Becker’s Payer Issues Podcast Balancing Innovation and Ethics: The Role of Agentic AI in the Payer Landscape
Apr 8, 2025
Neetu Rajpal, CEO and co-founder of Lilac Software, discusses the transformative impact of agentic AI in healthcare payers. She reveals how AI can streamline claim processing and close care gaps, especially in crucial areas like breast cancer screenings. Neetu emphasizes the importance of ethics, addressing bias in AI training, and ensuring patient-centered design. The conversation also dives into the balance between innovation and trust in healthcare technology, highlighting the need for regulatory compliance as we navigate this evolving landscape.
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Episode notes
AI Streamlining Claims Grievances
- Agentic AI can streamline claims grievances by cross-referencing member, policy, and plan information.
- It can then generate personalized responses and suggest execution plans, improving efficiency.
AI for Care Gap Closure
- Payers can use AI to address care delivery challenges, such as closing HEDIS gaps.
- AI can identify members needing services, determine the best outreach approach, schedule appointments, and address barriers.
Ethical and Patient-Focused AI
- Mitigate AI bias by using multiple models and monitoring their outputs.
- Keep the member at the center of AI tool development and ensure real-world needs are met.