Tag: ai

Bain & Company: Top Healthcare IT Priorities

Posted on by Jason Barry

Payors and providers are fighting different operational battles, but they’re using the same two-letter weapon to come out on top: AI, you guessed it. 

A joint report from Bain & Company and KLAS found that 80% of payors and 70% of providers now have an AI strategy in place, up from just 60% last year.

  • Providers are up against structural workforce shortages and rising patient volumes, while payors are contending with higher medical loss ratios and more regulatory scrutiny.
  • Bain and KLAS’ survey of 228 U.S. healthcare execs suggests that all signs point to one solution, and that’s deploying tech to improve margins.

Where are payors investing? Care coordination (57%) and utilization management (55%) were the top IT investment priorities for the second straight year.

  • Payors place total cost of ownership, functionality, and scalability ahead of suite convenience, so best‑of‑breed is still the default buying motion.
  • Plans are leveraging AI for everything from member engagement (35%) and enrollment (26%) to risk adjustment (26%) and prior auth automation (20%).

Where are providers investing? Revenue. Cycle. Management.

  • Half of providers ranked RCM among their top IT priorities, placing it above clinical workflows (34%) and EHRs (32%).
  • RCM = ROI. Accurate documentation and coding results in cleaner claims and fewer denials, which directly translates to higher revenue and lower expenses.
  • It’s also a match made in heaven for AI automation, and RCM currently represents the four most common AI use cases: ambient documentation (62%), clinical documentation improvement (43%), coding (30%), and prior authorization (27%).

Here’s the kicker. Providers cite EHR integration and interoperability as their biggest pain points, so most of them prioritize their EHR vendors for new solutions.

  • Only 20% of providers are primarily best-of-breed buyers, and two-thirds of Epic customers would choose an Epic option that’s “good enough” over a better competing product.

The Takeaway

It’s getting pretty hard to not be bullish on AI. There’s still plenty of uncertainty, but both payors and providers now seem to agree that inaction is the riskiest action.

AI Learns the Natural History of Human Disease

Posted on by Jason Barry

Clinical decision-making relies on understanding patients’ past health to improve their future health, an impossible task without first understanding how diseases progress over time.

That’s where a new study in Nature suggests AI is ready to help.

It starts with generative pretrained transformers. Researchers built a GPT, dubbed Delphi-2M, to predict the “progression and competing nature of human diseases.” 

  • Delphi-2M was trained on 400k UK Biobank participants (which lean healthier than the average person), and then externally validated on 1.9M Danish patients.
  • The training was designed to predict a patient’s next diagnosis and the time to it, using only data readily available within the EHR: past medical history, age, sex, BMI, and alcohol/smoking status.

How’d it do? The results speak for themselves:

  • Delphi-2M was able to forecast the incidence of over 1,000 diseases with comparable accuracy to existing models that are fine-tuned to predict single diseases.
  • Death could be predicted with eerily impressive accuracy (AUC: 0.97), and the survival curves that it simulated lined up almost perfectly with national mortality statistics.
  • Comorbidities emerged naturally from the training, and Delphi-2M was able to understand the progression from type 2 diabetes to eye disease to nerve damage.
  • Delphi-2M’s ability to predict heart attack and stroke matched established scores like QRisk, and it even outperformed leading biomarker-based AI models.

Better forecasts inform better policies. If policymakers can consult the Oracle of Delphi to see how many people will develop a disease over the next decade, the authors conclude that they’ll also be able to implement better regulations to prepare. 

  • Not a bad theory, assuming models trained on historical data can make forecasts that hold up to evolving treatments and populations (and that politicians act in the best interest of the people:).

The Takeaway

AI is reaching the point where it can predict thousands of diseases as well as the best narrowly focused models, and that could have big implications for everything from early screening to policymaking.

