BIP Summer 2024

to better outcomes and helping to create a more holistic approach to healthcare. Just 8% of people over 35 receive all the appro priate clinical preventive services recommended for them, according to the Centers for Disease Control and Prevention. To raise that percentage, compa nies like Elevance Health are leveraging AI to de velop a predictive model that uses clinical indicators like comorbidities and demographics to signal plan members who may fall into risk categories. In emergency care, AI tools are helping clini cians make split-second decisions by surfacing vital patient data in real-time to expedite triage and im prove outcomes. When paired with telehealth, AI enabled remote patient monitoring keeps patients out of hospitals and alerts care teams to changes in conditions before they become costly crises. Ethical and Privacy Considerations However, the AI revolution is not without its down sides. Monitoring for things like biases in patient care and hiring, plus privacy breaches that could threaten fundamental rights, is essential. Recog nizing the stakes, The White House champions a U.S. Blueprint for AI Bill of Rights, advocating for transparent and trustworthy AI. Early on, opaque black box algorithms — AI that does not show computational sourcing — made biased decisions veiled in secrecy, often to the detri ment of patients and organizational integrity. Re cent interventions by the Centers for Medicare and Medicaid Services (CMS) underscore the dangers, prohibiting algorithmic discrimination based on impersonal computations. CMS issued a notice in

February to Medicare Advantage plans that clarified that algorithms alone could not be used as a basis to deny hospital admission for these patients. A coordinated effort between government agen cies is underway to regulate AI’s impact, ensuring technology companies disclose algorithms, address bias, and fortify data security to prevent AI halluci nations, which is when an LLM perceives nonexis tent patterns and offers inaccurate output. An AI “nutrition label,” mandated by the Department of Health and Human Services, seeks to advance health data interoperability. The effort promises transparency in health IT platforms — used by more than 96% of hospitals and 78% of office-based physicians, according to HHS — to illuminate the inner workings of digital diagnostics. However, healthcare organizations, custodians of sensitive data and personally identifiable infor mation (PII) still remain vulnerable to cyberattacks, despite AI’s efforts to anonymize information. The Evolution Continues AI promises opportunities for improved patient outcomes, streamlined processes, and cost efficien cies. As AI continues to advance, agents and brokers must adapt and evolve. Embracing AI tools and technologies can enable more personalized and data-driven solutions, facilitating better decision making and optimizing healthcare planning. By proactively integrating AI, NABIP members can position themselves as indispensable partners in navigating the complexities of healthcare in the digital age. Andrea Gove is a freelance writer.

To stay abreast of AI advancements in healthcare planning, NABIP prioritizes ongoing education, collaboration with AI experts, and leveraging AI-powered tools for data analysis and

predictive modeling.

process this data, analyze the intent or sentiment in the mes sage, and respond in real-time to human communication. genAI chatbots Generative AI is a type of AI that can create new content and ideas, including conversations, stories, images, videos, and music. AI technologies attempt to

mimic human intelligence in nontraditional computing tasks like image recognition, NLP, and translation. Your organization can use generative AI for various purposes, like chatbots. Large Language Models (LLM) Large language models are very large deep learning

models pre-trained on vast amounts of data. The underlying transformer is a set of neural networks that consist of an encoder and a decoder with self-attention capabilities. The encoder and decoder extract meanings from a sequence of text and understand the

relationships between words and phrases in it.

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