The new Medicare 'Access' code for AI in chronic care is priced too low to be profitable if humans are kept in the loop. This clever incentive design forces providers to adopt genuine AI-driven leverage rather than simply relabeling human effort, a first for healthcare technology.

The most significant opportunity for AI in healthcare lies not in optimizing existing software, but in automating 'net new' areas that once required human judgment. Functions like patient engagement, scheduling, and symptom triage are seeing explosive growth as AI steps into roles previously held only by staff.

Hospitals are adopting a phased approach to AI. They start with commercially ready, low-risk, non-clinical applications like RCM. This allows them to build an internal 'AI muscle'—developing frameworks and expertise—before expanding into more sensitive, higher-stakes areas like patient engagement and clinical decision support.

The friction of navigating insurance and pharmacies is so high that chronic disease patients often give up, skipping tests or medications and directly worsening their health. AI can automate these tedious tasks, removing the barriers that lead to non-compliance and poor health outcomes.

The immense regulatory complexity in U.S. healthcare creates an estimated $500 billion "tax" of administrative bloat. The non-obvious opportunity is that by using AI to eliminate this waste, the savings could be redirected to fund expanded patient care, rather than just being captured as profit.

An "AI arms race" is underway where stakeholders apply AI to broken, adversarial processes. The true transformation comes from reinventing these workflows entirely, such as moving to real-time payment adjudication where trust is pre-established, thus eliminating the core conflict that AI is currently used to fight over.

Chronic disease patients face a cascade of interconnected problems: pre-authorizations, pharmacy stockouts, and incomprehensible insurance rules. AI's potential lies in acting as an intelligent agent to navigate this complex, fragmented system on behalf of the patient, reducing waste and improving outcomes.

Unlike the top-down, regulated rollout of EHRs, the rapid uptake of AI in healthcare is an organic, bottom-up movement. It's driven by frontline workers like pharmacists who face critical staffing shortages and need tools to manage overwhelming workloads, pulling technology in out of necessity.

An AI agent can track due dates for medication prior authorizations and pre-populate submissions. This transforms a manual, time-consuming letter-writing process into a simple, two-click approval, freeing up significant clinician time to focus on patient care instead of administrative burdens.