Planetary Health First Mars Next, a Michael Mann production 160 Navigating Headwinds, AI Risk, & Regulatory Crosswinds in Healthcare Payer Strategy"
Jun 7, 2025
Tom Shankle, a seasoned healthcare executive, joins Raihan Faroqui, an internal medicine physician and healthtech operator, alongside Vandna Bhrany, Managing Director at 8B Advisors. They dive into the key challenges facing healthcare payers, including the impact of AI-driven automation and evolving regulatory landscapes. The trio discusses navigating operational pressures in Medicare Advantage and the implications of increasing scrutiny from CMS. They emphasize the importance of AI governance and long-term strategic planning to thrive amidst these changes.
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AI Reveals Hidden Bias And Regulatory Pressure
- AI adoption exposes bias and regulatory risk in healthcare, prompting new rules and safeguards.
- Regulators are moving fast because existing AI can unintentionally discriminate against communities.
Stand Up Cross-Functional AI Governance
- Establish cross-functional AI governance committees including legal, clinical, actuarial, and compliance.
- Require vendor docs on training data, bias tests, and post-deployment monitoring before procurement.
Governance Is Not A One-Time Task
- Governance must be continuous because public LLMs and models evolve rapidly.
- Real-world monitoring and transparency are essential as models change post-deployment.