AI in Healthcare: Why Governance Must Catch Up with Innovation

Artificial intelligence is transforming healthcare. From personalized treatment recommendations to predictive modeling of disease patterns and automated clinical workflows, AI promises to make care more efficient, proactive and patient-centered. But as health systems implement these technologies, an important question looms: who’s making sure AI is safe, ethical and equitable?

At Solera, we believe AI governance must develop alongside the technology itself. As curators of a broad network of digital health solutions serving millions of lives, we don’t just embrace AI – we evaluate, monitor and guide its responsible use across our ecosystem.

The Importance of Effective Governance

In many industries, “move fast and break things” became the approach of innovation. But in healthcare, what breaks can negatively impact human lives, patient trust and health equity. AI systems without proper governance frameworks can lead to:

• Algorithmic bias that can reinforce existing health disparities

• Privacy vulnerabilities that potentially expose sensitive health information

• Over-reliance on automation that reduces human judgment in care decisions

• Regulatory non-compliance as AI laws develop across jurisdictions

These are real concerns. Studies have documented AI systems delivering different recommendations based on race, gender or socioeconomic factors. In healthcare, where the stakes are significant and trust is essential, governance must be a priority from the start.  

Our Risk-Based Approach to AI Governance

Solera’s role in connecting health plans, providers and digital health companies gives us insight into the challenges of AI oversight. Our network includes various condition-specific programs – from diabetes and obesity to mental health and musculoskeletal care – with partners increasingly using AI.

We’ve developed a risk-based framework for evaluating and monitoring the use of AI across our network:

• Tiered oversight: We apply appropriate controls based on risk level, with enhanced requirements for applications involved in diagnosis or treatment planning

• Transparency requirements: Digital health partners must disclose when AI is being used and provide explanations of how decisions are made

• Systematic evaluation: We require regular assessment with performance metrics to identify potential disparities

• Human-centered design: All AI systems must maintain appropriate human oversight, with healthcare professionals retaining responsibility for clinical decisions

• Ongoing monitoring: We implement processes to detect performance changes, potential biases, and security concerns before they impact patients

• Incident reporting: We maintain protocols for notification and remediation of AI-related issues

Building a Culture of Responsible AI

Effective governance isn't just about policies – it involves people. We're fostering a culture where AI ethics is a shared responsibility. This includes:

• Educating stakeholders about AI capabilities and limitations

• Facilitating discussion about potential risks and mitigations

• Recognizing Partners who demonstrate strong AI governance

• Regularly updating our standards as technology and best practices evolve

Contributing to Industry Standards at HealthSEC

HealthSEC is bringing together the industry’s leaders in privacy, security and innovation. We view this as an opportunity to discuss how AI can improve healthcare while maintaining necessary trust.

We’ll be sharing our governance framework and engaging in conversation about how payers, providers, and digital health companies can establish appropriate standards for AI governance. The sustainable path forward requires balancing innovation with accountability.

At Solera, we’re committed to helping our clients and partners navigate both the benefits and challenges of AI in healthcare. We invite others across the industry to join us in building a governance-first foundation for the future of digital health — where innovation and responsibility advance together.

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