How Do AI Agents Work?
A Guide for Healthcare Professionals
Artificial intelligence (AI) is no longer just a futuristic concept—it’s actively transforming healthcare as we know it. From optimizing clinical workflows to enhancing revenue cycle management, AI is paving the way for more efficient and accessible care. One of the most advanced developments in this space is Agentic AI—an intricate system of specialized AI agents that work together to automate complex tasks, analyze vast amounts of data, and assist in decision-making.
But how do these AI agents work, and what does this mean for healthcare professionals? Let’s dive in.
Understanding AI in Healthcare
AI has been around for decades, helping with everyday tasks like GPS navigation, auto-complete, and voice transcription. In healthcare, AI already plays a role in:
- Clinical decision support tools that assist providers in diagnosing and treating patients.
- Automated scheduling systems that optimize appointment management.
- Medical device monitoring that ensures equipment functions correctly.
- Revenue cycle management (RCM) tools that flag claim errors and automate workflows.
Recent advancements in machine learning have fueled a new wave of AI-driven solutions, including Generative AI (GenAI), which can create text, images, and insights from vast datasets. But the latest breakthrough—Agentic AI—is taking things even further.
What Is Agentic AI?
Agentic AI works by breaking complex tasks into smaller, specialized jobs that different AI “agents” handle independently. Think of it like a hospital team:
- The Manager (AI Coordinator): Like a doctor overseeing patient care, this AI assigns tasks to the right specialists.
- Agents: These are like nurses, pharmacists, or billing specialists—each handling a specific function.
The AI team gathers all the important details and presents them in a clear, easy-to-use way for providers. They can ask questions in plain language and get instant, actionable insights. Plus, the AI gets smarter over time, learning from real-world use to provide even better recommendations.
How AI Agents Work in Healthcare
Let’s explore a real-world example of Agentic AI in action.
Scenario: Determining Prior Authorization Requirements
A healthcare provider needs to determine which services require prior authorization for a patient visit. Here’s how Agentic AI handles this task:
- The provider asks, “Which services for this patient’s visit need prior authorization?”
- The Manager (AI Coordinator) activates relevant agents to tackle the request.
- The Encounter Agent retrieves patient visit details, including planned procedures and prescriptions.
- The Patient Agent gathers demographics and insurance coverage specifics.
- The Contract Analyzer Agent scans payer contracts to identify relevant coverage details and authorization requirements.
- The Manager (AI Coordinator) compiles all this information into a clear and concise response for the provider.
This process, which could traditionally take hours by human staff, is completed almost instantly, reducing delays and improving efficiency.
Where AI Agents Are Making an Impact
Agentic AI is already being used to enhance several areas in healthcare. Here are some examples of ways agentic AI can improve healthcare.
Clinical Operations
Make your work easier with a tool that automatically organizes treatment plans and guides care decisions. It helps ensure patients get the right tests and treatments based on their medical history and the latest best practices—like reminding a doctor to order a necessary test for a diabetic patient or suggesting the right antibiotic based on a patient’s allergies.
Administrative Workflows
Improve scheduling by ensuring the right staff are in the right place at the right time, reducing delays and preventing burnout. Plus, keep your clinic stocked by automating supply orders, so you never run out of essential items like gloves, medications, or equipment.
Population Health Management
Spot patients who may need extra care, ensuring they don’t fall through the cracks. You can also track health trends across your community, helping you improve patient outcomes and succeed in value-based care programs.
Revenue Cycle Management (RCM)
Make billing easier with automated tools that reduce claim denials and speed up payments. Get instant insights into insurance contracts to avoid compliance issues and lost revenue. Plus, improve coding accuracy to lower audit risks and keep your practice running smoothly.
Implementing AI Responsibly
Before adopting AI agents in healthcare, you must consider:
- Data security and compliance: Ensure AI tools meet HIPAA and other regulatory requirements.
- Human oversight: AI should assist—not replace—healthcare providers, with final decisions made by humans.
- Patient transparency: Inform patients how AI is being used in their care.
- Organizational buy-in: Train staff to integrate AI into workflows effectively.
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The Future of AI in Healthcare
As Agentic AI continues to evolve, it will play a key role in reducing administrative burdens, improving patient outcomes, and making healthcare more efficient. By understanding how AI agents work and implementing them responsibly, providers can harness the full potential of this technology.
Want to learn more? Download our whitepaper for an in-depth look at AI-powered solutions in healthcare.
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