AI Strategy: Can AI Rescue US Healthcare from a Gathering Storm?
US healthcare is entering what McKinsey calls a "gathering storm 2.0." After a 200 bps drop in EBITDA from 2019-2024, providers face another ~100 bps squeeze by 2027. Federal deficit pressure, new legislation, and shifting geopolitical priorities are pushing healthcare spend into the spotlight. A NATO move to take defense spending to 5% of GDP adds more weight to an already tight federal budget.
The policy squeeze
The One Big Beautiful Bill Act (July 2025) removes US$1 trillion from federal healthcare over the next decade. Expect tighter eligibility for Medicaid and ACA marketplaces. Site-neutral payment policies could compress hospital outpatient rates, and broader tariffs on medical supplies are pushing costs up.
The message is clear: traditional margin levers won't cover what's coming. Leadership teams need bolder operating changes with measurable run-rate impact.
Where AI creates near-term relief
McKinsey estimates AI, automation, and redesigned care models could deliver 9%-15% of national health expenditure in productivity gains. That's big enough to offset the headwinds if executed well.
- Providers: Automate prior authorizations, clinical documentation, and coding to lift gross revenue by 11%-17%. Target the admin backlog first-it's fast to implement and easy to measure.
- Payers: AI-driven care management can cut medical costs by 5%-11%. Claims and member services automation adds 13%-25% in admin savings.
- Pharma: Early data suggests 30%-50% lower clinical development costs from AI-enabled design, site selection, and trial execution.
Move care where it costs less
Shifting procedures from hospitals to ambulatory surgery centers (ASCs) is one of the fastest routes to structural savings. Nearly half of hospital outpatient surgical cases could move to ASCs with the right contracting and scheduling model. CMS has proposed adding 547 procedures to the ASC covered list for 2026-momentum is real.
See CMS guidance on ASC payment
Two agendas, one crisis
- Defensive (now): Tighten cost controls, refinance debt, exit underperforming assets, and lock in supply savings. Prioritize units with weak case mix or persistent negative contribution margin.
- Transformative (next): Embed AI into revenue cycle, care delivery, and service operations. Personalize patient engagement. Scale care models that push volume to lower-cost sites without losing quality.
The current labor shortage is a hidden advantage. With more vacancies than applicants, automation fills gaps instead of replacing people. Use it to reduce burnout and improve throughput.
90-day action plan
- Map the admin workload: Identify top 10 processes by volume and cycle time (prior auth, documentation, coding, claims edits). Build a simple backlog with owners and target outcomes.
- Pilot 2-3 AI workflows: Start with ambient clinical notes, automated prior auth drafting, and coding suggestions. Set guardrails and human review from day one.
- Realign sites of care: Create ASC-eligible case lists by surgeon and payer. Recontract and redesign scheduling to move volume within 60-90 days.
- Stand up an AI operating model: Small cross-functional pod (clinical, IT, RevCycle, compliance). Weekly releases, monthly value tracking, and a backlog that lives in finance.
- Measure hard results: Denial rate, days in A/R, note completion time, prior auth turnaround, OR utilization, care plan adherence. Publish the scorecard.
Guardrails you'll need
- Data and privacy: HIPAA-compliant workflows, minimum necessary data, and clear PHI handling. Keep audit trails.
- Clinical safety: Human-in-the-loop for any AI influencing clinical decisions. Bias testing and documented model limits.
- Revenue integrity: Coding and prior auth outputs reviewed by credentialed staff until quality is proven.
- Vendor control: Business associate agreements, model transparency, uptime SLAs, and exit clauses.
- Cybersecurity: Segmented environments, API monitoring, and regular red-team tests.
What this means for providers, payers, and pharma
- Providers: Treat admin automation as a core service line. Move eligible cases to ASCs without losing surgeon loyalty-align incentives and block time.
- Payers: Use AI care management to reduce avoidable utilization, then reinvest savings into member experience and provider collaboration.
- Pharma: Focus AI on protocol optimization, site selection, and faster data cleaning. Partner with systems that can enroll and track patients across settings.
Bottom line
There's no external rescue coming. Policy pressure and inflation are structural, not temporary. But the math supports decisive action: AI, automation, and site-of-care shifts can more than cover the margin gap if you start now and measure every step.
If you're upskilling teams to execute this agenda, explore role-based programs here: AI courses by job.
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