Agentic AI becomes a top 2026 priority for providers and insurers
Health systems and health plans are moving from pilots to scale. Most leaders see agentic AI as a direct lever for patient experience, clinical decision support, and workforce relief-not just back-office automation.
The data
- 85% of technology executives at health systems and insurers plan to boost investment in agentic AI over the next 2-3 years.
- 61% already have initiatives in build or implementation.
Where agentic AI is showing value
- Patient and member engagement: Humana is rolling out an agentic AI tool that helps staff respond to member inquiries faster and more accurately by summarizing calls and anticipating needs-such as flagging members who need help with coverage and benefit explanations.
- Clinical decision support from the record: Stanford Health Care is piloting agentic AI to analyze EHRs and surface relevant evidence for a physician's treatment decision, without requiring a manual search.
- Workforce operations: Sentara Health is automating nursing workflows like clinical documentation, saving thousands of nursing hours across its facilities in just months.
Why it matters now
Scaling generative and agentic AI is a top strategic priority this year for health systems and health plans-second only to managing regulatory and policy changes, per a December 2025 Deloitte survey.
- 98% of executives expect at least 10% savings within 2-3 years.
- 37% project savings above 20% in that same window.
What this means for your organization
Returns will vary. Large enterprises have an advantage in data, capital, and integration capacity. Smaller organizations can still win by focusing on targeted, high-yield use cases and partnering wisely.
As agentic AI shifts into strategic, proactive decision-making, you'll need clear business cases, disciplined vendor selection, and strong governance to protect patients, clinicians, and the enterprise.
A practical rollout playbook
- Pick 2-3 high-value use cases tied to measurable outcomes (e.g., reduce documentation time, cut average handle time, improve gap-closure rates).
- Ready your data: define sources, PHI handling, consent, and access rules. Map data lineage for auditability.
- Stand up governance: human-in-the-loop checkpoints, clinical safety review, bias testing, incident response, and model change control.
- Vet vendors on security (HIPAA, SOC 2), EHR and contact center integrations, token/compute costs, monitoring, and provenance.
- Design for workflow: integrate into the EHR inbox, care management tools, or agent desktops-no extra clicks.
- Train the workforce on prompts, escalation paths, and accountability. Clarify what the AI can and cannot do.
- Measure relentlessly: baseline, pilot, A/B test, then scale. Tie savings to budget lines, not just slideware.
Metrics that signal you're on track
- Cycle-time reductions (prior auth, care management outreach, benefits resolution)
- Clinical documentation time per encounter and after-hours charting
- First-contact resolution and average handle time for member calls
- EHR retrieval/search time and relevance of surfaced evidence
- Gap closure and readmission reductions attributable to proactive outreach
- Cost per case/encounter, nurse hours returned to care, and staff satisfaction
Common pitfalls to avoid
- Starting with diffuse, low-impact pilots that don't touch patient or member outcomes
- Over-customizing models before proving value with smaller, iterative deployments
- Ignoring integration-agents that live outside core workflows rarely get adopted
- Weak guardrails: no audit trails, unclear escalation, or unchecked prompt injections
- Scaling without governance, leading to inconsistent outputs and compliance risk
Bottom line
Agentic AI is moving front and center for providers and insurers. The winners will pair clear use cases with disciplined execution-secure data, tight workflows, measurable outcomes, and governance that earns clinician and member trust.
Looking to go deeper on practical implementations and governance? Explore AI for Healthcare and AI for Executives & Strategy for curated playbooks and training.
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