AI’s role in healthcare brings caution and opportunities 

Providers and insurance industry are partners in innovating with technology 

Advanced as artificial intelligence is becoming, the healthcare and insurance industries are still analog in a lot of ways. Both industries, however, are committed to making strides in technologies that will benefit each other. “On the path but early in the journey” is a good way to describe how several healthcare organizations and insurance companies are adopting various AI tools. In clinical settings, AI may introduce risks, but it also opens the door to numerous opportunities to improve the quality of care, which can mitigate medical errors.

AI technology promises to enable professionals to work faster and smarter over time. Optimizing AI requires centralized, dedicated leadership at every stage of the technology’s evolution.

Opportunities and risks

AI offers numerous opportunities to improve the status quo in clinical settings. For example:

• Patient intake. AI tools can accelerate what is still a partly manual process and prompt staff to collect information through relevant follow-up questions. Ask anyone who has been queried multiple times about what prescriptions they take, and it’s clear that staff aren’t all consulting the same information sources. Prompting is not an entirely new capability; electronic health records have built-in prompting, but AI can help staff draw out details from patient histories that improve the intake process and the patient experience.
• Ambient transcription. AI can digitally record and post conversations between clinicians and patients. Ideally, this shifts a nurse’s or doctor’s role from transcribing the conversation while looking at a computer screen to visually surveying the patient.
• Administrative efficiency. AI can improve the many administrative processes in healthcare, making them more efficient and potentially more accurate. These processes include billing, coding, inventory management, staff scheduling, and more.

At the same time, AI brings risks. These include:

• Errors. AI systems have been shown to produce mistakes and hallucinations, generating erroneous content.
• Biases. AI tools learn from interactions, and they tend to deliver answers aligned with the user’s preferences, even when those answers are incorrect.
• Uncertain reliability. AI is at an early stage in clinical prompting; therefore, clinicians should beware of unreliable information from AI when reaching diagnostic conclusions.

Parallel actions in insurance

The insurance industry also is implementing AI tools and systems to improve efficiency and accuracy. Healthcare and insurance have many of the same goals, struggles and concerns. These include a commitment to consider the value of AI tools and how to apply them, and identification of risk. Healthcare and insurance have long been partners in how to contemplate risk, analyze it and address it. Here are a few intersections:

• Intake. Policyholders and patients have a common need to convey information that helps us serve their needs.
• Administration. Billing, form filing, follow-up scheduling and other tasks are made easier through AI.
• Diagnosis and underwriting. Clinicians may use AI tools in reaching a diagnosis, and in a similar way, insurance underwriters may use AI-collected data to assess and price risk.

Questions to consider

We support AI as a powerful tool that is best applied when human-led and human-monitored. Just as AI empowers professionals to deliver better care and service, it also emboldens consumers to research and ask questions. This raises some issues healthcare and insurance professionals need to consider:

• How does AI help or hinder us in providing empathy? We cannot outsource empathy or decision-making. Patients and policyholders give their trust when professionals demonstrate expertise and empathy. AI so far is limited in its ability to emulate human empathy.
• How does AI support or enhance relationships? We tend to think about AI as saving time or effort, but it will never have the patient/provider relationship in scope, or the people-based nature of insurance. Relationships are foundational to healthcare and risk management. AI cannot replace human interaction.
• How does AI help us educate and involve the consumer? Involving patients in their own care is a good thing, and so is partnering with insurance buyers in managing their risks. AI is useful in relaying information that equips consumers to make better decisions with professional advice.

Effective communication with patients remains paramount

Considering the many open questions and legitimate concerns around harnessing the power of AI in the clinical setting, the critical need for empathy and effective communication with patients is unchanged. This remains true particularly following a harm event. For this reason, BHSI continues to sponsor Communication and Reconciliation Programs, including education and consulting offered by Dr. Thomas Gallagher, M.D., at Center for Harm Response (www.harmresponse.org – formerly The Collaborative for Accountability and Improvement).

“Active engagement is needed for patients’ care to be effective, to share valuable information pertaining to patients’ values and preferences, and to provide feedback on the functioning of the system. Without the patient perspective on care problems, patient safety incidents and liability claims are far more common,” Dr. Gallagher shared. This is a healthy reminder about the limitations of AI. “Patient engagement is a critical element of trusting patient-provider relationships, which are an important ingredient that allow providers to work with patients more effectively,” Dr. Gallagher added.

What’s coming next?

Healthcare continues to evolve, and so does risk. It’s critical for both industries to focus on what is ahead and analyze how technology may help achieve better outcomes for those we serve.

For more information about healthcare risk management solutions and resources, please visit www.bhspecialty.com.

By Leo Carroll | Senior Vice President, Head of U.S. Healthcare, Berkshire Hathaway Specialty Insurance  

Leo Carroll is Senior Vice President and Head of U.S. Healthcare at Berkshire Hathaway Specialty Insurance. He is responsible for the strategic growth and performance of the group’s Healthcare Professional Liability products.

Berkshire Hathaway Specialty Insurance (www.bhspecialty.com) provides commercial property, casualty, healthcare professional liability, executive and professional lines, transactional liability, surety, marine, travel, programs, accident and health, employer stop loss, homeowners, and multinational insurance. The actual and final terms of coverage for all product lines may vary. It underwrites on the paper of Berkshire Hathaway's National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor's. Based in Boston, Berkshire Hathaway Specialty Insurance has offices in Atlanta, Boston, Chicago, Columbia, Dallas, Houston, Indianapolis, Irvine, Los Angeles, New York, Plymouth Meeting, San Francisco, San Ramon, Seattle, Stevens Point, Adelaide, Auckland, Barcelona, Brisbane, Brussels, Calgary, Cologne, Dubai, Dublin, Frankfurt, Hamburg, Hong Kong, Kuala Lumpur, London, Lyon, Macau, Madrid, Manchester, Melbourne, Milan, Munich, Paris, Perth, Singapore, Stockholm, Sydney, Toronto, and Zurich.

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