AI Bias in Healthcare for Health Plan CEOs to Avoid Lawsuits & Increase Revenue with January Montaño

AI Bias in Healthcare for Health Plan CEOs to Avoid Lawsuits & Increase Revenue with January Montaño

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by guest January Montaño, MPS [https://www.linkedin.com/in/januarymontano/], CEO and Founder at January's Advisory Group [https://www.linkedin.com/company/januarysadvisorygroup/], to explore one of healthcare’s most urgent questions: Can AI improve outcomes without deepening inequities? The conversation dives into AI governance, vendor accountability, algorithmic bias, and the widening gap between healthcare organizations with robust AI infrastructure and those struggling to keep up. January shares why governance not technology alone will determine whether AI becomes a force for health equity or reinforces existing disparities. January’s Advisory Group, a Denver-based AI governance consultancy specializing in equitable, auditable, and revenue-generating AI systems. With nearly three decades of experience in healthcare policy, Medicaid, public health, and healthcare operations, January has advised health plans, hospitals, and government agencies on healthcare transformation, algorithmic accountability, and health equity. January has testified before the Colorado General Assembly on AI bias and serves as a leading voice on responsible AI adoption in healthcare. Expect to Learn: - Why AI governance is becoming a healthcare necessity, not a compliance exercise - Who is legally accountable when AI-driven healthcare decisions go wrong - How algorithmic bias can impact access to care, housing, and employment - Why rural hospitals face a growing AI divide - How health equity can drive financial performance and better outcomes - The role of social determinants of health in AI-powered healthcare - What healthcare leaders should do before deploying AI systems TIMESTAMPS: 00:00 – Teaser 01:26 – Why Healthcare AI Needs More Than Efficiency 00:59 – Setting the Stage: Healthcare’s AI Inflection Point 02:15 – January Montaño’s Journey Into AI Equity 05:22 – Who Is Accountable When AI Makes the Wrong Decision? 06:16 – Why Health Plans Carry the Legal Risk 09:24 – Defining Real AI Governance in Healthcare 10:41 – Building Governance Beyond Policies and Paperwork 13:03 – The Reality of AI Adoption Across Health Systems 16:30 – The Growing Digital Divide Between Large and Rural Providers 18:46 – AI, Social Determinants of Health, and Equity 19:43 – How Biased AI Restricts Access to Care and Services 22:06 – Examples of Responsible AI in Healthcare 23:22 – Introducing the ROI Equity Framework 24:31 – Why Equity Should Be Treated as Revenue 26:02 – Turning Equity Gaps Into Business Opportunities 27:09 – The Mount Sinai Food Insecurity Case Study 29:07 – Early Intervention and Better Patient Outcomes 30:50 – Connecting Food Security to Lower Healthcare Costs 33:08 – Stable Patients Create Sustainable Health Systems 35:04 – Rethinking Incentives in Healthcare Financing 37:20 – Long-Term Investment vs Short-Term Healthcare Economics 49:39 – A Practical Six-Month AI Roadmap for Health Plans 50:22 – The First 90 Days of Building AI Governance 51:11 – Auditing Existing AI Systems and Vendors 57:24 – Reporting AI Risk and Performance to the Board 58:47 – Creating a Defensible and Compliant AI Strategy 59:07 – Why Actuaries Must Move Beyond Accuracy 01:00:13 – Auditing Models for Fairness and Bias 01:02:42 – Closing Remarks Follow Guest January Montaño, MPS: LinkedIn: https://www.linkedin.com/in/januarymontano/ [https://www.linkedin.com/in/januarymontano/] Instagram: https://www.instagram.com/january.montano/ [https://www.instagram.com/january.montano/] Company LinkedIn: https://www.linkedin.com/company/januarysadvisorygroup/ [https://www.linkedin.com/company/januarysadvisorygroup/] Company Website: https://www.januarysadvisorygroupllc.org/ [https://www.januarysadvisorygroupllc.org/] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]

AI in Healthcare Is Quietly Denying Care and Making Biased Decisions with January Montaño

