About Aisha Moktadier

Aisha is an Integrated Marketing Specialist at BHM Healthcare Solutions, bringing over a decade of expertise in storytelling and strategy. Her passion for crafting impactful campaigns that connect, engage, and drive results stems from a lifelong love of words. When she’s not working, you can find her treasure hunting at thrift stores or snapping photos with her vintage Canon AE-1. She always has a book tucked in her purse and is on a personal mission to bake the world’s best English shortbread cookie.

BHM Earns NCQA Accreditation for Utilization Management

2025-01-14T13:18:35-04:00By |Healthcare Fraud and Abuse, NCQA Accreditation, Physician Compensation, Quality Improvement Programs, Strategic Planning, Telehealth and Telemedicine, Utilization Management|

BHM Healthcare Solutions, Inc. Achieves Prestigious NCQA Accreditation for Utilization Management

Tampa, FL — BHM Healthcare Solutions, Inc. (BHM) is proud to announce that it has been awarded a full three-year accreditation for Utilization Management by the National Committee for Quality Assurance (NCQA). This marks the third consecutive cycle that BHM has achieved this esteemed accreditation, underscoring our consistent ability to meet and exceed evolving industry standards and deliver high-quality care management solutions.

The NCQA Utilization Management Accreditation is a mark of distinction, earned only by organizations that meet or exceed rigorous standards of quality. This recognition demonstrates BHM’s ability to support healthcare organizations with robust and reliable utilization management processes that ensure optimal patient outcomes, efficient resource use, and alignment with regulatory requirements.

What This Accreditation Means for Its Partners

BHM’s accreditation highlights its:

  • Dedication to Excellence in Care, facilitating timely and effective healthcare delivery.
  • Commitment to Operational Transparency, adhering to evidence-based practices and ethical decision-making.
  • Capability to provide a Competitive Edge, helping healthcare organizations achieve their goals while fostering trust and collaboration.

“We are honored to receive NCQA’s three-year accreditation for Utilization Management,” said Eric Rosenberg, CEO. “This achievement not only reflects our commitment to quality and excellence but also reinforces our role as a dependable partner in supporting healthcare organizations with the highest standards of care.”

This accreditation is a testament to the hard work, expertise, and dedication of BHM’s team, showcasing its unwavering adherence to NCQA’s rigorous standards. 

By achieving this milestone, BHM solidifies its position as a trusted partner in the healthcare industry, setting itself apart through a commitment to exceptional care and meaningful collaborations.

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Contacts:

  • Rayliz Torres, Chief Compliance Officer
  • Jannis Paulk, Vice President of Marketing

About NCQA
The National Committee for Quality Assurance (NCQA) is an independent, nonprofit organization dedicated to improving healthcare quality. Through its comprehensive accreditation and certification programs, NCQA sets standards for healthcare organizations to promote excellence, accountability, and patient-centered care. For more information, visit www.ncqa.org.

About BHM Healthcare Solutions, Inc.
BHM Healthcare Solutions provides national behavioral health and medical review services & solutions for health plans, health systems, hospitals, and other insurers.

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For more information, please visit www.bhmpc.com.

Responsible Use of AI

2024-12-23T16:18:59-04:00By |Big Data, Business Intelligence, Healthcare IT|

Responsible Use of AI in Healthcare

Accountability, Transparency, and Ethical Oversight

Artificial intelligence (AI) has emerged as a powerful tool in healthcare, revolutionizing diagnostics, treatment planning, and operational efficiency. However, its adoption brings ethical, operational, and safety challenges that healthcare systems must address responsibly. This article explores the principles of accountability, transparency, safety, and fairness in AI use, drawing insights from recent studies and real-world examples.

What is Responsible Use of AI in Healthcare?

Responsible use of AI means deploying and managing these technologies to enhance patient care while encouraging ethical alignment, fairness, and accountability. It involves addressing critical issues such as bias, data security, and operational transparency.

Accountability: Taking Ownership of Outcomes

Accountability is foundational to the ethical deployment of AI in healthcare. It requires organizations and developers to assume responsibility for AI outcomes, whether positive or negative, and to establish clear frameworks for addressing errors or unintended consequences.

Key Findings:

  • Responsibility for Outcomes: Organizations must adopt accountability frameworks that define roles and responsibilities at every stage of AI deployment. Failing to address accountability can erode trust and lead to legal challenges (Social Science & Medicine). Organizations must adopt accountability frameworks that define roles and responsibilities at every stage of AI deployment. Failing to address accountability can erode trust and lead to legal challenges.
  • Felt Accountability: A culture of “felt accountability,” where healthcare professionals actively monitor AI performance, ensures responsible integration and minimizes risks (Lancet Digital Health). A culture of “felt accountability,” where healthcare professionals actively monitor AI performance, ensures responsible integration and minimizes risks.

Real-World Example:

An AI-powered diagnostic tool in radiology incorrectly flagged benign tumors as malignant in 12% of cases. The healthcare provider implemented immediate corrective measures, including algorithm retraining and clinician-led oversight, demonstrating accountability by addressing errors and preventing further harm.

