Englander Institute for Precision Medicine

Catalyzing Health AI by Fixing Payment Systems.

TitleCatalyzing Health AI by Fixing Payment Systems.
Publication TypeJournal Article
Year of Publication2025
AuthorsRazavian N, Batchu-Green P, Chowdhry V, Elemento O, Rajpurkar P, Saria S, Shah NH, Topol EJ
JournalNEJM AI
Volume2
Issue12
Date Published2025 Dec
ISSN2836-9386
Abstract

Despite rapid advances in artificial intelligence (AI) across sectors, health care remains one of the least transformed domains. This stagnation is not due to lack of data, clinical need, or innovation, but rather to persistent regulatory and economic misalignment. Even AI tools cleared by the U.S. Food and Drug Administration that meet clinical efficacy standards often face major barriers to adoption, largely driven by outdated reimbursement frameworks and fragmented incentives among stakeholders. The result is a systemic failure to deploy technologies that could meaningfully reduce clinician workload, shorten wait times, and improve patient lives. In this article, we examine the reimbursement landscape for health AI, focusing first on tools that fit existing regulatory pathways, outlining payment barriers and proposing policy reforms. These include resolving Current Procedural Terminology adoption bottlenecks, addressing integration overhead, and aligning pricing models with AI cost structures. We then extend the discussion to the emerging domain of generative AI in health care, highlighting the urgent need for prospective regulatory frameworks to ensure patient benefits. (Funded by the National Institutes of Health and the Leukemia and Lymphoma Society.).

DOI10.1056/aipc2500871
Alternate JournalNEJM AI
PubMed ID41695240
PubMed Central IDPMC12900248
Grant ListUM1 TR004407 / TR / NCATS NIH HHS / United States
U24 CA264032 / CA / NCI NIH HHS / United States
R01 AG079175 / AG / NIA NIH HHS / United States
UL1 TR002384 / TR / NCATS NIH HHS / United States
OT2 OD032720 / OD / NIH HHS / United States
R01 AG085617 / AG / NIA NIH HHS / United States

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