Harnessing Data and AI to Reimagine Healthcare Economics

Shared insights from Dr. Jigar Patel, M.D., FAMIA, Chief Medical Officer & Chief Product Officer, Claritev

Healthcare providers today face unprecedented financial headwinds. From shrinking government reimbursements to an aging population and persistent administrative burdens, the economics of care delivery are under strain.

On September 11, Modern Healthcare held a virtual briefing on Turning Insights into Impact: How Analytics Reshape Healthcare Economics that featured our own Dr. Jigar Patel, M.D., FAMIA, Chief Medical Officer & Chief Product Officer. He outlined how providers can rethink strategy through the lens of data and analytics.

The economics problem

“The incentives in healthcare are fundamentally misaligned,” Dr. Patel said. Providers operate in a high-cost, low-margin business while navigating regulatory complexity and demographic pressures. Consolidation has been one response, as smaller organizations seek the scale of larger systems. Yet without new approaches, financial distress and workforce strain will persist.

The AI advantage

Looking ahead, Patel sees cloud infrastructure, data science and artificial intelligence as essential enablers. Predictive AI (machine learning, deep learning) has long delivered efficiencies, while generative AI offers new ways to simplify complexity and improve patient engagement.

“The question isn’t just when to use AI,” he explained, “but also when not to. Sometimes a simple deterministic rule is the best answer. The real opportunity is balancing the advanced with the practical.”

The role of data

Dr. Patel highlighted how digitization has unlocked vast troves of structured and unstructured data. Federal mandates now make more than 500 billion machine-readable reimbursement records available, creating unprecedented transparency. What providers need is a way to:

Benchmark reimbursements against peers and competitors
Identify surprising pricing disparities
Strengthen payer negotiations with hard evidence
Detect and prevent revenue leakage

“Data transforms negotiations from speculation into strategy,” Dr. Patel noted. “Providers no longer have to guess what they should be paid.”

The bottom line

For providers, financial sustainability depends on more than cutting costs. It requires aligning economics, technology and patient engagement. With platforms like CompleteVue, Claritev helps organizations harness the power of data to achieve healthier margins while staying true to their mission.