When the CEO of behavioral health payer and managed care organization Magellan Health thinks about AI, its use falls into several buckets. But the verdict on whether AI could replace providers is unclear.
Caroline Carney, MD, of Centene subsidiary Magellan spoke with Becker’s about where AI stands in behavioral health-oriented plans and her predictions for the coming years.
Dr. Carney said administrative tasks — such as processing claims and exchanging files — will be the “readily apparent” use cases. One step further, administrative tasks more specific to patient care — helping clinicians summarize patient interactions and examining medical and pharmacy records — are another use. Even if AI scribes and similar tools drive up costs, in an era of shrinking appointment lengths, this coding could highlight the complex needs of patients, Dr. Carney said. Predictive modeling to better manage limited resources in care management is another asset that comes with AI.
However, there are still ways to go in understanding whether AI can serve as a proxy for providers.
“Can AI replace providers? Based on the literature, the jury is still out on that,” Dr. Carney said. “I like to think about AI tools being an adjunct to what the human is doing in therapy and not replacing therapists yet.”
Dr. Carney said AI has the potential to ease communication and customize resources therapists and their patients rely on, such as cognitive behavioral worksheets.
“There is a place for the use of AI in the clinical model, not yet to fully replace therapists,” she said.
Along with navigating AI in clinical spaces, Dr. Carney is also weighing other concerns, like whether underwriting can keep pace with morbidity amid Medicaid redeterminations and a lack of federal definitions for behavioral health terms, including “disabling mental disorder” and “active treatment” for substance use.
If definitions for these terms crop up state by state, Dr. Carney said this could be problematic for multistate plans, increasing complexity.
“I really would love for health plans to be in that position of having some of those definitions done so that we can start the processes needed to work with our members [and] work with our providers to ensure that people who need services don’t lose services,” she said.
