As hospitals expand their use of AI, Children’s Nebraska’s CIO is concerned that rising usage-based costs could eventually force physicians to weigh the expense of using the technology against the needs of their patients.
Ryan Cameron, executive vice president and chief information and innovation officer at Omaha, Neb.-based Children’s Nebraska, told Becker’s that hospitals need to rethink how they manage AI spending as more tools adopt consumption-based pricing.
While some AI applications charge fixed licensing fees, others bill organizations based on tokens, units used to measure AI processing. That creates uncertainty for hospitals trying to predict technology spending as adoption grows.
For Dr. Cameron, the concern extends beyond the bill itself.
“My job is to support the organization. The organization supports patients,” he said.
He said clinicians should not have to determine which patient encounters justify the cost of using an AI tool.
“They all are,” he said.
Who should own the AI bill?
Dr. Cameron cautioned against making the CIO or IT department solely responsible for keeping AI spending within budget.
Instead, he believes responsibility should be shared across clinical, operational, technology, finance and governance teams.
Clinicians should assess whether a tool improves care or reduces administrative burdens. Operational leaders should evaluate whether it produces the intended results, while IT teams focus on infrastructure efficiency and security. Finance and governance leaders should help determine whether investments are sustainable.
“If you haven’t done your AI governance homework, if you haven’t set up your policies, if you haven’t set up your review committees, tokenization is just going to make things really more difficult,” Dr. Cameron said.
Other health systems are adjusting how they oversee AI usage and costs.
At Philadelphia-based Jefferson Health, Luis Taveras, PhD, executive vice president and chief digital and information officer, told Becker’s that organizations risk runaway spending when employees do not understand the cost of using AI tools.
Jefferson has adopted a tiered approach to AI access, directing employees toward different technologies based on their needs and the capabilities required.
At Charlotte, N.C.-based Advocate Health, technology leaders have focused on selecting the least expensive AI model capable of reliably completing a task rather than automatically using the most advanced option.
The cost of AI is only part of the equation
At Children’s Nebraska, Dr. Cameron is revisiting financial operations practices, known as FinOps, as the industry moves toward more usage-based pricing.
He said vendors can estimate AI consumption using factors such as hospital size, patient volumes and expected utilization. However, those calculations do not necessarily explain whether an investment produces meaningful results.
“A token could equal multiple value propositions,” he said.
Dr. Cameron pointed to Children’s Nebraska’s Medicaid platform, which helps patients and families enroll in Medicaid, coordinate coverage and complete recertification.
Automating portions of that work could free patient access employees for more meaningful patient interactions, improve the patient experience and help address concerns about retroactive payments, he said.
For Dr. Cameron, those outcomes offer a more meaningful measure of value than the number of tokens consumed.
When adoption becomes the budget risk
Children’s Nebraska is familiar with variable cloud computing costs, but AI introduces uncertainty because organizations cannot always predict how widely employees will adopt new capabilities.
Dr. Cameron said the health system conducted AI ambition modeling to determine where it wanted to integrate the technology and which areas should remain more human-centric.
The organization has moved from Microsoft’s Dragon Copilot to Epic’s ambient documentation tool, Chart with Art, and is monitoring adoption and consumption-based costs.
Children’s Nebraska has not experienced a major unexpected AI usage bill that forced it to turn off a tool, Dr. Cameron said, but it remains early in the implementation.
He recommends hospitals consider maintaining a 5% to 10% contingency budget when adopting consumption-based technologies, particularly if utilization exceeds expectations.
The budgeting challenge extends beyond Children’s Nebraska.
Amy Trainor, BSN, RN, vice president and CIO of New Orleans-based Ochsner Health, told Becker’s in August that consumption-based pricing is creating new accountability requirements for health systems evaluating the financial returns of AI tools.
Epic’s combination of fixed and variable pricing has also complicated forecasting for organizations adopting AI capabilities within the EHR.
Will AI token costs eventually fall?
Despite the financial uncertainty, Dr. Cameron expects AI token costs to decline over time.
“I sure hope they fall,” he said.
He compared the current pricing model to the early days of text messaging, when consumers paid for individual messages before unlimited plans became common.
Dr. Cameron believes AI vendors could face similar pressure as organizations become more capable of building and hosting their own models rather than relying entirely on commercial offerings.
He also questioned whether token-based pricing will remain sustainable given the substantial investments AI companies are making in computing infrastructure and technology development.
For now, he believes hospitals are in a period of experimentation, purchasing and deploying AI tools before they necessarily know which applications will deliver lasting value.
As organizations become more capable of developing their own AI alternatives, he expects the pressure on vendors to rethink consumption-based pricing to grow.
“I would be surprised if they don’t,” he said of the prospect of token costs declining.
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