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AI Reality vs Expectations, Behavioral Health Gaps, and Death by a Thousand Vendors
April 20, 2026
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Together with
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“At the end of the day, we all share the same goals in healthcare. If something’s technologically possible that’s great, but if we aren’t leveraging the technology to improve the actual healthcare experience then we’re not getting after those bigger picture goals.”
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athenahealth VP of Government and Regulatory Affairs Joe Ganley
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AI promised less friction and lower administrative costs, but a new report from the Peterson Health Technology Institute suggests that it might actually be delivering the exact opposite.
The report stems from a stakeholder workshop that PHTI held to uncover AI’s impact on two of healthcare’s most hotly debated administrative processes: prior authorization and medical coding.
The main finding highlights an obvious predicament. Speeding up flawed processes doesn’t make them any less expensive. PHTI didn’t pin the blame on either side of the AI arms race.
- It found that payors are (mostly) using AI responsibly. They’re accelerating PA reviews and auto-approving more clean cases, while simultaneously improving code validation and risk adjustment – although the DOJ would probably disagree.
- Providers are also using their AI superpowers for good. They’re automating the PA workflows driving burnout and streamlining the coding processes that take clinician time away from patients.
That almost sounds like it should create some efficiency. The problem is that it’s the system that’s broken, and AI doesn’t fix the underlying issues.
- The report pointed out how AI tools for providers caused an uptick in billing intensity, which payors naturally responded to with across-the-board downcoding and other reimbursement reductions.
- AI might also reduce the cost for individual orgs to execute or appeal prior auths, but it won’t impact costs for the overall system if nothing gets passed on to patients.
- PHTI believes this makes reimbursement policy the strongest lever that can realistically be pulled to slash system-level spending.
Follow the incentives. Or in this case, the lack thereof.
- On paper, payors and providers should be competing for a finite pool of patients in an arena that rewards better products with smaller price tags. If AI cuts costs, providers would be able to bill less and payors could lower premiums.
Efficiency doesn’t translate to deflation. Payors or providers are rational market actors, and if AI can streamline a process that lets them hold onto more of their revenue, then that’s exactly what they’ll do.
The Takeaway
Bots arguing with bots might be faster than humans arguing with humans, but PHTI doesn’t see that eliminating friction from the overall system if nobody has any incentivize to make it happen.
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Abridge Named #1 Best in KLAS – Again
KLAS just named Abridge #1 Best in KLAS for Ambient AI for the second year in a row. The recognition was based on direct customer feedback from the nation’s largest and most complex health systems, which gave Abridge the highest overall satisfaction score and A+ ratings across Culture, Loyalty, Relationship, and Value. Discover why Abridge is the market-leading AI platform for clinical conversations.
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Privia Accelerates VBC Success With Navina
How do you give physicians new AI tools to accelerate VBC without slowing them down? Privia Health found its answer with Navina. They co-designed an under-one-hour training program that onboarded 800+ clinicians in the first year, driving 87% weekly active usage while providing clearer visibility into their patient panels. Read the full case study to see what it takes to make adoption stick and outcomes follow.
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- Death by a Thousand Vendors: Over 40% of employers now manage eight or more digital health vendors, and 60% are spending upwards of $2.5M per year to do it. That’s the big takeaway from a Solera survey of 106 HR leaders at orgs with 1k+ employees, which found that 80% need over five hours every week to manage their health vendors, while over a quarter need 11 hrs/wk for reporting, employee comms, and troubleshooting the programs. That’s prompted 70% of orgs to engage outside consultants to support their health benefit ecosystem, and three-quarters invest $100k annually in third-party assistance.
- Abridge Adds NEJM & JAMA: Abridge locked in multi-year content partnerships with NEJM Group (of NEJM fame) and the American Medical Association, which is spinning a lot of plates including JAMA and 11 specialty journals. The partnerships will deepen Abridge’s clinical decision support capabilities, which let clinicians ask questions and receive information grounded in both peer-reviewed research and patient context – during the clinical conversation when it’s most valuable. The CDS solution is already available with insights from Wolters Kluwer’s UpToDate, and it sounds like the new content will be up and running in the coming months.
- Behavioral Health Gap Widens: Trilliant Health’s just-released 2026 Behavioral Health Report showed that the patient volume for behavioral health-related medications surged 20% from 2018 to 2024, yet the treatment gap has only gotten wider. Prescriptions for stimulants (53%) and antipsychotics (45%) led the pack, and it was interesting to see that the share of scripts written by NPs and PAs jumped from 20.7% to 34.3% during the same period. Over a fifth of patients with anxiety or depression (22.4%) didn’t receive treatment in 2024 (up from 19.0% in 2018), and Trilliant expects patient demand to exceed clinical supply by nearly 37k psychiatrists in 2038.
