By Bryan Odegard, CEO, Benmedica
Artificial Intelligence (AI) dominates headlines in healthcare from Nvidia’s strategic expansion into medical AI, to policy volatility shaking up biotech investment. But beneath the noise lies a quieter, more foundational opportunity:
AI’s greatest near-term impact lies in operational clarity.
At Benmedica, we believe this is where AI becomes transformational and not by adding another dashboard or predictive widget, but by reshaping how core workflows operate. That’s where clinical, financial, and administrative friction is reduced. That’s where smarter decisions happen.
The Real Value: Embedding Intelligence Where It Matters
While the industry buzz often focuses on precision diagnostics, genomics, or wearables, the true ROI of AI comes when it's embedded into the information infrastructure of healthcare operations.
When application-layer AI is integrated directly into platforms, benefits logic, and real-time data structures, the results are measurable:
- Lower administrative drag
- Faster, more confident prescribing
- Smarter alternatives surfaced in real-time
AI doesn’t just speed up decisions—it can contextualize them. In a 2024 survey by BMC Digital Health, 84% of institutions reported using AI for decision support in clinical workflows, citing improved efficiency and patient flow as top benefits.
Platform-Level Integration: Not Just AI, but Application Intelligence
This is not automation for automation’s sake. It’s workflow-aware intelligence which is designed to recognize formulary nuance, plan design, and patient-specific cost dynamics.
Take Nvidia’s recent positioning in healthcare AI. Their focus isn’t only on imaging and diagnostics but on how their AI infrastructure integrates into data platforms used by hospitals and researchers alike. That same principle applies to benefit intelligence. We believe prescribing, benefit verification, and plan-aligned recommendations must be augmented by the same embedded intelligence and delivered at the right point in the care journey.
This is the foundation we’re building with BenCore™.
Governance, Model Quality, and the Shift from Hype to Accountability
Innovation without integrity is a risk. As AI expands across healthcare ecosystems, governance and model fidelity are no longer optional but rather foundational.
- Bias mitigation: AI models must be trained and validated to avoid reinforcing historical inequities.
- Transparency: Providers need visibility into how AI decisions are made and especially when clinical pathways are influenced.
- Standards-based frameworks: The SHIFT model (Sustainability, Human-centeredness, Inclusiveness, Fairness, Transparency) provides an emerging guidepost for ethical implementation.
At Benmedica, our platform vision is grounded in these principles. Any intelligence introduced into our system must be trusted, explainable, and rigorously reviewed because trust is the only real foundation for scalable impact in healthcare.
Looking Ahead: Smarter by Design
Even as policy shifts and market dynamics evolve, one thing remains clear:
Efficiency at the core beats novelty at the edge.
The future of care isn’t just faster. It’s smarter by design.
We’re focused on operationalizing that future through accountable infrastructure, embedded intelligence, and aligned partnerships. That’s where innovation becomes real.
📚 Referenced Sources
- Nvidia Wants to Be the AI King of Healthcare – Business Insider
Learn More - Trump Health Policy Uncertainty Sends Biotech Into Slump – Reuters
Learn More - Healthcare AI: Institutional Uses, Efficiency Gains, and Decision Support – BMC Digital Health, 2024
Learn More - Health Rounds: AI Can Have Medical Care Biases Too, Study Reveals – Reuters
Learn More - Responsible AI in Healthcare: The SHIFT Framework – Social Science & Medicine
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The Current Challenge: Visibility Without Clarity
- Only 32% of providers say they consistently see formulary and cost information in their prescribing workflow (Source: Surescripts 2023 Impact Report).
- 65%+ of prescribers would switch medications if offered a cost-effective, therapeutically similar option — yet those insights are rarely surfaced in real-time (Source: American Journal of Managed Care, 2021).
- Even as RTPB expands, it’s still often isolated post-prescription, offering price without guidance, and mock adjudication without optimization (Source: Health Affairs, 2022 – Real-Time Prescription Benefit Data Trends).
BenCore eRx+: Elevating Prescribing Workflows
BenCore eRx+ module adds intelligence, clarity, and clinical value where it matters most:
Precision F&B™
- Enhanced F&B files with tier descriptions, copay and deductible visibility, and therapeutically aligned drug alternatives at the first medication selection screen.
- Aligned for future NCPDP F&B v60 enhancements from pharmacy network visibility to indication-based alternatives.
Intelligent RTPB™
- Works with your PBM’s existing RTPB feed but enriches the transaction response with more accurate alternatives, plan-aligned messaging, and clearer cost insights.
- Enables smarter prescribing post-script, not just pricing data.
Bonus Value: NCPDP F&B v60 as a Strategic Lever
Too often, v60 is viewed as a standards update. But in reality, it’s an opportunity to improve plan adherence, lower costs, and eliminate unnecessary barriers.
Benmedica helps organizations not only comply but thrive with v60 through:
- Standardized v60 Deployment Program
- Indication-based alternatives & formularies
- Pharmacy network-aware F&B insights
- Streamlined file structure and clinical readiness
- SmartAlts® engine integration
"Let’s turn your compliance milestone into a strategic advantage."
The Impact
- $22.32 PMPY savings in commercial populations
- Up to 10x ROI through formulary-aligned alternatives
- 90%+ of claims impacted by just 1,200 clinically prioritized drug subsets
(Source: Point-of-Care Partners Whitepaper: From Ignored to Impactful, 2024)
Why It Matters for You
Whether you’re a health plan optimizing cost and adherence, a PBM enhancing your infrastructure, or a plan sponsor seeking ERISA-compliant transparency, BenCore’s eRx+ and v60 readiness unlock immediate value.
Beyond Big Savings: The Power of Small Wins
Traditional cost-saving strategies tend to prioritize high-cost drugs with the largest price tags. However, this approach leaves substantial savings on the table by overlooking smaller but frequent opportunities that create a major cumulative impact. Consider:
- Lower-cost alternatives in widely prescribed drug classes (e.g., antibiotics, antihypertensives, cholesterol medications) generate massive cumulative savings across a population.
- Therapeutic substitutions in less-targeted categories (e.g., dermatology, gastrointestinal drugs) uncover hidden savings that would otherwise go unnoticed.
By making these small, consistent optimizations, payors, PBMs, and health plans can scale incremental savings into measurable financial and operational benefits. A recent analysis demonstrated that shifting just 5% of prescriptions to lower-cost alternatives in a 500,000-member health plan resulted in millions in annual savings.
Unveiling Hidden Value with SmartAlts®
Benmedica’s SmartAlts® engine is built to unlock and deliver these hidden savings opportunities at scale. With a robust dataset of 18,000 drugs and 1,200 subsets of therapeutically similar alternatives, and proprietary clinical algorithms, SmartAlts® ensures cost-effectiveness without compromising clinical outcomes.
Conclusion
Transforming savings through intelligent drug alternatives communication is crucial. By ensuring that real-time prescribing information is accessible and relevant to prescribers, patients can achieve better health outcomes while minimizing costs.