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by guest January Montaño, MPS [https://www.linkedin.com/in/januarymontano/], CEO and Founder at January's Advisory Group [https://www.linkedin.com/company/januarysadvisorygroup/], to unpack the foundations of artificial intelligence in healthcare. From understanding the difference between automation and AI to exploring algorithmic bias, liability, governance, fraud detection, and patient impact, this conversation examines both the promise and the risks of AI adoption across health plans, providers, and healthcare operations. January explains why equity auditing is becoming a critical component of AI governance and what healthcare leaders must do before deploying AI at scale. January’s Advisory Group, a Denver-based AI governance consultancy specializing in equitable, auditable, and revenue-generating AI systems. With nearly three decades of experience in healthcare policy, Medicaid, public health, and healthcare operations, January has advised health plans, hospitals, and government agencies on healthcare transformation, algorithmic accountability, and health equity. January has testified before the Colorado General Assembly on AI bias and serves as a leading voice on responsible AI adoption in healthcare. Expect to Learn: - The difference between automation, machine learning, generative AI, and agentic AI - How AI is currently being used by health plans and healthcare providers - Why algorithmic bias occurs and how it impacts patient care - The role of AI in prior authorization, claims adjudication, and risk adjustment - How AI is helping detect fraud, waste, and abuse in healthcare - The growing legal and regulatory risks surrounding AI-driven healthcare decisions - What CEOs, CIOs, compliance teams, and actuaries should evaluate before implementing AI solutions Timestamps: 00:00 – Teaser 01:05 – Introducing January Montaño, MPS and the AI Equity Challenge 04:42 – Why Healthcare Needs a Strong Foundation for AI Governance 07:37 – Understanding Automation vs. Artificial Intelligence 10:12 – The Rise of Agentic AI and Multi-Agent Healthcare Systems 15:23 – Will AI Replace Jobs or Reduce Workforce Burnout? 19:59 – Where AI Is Already Operating Inside Health Plans and Hospitals 23:07 – How Algorithmic Bias Impacts Minority and Underserved Populations 31:23 – Is Managed Care Actually Managing Care in the AI Era? 33:06 – Understanding the Root Causes of AI Bias 35:07 – What AI Is Already Doing to Patients Behind the Scenes 41:38 – Can AI Improve Outcomes While Advancing Health Equity? 50:03 – AI’s Role in Fighting Fraud, Waste, and Abuse 55:10 – Who Is Liable When AI Makes the Wrong Decision? 57:08 – Questions Every CIO Should Ask Before Buying AI 58:09 – Governance Structures Every CEO Must Have in Place 01:06:58 – Why Actuaries Are the Last Line of Defense 01:13:45 – Measuring Differential Error Rates and Equity Risk 01:14:22 – Final Thoughts Follow Guest January Montaño, MPS: LinkedIn: https://www.linkedin.com/in/januarymontano/ [https://www.linkedin.com/in/januarymontano/] Instagram: https://www.instagram.com/january.montano/ [https://www.instagram.com/january.montano/] Company LinkedIn: https://www.linkedin.com/company/januarysadvisorygroup/ [https://www.linkedin.com/company/januarysadvisorygroup/] Company Website: https://www.januarysadvisorygroupllc.org/ [https://www.januarysadvisorygroupllc.org/] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]

AI could transform the healthcare system by predicting risk and fixing inefficiencies - Parul Mistry

