Healthcare delivery today looks vastly different than even a few years ago, with the emergence of artificial intelligence (AI) playing an exceptional role in its evolution. The average American can encounter AI when scheduling an appointment, in the doctor’s office assisting with notetaking, while navigating benefits and insurance questions, and in researching diagnoses. More than half of U.S. adults reported using AI for healthcare information, according to Salesforce’s Connected Health Consumer report.
AI technologies have benefitted patient care delivery for some time, and notably, applications can help reduce costs and fraudulent activity in the system as well.
With all the value of AI both promised and realized, HLC member companies continue to champion better technology that can lead to better patient outcomes. Below, we explore some of these innovations.
Providing Clinical Care and Diagnostic Support
Many of HLC’s members are implementing AI that helps clinicians diagnose, treat, and manage patients more effectively.
Synthesizing large data sets to uncover actionable insights is a significant benefit of AI. For example, Premier’s AI-enabled clinical decision support (CDS) solutions deliver real-time insights within the workflow, surfacing relevant patient, cost, and quality information at key decision points. This helps care teams deliver better outcomes while using resources wisely and safeguarding financial performance.
“Deployed responsibly, AI has the potential to fundamentally enhance quality, safety, and operational performance at scale,” said Dr. Emad Rizk, Premier’s President and CEO. “AI-enabled clinical decision support transforms complex data into actionable insights capable of elevating quality, protecting margins, and empowering teams across the enterprise.”
Other companies are developing tools to assist with testing and diagnostics efficiencies. Labcorp’s Test Finder is an AI‑supported search tool that helps clinicians quickly identify the right laboratory tests, improving speed, accuracy, and simplicity in ordering.
“Clinicians are under increasing pressure to do more with less,” said Dr. Brian Caveney, Labcorp’s chief medical and scientific officer. “Test Finder is designed to ease that burden by providing a faster, more intuitive way to navigate complex test menus, conduct research, and identify the right tests, so clinicians can focus on what matters most: their patients.”
AdventHealth’s AI‑Enabled Clinical Imaging flags potential acute abnormalities for clinicians so they can prioritize urgent cases for review, saving up to 45 minutes by prioritizing critical cases.
“AI-enabled clinical imaging is most valuable when it helps clinicians respond sooner to the time-sensitive cases that need immediate action—such as aortic dissection and stroke,” said Rob Purinton, AdventHealth’s chief AI officer. “At AdventHealth, we’re integrating timely AI results directly into our radiologists’ workflows so our care teams can prioritize urgent findings and support faster clinical decisions in situations where every second counts.”
Enhancing Workforce Productivity and Workflow Automation
Importantly, AI can also help reduce administrative burden and improve efficiency for providers and staff.
Prior authorization (PA) has become a prime area for the application of AI, given the administrative work required in this process. Epic’s Penny streamlines PA workflows, drafts denial appeal letters, and helps ensure smooth care handoffs. One hospital user, Summit Health, reported a 42% reduction in time spent on PA questions.
UnitedHealth Group’s Optum Real provides secure application programming interface (API) connections technology that allows two systems to share data instantly, without manual intervention, and can help reduce administrative costs from manual communication between payers and providers through call obviation. Based on estimated impact of automating transactions that are currently manual, 75% of calls and portal transactions can be obviated through existing APIs, including 28% on claim inquiry and 16% on prior authorization.
Ambient voice technology is another use case becoming more familiar to patients, with many doctors’ offices deploying these tools to help with notetaking and records. This application can provide not only significant patient value but benefits to the healthcare workforce. Outcomes reported by AdventHealth clinicians include less burnout (86%), better work‑life balance and job satisfaction (83%), and improved patient experience (80%).
Accelerating Research and Drug Development
Through its ability to rapidly process significant amounts of data and expedite the research process, AI is also helping bring new medicines to patients more efficiently.
“We’re in a moment where science and innovation are moving faster than ever before, and AI is playing a critical role,” said Rick R. Suárez, SVP, US President & Head of US BioPharmaceuticals Business Unit of AstraZeneca. “From the discovery of new targets through to clinical development, AI helps our scientists uncover new insights to guide R&D. But what excites me most is the combination: AI surfacing insights at scale and our scientists applying their judgment and expertise at every step to act on them. That is what gets new medicines to patients faster.”
AstraZeneca’s open-source generative AI framework, REINVENT, is used for the design of small molecules. The software uses advanced AI models to help scientists generate and optimize potential starting places for new medicines and has reduced the time needed to identify molecular structures that could become new treatments.