How to Foster Accountability

  • Define clear roles and responsibilities for AI-related decisions.
  • Conduct regular audits to ensure adherence to ethical standards.
  • Communicate openly about errors and implement corrective actions promptly.

Transparency and Explainability: Building Trust

Transparency in AI systems fosters trust among clinicians, patients, and stakeholders. It ensures that decisions made by AI systems are understandable and that users are informed about their limitations and potential biases.

Key Findings:

  • Transparency in Medical Devices: AI/ML-enabled medical devices must include clear documentation of data sources, intended uses, and performance metrics (npj Digital Medicine). AI/ML-enabled medical devices must include clear documentation of data sources, intended uses, and performance metrics.
  • Mitigating Black-Box Risks: Explainable AI models reduce mistrust and allow clinicians to validate AI-driven decisions (IRE Journals). Explainable AI models reduce mistrust and allow clinicians to validate AI-driven decisions.

Real-World Example:

A hospital implemented an AI-based triage system in its emergency department. To ensure transparency, the system provided clear explanations for its prioritization decisions, which clinicians could review and override if needed. This enhanced trust and improved adoption rates among staff.

Strategies for Transparency

  • Use AI models designed with interpretability in mind.
  • Train users to understand and validate AI outputs.
  • Clearly outline the strengths, limitations, and potential risks of AI tools.

Safety and Reliability: Prioritizing Patient Well-Being

Ensuring the safety and reliability of AI systems is non-negotiable in healthcare, where even minor errors can have serious consequences. Rigorous testing and continuous monitoring are essential.

Key Findings:

  • User-Centric Design: Tailoring AI systems to meet user needs enhances reliability and minimizes errors (Human-AI Interaction Review). Tailoring AI systems to meet user needs enhances reliability and minimizes errors.
  • Performance Monitoring: Ongoing evaluations are vital to identifying and mitigating risks in real-time (Lancet Digital Health). Ongoing evaluations are vital to identifying and mitigating risks in real-time.

Real-World Example:

An AI tool used for predicting sepsis risk in ICU patients failed to account for nuanced clinical variables, leading to false alarms. The hospital incorporated clinician oversight into the system, ensuring that flagged cases were double-checked before interventions were made.

Enhancing Safety and Reliability

  • Conduct extensive pre-deployment testing in controlled environments.
  • Incorporate user feedback throughout the AI lifecycle.
  • Implement real-time monitoring systems to identify and address anomalies.

AI should promote equity in healthcare, but biases in training data can lead to disparities in care delivery. Addressing these biases is crucial for ethical AI use.

Key Findings:

  • Outcome Fairness: Diverse datasets and fairness metrics help ensure equitable care delivery (Lancet Digital Health). Diverse datasets and fairness metrics help ensure equitable care delivery.
  • Real-World Monitoring: Regular evaluations of AI systems in clinical settings help identify and correct biases that emerge over time (npj Digital Medicine). Regular evaluations of AI systems in clinical settings help identify and correct biases that emerge over time.

Real-World Example:

A resource allocation AI system disproportionately prioritized urban hospitals over rural facilities. Developers addressed this by retraining the algorithm with more representative data, ensuring equitable distribution of medical resources across all demographics.

Mitigating Bias

  • Train AI models using diverse, representative datasets.
  • Regularly assess systems for bias and implement necessary corrections.
  • Engage ethicists and patient advocates in the AI development process.

Conclusion

The responsible use of AI in healthcare requires a multi-faceted approach that combines technical rigor with ethical oversight. By prioritizing accountability, transparency, safety, and fairness, healthcare organizations can harness AI’s transformative potential while safeguarding patient outcomes and trust. Collaboration among clinicians, developers, and policymakers will ensure AI continues to evolve as a force for good in healthcare.

References

  1. npj Digital Medicine – Analysis of transparency in AI/ML-enabled medical devices.
  2. Human-AI Interaction Review – Insights into user-centric design for safety-critical AI applications.
  3. Lancet Digital Health – Exploring outcome fairness and ethical principles in AI-driven healthcare.
  4. IRE Journals – Enhancing transparency in AI decision-making processes.
  5. Social Science & Medicine – Fostering accountability in healthcare AI.
  6. AI & Society – Frameworks for defining accountability in artificial intelligence.

Partner with BHM Healthcare Solutions

With over 20 years in the industry, BHM Healthcare Solutions is committed to providing quality consulting and review services that help streamline clinical, financial, and operational processes to improve care delivery and organizational performance.

Make the shift to a more effective utilization review process

Shutdowns Happen

2024-12-23T11:35:53-04:00By |Uncategorized|

The threat of government shutdown over financial disagreements is not new. Have we forgotten that the history of government shutdowns and the threat of defunding the government stretches back decades? Let’s take a look at the history of government shutdowns before we predict an outcome on this one.

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