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Dr. Randy Vogenberg, a healthcare professional and health economist, discusses the integration of AI in managed care with Tamara Thomas, focusing on clinical pathways and expert guidelines. Vogenberg explains that clinical pathways are operational plans based on expert guidelines, which are evidence-based recommendations from medical societies. Challenges include provider burden, potential delays, and the need for human oversight. The conversation also touches on the long-term goal of AI replacing static guidelines, predicting a 10-year timeline.
Part 1 covers the CMS Wiser program (Wasteful and Inappropriate Service Reduction), which currently uses AI for prior authorization in six pilot states aimed at saving billions, improving service delivery, and reducing delays.
