The following is a guest article by Amy Oliver, Founder & Healthcare Growth Connector at Azul Heart
This year felt different. Not less ambitious. Not less innovative. Just…optimistically serious in a prove-it-to-me-way.
And as I reflected on what all has transpired since February 2025, a few things stood out.
The Margin Reality
First, the administration passed legislation that significantly tightened (read: gutted) Medicaid reimbursements. Whether you refer to it as the “big beautiful bill” or something else, the reality is the same: when reimbursements tighten, everything shifts. Rural hospitals and safety net organizations feel it first. And gradually, the financial pressure means a dark cloud looms over nearly every technology conversation.
Second, the margin conversation has become unavoidable. Inflation didn’t miraculously reset, tariffs disrupted the global economy, and workforce costs didn’t normalize. Boards are asking harder questions, and CFOs are sharpening their already-very-sharp pencils. The bar isn’t, “Is this innovative?” It’s “Show me the operational impact and the hard ROI.”
And of course, third: it’s still all about AI. But AI isn’t the shiny object anymore… it’s a core part of infrastructure. And when something moves from “cool demo!” to “core functionality,” the implications touch everything: workflows, governance, rural access, cybersecurity, staffing models, revenue cycles, and even how health systems define growth.
From “Theatrical Innovation” to Intelligent Systems
In the intelligent health system session with leading health systems SSM Health, Encompass Health, and Inova; no one debated whether AI belongs in health systems. The conversation was about what makes a health system intelligent, and how everything needs to shift (including mentality, approach, systems, workflows, and even “spaghetti!”) to support the intelligence.
I heard a new-to-me phrase, “theatrical innovation,” and what a great description for solutions that don’t do much other than look pretty and shiny (or, alternative phrase: smoke and mirrors).
Rusty Yeager from Encompass talked about systems that can sense and respond, not just report. He described their mantra: standardize the process, automate the process, get data at scale, then scale the business. Because of that discipline and leadership, they can stand up a new hospital in 8-12 months and have it operate just like the other 170+ locations: same KPIs and same performance expectations. Flashy innovation has its place. At its core, intelligence is smart, repeatable execution.
There was also talk about standardization as consistency. Matt shared how their approach means patients receive the same predictable experience, regardless of where they enter Inova. Saad from SSM talked about positioning organizations at a foundational level to take advantage of what the industry doesn’t even know is coming next.
If 2025 was about what AI could do, 2026 is about what it has actually delivered, and which organizations will redesign care because of it.
From Efficiency to Expansion
The numbers I’ve heard recently aren’t theoretical. Patient outreach programs that historically converted in the single digits are now seeing engagement rates close to 30% using AI. A dietitian screening platform finds patients at-risk for malnutrition, leading to an increase in diagnoses of 39% and reducing length of stay. Another system increased patient contact volume so dramatically that they had to hire additional staff. Not because AI replaced humans, but because it unlocked demand that had been sitting dormant.
AI in 2026 means documenting the visit and finding the patients who never scheduled their visits.
There’s still discussion about time savings for clinicians, and that remains critical, but the conversation has expanded beyond efficiency into system capacity. It’s about reaching more patients without proportionally increasing staffing, and identifying care gaps that previously went unnoticed or were simply too under-resourced to close.
On another panel, we heard about a heat wave in New York last summer. A Medicare Advantage plan used AI agents to call 16,000 members during the hottest hours of the day, assess risk, and arrange transportation to cooling centers. Manually, that would have required thousands of people and millions of dollars. Instead, it created proactive outreach capacity at scale that would have been impossible to staff manually.
That’s not just cost avoidance; it’s proactive outreach at scale, addressing social determinants of health, and reaching patients who otherwise might have ended up in an ER. Gold medals all around, continuing the Olympic theme from John and Colin’s latest Healthcare IT Today pod!
Dr. Sarah Matt writes in The Borderless Healthcare Revolution that care is no longer confined by buildings or geography. Sixteen thousand outbound calls in four hours is exactly what borderless care looks like.
Inside the patient visit, ambient technology is moving beyond documentation. Real-time context from the record can surface care gaps or flag prior authorizations before patients even leave the room. Instead of “we’ll let you know,” it becomes “we already checked.” Resolving these tasks in the moment improves experience, supports outcomes, and protects revenue.
Earlier in the week, a CIO noted that for decades, hospital revenue growth and operating expense have moved almost in perfect correlation: add a billion in revenue, add a billion in cost. That equation has felt immovable. AI, implemented intentionally, may finally give organizations a lever to bend that curve.
Governance is Not Optional
Expansion brings risk.
I had lunch with a Bluebird Leader friend who works with a governance and risk platform, essentially AI monitoring AI. It sounds abstract (even “meta?!”) until you think through the questions it raises: Which AI tools are actually being used? Which are underutilized because training (whether LLM or staff) wasn’t sufficient? Which are being used in ways they shouldn’t be, introducing privacy exposure or compliance risk?
If AI is infrastructure, organizations need visibility into their AI ecosystem: what’s embedded, what’s shadow IT, what’s redundant, and what’s flat-out risky.
And it’s not just internal governance. Washington D.C. has entered the chat.
I met someone from HHS and joked, “Pretty quiet in DC these days, huh?”
As AI moves from documentation support to direct patient interaction, the legal exposure shifts. When AI advises a patient, triages risk, or recommends follow-up, the liability question isn’t theoretical anymore. Provider organizations, hopefully along with their vendor partners, are thinking about both innovation and protection.
That’s why the work from the CHIME policy team matters, and the team reiterated how important industry self-governance is. Clear principles around safety, transparency, data protection, and provider accountability are the difference between responsible scale and reactive regulation.
States are drafting approaches, and federal conversations are evolving. If the industry doesn’t define the guardrails thoughtfully, someone else will.
Brains Before Bots
As organizations bring these lessons back home, there will be temptation to layer AI onto yesterday’s processes and call it transformation. That’s incremental.
Real redesign challenges staffing models, rethinks call center strategy, reshapes internal teams, and questions whether “next best action” is enough when multiple actions can be completed in a single interaction. Governance must mature, leadership teams will think bigger, and creative operating models must evolve just as quickly as the technology.
Everything, from compliance to care delivery to internal culture, must keep pace.
As Rusty Yeager, the 2025 CHIME CIO of the Year, said during the panel, “You cannot outsource your brain.”
I ran into him later that evening and we laughed about how he wanted to land on something strong and memorable. It worked, and his line stuck.
AI can expand reach. It can close care gaps. It can reduce friction and bend curves. But judgment, accountability, and responsibility remain human work.
The brain still belongs to us.
Less Theater and More Throughput
This was my fourth ViVE. The first year, I mostly moved from session to session, absorbing as much as I could, wondering why everyone was so busy and what they were building and debating. This year, I found myself in fewer sessions and more conversations: hallway chats, quick lunches, exhibit hall walks, late-night reflections and ideas. The shift just wasn’t just in the industry. It was in me.
The ideas are still big. The connections are still bigger. But the expectation now is execution. And to me, that feels like the real revolution: less theater, more throughput.
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