Health system leaders on AI, affordability and the payer squeeze

On paper, an independent primary care physician and the CEO of an 18-hospital system don’t have much in common. Put them in the same conversation about payers, and the difference dissipates.

Chief Healthcare Executive, a sister publication of Medical Economics, is launching “The Roundtable,” an exclusive peer-to-peer discussion series that brings health system executives and clinical leaders together for on-the-record conversations, without prepared remarks, about the forces reshaping the industry.

This discussion is the series’ first installment.

Patients caught in the middle

Levy, a thoracic medical oncologist who says he is in clinic two to three days a week, kept the conversation grounded in the exam room.

He described Johns Hopkins’ contract fight with an insurer as “a collision of excessive prior authorizations, frequent treatment denials, administrative burdens and delayed payments.” It ended without an agreement, and patients he had followed for years could no longer see him.

Garrett, Hackensack Meridian’s CEO, described a contract dispute at the system last year in which the insurer’s notification letters interrupted cancer care for hundreds of patients mid-treatment, even though the contract was ultimately resolved.

Bhatt, a cardiologist who directs Mount Sinai’s Fuster Heart Hospital, argued the pattern should not be tolerated. “I don’t think putting patients in the middle of that is the right thing to do,” he said, calling for greater regulation at the state or federal level.

Beiner, Northwell’s chief operating officer, picked up Bhatt’s framing. Leverage in payer talks once came from size, he said, which is why large integrated networks grew up to match the insurers. He no longer thinks it works that way, and said leverage now rests on public and political rhetoric.

Northwell operates on a 1% margin by choice, Beiner said, because the alternative is not showing up for the communities it serves. He argued providers should stop being shy about saying so.

The staffing math will be familiar to anyone running a practice. Levy said the group that helps his patients get oral oncology drugs covered — appeals, co-pay problems, calls to insurers — has grown to five people. He said he cannot function without them.

Bhatt drew the line on administrative burden where most physicians would: nobody complains about work that helps a patient, but prior authorization paperwork is, as he put it, “designed to impede care.”

Levy said Johns Hopkins has seen a 30% to 40% spike in patient portal messages since artificial intelligence (AI) tools reached patients, and that answering them now consumes roughly 20% of his administrative time outside clinic.

Where AI is paying off

Beiner framed the stakes for technology bluntly. “Innovation will be either an ingredient of the answer to the affordability challenge or a threat to our traditional business model,” he said.

The panel put numbers on the table rather than promises. Garrett said Erin, an AI voice agent that calls discharged patients within 72 hours, has placed more than 40,000 calls since September and cut readmissions by 11%.

Levy said AI scheduling improved his infusion center’s efficiency by 10% to 15% in six months, and described chart-flagging that matches patients to clinical trials by tumor type and genetic marker. On trust, he said he tells patients outright when he is consulting an AI platform on a difficult case.

Garrett said transparency about a tool’s limits is what gets clinicians to adopt it.

The Roundtable’s inaugural discussion is a 10-part series, with a new episode posting each week through the end of August. The videos are free, though registration is required. The first three episodes are live now:

• Introductions and the one burning issue for our leaders
• A ‘perfect storm’ of change, and AI’s emergence
• The financial squeeze: Prevention, affordability and care beyond the hospital

All 10 segments will be available on Chief Healthcare Executive’s Roundtable show page.