How Modern Healthcare Organizations Are Using AI Agents to Unlock Workflow Efficiencies and Deliver Care-Critical Insights

Learn how Zelis is deploying AI agents with Snowflake Intelligence, immediately democratizing healthcare fintech insights and dramatically reducing data team workloads.

For a wealth of good reasons, the healthcare industry is investing heavily in AI. It’s actually leading in AI adoption compared to other markets in the economy — changing the industry’s reputation as a technology laggard. 

After years of struggles, shortfalls and staffing challenges, providers — for example, leading organizations such as the Mayo Clinic — have turned to the technology with urgency to help address everything from staff burnout to ever-shrinking margins. Private insurers facing constrained premium growth and rising medical costs due to higher care utilization and inflation rates, are also adopting AI to help alleviate their challenges. While healthtech companies are leveraging it to accelerate product innovation and improve go-to-market strategies. But often these investments are pilots or one-off solutions. While they are achieving impactful results, their outcomes and data insights are limited to one part of the business. 

The increasing agentic imperative

Healthcare leaders are realizing that an orchestrated system of AI intelligence is essential to unlocking widespread efficiencies and innovations. Such a system is a strategic shift that enables healthcare payers, providers, systems, public health and tech organizations to deliver the full scope of efficiencies, insights and innovation required in today’s highly complex healthcare environment. They are focusing on agentic AI to aid in everything from reducing costs and meeting mandates (such as value-based care from CMS) to accelerating decision-making and preemptively detecting fraud. 

Using agentic AI in these ways is just the tip of the iceberg for the industry. It’s not only transforming how tasks are organized and completed, but is driving an entirely new operating model.

The industry’s core enterprise agent workflows

Enterprise agents can help with myriad use cases across the health ecosystem. Below are a handful of the top priorities for the industry today. 

1. Clinical documentation and decision support: Agents can free up clinicians to spend more valuable time with patients instead of completing paperwork by transcribing clinical notes, and checking documents for errors and inconsistencies. They can also flag potential health issues for high-risk patients. For example, an agent could continuously monitor a patient, across EHR and Social Determinants of Health (SDoH) data, pharmacy fills and glucose monitors, to identify risk patterns -– not just a one-time event — allowing the physician to make an appropriate intervention faster.

2. Value-based care and population health management: Enterprise agents can operationalize value-based care at scale by orchestrating care pathways, predicting risks, measuring health outcomes and ensuring patients participate in preventive care. This can result in improved patient outcomes, lower total cost of care and stronger alignment across the entire ecosystem. 

   Agents can also play a powerful role in managing population health in value-based care models. With access to critical health data across the organization, enterprise agents enable healthcare providers, health systems and public health agencies to proactively manage population health by acting as continuous risk monitors, care coordinators and workflow accelerators across large patient panels. Healthcare organizations can then more effectively and quickly identify risks across thousands or millions of patients, allowing them to close care gaps, prioritize interventions and reduce avoidable utilizations.

3. Revenue cycle management and administrative operations: Agents for this use case deliver high ROI by taking on low-risk automation and decision-making tasks. For example, they can conduct medical coding, manage claims processes, and intelligently schedule appointments (such as optimizing appointment slots). This may lead to faster reimbursements, lower administrative costs and fewer denied claims.

4. Hospital and health system operations: AI agents can optimize and streamline hospital and health system operations by acting as real-time coordinators, forecasters and workflow engines across clinical, operational and financial domains, for example, improving patient flow and capacity management.

   Hospitals and health systems are complex organizations with tight margins, variable demand, staffing shortages and fragmented data. AI agents help organizations move from reactive to predictive management, continuously improving operational efficiency and processes.

Agents that are trusted, auditable and efficient

Grounded in Snowflake’s secure, interoperable platform, Snowflake Intelligence puts actionable intelligence in the hands of every business user. By quickly analyzing and extracting context and insights from the organization’s vast stores of multimodal valuable data across existing systems (such as EHRs and RCM platforms), dashboards and documents, insights are delivered to users across departments, teams and organizations. 

Using natural language, it empowers nontechnical teams to access critical health, financial and operational data to make more informed business decisions. With Snowflake Intelligence, there is no need to replace systems. The technology leverages Snowflake’s platform to bring data from disparate systems together for optimal interoperability.

