In our last post, we explored the upcoming Medicaid spending cuts and the unprecedented margin pressure they will create for health systems. The old playbook of simple belt-tightening won’t be enough to counteract these changes. To thrive in this new reality, leaders must turn to a more powerful, precise, and proactive solution: artificial intelligence.
By embedding AI and automation directly into core workflows, health systems can reclaim millions in lost revenue and create much-needed capacity—all without reducing essential services.
Here is a detailed operational framework with five AI-driven tactics that health systems can stand up fast to protect their margins and preserve access to care.
1. Automated Discharge Orchestration
The Challenge: Inpatient capacity is a persistent and costly challenge. Inpatient beds are often at capacity, creating upstream bottlenecks in the emergency department and PACU. Reducing length of stay by discharging patients on time can reduce this bottleneck, but overburdened staff struggle to align on a discharge plan, and even when a plan is in place care teams must spend hours digging through patient charts, calling and paging providers, and frantically coordinating with therapy, imaging and consult teams to avoid discharge delays.
The AI Play: AI-powered solutions, like Qventus’ Inpatient Capacity Solution, can automate and orchestrate the entire discharge process. Qventus’s solution uses machine learning models, locally trained on your hospital’s specific patient and care patterns, to set aggressive yet achievable estimated discharge dates (EDDs) and dispositions from the first morning of admission. Our AI teammates continuously pressure-test the discharge plan, identify opportunities for earlier discharge, and optimize the use of ancillary services to resolve bottlenecks before they occur.
The Impact: Health systems using this approach have reduced excess days by up to 30%, leading to increased patient volume, more revenue, and lower ED boarding rates as patients flow through the system more efficiently. Take a look at the results OhioHealth and Jackson Health System have achieved with Qventus’ Inpatient Capacity Solution.
2. Optimizing Operating Room Utilization
The Challenge: The operating room is a hospital’s primary revenue engine, yet over 30% of valuable OR time often goes unused. Manual scheduling processes, poor visibility to open time, and first-come, first-served booking inefficiencies mean ORs sit empty, high-value cases don’t get prioritized, and costly robotic assets are underutilized.
The AI Play: Deploy an AI-powered surgical growth solution that intelligently manages and markets OR time. Qventus’s Surgical Growth Solution predicts with high confidence which blocks are unlikely to be used up to a month in advance and uses personalized nudges to encourage surgeons to release that time. Then, it automatically markets that newly available time to surgeons who are the best fit based on the health system’s strategic goals, such as growing a specific service line or maximizing robotics use.
The Impact: Health systems using the solution add 3+ strategic cases per OR each month, increase robotic case volume by over 10%, and see, on average, an 11X ROI. For more details, read these case studies: Allina Health, Ardent Health, UHealth Miami
3. Predictive Risk Stratification for Surgical Patients
The Challenge: Last-minute surgery cancellations are a major source of wasted OR time and lost revenue. PAT teams are bogged down by manual processes, piles of paperwork, and administrative tasks that leave little time for pre-op care. These Inefficient, manual PAT processes waste valuable nurse resources and lead to patients who are not optimized for surgery.
The AI Play: Use AI and machine learning to continuously stratify patients by risk throughout their perioperative journey. Qventus’s Perioperative Care Coordination Solution flags patient-specific risks based on EHR data, chart notes, and even patient conversations. This allows care teams to proactively identify at-risk patients and connect them with the necessary optimization programs, ensuring they are ready for surgery and reducing the likelihood of last-minute cancellations.
The Impact: By flagging at-risk patients earlier, health systems can reduce 72-hour surgery cancellations by up to 40%, preventing millions in lost revenue and improving patient outcomes.
4. The AI-Powered Digital Patient Concierge
The Challenge: The pre- and post-surgical journey is often fragmented and confusing for patients, leading to no-shows, readmissions, and poor experiences. Staff spend countless hours on manual outreach, answering repetitive questions and chasing down information.
The AI Play: Deploy an AI assistant that serves as a 24/7 digital concierge for patients. This AI teammate can contact patients via voice, text, or email to gather intake information, coordinate appointments, provide pre-operative instructions, and answer questions. This patient concierge supports PAT staff so they can spend their time on high-risk patients who need the most support, ensuring all patients are optimized before surgery.
The Impact: This not only boosts staff productivity by up to 50% but also helps prevent no-shows and costly readmissions by keeping patients engaged and informed throughout their care journey.
5. Continuous Performance Feedback and Insights
The Challenge: Driving sustainable change across large, complex care teams is difficult. Leaders often lack the real-time visibility needed to identify bottlenecks and keep teams on track with new initiatives.
The AI Play: Leverage AI to provide predictive and real-time insights that drive behavioral change. Qventus’s platform provides leaders with relevant insights into operational performance, from OR utilization to discharge delays. It can identify the most impactful actions leaders and frontline staff can take to improve throughput and then deliver personalized nudges to prompt those actions at the right time.
The Impact: This creates a culture of continuous improvement, empowering teams with the data they need to make smarter, faster decisions that directly impact the bottom line and patient care.
Conclusion: Your AI Teammates are Ready to Deploy
Increased margin pressures as a result of the coming Medicaid reductions represents a fundamental shift in the healthcare economy. Meeting this challenge requires more than incremental improvements; it demands a transformation in how hospitals operate. The AI-driven plays outlined above are not futuristic concepts – they are practical, proven solutions that can be deployed quickly to deliver a significant and sustainable impact.
By automating workflows, empowering staff, and providing predictive insights, AI is the most effective tool health systems have to protect their margins, preserve access to care, and fulfill their mission in an increasingly challenging environment.
Ready to see these AI plays in action? Schedule a demo.
