AffirmedRx Intelligence™: AI Insights, Human Decisions

Innovation is Only the Beginning

Healthcare has never been a stranger to transformative technology. The difference now with AI is not simply what the technology can do, it’s how we choose to use it. In late 2022, OpenAI released ChatGPT to the public. Less than four years later, the AI industry is booming with advancements and competition.

At the turn of the century, electronic health records (EHRs) fundamentally changed how providers deliver care, but they came with unexpected responsibilities. A 2016 study funded by the American Medical Association found that for every hour physicians spent with patients, they spent nearly two more hours on EHR and desk work, plus one to two hours of their own time each night. That same tension showed up with Computerized Physician Order Entry (CPOE), which clinicians found it to be intrusive, clunky, and disruptive to their daily tasks.

These experiences offer an important lesson for this next wave of healthcare technology: efficiency alone does not define success. A tool can save time in one part of a workflow while creating new work, new risks, or new friction somewhere else. AI deserves the same level of scrutiny.

Why AffirmedRx Intelligence™

As a Public Benefit Corporation (PBC), AffirmedRx has always placed the member at the center of its mission. The emergence of AI does not change that; it reinforces the importance of being intentional about how new technology is used. That’s why we’re introducing AffirmedRx Intelligence™, our approach to using AI to support human expertise, strengthen decision-making, and create better experiences for the people we serve. It’s grounded in a simple principle: AI provides better insights and better tools, while people remain at the heart of the decisions that affect care.

This human-first approach is the core of AffirmedRx Intelligence™. Decisions that affect a member’s care will always be made by humans. This distinction matters because technology can identify an opportunity or flag a potential issue without understanding the full context of a person’s care.

At AffirmedRx, every team member is called a Steward. This is a reflection of our responsibility to use resources thoughtfully to improve patient outcomes and member experiences. AffirmedRx Intelligence™ reinforces this responsibility as we use AI. AI tools are adopted with intention, guided by thoughtful governance, transparency, and human oversight. At AffirmedRx, before AI tools are implemented, Stewards are equipped to understand their capabilities and limitations, as well as their environmental and human impacts. As a PBC, we approach innovation with a commitment to exploring what’s possible, advancing the industry, and ensuring that progress creates meaningful value for the people and communities we serve.

Setting the Standard

The AffirmedRx Intelligence™ Standard is a set of ten guiding principles that define how AffirmedRx uses AI. These commitments guide our approach to AI, balancing bold innovation with thoughtful decision-making and meaningful human oversight. Our goal is to use AI where it can create meaningful value for our members, clients, and teams. 

1. Human Oversight, Always
   Every AI-assisted decision that affects a member’s care or treatment must be reviewed and finalized by a qualified Steward. AI may inform our decisions but does not make them alone.
2. Purposeful, Resource-Conscious Use
   We use AI where it adds real, demonstrable value, not everywhere it is available. Every department-level use case is measured to determine its actual value. This is then compared to its resource cost, including the energy and environmental impact of running it, and we retire what isn’t earning its place.
3. Transparency and Member Choice
   We will use clear, plain language about where and how AI is used in our operations and in the services our members and partners rely on, including by telling members directly when AI is involved in an interaction that affects them. Transparency is not a disclosure buried in fine print; it is a practice.
4. Explainability and Auditability
   Any AI-informed decision can be traced and explained after the fact, in terms a person affected by it could actually understand. If we cannot explain it, we do not deploy it.
5. Bias Awareness and Ongoing Monitoring
   We actively look for bias in the data, design, and outcomes of our AI systems, and we monitor deployed systems over time for drift, unintended consequences, or unidentified risk.  
6. Data Protection and Security
   Data entered into or produced by our AI systems is protected with the same rigor as any other sensitive health and member information, and is handled in accordance with our privacy, security, and data-use policies and procedures.
7. Vendor Accountability
   We evaluate our vendor and technology partners at this same standard, and we maintain a working understanding of how AI is used in every system we rely on, not just the ones we build ourselves.
8. Human and Community Impact
   We consider how AI-influenced decisions affect real communities, including downstream health, environmental, and economic effects that may not show up in a claims report, and we treat that evidence as seriously as any financial metric.
9. Ethical Stewardship, Practiced by Everyone
   Every team member is trained to use AI ethically and responsibly on the job and beyond it, on an ongoing basis rather than as a one-time orientation. Responsible AI use is everyone’s job at AffirmedRx, not a specialty reserved for a few.
10. Accountability and Redress
    When our use of AI falls short of these commitments, we identify it, correct it, and provide members and partners with a clear way to raise concerns and seek a remedy. This Standard is a commitment we hold ourselves to, not just a statement of intent.

AI will continue to evolve. So will the ways healthcare organizations use it. At AffirmedRx, responsible innovation means thinking boldly about how we can reshape the pharmacy benefit industry and doing what’s right at every step, while keeping people at the heart of every idea, decision, and advancement.

That is the purpose of AffirmedRx Intelligence™. Not simply using AI, but using it with intention.