Healthcare organizations can confidently use agents for a variety of workflows with Snowflake Intelligence, because the technology enables:

• Quick, deep analysis: Healthcare organizations can quickly move beyond the “what” behind data to comprehensively understand the “why.” With a rich semantic layer — or translation layer that sits between complex, raw data and the people or agents who need to use it — in place, users are empowered with knowledge that can improve decision-making at scale.

• Explainable and auditable answers: Snowflake agents provide traceable actions and answers for every answer they generate. By providing the sources of answers and the lineage of data, agents provide the reliability and transparency healthcare organizations need for regulatory compliance and operational and clinical peace of mind — verifying “golden responses” every time.

• Built-in trust and governance: Built on Horizon’s enterprise-grade governance and security framework, Snowflake Intelligence:

  Protects data, apps and models with built-in encryption, unified role-based access control (RBAC), attribute-based access control (ABAC), monitoring and network policies implementation. This supports PHI protection across the organizations and regulatory compliance with HIPAA, CMS, FDA and other regulations.

  Protects sensitive data in multimodal formats with auto-classification, tagging and protection. 

  Visualizes the end-to-end flow of all data — including external data sets — and understands relationships with lineage.

It also provides healthcare organizations an enterprise intelligence layer that:

• Supports agent orchestration within established clinical and compliance governance frameworks.

• Is compatible with leading AI solutions and enables AI agents to find, understand and query data assets.

• Scales across regions and clouds, allowing healthcare organizations to connect and analyze data between providers, payers, public health agencies and more, in alignment with local regulatory requirements. 

Customer spotlight: Zelis accelerates near real-time insights with Snowflake Intelligence

Zelis is a leading healthcare financial technology company on a mission to modernize the healthcare experience for payers, providers and consumers. Their ultimate goal is to create a "digital payments and information highway" for the industry, focusing on accuracy, efficiency and reducing administrative and financial burden. 

But, to realize its mission, Zelis faced a crucial challenge: a high demand for immediate insights, which required an evolution from batch data processing to near-real-time data ingestion for true AI readiness.

To solve this challenge, Zelis partnered with Snowflake, migrating its entire data foundation from SQL Server to the Snowflake AI Data Cloud for Healthcare & Life Sciences. This transition laid the groundwork for their AI-driven strategy. Their new unified data foundation leverages several key Snowflake technologies, in addition to the AI Data Cloud, to ensure near real-time data access and enterprise-grade governance:

• Openflow ingestion framework: Now Zelis’ preferred tool, it ingests near real-time data from over 40 sources into Snowflake, a key step in their move away from batch processing.

• Horizon catalog: Provides essential enterprise security and governance capabilities, including categorization (supporting compliance with HIPAA and other regulations), anonymization and access controls to quickly enable users with high-velocity data.

• Snowconvert AI: This tool accelerates the migration of any remaining legacy workloads to Snowflake, enabling a complete, modern data environment.

The impact of Snowflake Intelligence Agents for Zelis

With its data foundation in place on Snowflake’s unified, governed platform, Zelis deployed Snowflake enterprise agents, transforming its operations and team capacity.  Agents now provide near real-time answers to questions, democratizing data insights across the organization and significantly reducing demand on the core data team. They have also streamlined workflows and reduced reliance on routine data requests. 

Zelis’ results with Snowflake Intelligence demonstrate significant gains in speed, scale and strategic focus:

• 20+ production agents are now deployed with Snowflake Intelligence.

• The data team’s efficiency has soared, creating impactful proof-of-concept (POC) agents in just one day and moving them into full production two days later.

• This performance has successfully scaled insight delivery to hundreds of users across the company.
• The transition has elevated the role of analysts from manual curators to high-value strategists.

The next wave of technology transformation is well underway in the healthcare industry. Organizations across the ecosystem — from payers and providers to healthtech companies and public health agencies — are rapidly evolving how and where they use AI. Leaders are adopting enterprise agents, fundamentally changing how they operate and leverage data insights — allowing them to more free up precious time and resources to focus on providing and ensuring the highest quality of care for patients. 

Want to see Snowflake Intelligence in action? Watch our Reimagining Cost of Care Management with Snowflake Intelligence demo.