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.
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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.
Leaders must resist the temptation to deploy the most powerful AI model simply for a competitive edge. The primary strategic question for any AI initiative should be defining the necessary level of trustworthiness for its specific task and establishing who is accountable if it fails, before deployment begins.
Focusing on AI for cost savings yields incremental gains. The transformative value comes from rethinking entire workflows to drive top-line growth. This is achieved by either delivering a service much faster or by expanding a high-touch service to a vastly larger audience ("do more").
Using AI for incremental efficiency gains (10% thinking) is becoming table stakes. True competitive advantage lies in 10X thinking: using AI to fundamentally reimagine your business model, services, and market approach. Companies that only optimize will be outmaneuvered by those that transform.
A critical error in AI integration is automating existing, often clunky, processes. Instead, companies should use AI as an opportunity to fundamentally rethink and redesign workflows from the ground up to achieve the desired outcome in a more efficient and customer-centric way.
Most companies use AI for optimization—making existing processes faster and cheaper. The greater opportunity is innovation: using AI to create entirely new forms of value. This "10x thinking" is critical for growth, especially as pure efficiency gains will ultimately lead to a reduced need for human workers.
An effective AI strategy in healthcare is not limited to consumer-facing assistants. A critical focus is building tools to augment the clinicians themselves. An AI 'assistant' for doctors to surface information and guide decisions scales expertise and improves care quality from the inside out.
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.
The proliferation of separate AI tools for providers (upcoding, auth requests) and payers (denials, downcoding) will lead to automated conflict. This friction could worsen administrative burdens rather than easing them, creating a high-speed, zero-sum game played by algorithms.
The core issue preventing a patient-centric system is not a lack of technological capability but a fundamental misalignment of incentives and a deep-seated lack of trust between payers and providers. Until the data exists to change incentives, technological solutions will have limited impact.