Medicare Advantage plans are actively deciding what to fund next in artificial intelligence. But those decisions are rarely made in one room. These siloed decisions can undermine the efficiencies AI is meant to deliver.
Risk adjustment, quality, and compliance each have their own leaders, vendors, and priorities. But the data sources for those priorities often overlap, and so can efforts to retrieve and refine that data. Costs compound when teams make duplicative investments. And sometimes, so does risk: A platform that facilitates coding could create new efficiencies, but it could also introduce new compliance questions. Moreover, when decisions are siloed and tech investments are sequenced function by function, the resulting redundancies, gaps, and potential risk tend to surface late, when the cost of addressing them is highest. Many risk adjustment teams today are grappling with the question: What’s the best way forward?
This session tackles that question directly. Becker’s Healthcare hosts a candid discussion on Oct. 27 about which AI use cases deliver true operational efficiencies, where human oversight still needs to sit, and what tech-stack overlap means for the order in which plans invest.
Key takeaways:
- Where AI is creating the most value across risk adjustment, Star Ratings and compliance today
- The line between decisions AI can accelerate and decisions that still require clinical, coding, or compliance judgment
- Why strategizing AI investment across the three functions matters more than optimizing any one of them