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by guest Parul Mistry, MD, MA [https://www.linkedin.com/in/parulmistrymd/], a physician executive with more than 20 years of leadership experience. The conversation explores the evolution of medical management in health plans, the limitations of traditional disease management, and the growing importance of whole-person care, social determinants of health (SDOH), interoperability, and AI-driven population health strategies. Parul Mistry provides an insider’s perspective on how health plans, providers, actuaries, and medical management teams can better collaborate to improve healthcare outcomes while addressing rising healthcare costs and administrative complexity. Parul Mistry has more than 20 years of leadership experience across various aspects of healthcare including Medicaid managed care, provider systems, payment integrity, and digital health. She has led enterprise efforts in population health, utilization management transformation, quality improvement, clinical operations, with a strong focus on improving outcomes for vulnerable populations. Expect to Learn: - What a Chief Medical Officer (CMO) actually does inside a health plan - The difference between traditional care and population health - Why disease management programmes are fading out - How complex case management evolved from disease management - The future role of health plans in 2026 and beyond - How AI and predictive analytics can improve population health - The pros and cons of point solution vendors - Why primary care and SDOH remain underfunded - How actuaries and medical management teams can collaborate more effectively Timestamps: [00:00:00] - Teaser [00:01:07] - Introduction of Parul Mistry [00:04:31] - What does a Chief Medical Officer actually do? [00:06:38] - Population health vs traditional reactive healthcare [00:11:48] - The evolution and decline of disease management programmes [00:15:21] - Why healthcare is shifting toward complex case management [00:26:19] - What utilisation management was originally designed to do [00:28:48] - Improving payer-provider relationships and reducing friction [00:32:12] - Why population health struggles to bend the healthcare cost curve [00:40:59] - The massive impact of social determinants of health (SDOH) [00:44:06] - Why healthcare ROI cannot be measured in one-year cycles [00:46:05] - What role health plans should play in modern healthcare [00:52:28] - AI, predictive analytics, and the future of population health [00:57:16] - How technology can personalize member engagement [01:06:09] - Why social determinants of health remain chronically underfunded [01:08:06] - The need for stronger investment in primary care [01:09:16] - Collaboration between actuaries and medical management teams [01:12:01] - Closing thoughts and final takeaways Follow Guest Parul Mistry: LinkedIn: https://www.linkedin.com/in/parulmistrymd/ [https://www.linkedin.com/in/parulmistrymd/] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]

How Medicaid Is Losing Billions of Dollars Due to Mispricing and Lobbying Power with Christopher Drumm

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by Guest Christopher Drumm [https://www.linkedin.com/in/christopher-drumm-17697110/], Founder of Drumm and Daughters LLC [https://www.drummanddaughters.com/] to unpack decades of experience at the intersection of healthcare, politics, and public service. From grassroots ward politics in Philadelphia to shaping Medicaid policy across multiple states, Christopher shares an insider’s view of how managed care evolved, and where it’s headed. They talk about the realities behind lobbying, the challenges facing Medicaid today, the financial pressures on health plans, and the growing crisis of rural hospitals. Along the way, Christopher offers candid stories, practical insights, and a deeply personal perspective on prevention and public health. Christopher Drumm is a Philadelphia native and seasoned healthcare lobbyist with a career spanning local, state, and federal government. He began in grassroots politics in the 1980s, becoming the youngest leader of Philadelphia’s 63rd Ward. Christopher later spent over a decade at Saint Joseph’s University securing major public funding initiatives before leading government affairs at AmeriHealth Caritas for 20 years. There, he played a key role in expanding Medicaid managed care programs across multiple states. Today, Christopher runs his own consulting practice, focusing on healthcare policy, distressed hospital turnaround efforts, and strategic advocacy. Expect to Learn: - How lobbying actually works behind the scenes in healthcare - Why managed Medicaid exists and how its role has evolved - The real reasons health plans are struggling financially today - Key tensions between states and insurers - Lessons from major Medicaid rollouts - Why rural hospitals are collapsing and what it takes to save them - The importance of prevention and social determinants of health - How politics, personalities, and trust shape healthcare policy decisions Timestamps: [00:00] – Teaser [01:43] – Introduction of Christoper Drumm [03:06] – Growing Up in Mayfair & Early Influences [04:34] – Entry into Politics & First Campaign Experience [06:01] – Transition into Lobbying [08:32] – Work at Saint Joseph’s University [11:16] – Joining AmeriHealth Caritas [13:39] – What Lobbying Actually Involves [14:407 – Building Relationships in New States [19:29] – Role of Managed Care in Medicaid [22:18] – Advocacy Challenges & Political Realities [24:28] – Iowa Case Study: When Medicaid Goes Wrong [31:05] – Policy vs. Personality in Decision-Making [32:02] – Key Tensions Between States & Health Plans [33:50] – Quality of Care in Medicaid [37:32] – Why Health Plans Are Struggling Financially [40:11] – Current Work: Distressed Hospitals [48:12] – Rural Health Transformation Programs [52:25] – Closing Thoughts Follow Guest Christopher Drumm: LinkedIn: https://www.linkedin.com/in/christopher-drumm-17697110/ [https://www.linkedin.com/in/christopher-drumm-17697110/] Company Website: https://www.drummanddaughters.com/ [https://www.drummanddaughters.com/] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]

