AI can perform care represented in 16% to 22% of U.S. outpatient claims, according to an analysis from McKinsey & Co. That work accounts for 13% to 19% of outpatient spending.
The Sept. 28 analysis of 2024 commercial, Medicare and Medicaid claims found that roughly 2 billion to 3 billion outpatient claims involve services clinical AI could potentially perform. McKinsey calls this category “discursive care,” meaning reasoning- and dialogue-based work such as intake, triage, diagnosis, referrals and follow-up that doesn’t require a hands-on exam.
Evaluation and management visits involving no additional care, or only low-complexity care, made up 11% to 15% of outpatient claims and 8% to 12% of spending. Interpretation of diagnostic or imaging results accounted for 5% to 7% of both claims and spending.
Physician offices, clinics, virtual settings and urgent care are likely to see the largest share of AI-driven change, the authors said.
The analysis also estimates that AI can perform a substantial portion of core tasks for 11 million of 19 million healthcare workers. McKinsey said it does not expect the overall workforce to shrink because it projects net demand for care to rise.
Fee-for-service providers risk losing low-acuity visit volume. Organizations in value-based arrangements could use AI to improve their care management economics. McKinsey said payers stand to gain more than providers as AI becomes the patient’s “front door” to care.
The authors also flagged deskilling as a risk. Clinicians who lean on AI without deliberate practice could lose the ability to perform those tasks on their own.
