The new B2B?

AI’s efficiency pitch in healthcare, meet: the industry’s misaligned incentives. ICYMI, a new analysis from Blue Cross Blue Shield Association found that AI coding tools added roughly $942M in spending between 2023 and 2025, pointing to more hospital encounters being coded at higher levels of complexity and a rise in secondary diagnoses. Meanwhile, payers are bringing their own AI to the table, using the technology to streamline prior authorization and claims review.

The back-and-forth between providers and payers already has consequences for people waiting on care. According to recent research from The Commonwealth Fund, about one in five working-age adults with private insurance said they or a family member had a doctor-recommended service denied by their insurer in the past year. And among those who experienced a denial, 41% said it delayed care. Nearly a third said a health problem worsened as a result.

So what does this increasingly common “bot-to-bot” dynamic mean for patients? More complete coding could push healthcare spending higher, with the potential to eventually show up in premiums and out-of-pocket costs. More automated scrutiny from payers could counter some of that spending, but it could also add another layer to an already burdensome claims process. If providers get better at capturing reimbursement while payers get better at challenging it, patients may find themselves caught in a faster-paced version of the same old exchange. While these tools may save staff time for the organizations deploying them, there’s still ample opportunity to apply AI toward the end of improving the patient experience.

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