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.

AI's impact on healthcare will be a bifurcation. One end will be hyper-efficient, low-cost, AI-driven telehealth. The other will be high-touch, relationship-based advanced primary care. The traditional, inefficient fee-for-service model in the middle will become obsolete, much like Amazon and luxury retail hollowed out department stores.

Healthcare has historically been a service, with costs tied to licensed professionals. AI models like Gemini and ChatGPT are changing this by providing medical advice, effectively turning healthcare into a product. This shift, currently tolerated by regulators, could dramatically lower costs and increase access, just like software products.

Dr. Wachter warns that unless payment models change, AI will be used to maximize revenue, not lower costs. If the system rewards doing more or using more expensive treatments, AI decision support will guide clinicians toward those choices, potentially inflating the overall cost of care despite efficiency gains.

Applying AI to a fundamentally flawed system like U.S. healthcare billing doesn't fix it. Instead, it creates an arms race where insurer bots fight hospital bots over claims. This only increases complexity and benefits the technology providers, while the core problems remain unsolved.

While clinical AI is promising, the most immediate ROI is in tackling the $1 trillion in administrative waste (20-25% of total costs). AI can automate friction points like scheduling and prior authorizations, directly improving the patient experience and bending the cost curve.

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.

The most tangible ROI for AI in healthcare today isn't in complex diagnostics, but in operational efficiency. AI scribes that free up doctors, intelligent call centers that triage patients correctly, and automated claim management are solving major bottlenecks and fighting burnout right now.

Mark Cuban claims complex healthcare contracts are designed to be confusing. Running these multi-hundred-page documents through an LLM like Claude with a simple prompt can reveal where companies are being overcharged, creating immediate bottom-line savings and increased cash flow.