The healthcare industry's adoption of artificial intelligence remains surprisingly low despite its transformative potential, with only 19% of medical providers and 12% of dental providers currently utilizing AI technologies, according to recent data from the CAQH Index.
Erin Weber, MS, chief policy and research officer at CAQH, emphasizes that standardization and cross-industry collaboration are critical to expanding AI's role in healthcare beyond its current limited applications in administrative tasks.
"Standardization is essential, and I live and breathe this every day. AI can't work well if it's built on inconsistent or messy data," Weber stated in an interview with The American Journal of Managed Care® (AJMC®). "We need common formats, rules, and processes to ensure the underlying data are usable across different systems."
Current State of AI Adoption in Healthcare
Despite significant media attention and investment in healthcare AI, implementation remains in early stages for most organizations. The limited adoption is attributed to several key barriers, including concerns about data privacy, potential algorithmic bias, implementation costs, and questions about return on investment.
When AI is being used, it's primarily focused on administrative functions rather than clinical applications. This cautious approach reflects the industry's recognition of both AI's potential and its risks.
"Providers are understandably cautious when it comes to AI; so am I," Weber noted. "Concerns about data, privacy, bias, and costs are all valid, but beyond that, there's often a disconnect between what AI tools are designed to do and what providers actually need in their daily workflows."
Priority Areas for Expansion
Weber identifies several high-friction areas that should be prioritized for AI integration:
- Eligibility verification
- Prior authorization processes
- Claims correction and processing
These administrative functions represent significant pain points for providers, payers, and patients alike. Automating these processes through AI could reduce administrative burden, decrease costs, and improve patient access to care.
"If we can automate these processes using AI, we can reduce that administrative burden, save time, and, ideally, help patients access care more quickly and efficiently," Weber explained.
The Critical Role of Data Standardization
For AI to function effectively across healthcare systems, standardization of data and processes is non-negotiable. Initiatives like CAQH Core are working to establish consistent, industry-wide requirements that support interoperability and scalable innovation.
Weber emphasizes that the focus should shift from mere data availability to data usability—ensuring that information can generate meaningful insights and actionable recommendations across different AI platforms and healthcare settings.
Stakeholder Collaboration as a Foundation for Success
The expansion of AI in healthcare cannot be achieved by any single entity. Weber highlights the necessity of collaboration between providers, health plans, and technology partners to develop solutions that address real-world needs.
"When providers and health plans collaborate early, sharing data or insights, they can co-develop AI tools that improve the entire revenue cycle rather than just fixing individual pain points," Weber said. "This kind of partnership builds trust and ensures that the AI solutions align with both clinical workflows and payment processes."
The Role of Policymakers and Researchers
Policymakers have a critical responsibility in establishing clear guardrails for AI implementation, including enforceable standards for data privacy, security, and fairness. These frameworks help build the trust necessary for broader adoption.
"Policymakers can really set the guardrails, creating clear, enforceable standards for data privacy, security, and fairness," Weber stated. "They can also provide funding or incentives to help smaller practices, rule providers, and those underserved and under-resourced organizations to help them access and implement these technologies."
Researchers play an equally important role in measuring effectiveness, identifying potential biases, and developing strategies to improve AI tools over time. Their work ensures that AI implementation is evidence-based and delivers measurable benefits.
"Researchers also have a critical role in measuring what works, identifying where bias creeps in, and developing strategies to improve AI tools over time," Weber added. "The last thing we want to do is start adopting technology that has no proven ROI [return on investment]."
A Vision for the Future
Looking ahead, Weber envisions a future for AI in healthcare built on three foundational elements: collaboration, trust, and usability. Achieving this vision requires investment in strong data standards, public-private partnerships, and designing tools with input from frontline stakeholders.
"If we do this right, I'm hopeful AI won't replace people; it will empower them," Weber concluded. "It will simplify the complexity of our system so that every stakeholder, from the clinician to the patient, can really focus on what matters most, which is better care."
As the healthcare industry continues to navigate the complexities of AI implementation, the emphasis on standardization, collaboration, and thoughtful integration offers a promising path forward—one that could ultimately transform administrative burdens into opportunities for enhanced care delivery and improved patient outcomes.
