Some major local players see potential for AI to help with healthcare costs, but with rules in place

Like a rain cloud that follows around an unlucky cartoon character, the cost of healthcare perpetually hangs over Beacon Hill. It’s expensive, it keeps growing and the sometimes conflicting interests of hospitals, their employees, drugmakers, patients and insurers mean there’s no easy fix. 

Take that evergreen conundrum, mix it with one of the biggest regulatory questions du jour — what should be the rules of the road around AI — and a major challenge for policymakers could be looming ahead. 

Healthcare industry and government leaders will convene in downtown Boston today for the Health Policy Commission's annual cost trends hearing, trying to unpack another year of increased spending and considering ways to bend the curve. 

Ahead of the event, insurers, providers and pharmaceutical companies all flagged their priority areas for affordability action, with many focusing on bolstering primary care, improving transitions from hospitals to other settings, lowering drug costs and supporting innovative ways to deliver care. But a handful also zeroed in on artificial intelligence as one strategy for savings. 

Testimony from UMass Memorial Health describes responsible AI deployment as an efficiency upgrade that can help with a "structural supply-and-demand problem" within healthcare, as fewer clinicians enter the field while an aging population needs more care. 

The health system says using AI-enabled tools to capture insurance information cut down on eligibility denials, while another tool helps flag time-sensitive patient messages to providers.   

The UMass Memorial comments identify challenges, too, including investment costs, technology that's advancing faster than federal and state regulations, and the need to ensure that clinicians’ judgment stays supreme. They warn of a potential "administrative arms race" if insurers "use automation to increase denials or documentation demands," saying the state should hold payers to the same standards as providers when it comes to transparency and human oversight. 

Drug company AbbVie, which employs more than 2,000 people in Massachusetts, also drew attention to potential AI use by insurers — particularly to accelerate processes that can delay treatment, like step therapy or prior authorization. A system can become more efficient administratively but deliver a worse outcome for the patient, AbbVie's testimony said. 

For its part, insurer Cigna Healthcare said the AI tools and other technologies it uses "simplify healthcare, improve clinical decision-making and reduce administrative burden," but don't replace professional human judgment. 

Cigna said it sees a need for collaboration across the health care realm on responsible AI adoption, with monitoring to ensure fairness and accuracy and no conflicting requirements that drive up costs. 

If the Legislature does decide at some point to write up specific rules over AI in healthcare, balancing all the players' interests will be a tall task. Especially for a body that hasn't yet reached deals on a primary care overhaul and guardrails for large AI developers, with less than two months of a two-year term remaining. 

Thanks to everyone who took a shot at last week’s trivia question — and to the dedicated Margaret Heckler fans in particular — asking who was Massachusetts' first congresswoman. Edith Nourse Rogers won a 1925 special election to succeed her late husband John Rogers, and was reelected 17 times after that. Got a favorite historical tidbit that would make a good trivia question? Pass it along at [email protected].

8:30 | Health Policy Commission holds its annual cost trends hearing, bringing together representatives from state government, hospitals, insurers and trade groups to focus on the underlying drivers of escalating health spending and potential cost-cutting solutions. Attorney General Andrea Campbell gives opening remarks and HPC Executive Director David Seltz presents data on recent cost trends | Suffolk University Law School, 120 Tremont St., Boston

8:30 | EdVestors awards a $100,000 prize to a Boston public school, announced as a surprise during the ceremony, that has demonstrated improvement in student outcomes. Mayor Wu, BPS Superintendent Skipper and EdVestors President a& CEO Marinell Rousmaniere participate. | The 521 Overlook, Fenway Park, Boston

9:00 | Public Health Council meets | Agenda and Access

9:00 | Board of Higher Education Commissioner Search Advisory Council meets | Agenda and Zoom

9:00 | Boston Foundation plans to release the Annual Greater Boston Housing Report Card that explores regional and municipal housing trends, as well as the impact of current events and public policies | Edgerly Center for Civic Leader, 75 Arlington St., Boston | Livestream

9:30 | Massachusetts Adoption Resource Exchange hosts a National Adoption Month reception featuring a youth speaker and artwork created by young people who have been in foster care. The artwork is on display on the State House's fourth floor through Friday | Room 437