Strengthening Patient Experience and Engagement
Always looking to maximize the quality-of-care delivery, many organizations are leaning into AI technology that supports patients throughout their health journey.
The Cigna Group’s AI‑Powered Virtual Assistant provides members with personalized, on‑demand support for benefits, coverage, and care navigation, with more than 80% of users finding the service helpful.
For Medicare Advantage (MA) beneficiaries, eHealth’s AI‑powered benefit advisor Alice supports the enrollment and the post-enrollment experiences, helping address common inquiries such as application status, ID card inquiries, and billing questions. When consumers call eHealth, Alice handles 100% of after-hours MA inquiries and on-going customer support after enrollment. Alice works in tandem with eHealth’s licensed insurance agents, who are able to focus on providing more personalized, high‑value guidance, especially during the busy Medicare Annual Enrollment Period.
“As more Americans seek expertise when evaluating their Medicare coverage options, AI is playing a key role in streamlining how beneficiaries shop for and use their Medicare Advantage plans,” said Derrick Duke, CEO of eHealth. “While licensed agents remain essential as expert guides, AI benefit advisors help facilitate a faster and more seamless shopping and support experience, including by eliminating after-hours wait times and ensuring a 100% answer rate. Through a system that prioritizes empathy with a customer-first approach, Alice has earned an exceptional rating from over 74% of callers.”
Sword’s AI Care platform combines human-in-the-loop AI with licensed clinical specialists to predict, prevent, and treat musculoskeletal, women’s, mental, and cardiometabolic health. It is one platform with shared clinical memory that travels with the patient member across every program, continuously personalizing care and tying pricing to outcomes, not activity. Notably, 67% of its members become pain free, with up to 70% lower surgery intent and 50–64% fewer anxiety and depression symptoms.
Patients using Verily Health’s Verily Me can find Violet, a conversational AI agent, embedded throughout the app. Violet’s Symptom Assessment with Context helps users safely overcome care barriers and accelerate access to high-quality guidance.
Detecting Fraudulent and Erroneous Activity
As many in the government and among healthcare policymakers focus on reducing fraud, waste, and abuse, healthcare companies are using AI as a tool to support these efforts in the sector.
With pharmacy misuse and invalid copay behavior contributing to $5B in losses each year for pharmaceutical manufacturers in the US, ConnectiveRx has developed a solution to address this issue with proven results.
“With all the technology solutions in healthcare, being AI-forward is easy to claim. Proving it changed an outcome is the real test,” said Harry Totonis, ConnectiveRx’s CEO. “In our recent pharma market survey, more than 80% of medication access professionals found an AI-forward partner ‘appealing,’ but when we asked what they actually wanted, 61% said that AI must be tied to smarter execution, with proven results.”
The company’s ShieldRx is an AI‑driven solution, currently deployed by a top five pharma company, embedded directly into pharmacy workflows to detect suspect behavior, such as misuse or invalid copays, and intervene before claims are processed. This reflects the company’s lens on AI use, which is to apply it only where it genuinely improves accuracy and speed in decision-making. Their other AI-driven capabilities assist drug manufacturers by screening patient populations to identify those outside a target market or by flagging payment anomalies in prescription buy-and-bill programs very early in the cycle.
Cotiviti has developed a suite of AI‑driven, augmented intelligence solutions that combine fine-tuned agents, knowledge graph retrieval, and orchestrated context and tool calls to proprietary data and models. For example, in coordination of benefits, Cotiviti developed a new model leveraging AI and machine learning to help identify newborns with the highest probability of other primary coverage, using plan enrollment information, member demographic data, and claims history. This not only identified previously uncaptured opportunities but reduced false positives, significantly decreasing the possibility for member abrasion during a sensitive moment in their lives.
“The power of AI isn’t in removing humans from the process,” explained Chris Coloian, Cotiviti’s chief strategy officer. “We leverage it so our clinical, technical, and investigative experts can focus on the highest-value opportunities to improve payment accuracy and reduce fraud, waste, and abuse, which preserves program integrity for payers, reduces friction for providers, and protects plan benefits for members.”
With so many available use cases for AI technology already, it’s amazing to envision what the care delivery field may look like in five or ten years. Amidst the changes to come, HLC’s members will continue responsibly deploying emerging technologies in ways that ultimately provide the best care possible for patients.
