During his Nov. 5 fireside chat at Becker’s CEO+CFO Roundtable, Mark Cuban urged health system leaders to point AI at their contracts and ask: “Where are they ripping me off?”
At Columbia, Mo.-based MU Health Care, that work is already underway, CFO Greg Damron said, speaking on a panel later that day. He said the system’s payer contracting team has become one of its leading adopters of the technology.
“I think that’s been out of necessity trying to be able to ingest these large payer contracts, find all of the loopholes and dodges that are in there, all the policy updates,” Mr. Damron said.
The contracts themselves are only part of the exposure. Mr. Damron said the bigger risk often sits in the policy changes payers issue after an agreement is signed.
“It’s not so much the contract, but unless you have specifically put language into your agreement that limits their ability to make policy changes, you’re at their whim as far as issuing policies, some of which are horrible policies, by the way,” he said.
He pointed to emergency medicine and anesthesia payment policies introduced over the last couple of years, including rules that would cut off reimbursement partway through a case. Policies like that do not create the right incentives for anyone, he said, and make for bad PR. AI gives his team the ability to process those changes and push back on payers aggressively, he added.
“It is a war right now, both at the IT level between our billing systems and their payment systems and then at the sort of administrative level,” Mr. Damron said.
At Providence, R.I.-based Care New England Health System, CFO Todd Conklin is applying the same idea to the system’s vendor contracts, using a tool built in-house.
“I happen to have a CIO colleague that is pretty skilled at developing those tools for us,” Mr. Conklin said.
About a month ago, Mr. Conklin and the CIO agreed to run the contracts of Care New England’s two largest IT partners through an AI tool the CIO developed, he said. Once the tool is refined, they plan to apply it to all of the system’s supply chain contracts, though Mr. Conklin acknowledged the IT team will need more resources to get there.
For smaller organizations, the starting line is further back. Glenn Williams, CFO of Community Hospital in Grand Junction, Colo., said the hospital recently brought on a new third-party administrator and did not use AI to review that contract line by line.
“We’re a smaller independent hospital and so from a technological standpoint we are definitely behind the power curve,” Mr. Williams said.
Technology and AI are among the hospital’s biggest priorities beginning in 2027, following a strategic planning cycle that just wrapped, Mr. Williams said. Because of its size, Community Hospital cannot afford to choose the wrong tool, he added, and the work starts with optimizing the systems it already has. Layering advanced AI on top of an unoptimized structure, he said, is like putting a high-powered jet on a Pinto.
“We absolutely have to get in the AI space because right now we’re fighting a technology problem with people and my pool of people are really small,” Mr. Williams said.
