How to Solve a Trillion-Dollar Healthcare Problem
Rohan Ganesh |
We all know that booking a medical appointment takes time. So does managing referrals, ordering prescriptions, and checking (and then disputing) insurance coverage. Healthcare accounts for 17%—or $4 trillion—of America’s gross domestic product. And healthcare administration is a quarter of that.
Every dollar that’s spent on healthcare administration is a dollar that’s not available to make people healthy or prevent them from getting sick. Every inefficiency in the system is a speed bump to better care for patients, more resources for physicians, and lower costs across the board.
The growth in healthcare administration is staggering. According to data from the Bureau of Labor Statistics, between 1970 and 2015, the number of clinicians grew 150%, while healthcare administrator jobs grew over 3,000%. This especially hurts independent and small-office providers, where inflated administrator-to-physician ratios cause financial stress, budget cuts, and compromises in care delivery.
It’s a trillion-dollar problem. And we’re finally at the moment to solve it with a powerful system of AI-powered assistants known as agentic workflow automation.
Next generation AI automation
AI agents are changing the old paradigm of enterprise automation. Unlike legacy robotic process automation, which can be used only in highly defined, rigid, high-volume use cases, AI agents are intelligent, flexible, and autonomous problem solvers that are becoming increasingly robust. The key advance is in AI agents’ ability to solve small goals in service of a larger overarching goal.
Imagine a patient with a skin issue trying to book their first appointment with a dermatology specialist. An AI agent will split up the overarching goal—booking the appointment—into smaller goals: (1) check the patient’s referral, (2) flag missing information, (3) confirm suitable times, (4) send a reminder before the day of the appointment. AI agents can determine when a subgoal has been achieved and move to the next step. And they can work across modalities, like reading and writing text as well as performing phone calls in a human voice.
This technology will smooth every stage of healthcare delivery. It will supercharge a clinic’s front office capabilities and facilitate better communication with patients. It will scrutinize patients’ charts to avoid costly errors. And it will verify medical codes and coverage policies to quickly reconcile payments between patients, providers, and insurers.
Money saved through AI-driven administrative efficiency will be widely distributed. Doctors and clinicians will find reductions in overhead, making them more revenue to a point. The extra savings will mean more resources for prevention and care, allowing them to allocate more time and resources to patient care and innovative treatments. This could lead to a shift where medical professionals focus more on quality care than administrative tasks.
Crucial guardrails and industry stability
Security is a central piece of this transformation. Giving machines too much agency is a legitimate concern and risk. Healthcare data is not only sensitive—it’s protected by federal and state laws. But compared to current healthcare systems that often rely on aging computer systems vulnerable to data breaches, generative AI offers increased capacity to detect and identify bad actors and to incorporate extra layers of security. AI systems can employ advanced encryption, real-time monitoring, and anomaly detection to protect patient data more effectively than before.
People will be a central part of building and maintaining these systems. Clinicians will still need administrators to make sure systems work smoothly and optimally. Human oversight will be crucial to managing complex situations and escalations and ensuring the technology functions correctly. Ongoing training and support for healthcare professionals will be essential to integrating AI seamlessly into the healthcare workflow.
Just as medical breakthroughs like vaccines, new therapies, and surgical techniques have pushed healthcare to evolve, so too will this advance in administration. Eventually, clinicians will have their own AI agents that can confer with patient agents. This is the key to a more efficient, responsive, and patient-centered healthcare system, where the focus is squarely on delivering high-quality care rather than navigating administrative hurdles.
The journey toward integrating AI into healthcare administration is not just about cutting costs or speeding up processes—it’s about fundamentally transforming how we deliver and receive healthcare. By embracing these technological advancements, we can create a system that is more equitable, efficient, and effective for everyone.
