As healthcare organizations face rising pressures from labor shortages, financial constraints, and the shift to value-based care, technology is stepping in to help. One of the most important developments is agentic AI, a new form of intelligent automation that goes well beyond rules-based workflows and traditional process automation.
A recent Forrester article calls agentic AI “a new era of intelligent automation” that promises to improve resilience, reduce operational friction, and unlock new efficiencies across the healthcare system. At Productive Edge, we see this shift as not just promising, but essential for both payers and providers.
Agentic AI is fundamentally different from robotic process automation (RPA) or static analytics dashboards. These systems are designed as intelligent digital agents that can observe their environment, interpret data, make recommendations, and, in limited and controlled cases, take action without requiring human intervention.
This type of automation is particularly useful in healthcare, where numerous processes are complex and interdependent. For example, an agent handling discharge coordination doesn’t just send instructions. It can also initiate referrals, confirm follow-up appointments, check for care gaps, and monitor patient compliance.
Agentic AI is not a future concept. It’s already being used across healthcare operations, including:
Care Management: Agents help verify eligibility, update care plans, and identify gaps in real-time.
Revenue Cycle Management: From claims submissions to denial resolution, agents can handle repetitive tasks while adapting to changing rules and conditions.
Patient Engagement: Systems are utilizing multi-agent models to manage outreach, enhance medication adherence, and close care gaps.
Utilization Review: Agents can analyze clinical records, suggest next steps, and support concurrent review processes to reduce delays.
Many of these solutions are built on a composable architecture that connects with EHRs, CRMs, and cloud data systems, making adoption and integration much more feasible than in years past.
For payer and provider leaders, agentic AI is a strategic tool. It can accelerate digital transformation without requiring a complete system overhaul. The key is to start where automation has the most significant impact, such as discharge workflows, pre-authorizations, or claim escalations.
“Agentic AI enables a new class of digital agents that actively collaborate with clinicians, care teams, and back-office operations,” said Raheel Retiwalla, Chief Strategy Officer at Productive Edge. “This is not just about automating tasks. It’s about giving your organization the ability to move faster and with more confidence.”
This isn’t just a conversation for technical teams. Business leaders should focus on defining clear outcomes, such as improved throughput, enhanced patient experiences, or reduced administrative burden. Agentic systems can then be trained to pursue those goals.
A phased approach is best:
Assess high-friction areas where intelligent agents can provide quick wins.
Design and Pilot with measurable KPIs and integration plans.
Scale across service lines, ensuring compliance and interoperability.
With support for standards like HL7 and FHIR, and growing confidence in AI governance models, the path is more apparent than ever.
At Productive Edge, we’re helping healthcare organizations move beyond the hype and build agentic systems that solve real problems today.