Abstract

A practical roundtable discussion with community-based plans, Alliance Health and Mountain Health CO-OP, about key strategies, challenges, and opportunities for leveraging AI to enhance care delivery and improve member outcomes.

Author: Siftwell Team

Siftwell hosted a roundtable with Alliance Health and Mountain Health CO-OP in partnership with ACAP to discuss how community health plans are:

  • Practically adjusting and optimizing their operations using artificial intelligence (AI) and other strategies
  • How they are improving health equity for diverse populations by closing health disparity and access gaps
  • How they ultimately are aspiring to improve the health and wellbeing of populations.

The discussion highlighted key strategies, challenges, and opportunities for leveraging AI to enhance care delivery and improve member outcomes.

Here’s a quick overview of the discussion, but watch the full conversation on-demand above.

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The conversation began with an overview of the diverse datasets being utilized in community health plans, including claims data, behavioral health service data, physical health data, pharmacy data, electronic health record (EHR) data, and social determinants of health (SDOH) data. The panelists emphasized the importance of integrating these datasets to gain comprehensive insights into population health and unique member needs.

One of the central themes of the discussion was the utilization of AI models to analyze and contextualize data, enabling community health plans to:

  • Identify populations at risk with member profiles
  • Improve cancer screening adherence rates
  • Optimize care management encounters
  • Enhance member retention and reduce churn

Both Mountain Health CO-OP and Alliance Health underscored the positive impact of AI on their organizations, with improvements in risk adjustment, quality scores, and proactive population health management.

“If you are a plan considering the implementation of AI, you need to start now. The runway is long because there is lots of testing involved to make sure models are absolutely accurate,” said Blair Fjeseth, COO of Mountain Health CO-OP. “But my main point really is don’t be afraid of it because it’s something that we all need to embrace. And you want to make sure that you have a partner that you can trust.”

Both leaders emphasized partnerships and trust as critical components of successful AI implementation, with special consideration given to collaborating with trustworthy partners. They also discussed the significance of ensuring compliance with HIPAA regulations and maintaining data security when using AI models.

Throughout the session, there was a strong emphasis on staying informed about healthcare policy changes and understanding how they might impact the use of AI in the industry.

The session provided valuable insights into how AI and machine learning are transforming community health plans, enabling them to efficiently navigate complex healthcare challenges, and deliver high-quality, personalized care to their members. By harnessing the power of AI, community health plans can drive innovation, improve outcomes, and ultimately, enhance the health and well-being of the communities they serve.

→ Watch the full roundtable discussion