Artificial intelligence won't save healthcare, but can help stop wasting millions

In 2016, when I was in business school, I wrote a work on blockchain and its impact in healthcare. At the time, all experts were confidently announcing that the new technology would “change” health care. I remember thinking that I really didn't get it. Systemic problems in healthcare, economic incentives that promote disease rather than health are inconsistent, and blockchain technology will not even be addressed remotely. Absolutely, blockchain helps ensure data privacy, but it's a key point solution, not a comprehensive solution for us to really revolutionize healthcare.

The current conversation around generating AI (Genai) has caused me to attack me with a similar vein. Yes, I believe Genai can enable solutions that will significantly affect the healthcare workflow. An example is through the automation of low-risk, repetitive tasks, such as those related to administrative responsibilities. Imagine a mundane management task processed by AI, recommended to human users based on exceptional outliers. Automate these workflows clinicians to focus on patients and provide improved care.

To take the technology further in 2025, Genai in healthcare needs to shift from potential value to practical value, with a focus on bringing specific benefits to clinicians and patients. The healthcare system will develop a powerful governance system to evaluate, purchase, implement and continuously monitor Genai solutions and require the ROI of any solution. The transition from the hype cycle to the value cycle will focus on quantifying the benefits of Genai. One example is measuring reduced administrative burdens such as time savings and the use of tools such as environmental scribes to reduce clinician burnout.

But to truly “innovate” health care, we need to address the fundamental need for those large administrative tasks that are essentially required, without adding value, and represent a dollar that has no impact on quality patient care. To obtain primary care providers in order to get $100 in payment for patient services, they have to spend $20.49 in administrative expenses, according to a new JAMA Network study. These administrative costs represent a 20% tax on patient care, providing zero value for better healthcare outcomes.

Can Genai help standardize administrative costs? Genai has addressed the prior authorization task, but the difference in the payer's requirements for prior authorization clinical data and medical necessity limits its effectiveness. What if previous authorized data and medical necessity requirements were standardized in all states, federal and commercial payers? Genai can also analyze the numerous payer contracts held by the healthcare system, all of which vary greatly between different state, commercial and federal payer business scopes to find common ground and standardize payer contracts. Finally, imagine Genai as a tool that implements a single transaction model that allows healthcare systems to trade for state, federal and commercial payers in a unified way.

While one might claim that AI will never replace doctors, we can use AI to help improve the overall scaffolding of health care reimbursement, reduce costs and free up spending to focus on expenses directly related to patient care activities.

Using Genai to solve administrative tasks of your own spending can improve workflows, but it cannot solve the basic system problems facing healthcare. Yes, we need to revolutionize healthcare. However, it requires regulating all of the above through standardization of data exchange, simplified and simplified payment methods, and comprehensive health care policies. This requires human efforts, however, Genai can be enabled.

Photo: Damon_moss, Getty Images

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