Improving care and cutting costs

How can healthcare spending be reduced without compromising care?

In this article, originally published by our sister publication, Healthcare Innovation, Viz.ai’s Dr. Andrew Ibrahim addresses how current tools and innovations can improve reliability at the point of care, resulting in more favorable patient outcomes and reduced waste without adding administrative burden.

To reduce healthcare waste, CMS must focus on how care is delivered

In Washington, policymakers are debating how to reduce waste in Medicare and Medicaid spending without restricting access to care. The focus is well placed. The next step is making sure reform actually translates into better care at the bedside. From my time as a practicing surgeon to my current role as chief clinical officer at Viz.ai, I have seen firsthand the gaps between policy goals and on-the-ground reality. 

Nowhere is that more evident than in emergency stroke care.

When a patient arrives at a rural hospital showing signs of stroke, the clinical guidelines are clear– treatment needs to begin as quickly as possible. But too often, delays and inconsistencies in care get in the way. Imaging must be reviewed. Specialists must be consulted. Transfer decisions must be made. When coordination falters, or hospitals operate under different processes, precious time is lost – and for stroke patients, lost time means lost brain cells. Every minute of delay adds days to their rehabilitation and increases care costs.

Unwarranted variation in care delivery is not a new problem, nor is it limited to stroke. It extends to heart attack, cancer, and other high-risk conditions where evidence-based standards are well established. What varies is not what we know clinically but whether health systems can execute it consistently, regardless of geography, staffing, or resource constraints.

Addressing variation in care delivery sits at the heart of the challenge facing the Centers for Medicare & Medicaid Services (CMS). Programs such as the Rural Health Transformation Program aim to stabilize hospitals and expand access to care. These efforts lay critical groundwork, but the real opportunity lies in pairing needed infrastructure investments with modern tools that ensure care is delivered reliably no matter where you are. As lawmakers debate how to strengthen Medicare and Medicaid, the focus cannot remain solely on coverage and payment reform; it must also address how care is delivered in real time.

Solutions such as AI Care Pathways are designed to close this execution gap. These agents analyze clinical data, electronic health records, and imaging in real time to identify potential concerns, alert the right specialists, and guide the next evidence-based step. By providing clinicians with timely information, connecting the right teams, and clarifying next steps, these tools help reduce the delays and friction that too often slow down care. The consistency of high-quality care that was only possible in a narrow number of destination, elite hospitals is now achievable at scale across community and rural settings, where most patients prefer to receive their care.

Improving reliability at the point of care directly advances CMS’s core priorities: better outcomes for high-cost conditions, stronger performance in value-based models, expanded access without deepening workforce shortages, and reduced waste without adding administrative burden.

In our current system, too much Medicare and Medicaid spending fails to translate into better outcomes. Some of those extra costs come from care that doesn’t follow established guidelines. Others stem from fragmented responsibility or uncertainty, which can lead to unnecessary admissions, transfers, and testing. 

Traditional oversight tools, such as audits and reporting requirements, are important but struggle to keep pace with the size and complexity of federal programs. Rather than replacing these tools, delivery-level innovation can help reinforce them by preventing avoidable variation before it results in excess cost.

Policymakers should prioritize delivery-level solutions that improve care quality as decisions are being made, not months later. Such solutions fill this gap by embedding clinical standards, coordination logic, and documentation directly into the doctor’s workflow. By standardizing detection, triage, and documentation at the point of care, these systems reduce ambiguity and clarify accountability. When clinicians can rely on rapid coordination and specialist input, they can act earlier and more precisely. Patients who need advanced care receive it faster. Those who do not are less likely to enter costly cascades of low-value interventions.

Thoughtful integration of AI-powered software addresses over-utilization not through blunt restrictions, but through better-informed medicine. Many unnecessary admissions or procedures are not the result of bad intentions. They are a result of uncertainty and uneven access to expertise. When unwarranted variation decreases, both outcomes and efficiency improve.

There are also implications for program integrity. CMS processes more than a billion claims annually and continues to report significant improper payments across Medicare and Medicaid. While some cases involve fraud, many stem from documentation gaps, fragmented processes, or misalignment between care delivery and payment requirements. Strengthening reliability at the point of care improves documentation and transparency organically, aligning clinical decision-making with payment requirements without layering on additional administrative complexity.

None of this is a cure-all. Technology alone will not fix structural challenges in healthcare financing or workforce distribution. But it can address the long-standing gap between what clinical evidence recommends and what patients consistently receive.

As debates in Washington continue over how to reduce waste without compromising access, there is real momentum for healthcare. Together, we must pair that momentum with solutions that improve care in the moment it’s delivered. The tools are already here. Aligning policy with what works at scale can help ensure Medicare is not just sustainable on paper but consistently effective for patients at the bedside.