The US healthcare system spends over $1 trillion annually on administrative costs. Much of this burden stems from knowledge work: tasks that focus on problem-solving, decision-making, and generating new ideas or insights. From prior authorizations to drug discovery, these workflows are not only expensive but also mentally taxing for clinicians and staff.
Agentic AI offers a breakthrough — intelligent automation that acts independently, learns over time, and adapts to changing conditions. Unlike other mature (and older) automation technology, these agents can automate complex workflows such as utilization management and compliance documentation by retrieving, transforming, and enriching data from diverse sources like clinical records, emails, and claims history. Their ability to reason, plan, and take goal-directed action across systems positions them as a transformative force in healthcare.
What This Means For The Healthcare Industry
Agentic AI is ushering in a new era for healthcare by enabling systems that can act autonomously, monitoring performance, making decisions, and initiating actions without constant human input and oversight. By taking over routine, repetitive tasks, it frees healthcare staff to focus on higher-order thinking, clinical judgment, and patient-centered care. When human empathy and expertise are combined with AI’s analytical power, healthcare organizations (HCOs) can create a more responsive, efficient, and intelligent system of care. This shift will take shape in many forms across the ecosystem:
Health systems will leverage smarter workflows and expect better outcomes. For healthcare providers, agentic AI can reduce clinician and staff workload by managing complex workflows autonomously. By offloading time-consuming administrative tasks, agentic AI gives clinicians and administrators more time to focus on strategic, high-impact work. For example, Jorie AI improves revenue cycle operations by automatically routing denials: It monitors claims, classifies denial reasons, tags them, and assigns them to the correct queue with supporting documentation — without human intervention.
Insurers will drive faster, more accurate decisions and improve operational scalability. Health insurers will look for AI agents that can autonomously flag anomalies in claims, detect fraud, and ensure compliance in real time. These systems should also streamline prior authorization and member engagement processes. Companies like Autonomize AI are already reporting up to 55% time savings.
Employers’ expectations for savings will grow. As health insurers adopt agentic AI to boost operational efficiency, employers will look for them to pass those savings on to consumers. Employers will also expect more personalized, proactive engagement models for their employees. Employers and their benefit partners can look to use agentic tools to analyze utilization patterns and uncover additional opportunities for cost savings in plan design.
Consumers will gravitate toward health navigation tools. Consumers will expect smarter virtual assistants that guide them through plan selection, help manage claims, and offer real-time health insights leveraging their data. Naaya’s Claims Advocate tool replaces the manual denials process and empowers members to tackle a major source of frustration — one that often leads to overturned decisions but previously demanded extensive manual effort.
Pharma will accelerate drug discovery and streamline regulatory processes. Pharmaceutical companies can use agentic AI to accelerate product development, regulatory navigation, and drug discovery by autonomously analyzing vast datasets and identifying promising compounds. Tools like Writer’s FDA guidance agent are already helping teams interpret complex policies in real time.
Proceed With Innovation — And Caution
While the potential is vast, agentic AI also brings risks—unintended outcomes, unpredictable behavior, and safety concerns. Failures could lead to legal, reputational, or patient harm, making safeguards like emergency shutdowns, human oversight, and fallback mechanisms essential. HCOs must be disciplined and deliberate with AI-related experiments.
In their journey to leverage cloud as a strategic engine driving transformation, become intelligent organizations, and adopt agentic AI, HCOs should start with low-risk, high-impact workflows and use simulation tools to validate agent behavior. Like new hires, agents must be trained, supervised, and gradually granted autonomy. Though agentic AI won’t replace entire processes overnight, it will augment human capabilities and unlock new efficiencies — one workflow at a time. This is more than automation; it’s a paradigm shift toward sustainable transformation in healthcare.
Take The Next Step
The shift to agentic AI is already underway, and HCOs that act now will shape the future. For a deeper dive into how agentic AI can revolutionize your HCO, Forrester clients can schedule an inquiry or guidance session to dig deeper and learn how to implement agentic AI effectively and stay ahead in the AI revolution.
