The Role of AI in Future Value-Based Care Reimbursement With: Stephen Speicher, MD, MS
Dr. Stephen Speicher, Senior Medical Director at Flatiron Health, offers a thought-provoking look into how artificial intelligence may become a requirement—not just an option—in future value-based care models. In this clip, he explores whether insurers might eventually mandate AI use in clinical decision-making as a condition for reimbursement, especially if AI demonstrates measurable improvements in patient outcomes. While the cost of AI today often falls on the healthcare provider, Speicher suggests a future where insurers not only pay attention to AI utilization but actively incentivize or even demand it. This shift could redefine how 'value' is operationalized in value-based healthcare, raising new questions about reimbursement, care quality, and access. His insights offer a forward-looking framework for understanding the evolving intersection of health tech and reimbursement models.
Episode Contents:
About the Guest
Dr. Stephen Speicher is a pediatric hematologist and oncologist and the Head of Clinical Oncology and Safety at Flatiron Health. He specializes in healthcare quality and innovation through technology. https://flatiron.com
Key Takeaways
- • AI could become a reimbursable or mandated part of clinical workflows
- • Value-based care models may evolve to include AI as a requirement
- • Insurers might reward or demand AI use for improved patient outcomes
Transcript Summary
Could AI tools create a new layer of insurance complexity in care delivery?
Dr. Speicher notes that while AI currently doesn’t incur direct insurer costs, that could change if AI becomes billable. If that happens, prior authorization and reimbursement complexities could follow.
Is there a scenario where insurers might *require* AI use in clinical care?
Yes. If robust studies show that AI tools enhance outcomes and quality, insurers might eventually require their use within value-based care contracts to ensure optimal results and cost-effectiveness.
How might AI integrate into value-based care models?
Speicher envisions AI tools becoming essential—bundled into care models as value drivers. Instead of optional enhancements, AI may become foundational to meeting insurer standards for quality care.
More Topics
- AI in Patient Care
- AI in the Healthcare Industry
- AI and Medical Innovation
- Healthcare Ethics and Policy
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About the Series
AI and Healthcare—with Mika Newton and Dr. Sanjay Juneja is an engaging interview series featuring world-renowned leaders shaping the intersection of artificial intelligence and medicine.
Dr. Sanjay Juneja, a hematologist and medical oncologist widely recognized as “TheOncDoc,” is a trailblazer in healthcare innovation and a rising authority on the transformative role of AI in medicine.
Mika Newton is an expert in healthcare data management, with a focus on data completeness and universality. Mika is on the editorial board of AI in Precision Oncology and is no stranger to bringing transformative technologies to market and fostering innovation.