Wolters Kluwer Jumps in the GenAI Ring With UpToDate Expert AI

Posted on by Jason Barry

Right when you think Wolters Kluwer might just let everyone else have all the AI fun, it debuted UpToDate Expert AI to give the world’s most widely used clinical decision support tool a much-needed AI overhaul.

Wolters Kluwer took its time with the launch. The incumbent CDS juggernaut is used by 3M doctors worldwide, so it had plenty of users to disappoint with a hasty roll out.

  • That said, nimble competition has been gaining ground pretty much as fast as it takes to download OpenEvidence from the App Store.
  • The good news is that WK made the most of the extra development time.

Here’s what sets UpToDate Expert AI apart. Unlike general-purpose chatbots, the AI-enhanced version of UpToDate is built exclusively on WK’s peer-reviewed content library.

  • It draws on 30+ years of evidence-based research authored by 7,600 experts, rather than the open web or selective journals.
  • That allows it to quickly answer complex clinical questions, while surfacing all of its sources, assumptions, and step-by-step reasoning directly in the response. Probably safe to assume that also helps with hallucinations.
  • Those answers still manage to be easy to scan at the bedside and will look extremely familiar to any doctor that’s ever read an UpToDate article (or one that’s been reading them for a decade).

The extra time in the oven means that more features are baked in. Wolters Kluwer knows its audience, and UpToDate Expert AI’s biggest leg up on the competition is its fine-tuning for health systems.

  • Enterprise-grade governance, compliance, and workflow integration are all standard out-of-the-box, giving UpToDate Expert AI an advantage for a system-wide implementation over OpenEvidence or Doximity.

The Takeaway

It turns out that the 800-pound clinical support gorilla wasn’t going to let the newcomers eat its lunch forever, and UpToDate Expert AI gives health systems plenty of reasons to keep rolling with Wolters Kluwer.

Penguin Ai Raises $30M to Arm the AI Agent War

Posted on by Jason Barry

Payors and providers are in an AI arms race, and Penguin Ai just raised $30M to supply both sides with agents to outcompete each other.

Penguin goes far beyond point solutions. The enterprise AI platform combines proprietary LLMs with AI tooling that both payors and providers can use to configure custom agents for their own back-office processes. 

  • The platform enables customers to prep their data for AI, use pre-built LLMs via APIs, or start with a ready-made agent for medical coding, prior auths, claims adjudication, appeals management, risk adjustment, medical chart summarization, or payment integrity.
  • The ultimate goal is streamline high-volume workflows and cut down on the billions of dollars of administrative waste that the healthcare industry generates every year.

The agent wars have begun. Payors and providers across the country are racing to enlist AI agents to fight for an advantage in a system that’s historically been plagued by inefficiencies and headbutting.

  • Providers vs. Payors: Doctors and hospitals are leveraging agents to fight back against billing denials – filing floods of appeals and automating responses faster than any human could manage alone.
  • Payors vs. Providers: Health plans are rolling out agents to instantly review claims, prior auths, and appeals requests – enabling mass, automatic care decisions that overwhelm providers.

Penguin CEO Fawad Butt has been in the buyer seat. He spent his career serving as the chief data officer at some of the biggest names in the industry: UnitedHealthcare, Kaiser Permanente, and Optum.

  • He founded Penguin to build the platform he saw was missing, and that adds a lot of credibility as Penguin takes on incumbent admin agent dealers like Innovaccer and Autonomize AI.

The Takeaway

The agent wars are in full swing, and Penguin is bringing a comprehensive platform to a battlefield full of point solutions. 

Doctors Who Use AI Are Viewed Worse by Peers

Posted on by Jason Barry

The research headline of the week belongs to a study out of Johns Hopkins University that found “doctors who use AI are viewed negatively by their peers.”

Clickbait from afar, but far from clickbait. The investigation in npj Digital Medicine surfaced interesting takeaways after randomizing 276 practicing clinicians to evaluate one of three vignettes depicting a physician: using no GenAI (the control), using GenAI as a primary decision-making tool, or using GenAI as a verification tool.