Mental Health Is Getting Worse & Leading to Depression, ADHD Bipolar, Suicide with Dr. Nadeem Shamsi

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/] sits down with Dr. Nadeem Shamsi [https://www.instagram.com/nadpsych?igsh=dzFmeHg5ZDRmcXIy], a board-certified psychiatrist with over 20 years of experience. He is a Member of American Psychiatric Association [https://www.linkedin.com/company/american-psychiatric-association/] & a Diplomate of American Board of Psychiatry [http://linkedin.com/company/american-board-of-psychiatry-and-neurology-inc/about/trk=biz-companies-cym]. He discusses the growing concerns around mental health, including depression, ADHD, and bipolar disorder. They talk about the challenges of diagnosing and treating these conditions, the importance of early intervention, and the role of medication and therapy in helping patients. The conversation also covers the rising prevalence of mental health issues, particularly post-COVID, and highlights how more awareness, better access to care, and a shift in societal attitudes are needed to address these critical issues. Dr. Nadeem Shamsi is a board-certified psychiatrist with over 20 years of experience in mental health care. He specializes in diagnosing and treating conditions such as depression, ADHD, and bipolar disorder. Dr. Shamsi is dedicated to providing personalized care, combining medication management and psychotherapy to help patients regain stability and improve their quality of life. Expect to Learn - The challenges of diagnosing and treating mental health conditions like depression, ADHD, and bipolar disorder - The importance of early intervention and personalized care in improving patient outcomes - How medication management and therapy can work together to support mental health recovery - Why mental health issues are becoming more prevalent, particularly post-COVID - How increased awareness and access to care can help address the growing mental health crisis Episode Breakdown with Timestamps [00:00:00] – Teaser [00:01:59] – Introduction and Dr. Nadeem Shamsi’s Background [00:03:52] – Dr. Shamsi’s Transition to Private Practice [00:06:31] – Difference Between Psychiatrists and Psychologists [00:09:15] – Understanding Depression, ADHD, and Bipolar Disorder [00:13:10] – Why ADHD is Diagnosed More in Adults Now [00:16:22] – Trends in Diagnoses Across Age and Demographics [00:17:42] – Addressing the Bipolar Disorder Debate [00:19:31] – Diagnosing Bipolar Disorder vs. Depression [00:21:36] – Understanding DSM [00:22:27] – Coexisting Mental Health Disorders and Their Challenges [00:26:52] – Recognizing Symptoms of Mental Health Disorders [00:33:48] – The Role of Family in Supporting Mental Health Treatment [00:36:51] – The Complexity of Suicide Prevention [00:41:53] – Normalizing Conversations About Mental Health [00:45:41] – Challenges in Accessing Mental Health Care [00:51:20] – Social Impact of COVID on Mental Health [01:06:01] – Shift in Mental Health Policies and Patient Rights [01:10:44] – Balancing Quality Care with Time Constraints [01:16:50] – If You Could Change One Thing in Psychiatry: Breaking Stigma Through Education and Awareness Follow Guest Dr. Nadeem Shamsi: Instagram: https://www.instagram.com/nadpsych [https://www.instagram.com/nadpsych] Website: https://mnshamsipc.com/our-team/nadeem-shamsi-m-d/ [https://mnshamsipc.com/our-team/nadeem-shamsi-m-d/] Follow Guest’s Companies: - M.N. Shamsi P.C. Center Psychiatry & Counseling: Website: https://mnshamsipc.com/ [https://mnshamsipc.com/] Instagram: https://www.instagram.com/shamsi_office/ [https://www.instagram.com/shamsi_office/] Facebook: https://www.facebook.com/profile.php?id=61562855849550 [https://www.facebook.com/profile.php?id=61562855849550] - American Psychiatric Association: LinkedIn: https://www.linkedin.com/company/american-psychiatric-association/ [https://www.linkedin.com/company/american-psychiatric-association/] Website: https://www.psychiatry.org/ [https://www.psychiatry.org/] Instagram: https://www.instagram.com/apapsychiatric/ [https://www.instagram.com/apapsychiatric/] Facebook: https://www.facebook.com/AmericanPsychiatricAssociation [https://www.facebook.com/AmericanPsychiatricAssociation] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]