AI for better care: Revolutionizing the healthcare industry
Discover 6 ways artificial intelligence is helping make health care work smarter, plus what employers should look for in a carrier.
Healthcare systems worldwide are grappling with rising costs, clinician burnout, staffing shortages and fragmented care delivery. In the U.S. alone, health spending reached $4.9T in 2025, yet inefficiencies persist across the board.1
Enter artificial intelligence (AI) — technology designed to think, learn and solve programs like humans, helping reshape how care is delivered, accessed and experienced. In fact, the use of AI in health care is projected to grow from $37B in 2025 to $614B market by 2034.2
For employers, this transformation is more than a technological evolution — it’s a strategic opportunity to improve employee health and future-proof benefits programs.
“AI has the potential to help solve some of the challenges faced by the healthcare industry, specifically the complexity of navigating the system,” explains Jean-François Beaulé, executive vice president of design and innovation for UnitedHealthcare Employer & Individual.
“Making health care more affordable can start by removing inefficiencies. Working toward a transformational experience requires simplifying and speeding up the time it takes members to get answers about accessing and managing their benefits.”
Beaulé emphasizes that leveraging AI must be done responsibly and with careful consideration. “It’s not about removing human oversight; it’s about automating processes to provide pertinent information and data analysis faster which can free up time for more human interaction,” he says. This approach can support providers in delivering care, help employers develop health care strategies tailored to their workforce and give members with quicker answers to benefit questions.
Health care is deeply personal and often complex. That’s why employers, brokers and consultants should do their due diligence and select a carrier that adheres to high standards, with strict guidelines and policies to ensure AI is developed and implemented in ways that protect the quality and safety of health care services.
“Advancements in AI are already being applied in health care. Without the proper infrastructure and oversight in place, it’s like owning a race car but driving on roads with speed bumps every 5 miles,” says Beaulé. “If we want to ensure AI is being used fairly, ethically and as intended, we have to think of transformative applications — not just how quickly we can bring it to market. For us, that also includes a rigorous review process, an expert review board and constant human oversight.”
“AI has the potential to help solve some of the challenges faced by the healthcare industry, specifically the complexity of navigating the system.”
Understanding the many types of AI
From content creation to streamlining everyday tasks, AI has opened a world of possibilities. Here are the key variations:
Artificial intelligence (AI): Enables machines to mimic human behavior
Machine learning (ML): A type of AI which uses statistical methods to help machines improve with experience
Deep learning: A type of ML that interprets multi-layer neural networks across large, complex datasets
Conversational AI: A type of deep learning capable of understanding, processing and responding to human language in a natural, back-and-forth dialogue
Generative AI: A type of deep learning capable of generating new content to address broad task requests
Agentic AI: A type of deep learning and generative AI capable of autonomous decision-making
Ambient AI: A type of ML that “listens” to conversations and observes environments to perform tasks like scribing clinical notes
6 ways AI is making health care work smarter
AI innovations are setting new standards for smarter, more connected health care experiences. When combined with human oversight, AI has the potential to transform the industry in these areas:
1. Disease prediction
AI can help identify the sickest or highest risk individuals and support providers in taking the best course of action in a timely manner. Algorithms analyze evidence-based data to detect markers of undiagnosed conditions or increased risk. Clinicians then review predictions and recommend appropriate interventions. It’s important to note that AI does not replace clinical judgment, it supports it.
2. Care coordination
AI can help coordinate information sharing across providers and carriers, creating a more holistic view of an individual’s coverage, medical history and care preferences. This can help enable providers or advocates to navigate those individuals to the most appropriate care or next-best action — sometimes even helping to surface services based on what members in similar situations have benefitted from.
3. Simpler navigation
By factoring in a member’s health care journey, coverage and personal priorities, AI can enable more timely prompts, prioritized search results and relevant options that help them navigate the health system. This can work to reduce confusion, improve benefit understanding and support more informed choices that may result in improved health outcomes, lower costs and better overall health care experiences.
4. Quicker issue resolution
Conversational AI-powered chat tools help members get answers to questions about coverage, costs and general inquiries. When integrated into tools used by providers, Advocates, brokers, consultants and employers, AI can offer greater visibility into member benefits and potential issues they may be experiencing. This can lead to faster, more informed and personalized resolutions — and can reduce the time employers, brokers or consultants spend addressing employee concerns.
5. More personalized support
When members help with specific or complex questions, AI can be used to help understand the general reason for the call and route them to the appropriate department for live support. In some cases, AI can also recommend resources and services that may be relevant to the member’s unique care journey. This helps reduce the number of steps and people a member interacts with to get the care and support they need.
6. Streamlined processes
One of the biggest friction points in health care is the time it takes to move from point A to point B. AI can help streamline processes by prioritizing prescription refill requests, flagging claims with missing or inaccurate information; generating report summaries, automating manual data entry and more. These efficiencies benefit everyone — members, providers, carriers, brokers, consultants and employers.
Potential ROI to employers
- Lower costs through earlier diagnoses and interventions, reduced administrative burden and increased productivity as healthier employees tend to take fewer sick days and stay more engaged at work
- Improved employee retention as workers experience a better health benefits journey — easier navigation and access to care, clearer cost and coverage information, timely personalized support and more coordinated care
What to look for in a carrier
Understanding how a carrier uses AI is important in helping ensure employees receive a best-in-class health benefits experience — and that AI is deployed ethically and responsibly. Here are key questions to ask when evaluating carriers:
- How is AI being used to simplify and personalize members’ health care experience?
- What safeguards are in place to protect member data and ensure AI is being used ethically and responsibly?
- How is AI streamlining tasks related to benefits enrollment, administration and management?
- How is AI supporting clinicians and health care professionals without it making decisions for them?
- How is AI speeding up claims processing, and what human oversight ensures claims aren't decided solely by AI?
- How does a carrier compare to competitors in its use of AI and the standards it upholds for responsible implementation?
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