  • Participants rated the clinical skill of the physician using GenAI as a primary decision-making tool as significantly lower than the physician who didn’t use it (3.79 vs. 5.93 control on a 7-point scale). 
  • Framing GenAI as a “second opinion” or verification tool improved the negative perception of clinical skill, but didn’t fully eliminate it (4.99 vs. 5.93 control). 
  • Ironically, while an overreliance on GenAI was viewed as a weakness, the clinicians also recognized AI as beneficial for enhancing medical decision-making. Riddle us that.

Patients seem to agree. A separate study in JAMA Network Open took a look at the patient perspective by randomizing 1.3k adults into four groups that were shown fake ads for family doctors, with one key difference: no mention of AI use (the control), or a reference to the doctors using AI for administrative, diagnostic, or therapeutic purposes (Supplement 1 has all the ads).  

For every AI use case, the doctors were perceived significantly worse on a 5-point scale:

  • less competent – control: 3.85, admin AI: 3.71; diagnostic AI: 3.66; therapeutic AI: 3.58
  • less trustworthy – control: 3.88; admin AI: 3.66; diagnostic AI: 3.62; therapeutic AI: 3.61
  • less empathic – control: 4.00 ; admin AI: 3.80; diagnostic AI: 3.82; therapeutic AI: 3.72

Where’s that leave us? Despite pressure on clinicians to be early AI adopters, using it clearly comes with skepticism from both peers and patients. In other words, AI adoption is getting throttled by not only technological barriers, but also some less-discussed social barriers.

The Takeaway

Medical AI moves at the speed of trust, and these studies highlight the social stigmas that still need to be overcome for patient care to improve as fast as the underlying tech.

Healthcare’s Sci-Fi Future at Epic UGM

Posted on by Jason Barry

Where there’s smoke, there’s fire, and Epic just lit up its sci-fi themed User Group Meeting with enough futuristic new solutions to prove last week’s rumors true – and then some.

The future is now. This year’s event gave us a look at over 160 AI projects currently under development at Epic, including a three-product family set to immediately shake up the industry.

ART is a provider copilot for charting, pre-visit summaries, queuing up orders, and yes – ambient scribing.

  • ART will reportedly be able to provide real-time suggestions during visits, and its highly-anticipated scribe still came as a surprise after Epic revealed that it will be powered by Microsoft when it arrives in early 2026. More on that later.

Emmie is a patient-facing advocate within MyChart that can help with everything from scheduling and reminders to education and navigation.

  • Epic is positioning Emmie as the best place for patients to ask health questions and get answers that are actually grounded in their personal medical history.

Penny is an administrative assistant targeted at revenue cycle management, generating appeal letters, and supporting back-office tasks.

  • There isn’t as much information out there on this one, but Epic doesn’t appear to be shying away from claims and payor workflows.

The EHR is dead, long live the CHR. Judy grabbed even more headlines by announcing that she’s retiring the term “EHR” in favor of “Comprehensive Health Record,” which seems fitting considering the other major announcements that joined the Big Three.

  • Cosmos AI will provide diagnosis and treatment support, as well as discharge planning.
  • MyChart Central will give patients a single login across all sites of care.
  • Flower Pot will expand access to lightweight Epic implementations for smaller practices.

The scribe is real. Now what? Epic’s decision to team up with Microsoft on documentation was pretty unexpected given its 46-year track record of building everything in-house, confirming that the CHR giant would rather bend its core rules than lose market share.

  • Scribes proved how fast health systems would layer on their own AI if Epic couldn’t keep up, and we’ll now have to wait and see if the cost and experience of Epic’s scribe is enough to compete with the flock of ambient AI innovators dedicated to this problem.
  • Epic might own the “operating system,” almost as much as Microsoft owns Windows, but just because MS Paint exists doesn’t mean the world doesn’t need Adobe Photoshop.