9:30 | Senate Committee on Juvenile and Emerging Adult Justice holds an informational hearing on the implementation of Vermont's Raise the Age Law and its impact on recidivism rates | Room 222 | More Info and Livestream

10:00 | Energy Efficiency Advisory Council holds a virtual public listening session about the next Three-Year Plan for Mass Save, which would cover 2028 through 2030 | More Info and Access

10:00 | Secretary of Veterans Services Eric Goralnick and Christine Baldini, superintendent of the Veterans Home at Chelsea plan to be among the attendees at the Chelsea home's annual Veterans Day ceremony | Massachusetts Veterans Home at Chelsea, Great Hall, 100 Summit Ave, Chelsea

1:00 | Local Government Advisory Commission meets. Administration and Finance Secretary Matt Gorzkowicz gives an update on state revenue collections and a budget outlook for the year ahead | Room 157 | Zoom

2:00 | Rural Policy Advisory Commission meets | Agenda and Zoom

3:30 | Members of 32BJ SEIU who work as unarmed security officers at public and private sites across greater Boston, including Cambridge biotech companies, Boston office buildings, and higher education sites, rally to demand security contractors agree to a union contract with better health benefits | Outside Kendall Square/MIT Red Line MBTA Station

6:00 | MassDOT holds a design public hearing to present the design for a proposed project that would modernize the Main Street (Route 32) corridor in Monson, including updated sidewalks and curb ramps and new crosswalks | Granite Valley Middle School, 21 Thompson Street, Monsoon | More Info

6:00 | MassDOT holds a public informational meeting to discuss the proposed Armory Street Bridge Replacements project in Springfield. The project would consist of demolition and reconstruction of two bridges that carry Armory Street over active and abandoned CSX railroad tracks | Naismith Basketball Hall of Fame, 1000 Hall of Fame Avenue, Springfield | More Info

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A GREEN GOODBYE: Climate chief Melissa Hoffer, on her final day in the Healey administration before leaving to lead Vermont Law and Graduate School, told advocates that affordability and the transition to clean energy cannot be treated as competing interests. The future of the role she left behind is unclear: Gov. Healey created Hoffer's first-in-the-nation Cabinet-level post on her first day as governor and has not publicly announced a successor. | State House News Service (gift link)

VIEW FROM SUBURBIA: Some towns that balked at the MBTA Communities Act narrowly voted in favor of the failed ballot question to allow single-family homes on smaller-sized lots, while Question 7 failed in other suburbs where residents want local planners to have the say over the character of their neighborhoods. It's the latest chapter in a housing rules tug-of-war between towns and the state. | Boston Globe

HOUSING CRUNCH BY THE NUMBERS: A new report card from the Boston Foundation paints a picture of an uncertain housing market where prices have moderated but still push homeownership out of reach for many, with the median single-family home price over $1 million in 32 Greater Boston communities while average rent tops $3,000. | MassLive

STRIKE WATCH: Brigham and Women's nurses are gearing up to strike Thursday. Gov. Healey and Mayor Wu attended the start of Monday's negotiations between the union and Mass General Brigham to urge the two sides to keep talking. | WCVB

SUTTON INFLUX: The Kraft Group is proposing a 10-building data center campus in the central Mass. town of Sutton, representing an investment of more than $16 billion — more than five times the assessed value of all the town's property today. | Telegram & Gazette

CRYPTO NO-GO: Springfield could be the next to join more than two dozen Massachusetts communities to locally ban cryptocurrency kiosks, with a December city council vote planned. The city is home to about three dozen crypto ATMs, and Mayor Domenic Sarno says fraudsters and scammers have used the machines to steal more than $1 million. | WWLP

MUSICAL CHAIRS: Amy Carnevale says she won’t run for a third term leading the Mass. GOP, in the wake of what she called "a particularly demanding election cycle." So far, at least two candidates are in the mix to succeed her — Elizabeth Dionne, this year's Republican nominee for treasurer, and Sandwich Republican Town Committee Chair Gene Parini. | NBC10 Boston

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