[WHITE PAPER] BEYOND LEGACY CARE MODELS: SAFE MEDICAL AI FOR PAYERSDOWNLOAD nOW

The responsible use of AI in healthcare

Health Plans

The responsible use of AI in healthcare

Table of Contents

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      The modern front door to healthcare is just one click away

      KEY TAKEAWAY

      AI streamlines healthcare access, accelerates treatment planning, and lowers operating costs for many stakeholders across the healthcare ecosystem, including payers and health systems. In fact, in a recent survey of U.S. health systems, 100% of respondents said they already use AI for a variety of tasks, including managing medical documentation. 

      While AI is an effective tool with numerous medical applications, it must be used responsibly to ensure positive patient outcomes.

      AI applications in clinical operations

      Counsel’s responsible approach to AI starts from the bottom up. Counsel AI is built and trained solely on verifiable, trustworthy sources, including peer-reviewed medical guidelines. The result is an intelligent, purpose-built medical AI platform focused on quality of care, accuracy, and regulatory compliance. 

      To implement effective AI safety guardrails, solutions like Counsel leverage agentic frameworks combined with physician oversight.

      To securely answer a range of patient health queries, Counsel triages care by leveraging agents such as:

      • A history-taking agent that collects relevant information and responds to the patient with initial advice or recommends chatting with an in-house physician.
      • A context-retrieval agent that reviews a patient’s relevant medical history, lab results, prior conversations, medications, and more.
      • An emergency detection agent that uses this information to determine whether a patient should go to the emergency room.
      • A doctor escalation agent that determines if a patient should seek in-person care or chat with a provider.

      The contextualization from the context-retrieval agent mirrors the way medical professionals approach diagnoses, yielding more informed and actionable insights for both physicians and patients. Specifically, these insights help formulate an effective care plan that aligns with the patient's overall health and needs.

      Automatic, detailed insights likewise optimize clinical workflows for physicians. This information is surfaced to providers through Counsel’s Clinician Cockpit, a proprietary EHR. While Counsel handles the majority of patient concerns without escalation, when doctor-led care is needed, the Clinician Cockpit displays a summarized, accurate snapshot of a patient’s medical history, expediting decision-making and care. These insights and tools further improve the patient experience by enhancing diagnostic precision.

      The deployment of solutions like Counsel enable continuous, scalable primary care, reducing the burden on busy emergency rooms or urgent care centers, and maintaining regulatory compliance within a shifting AI landscape.

      Governance and compliance frameworks for AI

      Counsel’s multi-agentic framework enhances platform security, especially for enterprise organizations. By leveraging different AI agents, Counsel more closely and accurately adheres to patient care guidelines. Several independent safeguard agents run in every member interaction, ensuring every exchange meets clinical, legal, and enterprise-level standards for safety and compliance. 

      In addition to AI guardrails, Counsel maintains strict adherence to:

      • The Health Insurance Portability and Accountability Act (HIPAA): HIPAA is perhaps the most prominent and far-reaching regulatory framework in the healthcare industry. It’s designed to safeguard Protected Health Information, a major concern for AI platforms, as fault for data breaches and leaks falls on healthcare organizations. Counsel maintains HIPAA compliance to shield users against persecution, fines, and reputational damage.
      • System and Organization Controls (SOC 2): SOC 2, a product of the American Institute of Certified Public Accountants, outlines organizational standards for data integrity, confidentiality, and reliability. It outlines effective security protocols, allowing users to feel secure when outsourcing operations and providing sensitive information to third parties. Counsel maintains SOC 2 compliance by upholding strict security practices across the platform.

      Counsel also employs clinician supervision on every patient interaction to ensure reliable security. Healthcare organizations are required to uphold a minimum standard for care quality. While Counsel AI can assess patients and respond to their inputs, it can’t resolve every medical query a user may have.  This is why physician oversight maintains both patient safety and legal defensibility. In uncertain situations, the platform defers to a real doctor for further assessment and analysis. This prevents misdiagnoses and upholds the quality of care, enabling organizations to responsibly utilize medical AI without concern for regulatory non-compliance. 