The Takeaway

Some call it consolidation. Others call it innovation. Either way, this year’s UGM will probably go down as a key step along Epic’s march toward intergalactic domination. 

Is AI Robbing Physicians of Their Skill? 

Posted on by Jason Barry

A study in The Lancet threw some refreshingly cold water on the AI hype train after finding that healthcare’s shiny new models might be de-skilling physicians.

Here’s the setup. Researchers tracked four Polish health centers that gave their gastroenterologists AI to help spot polyps during colonoscopies before yanking it away after three months.

  • Long story short, the doctors’ ability to detect polyps plummeted 6% below baseline following the AI rugpull.
  • Unassisted polyp detection rates fell from 28.4% before the AI teaser to 22.4% after, raising concerns that relying on AI might rob physicians of hard-won skills. 

Sounds familiar. The findings echo a recent MIT preprint that showed that people who used AI to write essays used less of their brains and had worse recall of their writing than those who mustered up the words on their own.

  • That’s probably not a shocker to anyone that’s used ChatGPT for more than five minutes, but it’s easy to see that it might spell trouble when applied to medicine.
  • If gastroenterologists start leaning on AI to detect polyps, what happens if they lose their ability to detect them without it?

Right idea, wrong question. People were better at mental math before they had calculators, but that doesn’t mean society would be better off without them. The question we have to ask ourselves is, which skills are we willing to lose?

  • Gastroenterologist Dr. Spencer Dorn nails it: AI doesn’t just risk de-skilling doctors in polyp detection, it risks diminishing their overall critical thinking skills.
  • “My real concern is not the technical skills we can afford to lose, but the foundational ones we can’t: critical thinking, sound judgment, and compassionate care. These aren’t just important to preserve – they’re irreplaceable.”

The Takeaway

If doctors keep outsourcing their thinking to AI, it could be a one-way ticket to a world where Dr. GPT is the only one patients can turn to. Seems dystopian, but is it really that bad if it also means better outcomes for those patients?

AI Spotlight on Epic, Abridge, and Oracle 

Posted on by Jason Barry

Epic, Abridge, and Oracle just gave us a year’s worth of blockbuster AI announcements in three days, and at least one of them was more than speculation and old news.

‘Twas the week before UGM, and the rumor-mill has been overheating with reports that Epic might finally launch its own EHR-native scribe at its upcoming User Group Meeting.

  • Over 40% of U.S. hospitals are already on Epic, which means its scribe would have access to one of the biggest distribution channels in healthcare even if its UX and performance aren’t best-in-breed (which they won’t be).
  • That means about 100 ambient AI startups could be about to find out why scribing is a feature – not a product – and the race will be on to differentiate through other capabilities like RCM and specialty-specific tuning.

Abridge doesn’t plan on being commoditized. Less than 24 hours after Epic’s scribe leaked, Abridge unveiled the exact type of solution that’ll define who survives the incumbent squeeze: real-time prior authorization at the point of conversation.

  • Abridge is co-developing the new solution alongside Highmark Health, a Pittsburgh-based payvidor that operates both a multistate payor division and the 14-hospital system Allegheny Health Network.
  • Integrating Abridge’s ambient AI platform across Highmark’s entire organization will allow patients to get approval for necessary treatments before they even leave the office, a perfect example of how “scribes” can be truly transformative beyond just transcripts.

Oracle couldn’t let Epic and Abridge have all the fun. It decided to “usher in a new era of AI-driven health records”… by reintroducing us to the same AI EHR it unveiled last October.

  • Although mostly a PR stunt to grab headlines ahead of UGM, the new EHR includes several features that underscore where the AI puck is heading, including a native scribe, voice-first navigation, and agents to support clinical workflows.
  • These features are also a good list of use cases where startups might not have a lot of juice left to squeeze after EHRs start bringing them in-house (and prior auths just so happen to be the last thing Oracle wants to get its hands dirty with).

