Latest / Becker’s Healthcare Podcast / AI Governance, Prior Authorization and the Future of Healthcare with Dylan Reid

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AI Governance, Prior Authorization and the Future of Healthcare with Dylan Reid · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where they go to
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  - pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Scott Becker with the Becker's Healthcare
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  - Podcast.
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  - I am thrilled today to be joined by
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  - Dylan Reed. Dylan's a fascinating leader in health
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  - care, a terrific, terrific person. He's gonna start
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  - to say a little bit about what he's
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  - up to, what he's doing, a little bit
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  - about trends he's watching in health care, and
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  - a lot more. Dylan, can you take a
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  - second and introduce yourself?
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  - Yes.
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  - I'm Dylan Reed, the president of Dylan Reed
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  - Media LLC.
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  - I operate
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  - at the intersection where artificial intelligence
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  - meets health care reimbursement and prior authorization.
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  - Through my business, I help health systems, payers,
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  - AI product teams safely deploy
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  - AI tools
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  - and to make sure that those systems actually
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  - follow the rules and align perfectly with CMS,
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  - FDA, and federal regulatory expectations,
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  - specifically through fast paced governance, messaging sprints,
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  - and deeper,
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  - strategic deployment programs.
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  - And what's,
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  - you know, my whole approach to,
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  - business
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  - has been really shaped by a lot of
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  - unusual influences.
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  - One person in particular was former owner, Raiders
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  - owner, Al Davis, you know, really taught me
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  - to embrace being different and stay loyal to
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  - the people who commit.
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  - Another one that I have high,
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  - high respect for, never was a fan of
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  - the of the college football team, but Nick
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  - Saban
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  - really taught me that success always comes down
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  - to the fundamentals
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  - as well as the boring details.
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  - And, you know, kinda carrying
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  - that northern mannerism with southern hospitality
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  - really shows up in how I lead, which
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  - is direct and disciplined, but warm and consistent.
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  - And,
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  - you know, it's it's interesting because,
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  - you know, prior authorization, we have this tendency
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  - to think of it as just a clinical
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  - workflow,
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  - but it really determines whether a human being
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  - gets access to life altering care.
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  - You know, really helping teams understand what their
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  - AI is doing so that bad automated decisions
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  - don't end up hurting patients,
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  - clinicians, or payers.
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  - Thank you so much. And and and and
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  - and talk for a second about what trends
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  - are you watching in health care currently?
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  - Mhmm.
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  - Yes.... Focused on and what trends?
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  - Yes. So the first is the collision between,
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  - you know, AI cost reduction
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  - and, you know, actual workflow,
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  - reality, which, you know, I wanna start off
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  - by saying,
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  - you know, Becker's payers,
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  - that I read religiously, you know, really does
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  - a great job in, you know, you know,
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  - having those deeper conversations.
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  - You know, a lot of the health system
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  - leaders are rushing into AI
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  - thinking it automatically fixes system... Systemic overload,
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  - looking, you know, looking strictly at immediate labor
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  - savings.
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  - But cost
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  - cost reductions alone
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  - don't solve long term operation problems. You know,
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  - really looking,
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  - and tracking how forward thinking organizations
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  - are moving past buzzwords
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  - to explainable governed
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  - AI that accounts for downstream legal, clinical, and
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  - financial risks, you know,
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  - six to twelve months out.
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  - The second trend that I'm really watching is
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  - the growing clinical advocacy gap and the regulatory
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  - crackdown on black box algorithms. You know, for
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  - years, it's, you know, it's been payers and
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  - tech developers
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  - built automated health care workflows without sufficient input
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  - from the clinicians actually treating the patients.
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  - And the impacts of that have been, you
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  - know, major friction, and now regulators like CMS
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  - are stepping in with strict mandates around automated
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  - prior authorization and decision making transparency.
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  - You know, the trend moving forward
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  - is not
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  - more automation, but it's a mandatory demand for
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  - absolute truth, audibility, and clinical alignment in every
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  - algorithm that is deployed.
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  - Thank you. And as you look at
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  - younger leaders, emerging leaders, I love the Al
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  - Davis and analog. I love Nick Saban.
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  - My my personal
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  - dislike for a college football team really lies
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  - mostly with the University of Michigan.
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  - So after the
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  - Ohio State University
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  - wide receiver this week lambasted
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  - my University of Illinois,
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  - they're both moving up my charge of teams
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  - to share against Ohio State and Michigan, which
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  - is hard because they're big rivals themselves.
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  - But what advice do you give to emerging
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  - leaders, Dylan? What do you tell emerging leaders
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  - about building a successful career, about having an
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  - impact, about thriving and enjoying themselves?
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  - Definitely. So I would break my advice into
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  - three core principles.
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  - So the first is rewrite your definition of
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  - winning.
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  - You know, real leadership isn't about dramatic breakthroughs
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  - or fighting every battle. It really comes from
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  - speaking up for your team,
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  - showing up every single day by sticking to
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  - the fundamentals
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  - and doing the unglamorous
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  - work correctly.
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  - The second is treat culture as daily behavior
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  - and not corporate slogans. You know, organizational
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  - chaos
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  - you know, happens when leaders really fail to
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  - communicate clear expectations
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  - and align roles properly,
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  - which then forces employees
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  - to be like, you know, what am I
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  - supposed to do? And then that's how survival
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  - mode happens, you know, which then drives turnover
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  - and then massive inefficiencies
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  - across organizational workflows. And, you know, strong culture
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  - is simply
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  - disciplined role alignment and consistent communication.
