral health directory Headway and PBM CapitalRx claiming the title in 2023. That’s down from over 52 new unicorns between 2021 and 2022, as companies forced to come back to the funding table are doing so at lower valuations. About 70 current digital health unicorns raised a combined $12B in 2021, but that total fell off a cliff to $1.2B last year.

• Permanent Pandemic Prescribing: Last week brought an HHS decision to make some pandemic-era prescribing flexibilities permanent, allowing providers to prescribe opioid use disorder treatment buprenorphine through telehealth without an in-person visit. The rule applies only to certified opioid treatment programs, but the Substance Abuse and Mental Health Services Administration said the decision dramatically expands the patient reach of drug therapy. The rule goes into effect this April, with a compliance date of April 2026.

• CHS Leans in on Google AI: National hospital chain Community Health Systems completed its migration to Google Cloud, having spent the last year getting the data across its 71 hospitals in 15 states on the FHIR standard. CHS is now looking to use its FHIR data warehouse as a starting point for a wide range of generative AI initiatives, with core focus areas including clinical documentation, admin task automation (they use the example of assisting with denial appeal letters), and providing patients with contextualized SDOH resources.

• First QHIN-EMS Collab: Beyond Lucid Technologies announced what appears to be the first collaboration between a QHIN and a mobile medicine company, selecting MedAllies as its QHIN partner to make its EMS providers more efficient while helping to share data with hospitals during patient transfers. Responders and their hospital partners will gain access to key patient data prior to arrival at a patient’s side, then be able to share key patient information with healthcare facilities prior to transfer.

• AI For Heart Care: Three in 5 Americans believe AI will lead to better heart care, according to a 1,000-person survey from the Cleveland Clinic. Many Americans are taking a positive outlook on AI due to feature improvements they’ve already seen on their wearables. Half of respondents use at least one type of tech to monitor their health, while 53% said their wearables cause them to exercise more regularly. Clinicians on the other hand are excited about AI’s potential to “help process data for certain studies like echocardiograms, or CT scans, or MRI.”

• 24-Year Old Hospital CEO: At age 22, Aidan Hettler has just graduated from Colorado State University’s business school, and had no healthcare experience when a leader at CO-based Sedgwick County Health Center reached out to him about the rural hospital’s CEO role. After a well-prepped interview on the state of the hospital and the direction he thought it should take, Hettler got the job in the big chair. Not sure how much to read into that re: the dire straits of rural hospitals, but this Becker’s interview gives a short-and sweet breakdown.

• Talkspace Teams Up With Bicycle: Virtual therapy company Talkspace is teaming up with opioid use disorder platform Bicycle Health, allowing the two companies to easily refer patients to one another. Partnerships like these make perfect sense for patients considering the close relationship between OUD and mental health needs, while also giving the providings a new path to connecting with the exact customer base they’re trying to reach.

• Apple’s VR Play: Apple launched its long-awaited Apple Vision Pro headset, which supports image viewing in an augmented reality/virtual reality environment that Apple has dubbed spatial computing. At $3,499, it’s up for debate whether the Apple Vision Pro is one of the most expensive toys ever made or a decently accessible digital health tool, and researchers have already begun experimenting with use cases like image-guided interventional procedures to see how the tech holds up in the clinical realm.

• Karoo Health’s VBC Validation: Cardiology value-based care enablement company Karoo Health released results from its first proof of concept study, showing solid VBC progress at its partner practices. Cardiology practices that adopted the Karoo platform were able to convert 70% of their eligible patients to the Karoo VBC model over the six month study period, far better than the 25% to 30% rates that Karoo says is typical with other VBC companies. Once enrolled, 95% of those patients became engaged with the digital platform, and 21.7% of their unnecessary ED visits were avoided.

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