That’s more than a band-aid. That’s a survival strategy.

What to look for
Not all AI platforms are created equal. For hospitals, providers, and payers evaluating their options, there are a few must-have qualities to seek out:
Agentic AI workflows: From prior authorizations to claims management, a good platform should reduce manual labor and free up human staff for high-value care outcomes impact.

Real-time predictive analytics: Look for tools that don’t just analyze past performance but flag potential issues—like likely readmissions, appointment no-shows, coding errors, or, say a measles outbreak—before they happen.

Proactive patient engagement: Leverage platforms that connect directly to the individual member or patient. The best solutions include continuous patient engagement/communication and consolidated remote patient monitoring (RPM)--that is, a member’s devices, including homecare and wearables that can be aggregated and monitored on a single case manager’s dashboard.

Interoperability: A robust AI platform must connect seamlessly with your existing electronic health records (EHR), billing systems, and patient portals, as well as comply with current and upcoming federal and state interoperability regulations.

Scalability: Whether you're a rural hospital network or a statewide Medicaid plan, the platform should scale easily to meet your organization’s evolving needs.

Security and compliance: HIPAA-compliant infrastructure is non-negotiable. Make sure your vendor uses end-to-end encryption and offers audit trails.

At a time when budgets are shrinking and the stakes are rising, investing in a reliable AI-enabled health management system isn’t just strategic—it’s essential.

But we’re behind
If you think this advice is old news, that’s where you’d be wrong. Turns out that even though everyone in healthcare has been hearing about the benefits of AI nearly every day for a decade, the industry hasn’t actually embraced AI on a meaningful scale.

In fact, in the last three years, a plethora of academic, think-tank, and corporate research has found how woefully behind our industry is when it comes to AI.

In January, a healthcare-focused report from EY, which surveyed CIOs, found that while “49% see GenAI technology as enhancing organizational value and driving 2x return on investment (ROI), … only 13% have implementation plans established.”

A 2025 Amazon Web Services study found only 9% of healthcare workers report advanced AI fluency. That’s dead last among major industries.

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