- Assort Moves Into Dermatology: Assort Health is bringing its AI agents to dermatology, one of “the most operationally demanding specialties” in healthcare. Dermatology appointments run the gamut from Botox to melanoma, and schedulers frequently have to interpret symptom descriptions that aren’t much better than “a weird spot” or “a bump” to determine whether a patient needs a cosmetic consult or same-day biopsy. Assort’s specialty-trained voice AI agents are ready to help manage that at scale after helping early partners like MDCS Dermatology increase appointment volume by over 29% in two years.
- LLMs Aren’t Doctors: A new study in JAMA Network Open provided the latest confirmation that AI is improving at the science of medicine, but it still can’t replicate the art of seeing a new patient. MGB researchers introduced a new PrIME-LLM framework to score the clinical reasoning of 21 leading LLMs models on their full diagnostic process instead of just the final answer. While every model nailed the final diagnosis over 60% of the time, none managed to produce the right differential diagnosis in more than 6 of the 29 test cases.
- Omada Muscle Math: Omada released results from a 12-week study that added to the growing body of evidence showing wraparound support is more than a “nice to have” for GLP-1s. Members in Omada’s GLP-1 Care Track, which supports the meds with tailored programming that emphasizes activity and strength, lost nearly double the total body weight (6.0% vs. 3.3% of starting weight) and 2.1x more body fat than those not on the specialized track. This is one of the first studies in the space that analyzes body composition instead of just weight, and Omada’s members that preserved (or even improved) muscle mass will be the first to tell you that not all weight loss is created equal.
- Walmart Expands Better Care Services: In other GLP-1 news, Walmart is expanding its Better Care Services platform with new offerings for patients on the weight loss meds. Better Care Services brings together virtual care, nutrition services, and pharmacy access in a single experience enabled by its growing partner roster. The latest additions include Aaptive (fitness app), Berry Street (nutrition therapy), Curai Health (AI-driven self-guided care), MyCare by Twin Health (insights into how food, sleep, and activity affect the body), and Wheel (full-service virtual weight management care).
- Patients Reject Doc Grading Criteria: Clinicians shouldn’t be graded on how many of their patients attend screening exams like mammography. That’s according to 1.9k patients surveyed in a JAMA Health Forum study that assessed whether screening should be a performance metric for grading physicians. Just over half (51%) said doctors shouldn’t be scored on how many of their patients got screened, while 21% said that they should be. Screening rates have been proposed as a metric to encourage guideline-concordant care, and it seems like most patients would oppose the proposal.
- Direct-to-Patient Guardrails: With more pharma companies launching direct-to-patient platforms on what seems like a weekly basis, the Digital Medicine Society kicked off a new initiative to help establish a foundation to ensure they can operate safely. Optimizing Direct-to-Patient Strategies for Pharma is a cross-sector effort that brings together pharma companies, digital pharmacies, and virtual-first providers like Wheel and Welldoc to build a shared blueprint for scaling DTP models responsibly. Welldoc’s chief AI officer told Fierce that the initiative has concrete objectives to “tame the Wild West before it becomes the Wild West.”
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State of Payor Enrollment and Credentialing
AI is changing the way that healthcare leaders tackle provider network management. Medallion’s latest report breaks down the biggest challenges, emerging trends, and how automation is transforming the landscape. Get the insights you need – read the full report today.
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Improving GLP-1 Treatment for the Long Term
Looking to make GLP-1 prescribing safer and more effective long term? Explore Withings’ suite of remote patient monitoring devices, designed to deliver the continuous, clinically relevant insights that care teams need to proactively monitor patients, identify risks early, and intervene with confidence.
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- Virtual-First, Local Always: The humans of healthcare can get lost in the background at conferences full of robo-docs and AI assistants, but deep personal connections are just as key as new technologies for driving better outcomes. Find out how Ovatient is keeping care “virtual-first, local always” in Digital Health Wire’s rapid-fire interview from the ViVE exhibit hall.
- The AI Hardware Built for Clinical Work: Phones were never meant to be propped on a desk for a 12-hour clinical day. Heidi Remote transcribes patient sessions offline, stores them securely on-device, and syncs to Heidi whenever you’re in range. Just clip on and get to work with the Heidi Remote.
- Shape Health AI at DHAI 2026: Mark your calendars. The Digital Health & AI Innovation Summit is bringing together AI leaders from across the industry for a live event in Boston on June 8-9th. This year’s agenda is packed with 150+ speakers and content curated specifically for the pioneers shaping health AI. Reserve your spot for DHAI 2026 today.
- Unlock Accurate Transcription With Medical Mode: Unlocking accurate transcription of even the most complex medical terminology is now as easy as adding a single line of code. AssemblyAI’s new Medical Mode eliminates errors on the words that matter most – medicine names, dosages, and clinical diagnoses – so that you can ship solutions that perform when accuracy isn’t optional. Start building with Medical Mode today.
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