The Takeaway

Native scribing is (very likely) on its way to Epic, Abridge is giving patients the gift of time with instant prior auths, and Oracle is banking on voice for the future of EHR navigation. What a week for digital health.

The Generalist-Specialist Paradox of Medical AI

Posted on by Jason Barry

Technological advances have ushered in an era where many AI models outperform specialists on specific tasks, but AI still lags far behind experts in less controlled settings.

That’s the Generalist-Specialist Paradox of Medical AI laid out in a recent NEJM AI editorial, which paints a picture of a world where AI might soon start redrawing the boundaries of medical specialties as they exist today.

  • AI is already delivering great results on well-defined tasks like interpreting EEGs or CT scans, but it’s still consistently struggling on generalist tasks with less clear boundaries.
  • If that trend continues, the article argues that tasks that used to be in the hands of specialists will be at the fingertips of primary care (just as tasks that used to belong to primary care will now belong to patients).

LLMs don’t care what specialty a case belongs to. They can ingest the full clinical context across visit notes, labs, and imaging to come up with the most probable diagnosis.

  • Breyer Capital Partner Dr. Morgan Cheatham recently made the case that this feature of AI could lead to the collapse of traditional medical specialties as we know them.
  • “Some domains will converge. Others will splinter into new subspecialties defined not by organ systems, but by data fluency, workflow design, or model supervision.”

Not so fast. There’s no doubt that AI will reshape roles, but that doesn’t mean that specialists are about to start offloading everything onto generalists.

  • High-quality care requires more than following AI-friendly guidelines, and specialists incorporate judgment earned through years of experience to deliver effective treatments. LLMs are also still a ways away from replacing anyone’s hip.
  • Primary care providers also aren’t exactly sitting around looking for extra work, and it’s far-fetched to think that they can start taking on specialty care for their ever-growing patient panels.

The Takeaway

AI might be great at well-defined tasks like many seen in specialty care, but we’re still a ways away from having primary care physicians replacing cardiologists.

Ambience Healthcare Joins Unicorn Club With Series C Raise

Posted on by Jason Barry

Another week, another ambient AI mega-round – this time from none other than Ambience Healthcare and its massive $243M Series C.

Welcome to the unicorn club. The round vaulted Ambience’s valuation to $1.25B, making it the second-highest valued startup in the ambient arena behind Abridge, which was valued at an eye-popping $5.3B during its recent $300M Series E.

  • Funnily enough, a16z led both rounds. We don’t usually see VCs cut a check for a startup then turn around and fund their biggest competitor, but playing both sides is a great way to not lose a race.

Ambience isn’t just a scribe. It’s an ambient AI platform for documentation, coding, and clinical documentation integrity.

  • The platform was “architected with the understanding that health systems are not monolithic enterprises” and adapts to the unique context of different care settings.

If you ain’t first, you’re last. Ambience was one of the only ambient AI players to lean in on the revenue cycle component right out of the gate, and the head start is reflected in the results from head-to-head pilots.

  • During a six month bake-off at Cleveland Clinic (now a happy customer), Ambience saw 80% clinician utilization and an NPS of 60, both the highest by a wide margin.
  • Ambience Co-Founder Nikhil Buduma told us that the secret sauce is the platform’s ability to make clinicians feel like “it’s almost reading their minds,” which is made possible by continuous fine-tuning the model for individual specialties.

Where do we go from here? If the launch of Doximity’s free scribe taught us anything, it’s that documentation is officially a commodity. Ambience’s new funds will help it do everything else.

  • That includes diving deeper into the revenue cycle and clinical trials, as well as moving upstream into taking care of patients outside of the four walls of the clinic.
  • It also includes scaling up operations, and Ambience has already begun hiring dozens of former startup founders to lead its new verticals.

The Takeaway

We’re now in a world where perfect transcripts are table stakes, which means the winners of the ambient AI race will be the companies that can help carry the tasks happening after the clinical conversation. Ambience just bulked up to do some heavy lifting.

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