AI agents in healthcare are increasingly becoming a vital part of healthcare operations with experts predicting their usage to reach 33% by 2028. A healthcare AI agent is a software program that manages complex workflows for users in healthcare settings. They are considered more than just automation systems, digital employees, and chatbots. They have the autonomy to complete tasks without the need of human assistance and can improve performance based on results. Let’s explore the rise of AI agents, particularly in healthcare below.
The Rise of AI Agents
AI agents are increasingly being applied to front- and back-office operations, with a strong focus on administrative workflows. These include benefits identification and out-of-pocket cost estimation; inbound referral processing; insurance capture and verification; prior authorization submission and status verification; medical necessity pre-qualification for prior authorization; inbound document indexing; lab requisition forms; and prescription refill request processing. This evolution goes far beyond what standard AI can deliver considering that public-facing models are often constrained by limited or biased data and restricted access to healthcare-specific information such as patient records and EHR systems. Adoption also comes with strict policy and regulatory requirements, particularly HIPAA compliance.
Last year, about 66% of physicians acknowledged the use of AI automation in their operations, which is mostly used to address administrative challenges. Today, several healthcare organizations are adopting AI agents to transform the operational and technical systems that support patient care.
Examples of AI Agents in Healthcare
One example is the use of autonomous insurance verification agents that collect and analyze data from multiple sources such as referral orders and requisition forms so that payers are instantly identified and verified for benefits on the spot using only card images. These agents can also detect coordination of benefits and estimate patient out-of-pocket expenses, leading to better time and cost savings.
Another example is the enhanced benefit verification agents that leverage payer portals and AI calls to identify service-specific requirements, filling in gaps traditional verification can sometimes overlook and reduce denials caused by incomplete or unavailable data. They can even determine provider network status and other authorization requirements. Insurance discovery agents can detect hidden payment coverages with just the use of a patient’s demographics even if insurance card or additional info is not available, leading to quick overturns of denials related to incorrect coverage while removing the need for manual insurance searches and patient calls while maximizing revenue.
Prior authorization automation agents streamline the entire authorization process, from verifying medical necessity to submission. They monitor the real-time status with payers, which removes the burden of tracking payer guidelines manually using spreadsheets, accelerates processing times, and reduces costs tied to staff retraining due to shifting payer rules.
Document processing workflow automation agents are capable of reading, interpreting, and executing actions on various document types, including referrals and medical notes. Automating these tasks leads to reduced burden on the staff, less need for manual data entry, improved accuracy, and better data accessibility.
By creating more efficient workflows, AI agents ease the administrative load on health systems, provider groups, and ambulatory services while boosting efficiency and financial performance. In fact, some organizations have reported revenue growth exceeding 20% due to increased productivity and more than 50 hours saved per week with AI-powered document processing. Deploying specialized agents have additionally led to cost reductions of 40-70% and significantly shortened referral processing times from hours to mere seconds. Patients benefit as well, with faster diagnoses, tailored treatments, increased time spent with care teams, and higher satisfaction thanks to a smoother patient experience.
More than 70% of healthcare workers think AI agents will play a critical role in the industry within the next few years. With healthcare facing persistent challenges from workforce shortages and heavy administrative demands, AI agents have great potential to drive meaningful change. However, the pathway to widespread implementation is still riddled with challenges.
For 83% of healthcare workers, AI agents gain value when they cut down administrative work and improve staff efficiency. 79% believe AI agents that provide reliable data access are what is needed while 77% think ease of use is important and 73% consider solutions that come with training and accurate results are critical for wider adoption.
Conclusion
AI agents are capable of unlocking savings, increasing revenue growth, and giving healthcare teams the time that can be used to provide better patient care and results.
Source: Orbit Healthcare