      Benefits of using responsible medical AI to drive your innovation strategy forward

      Healthcare organizations worldwide are reaping the benefits of responsible AI integration. Two-thirds of physicians already use AI for tasks like:

      • Medical documentation
      • Creating discharge instructions and care plans
      • Translation
      • Medical research summaries
      • Assistive diagnostics 
      • Chart summary generation
      • Patient communication
      • Treatment recommendations

      By automating part or all of these tasks, healthcare organizations can improve network efficiency, save on operational costs, and free up more time to commit to patient care.  In fact, by handling initial patient assessments, Counsel has helped healthcare organizations:

      • Improve resolution rates without escalation: Counsel resolves 96% of patient issues without escalation or claim submission. Fewer claims and clinical consultations mean lower operational costs for payers. In addition, in-network doctors don’t spend as much time with less complex issues, allowing them to focus on treating complex conditions.
      • Replace nurse lines and other telehealth services: Modern AI’s capabilities rival the care patients receive from nurse lines. Over three-quarters of callers only need a review or verbal advice when they phone in, which advanced AI platforms can now replicate. With AI adoption rapidly rising, the cost savings, versatility, and immediacy of automated systems pose a serious challenge to the continued use of nurse lines and similar telehealth services.
      • Reduce unnecessary Emergency Room (ER) visits: Intelligent, capable medical AI leads to more accurate diagnoses and care plans, boosting patients’ peace of mind and trust in medicine. When patients trust their platform, diagnoses, and treatment, they’re less likely to rush to the ER and more likely to follow their care plans. Patients’ satisfaction and trust in Counsel reduces ER visits by 24% versus regular, consumer-facing AI tools.
      • Enhance member experiences: 64% of patients wish healthcare providers took more time to understand them. 66% feel they're more rushed than in the past, and only 10% of patients give their healthcare experiences an A grade. Doctors often do not have the time to fully address a patient’s concerns, but medical AI isn’t bound by human limitations. 

      The upsides of responsible AI use in healthcare are clear: Lower costs, higher resolution rates, enhanced patient satisfaction, and more. So, how can you implement AI at scale to realize these benefits in your organization? 

      Implementing responsible AI at scale

      Responsible medical AI usage is critical for health plans. Counsel’s platform has been designed to deliver:

      • Audit-ready documentation: Counsel’s traceable chain of evidence includes actions, inputs, and reasonings from each patient interaction. This digital paper trail maintains defensibility in case of legal allegations or external audits.
      • Tight security practices: End-to-end encryption scrambles data sent between your member population and platform. Even if malicious actors are able to intercept it, they won’t be able to make sense of it without the proper key. Other security measures, like secure messaging, ensure patient data remains within privileged parties.
      • Physician oversight: With clinical supervision available for every interaction, patients can rest assured that the diagnoses and care plans they receive are based on accurate, trustworthy medical advice.
      • Continuous monitoring: Counsel routinely incorporates feedback from in-house physicians and partners to further align the platform with medical best practices. Similarly, Counsel keeps an eye on advancements in AI security and hacking techniques to ensure the latest, most robust protocols are in place.  

      These safeguards enable healthcare organizations to safely scale access and meet the needs of diverse patient populations.

      Leverage AI responsibly and with confidence

      With Medical AI from solutions like Counsel, organizations can expand access to care cost-effectively.

      The added benefit from partnering with Counsel as a payer is the ability to deploy its platform via an embedded, white-labeled option. Counsel fits into any portal or member applications, enabling brand continuity while extending clinical workflows and platform capabilities to any organization.

      Partner with Counsel to bring safe, AI-powered comprehensive care to your plan members.

      The modern front door to healthcare is just one click away

      Sources
      Counsel Health Editorial Team
      Counsel Health Editorial Team

      The Counsel Health editorial team is a multidisciplinary group of writers and editors dedicated to delivering clinically grounded, evidence-based health information. Their work is informed by real-world care delivery and guided by physician expertise, ensuring content is accurate, accessible, and trustworthy. By translating complex medical topics into clear, practical guidance, the team helps readers understand their health, explore care options, and make informed decisions in a rapidly evolving healthcare landscape.

      Counsel Health Editorial Team
      Dr. Cían Hughes
      Chief Scientific Officer

      Dr. Cían Hughes is a physician-scientist with over a decade of experience in health AI research. He began his career as an academic surgeon and, in 2015, joined Google DeepMind as its first Clinical Research Scientist, helping to found the DeepMind Health team. Prior to DeepMind, he was an NIHR Academic Clinical Fellow in Otolaryngology at University College London, working across the UCL Ear Institute and the Farr Institute while maintaining clinical practice.

      Our content is created for informational purposes and should not replace professional medical care. For personalized guidance, talk to a licensed physician. Learn more about our editorial standards and review process.

      [WHITE PAPER] BEYOND LEGACY CARE MODELS: SAFE MEDICAL AI FOR PAYERSDOWNLOAD nOW