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Research Paper | Pharmacy | United States of America | Volume 13 Issue 4, April 2024
Evaluating the Role of AI and Identifying Use-Cases in U.S. Managed Care Organizations
Dinesh Kabaleeswaran [3] | Iswarya Chandramouli
Abstract: In the United States healthcare system, the payer stakeholder group ensures drug reimbursement coverage and access for patients. Historically, payers do not often initiate the adoption of new systems, processes, and technology. In an age where artificial intelligence (AI) utilization is rapidly increasing across industries and across the overall healthcare system, it is important to understand the implications that AI may have within payer organizations in areas such as healthcare data processing, treatment protocol identification, prior authorization reviews, and other functions. This research therefore explores perceptions of AI familiarity, usefulness, and security concerns across 63 payers and 103 physicians to determine the likelihood of AI implementation within managed care organizations. Based on the results discussed in this research study, payers report familiarity with AI tools and describe whether they are open to utilization and incorporation into current systems to reduce administrative burden across departments, but serious concern exists on the security of AI tools with sensitive payer, physician, and patient data. As a point of future discussion, it will be important for researchers in this space to explore utilization of AI tools, its role in streamlining time-consuming processes, and creating opportunities for better care and optimal patient results. Further research will support greater understanding for appropriate AI application and use within managed care organization to create smooth access to care and therapies for patients.
Keywords: Artificial intelligence, AI Tools, ChatGPT, managed care, patient access, claims data, data integration
Edition: Volume 13 Issue 4, April 2024,
Pages: 1199 - 1203