Insurance payment for artificial intelligence technology: Methods used by a stroke artificial intelligence system and strategies to qualify for the new technology add-on payment

Abstract

The first ever insurance reimbursement for an artificial intelligence (AI) system, which expedites triage of acute stroke, occurred in 2020 when the Centers for Medicare and Medicaid Services (CMS) granted approval for a New Technology Add-on Payment (NTAP). Key aspects of the AI system that led to its approval by the CMS included its unique mechanism of action, use of robotic process automation, and clear linkage of the system’s output to clinical outcomes. The specific strategies employed encompass a first-case scenario of proving reimbursable value for improved stroke outcomes using AI. Given the rapid change in utilization of AI technology in stroke care, we describe the economic drivers of stroke AI systems in healthcare, focusing on concepts of reimbursement for value added by AI to the stroke care system. This report reviews (1) the successful approach used by the first NTAP-approved AI system, (2) economic variables in insurance reimbursement for AI, and (3) resultant strategies that may be utilized to facilitate qualification for NTAP reimbursement, which may be adopted by other AI systems used in stroke care.

Fortaleciendo el sistema de reembolso GRD en Chile

“…Responder rápidamente a la innovación y facilitar su reembolso en esquemas ordenados de ajuste por tecnología, ha sido la consigna del programa de pago adicional por tecnología del Medicare en Estados Unidos, atendiendo a la premisa que los costos del sistema GRD reflejan la estructura de costos con una ventana temporal o retraso de dos años y su utilización no refleja, en lo inmediato, los reembolsos necesarios para tecnología reciente (Manz et al, 2020). De esta forma, tanto el Medicare como el Medicaid incluso se han abierto a emplear estos instrumentos de corto plazo para financiar inteligencia artificial en infarto cerebrovascular (Hassan, 2021;Murray et al, 2022).…”