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  - The third thing is about be ruthless about
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  - people selection.
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  - And what I mean by that is focus
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  - entirely on finding people who understand where you're
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  - going, not just people who remember where you
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  - have been.
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  - Stop spending energy on people who project their
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  - limb... Own limitations onto your vision. You know,
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  - I really challenge every leader listening
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  - to take one intentional
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  - action in the next twenty four hours. You
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  - know, for example, change the way you ask
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  - questions when noise enters your office. You know,
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  - when someone asks... Comes to you with a
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  - vague narrative,
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  - you know, everyone is upset about this new
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  - AI system, for example.
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  - I would say reject the vagueness,
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  - ask immediately
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  - who
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  - specifically, and what are the next steps needed,
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  - and why did that workflow fail in the
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  - first place. And so when you eliminate vague
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  - narratives,
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  - your organization
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  - instantly becomes clearer,
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  - more accountable
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  - as... You know? And I think it's important
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  - to say this far less political.
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  - I I love that concept of...
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  - Right. You hear so often people say, everybody
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  - hates the HR. And, of course, far more
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  - important is, well, what specifically... Because we can't
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  - get rid of the HR in 2026.
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  - It's not going away. So so what exactly
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  - can we do where can we help stuff
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  - like that? And then actually being responsive and
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  - truly helping is the flip side of that.
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  - But, yes, the general negativity
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  - is not really helpful.
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  - Some specificity, and it's, of course, frustrating for
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  - providers and clinicians if everything seems so difficult
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  - to you. So I think there is some
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  - of that. But Mhmm. But but, no, I
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  - I I I love that. Any other trends
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  - that you're watching currently or things that you're
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  - particularly focused on that you wanna share with
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  - the audience today?
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  - Definitely.
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  - So one question
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  - that has really,
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  - you know, been at the back of my
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  - mind because
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  - not only am I, you know, in the
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  - strategic comm side,
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  - the political regulatory side of AI health care,
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  - but I also,
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  - am in the process of expanding
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  - my, technical capabilities.
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  - So I am not a developer or
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  - an engineer by training.
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  - But I think
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  - part of,
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  - I think, the miscommunication
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  - in AI, you know, in health care in
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  - particular,
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  - is you have great public policy people
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  - who write a white paper and, you know,
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  - the Scott... Like, an executive is not gonna
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  - take the time to read a 20 page
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  - white paper, you know, and it's all buzzwords,
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  - and it really doesn't,
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  - you know, say anything.
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  - And then you ask them about the technology
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  - and then the techno... And, you know, they're...
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  - You know, it goes, you know, right over
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  - the person's head. On the, you know, on
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  - the tech side,
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  - you know, you have great people building the
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  - products,
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  - but then, you know, the issue is is,
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  - like, okay. Like, how do you navigate the
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  - political waters? Like, who's the decision maker? Like,
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  - you can't expect...
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  - You know you know, how I like to
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  - think about it is you can't drop a
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  - plate in front of someone and just expect
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  - them to be like, oh, you know, this
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  - is good. Trust me on this. You know?
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  - So it's kind of... You know, how do
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  - you eliminate those miscommunications?
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  - And so
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  - I really took it upon myself to learn
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  - just how to code and, you know, how
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  - to build things because I think you need
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  - to have an understanding of how the tech
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  - works
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  - if you're gonna be, you know, in the
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  - AI health care industry, whether that's, you know,
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  - in prior auth, whether that's in reimbursement, whether
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  - that's in patient
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  - advocacy. You know, it's... Having a solid understanding
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  - of that tech is gonna be...
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  - I I would say it's a nonnegotiable
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  - at this point. You know? So the question
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  - that I've been really interested in is, how
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  - can we successfully integrate,
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  - you know, AI agents with the core of
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  - health care insurance?
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  - You know, like, prime example is... You know,
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  - and I know it's... You know, I'm gonna
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  - show, you know, my my nerdiness on, you
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  - know, on your podcast, but,
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  - you know, COBOL, for example,
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  - you know, like, how that's been, you know,
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  - a big language in, you know, government inter...
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  - Infrastructure,
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  - because you need to have an understanding of
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  - why that code was built... Was coded the
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  - way it was and how do you successfully
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  - integrate that into modern interfaces. So I just
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  - think, you know, just taking some time to
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  - learn the technology. Now I'm not saying everyone
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  - needs to be an engineer developer tomorrow because
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  - that's not realistic.
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  - But just spending time in
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  - in the code and the technology,
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  - because for me, it's really helped me understand
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  - when, specifically, when it comes to prior authorization
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  - reimbursement, how to think differently by asking better
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  - questions.
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  - No. I... And I and I love that.
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  - And and I think your concept of somebody
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  - really needs to know what's behind, what's going
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  - on, what the tech is, what's happening It
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  - is so right on.
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  - Dylan, I wanna thank you so much for
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  - joining us today on the Becker's Healthcare podcast.
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  - I always love getting a chance to visit
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  - with you. Thank you so much for joining
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  - us. Thank you for having me, Scott.