Using AI to Protect Healthcare Systems with Kurt Spear | Highmark

possible and how sophisticated they've become so quickly.

Think about the balance of technology and the benefit versus the risks.

And you kind of play in on both sides of that.

How do you how do you think about that moving forward?

Yeah, the way I try to think about it is really what's the good, the bad, right? So meaning how is it going to be used against us from the bad actors perpetrating fraud, as well as how can we leverage it for goods? But The thing that I always have in the back of my mind and trying to balance it all out is leveraging the skills and the experience of our people, I think is most important because the technology is going to continue to get more robust.

It's going to get smarter.

Anytime you go into LinkedIn or anything, I mean, the volume of AI articles and how sophisticated the technology is.

I mean, it changes every day, every hour, which can really help us, right? But to me, it's about keeping our people really front and center and being able to leverage their knowledge and expertise to figure out how can we use AI to make us more effective, more efficient.

But also, what are some ways that it could be used in a nefarious way, potentially against us and against our members? And think about AI as another tool in our toolbox, right? Super important one.

I try to think of it as a tool and that we need to arm our people with it, teach them how to use it, and think about how it could potentially be used against us as well.

Exactly.

Well, when you think about guardrails for AI, and I think people listening could take what you've learned as far as some core principles that maybe they should be thinking about in healthcare around AI.

Do you have any advice about guardrails and how to implement them in your organization?

Yeah, I get the question a lot, especially from some of the smaller health plans, right? And thinking about where do we start with AI and how do we implement it and how do we use it? And it's always a great question, especially for an SIU that might have three people in it, right? Or four people.

And one, not having the people power to kind of launch technology.

maybe as robust as a department would like, but also from a funding perspective, right? Like how do we leverage our dollars in the best way possible? And I always think about it in two ways.

One is start with something that you're almost certain you can be successful with, right? So come up with a use case that you've worked across the enterprise to develop because it's probably going to take people from your IT functions, from your governance teams to make sure you're applying it in an ethical way and according to all your state requirements, et cetera.

So really leverage the core team of your people across the enterprise and come up with a scenario that you feel really good and confident about.

The second is try not to get tied down to one specific technology.

Because again, the technology changes, I mean, so frequently, so quickly that you want to leave yourself open that as things evolved, as your use case changes or expands, that you can continue to apply it to those different technologies.

I know the one way that I've always thought about it is from a member encounter perspective, right? So We sign up for a health plan policy.

We go to our doctor.

We have a visit.

We have follow-up care.

We get a prescription.