Provider Use of AI in Healthcare

October 2025

Authors

Joe Dorocak, ASA, MAAA

Director, Enterprise Business Intelligence

Medical Mutual

Don McLellan, ASA, MAAA

Senior Director Healthcare Economics

Cleveland Clinic

Executive Summary

Artificial intelligence is rapidly transforming healthcare delivery, and actuaries are uniquely positioned to guide its responsible and impactful adoption. This report highlights how AI technologies—ranging from predictive analytics to generative and agentic AI—are being used by leading health systems to improve patient outcomes, streamline operations, and reduce costs. Use cases such as patient risk stratification, hospital throughput optimization, and prescriptive analytics demonstrate how AI can enhance decision-making and resource allocation. These models rely heavily on actuarial principles: data integrity, model explainability, and risk segmentation. Actuaries can play a critical role in validating these models, ensuring fairness, and aligning them with business objectives in value-based care arrangements.

As AI systems become more autonomous and complex, actuaries would significantly benefit from expanding their influence beyond traditional forecasting and cost modeling. The rise of agentic AI introduces new dimensions of risk—ethical, operational, and regulatory—that call for actuarial oversight. Actuaries are well-equipped to contribute to model governance, bias mitigation, and scenario planning, especially as synthetic data and digital twinning reshape the data landscape. The report lays out some opportunities for actuaries to embrace collaboration across payer-provider boundaries, advocate for transparency, and help build trust in AI-driven healthcare. By doing so, actuaries can elevate their role from technical experts to strategic partners in shaping the future of healthcare.

Material

Provider Use of AI in Healthcare

Acknowledgements

The researchers’ deepest gratitude goes to those without whose efforts this project could not have come to fruition: the Project Oversight Group for their diligent work overseeing, reviewing and editing this report for accuracy and relevance.

Project Oversight Group:

Ken Avner, FSA, MAAA

K. Beth Baker, FSA, MAAA

Joan Barrett, FSA, MAAA

Greg Fann, FSA, FCA, MAAA

Prashant Nayak, ASA, MAAA

David Schraub, FSA, MAAA, CERA, ACA

Sudha Shenoy, FSA, MAAA, CERA

Norman Storwick, FSA, MAAA

David Wierz, MBA

At the Society of Actuaries Research Institute:

Achilles Natsis, FSA, MAAA, FHLI, Health Research Actuary

Barbara Scott, Senior Research Administrator

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