Health IT Leaders Eye AI, Data Sharing to Improve Affordability

Members of the Health IT Advisory Committee opened a wide-ranging discussion on healthcare affordability Thursday with a call for stronger interoperability, streamlined prior authorization and more transparent use of health data and AI. 

National Coordinator for Health IT Thomas Keane called affordability one of the most pressing issues in healthcare today and said health IT can improve affordability across the healthcare system, “from backend administrative operations to clinical care to patient-facing tools.” He called on the committee — which was established to provide recommendations to the national coordinator on policies, standards and certification criteria — to explore ways to advance affordability through the smarter use of data and technology. 

Affordability is one of the three key priorities of the ONC along with liquidity and technology evolution, Keane said.

“It’s where these priorities intersect that we got the biggest impact for patients. We want to use forums like HITAC to understand progress and opportunities in health IT that can make healthcare more affordable — whether that’s lowering out of pocket costs at the pharmacy counter, cutting administrative waste or giving patients tools to avoid unnecessary care,” he said. “We all know how important it is to have a healthcare system that delivers the right information to the right person at the right place and the right time, but it’s also equally important to do it in a way that helps lower costs for the American people.” 

Industry Partnerships

Committee Co-Chair Eliel Oliveira, CEO at Connxus, Texas HIE, a health information exchange, commended what he described as growing alignment between federal agencies and the healthcare technology sector. 

“There is renewed focus on data liquidity, on reducing unnecessary burden through prior authorization and fraud prevention, while also strengthening core standards, patient access of their data, and on building the infrastructure required for more connected, intelligent healthcare system,” he said. “These are not incremental changes, as you all know. They represent a meaningful shift towards making health data more usable, more accessible and more impactful across the care continuum.” 

Much of the hearing centered on prior authorization, which several panelists described as one of the clearest examples of how fragmented administrative systems increase costs and delay care. During a discussion on modernizing administrative workflows, participants repeatedly pointed to inconsistent payer requirements, lack of transparency and outdated communication systems, such as faxing, as major barriers. 

AI and Automation

Committee members also questioned whether new AI-driven prior authorization systems could unintentionally worsen coverage restrictions or increase documentation demands.  

“Doesn’t this just incentivize payers to heighten documentation requirements and narrow coverage boundaries as well? And how do we prevent that? That’s one of the things that we’re really worried about on the provider side, is that as we develop all of these tools — and we’re really excited about all of these tools that help decrease the burden and improve care for our patients — that all of the coverage … will decrease and that the requirements will increase,” said Hannah Galvin, chief medical information officer at Cambridge Health Alliance. 

Shila Blend, health information technology director of the North Dakota Health Information Network, North Dakota’s statewide health information exchange, said that as automated tools are introduced, it’s important to keep human oversight. 

“My caution on there … as these things are piloted, is just to really make sure we still have a human element before that final denial,” she said. “I’ve heard stories of some of these things occurring with the automation and denials and without that human element and … the appeals process of those things is very cumbersome and time intensive. So as we develop these things, we want to make sure that, you know, patient care is not being impeded by it.”