In 2024, less than 1% of enterprise software applications included agentic AI in 2024, but usage is expected to surge to 33% by 2028. A healthcare AI agent is an AI system or program that autonomously performs tasks for a human or another agent. They are not considered just chatbots, automation systems, and digital employees. AI agents are given autonomy for completing tasks, are capable of working without human input, and can improve performance based on outcomes.
AI agents have begun to emerge in front- and back-office operations, especially within administrative workflows like insurance capture and verification; benefits identification and out-of-pocket cost estimation; inbound referral processing; medical necessity pre-qualification for prior authorization; indexing inbound documents; payer correspondence letters; prescription refill request processing; and lab requisition forms. For the healthcare industry, this goes well beyond standard AI, especially since public-facing models are trained on limited or biased data and are limited to what data they can access, which typically includes information like healthcare records, EHR systems, and prescriptions. They also face policy and regulatory barriers that usually involve HIPAA compliance.
In 2024, three in five (or 66%) of physicians said they used AI. But where does AI create the most value for healthcare organizations? For many, it would be in streamlining administrative tasks through automation. That’s why healthcare providers are embracing AI agents in healthcare to transform the “backend” operations of healthcare.
For example, an autonomous insurance verification agent extracts and interprets data from insurance cards, referral orders, and requisition forms. This allows the AI agent to instantly identify payers and verify benefits in real time from card images. It makes it easier for AI agents to detect coordination of benefits and carve-outs as well as estimate patient out-of-pocket costs. All of this leads to overall time and cost savings.
An enhanced benefit verification agent uses payer portals and AI voice calls to identify service-specific requirements, enabling it to bridge gaps that traditional verification misses while leading to fewer denials due to incomplete or missing data. An AI agent is further able to identify provider network status and authorization requirements.
An insurance discovery agent can find hidden payment coverages using only patient demographics with no insurance card or additional information required. This makes it possible to quickly overturn denials tied to missing or incorrect coverage, maximize revenue capture, and eliminate manual insurance searches and patient calls.
A prior authorization automation agent fully automates the prior authorization process from medical necessity checks to submission before tracking its real-time status across payers. This process eliminates payer guideline spreadsheets so organizations can stay current without the need for manual tracking while speeding up processing times and cutting costs from staff retraining.
A document processing workflow automation agent can read, understand, and act on a wide variety of documents, from medical notes and referrals to payer correspondence, without making human employees waste more time. This agent can streamline document processing, eliminate manual efforts to validate information, and reduce manual data entry while boosting data accuracy along with accessibility.
The use of AI agents to help with these processes can lead to a better quality of life and reduce administrative burdens for provider groups, health systems, and ambulatory services. In fact, organizations have already seen more than a 20% increase in revenue through increased productivity along with more than 50 hours saved through providers using AI-powered document processing automations weekly. They have also achieved cost savings of 40% to 70% by deploying specialized AI agents as well as reduced referral processing time from 24 hours to 24 seconds. Furthermore, patients can experience better outcomes from the use of AI agents, such as faster diagnoses, customized treatment plans, more time spent with dedicated healthcare staff, and increased patient satisfaction through improved overall experience.
Currently, 71% of healthcare workers believe agentic AI will be vital to healthcare in the next five years. AI agents are expected to transform healthcare, an industry that has been continuously challenged by labor shortages and administrative overload. But what will it take to fully integrate AI agents into the healthcare industry?
83% of healthcare professionals think AI agents can be better embraced in the industry if they help healthcare workers spend less time on administrative tasks and ensure staff can do their jobs more efficiently. 79% highlight AI solutions that provide access to reliable data, 77% highlight solutions that make AI easy to use, and 73% highlight solutions that come with proper training as well as those that offer trustworthy, accurate outputs.
With AI agents, healthcare workers save time, money, and labor that can instead be used to improve patient care.
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