Executive Overview
The modern American healthcare landscape is increasingly defined by a high-stakes, digital arms race. On one side, health insurance payers deploy sophisticated artificial intelligence and automated algorithms to screen, scrutinize, and deny prior authorization requests. On the other side, healthcare providers fight back with their own suite of AI-powered tools designed to streamline appeals, reverse claim denials, and force payment.
To many industry insiders, this tit-for-tat technological battle is seen as the cutting edge of healthcare administration. However, to industry veterans who have witnessed the battlefield from both sides of the fence, this dynamic is not progress—it is a trap.
Enter Ashis Barad, Chief Digital and Information Officer at the renowned Hospital for Special Surgery (HSS). Having practiced as a physician at Sutter Health and Baylor Scott & White Health, and having built and deployed internal AI tools as a digital leader for Highmark Health and Allegheny Health Network, Barad possesses a rare, 360-degree view of the healthcare ecosystem.
His thesis is both radical and pragmatic: the ongoing race between payers and providers to out-automate and outmaneuver one another is a costly, finite game that ultimately drives up administrative inflation. Rather than investing millions into tools designed solely to bypass bureaucratic hurdles, Barad argues that payers and providers must pool their distinct data assets to build a deflationary, collaborative artificial intelligence ecosystem. By combining the deep clinical granularity of elite providers with the broad actuarial data of insurance payers, the industry can transcend reactive prior authorizations entirely, moving instead toward hyper-personalized, value-driven care pathways.
Detailed Chronology: A Career Forged on Both Sides of the Aisle
To understand the weight of Barad’s warnings against the current payer-provider tech war, one must examine the professional trajectory that led him to this conclusion. Barad’s career mirrors the evolving intersection of clinical practice, health system administration, and digital health transformation over the last two decades.
Phase 1: The Clinical Foundation
Barad began his medical career on the front lines of patient care, practicing as a physician at Sutter Health and later at Baylor Scott & White Health. It was during these foundational years in clinical practice that Barad first encountered the staggering administrative friction that burdens modern medicine. Long hours spent navigating fax machines, phone trees, and rigid insurance checklists exposed him to the daily frustrations shared by physicians nationwide.
Recognizing that clinical inefficiencies could not be solved at the bedside alone, Barad naturally gravitated toward digital leadership. At Baylor Scott & White Health, he stepped up to lead early organizational pushes for better digital health tools, attempting to bridge the widening gap between clinical workflows and emerging health information technologies.
Phase 2: Crossing the Payer-Provider Divide
In 2022, Barad made a career-defining move, crossing the historic divide between clinical delivery and health insurance. He assumed the role of Chief Digital and Information Officer at Allegheny Health Network (AHN) and its parent company, Highmark Health.
This dual-role integration—operating within an organization that encompasses both a massive provider network and a major health insurance plan—gave Barad a rare, insider’s perspective. He witnessed firsthand how payers conceptualize risk, build and deploy artificial intelligence internally, and structure the algorithms that govern utilization management and prior authorization. Rather than viewing payers as faceless adversaries, his tenure at Highmark Health taught him the structural limitations and operational pressures that drive insurance companies to rely on automated denial systems.
Phase 3: The Hospital for Special Surgery and the Call for a New Paradigm
Two years ago, Barad returned firmly to the provider side of the ecosystem, joining the Hospital for Special Surgery (HSS) as its Chief Digital and Information Officer. HSS is a global powerhouse in orthopedics, routinely performing tens of thousands of specialized surgeries annually.
Immersed once again in the specialized, high-volume environment of an elite provider institution, Barad quickly realized that the escalating technological arms race between providers and payers was fundamentally flawed. While both sides were spending heavily to out-automate each other, the core problems of administrative waste, system-wide inflation, and patient friction remained unsolved. This realization crystallized into his current philosophy: the industry is trapped playing a "finite game" of tactical wins and losses, when it desperately needs to pivot to an "infinite game" of structural collaboration.
Supporting Context & Metrics: The Anatomy of an Inefficient Ecosystem
To appreciate why Barad labels the current tech race an "inflationary route," one must analyze the economic and structural realities of modern healthcare administration.
The Cost of Administrative Friction
Prior authorization has long been cited by physicians and hospital administrators as one of the most burdensome aspects of modern clinical practice. According to data from the American Medical Association (AMA), the vast majority of physicians report that prior authorization leads to care delays, patient abandonment of treatment, and significant administrative waste.
To combat this, health systems have increasingly invested in generative AI and automated appeal platforms. These tools rapidly draft appeal letters, pull relevant electronic health record (EHR) data, and resubmit denied claims with minimal human intervention. Conversely, payers have countered with advanced AI models capable of processing millions of prior authorization requests in seconds, often utilizing blunt, algorithmic cutoffs to flag and deny treatments based on cost thresholds rather than nuanced clinical needs.
This back-and-forth spending creates a dangerous financial feedback loop. Every dollar a health system spends on AI denial-management software, and every dollar an insurer spends on automated authorization filters, adds a new layer of administrative overhead to a healthcare system that already consumes nearly 18% of the U.S. Gross Domestic Product (GDP).
The Asymmetry of Healthcare Data
At the heart of this inefficiency lies a fundamental data asymmetry between payers and providers:
- What Payers Have: Insurance companies possess vast populations of claims data, allowing them to track broad macro-trends, basic readmission rates, infection metrics, and initial surgical outcomes across diverse demographics. However, they lack deep, granular clinical context. A payer might see that a patient underwent a joint replacement, but they rarely have access to the intricate imaging data, biomechanical metrics, or longitudinal functional outcomes that define specialized care.
- What Providers Have: Elite provider institutions generate rich, unstructured, and structured clinical repositories. For example, HSS performs more than 40,000 orthopedic surgeries annually—more than double the volume of any other hospital in the United States. Through years of specialized practice, HSS has built a sophisticated data repository that directly links complex pre-operative imaging data to long-term surgical outcomes.
However, because these two data silos remain largely disconnected, insurers must rely on blunt, generalized guidelines to evaluate complex cases, while providers are forced to fight these decisions post-hoc.
Official Statements and Insights from Ashis Barad
In recent discussions, Ashis Barad has pulled back the curtain on how these data silos can be dismantled through proactive dialogue and cross-industry cooperation. His insights offer a roadmap for how health systems and insurers can alter their technological trajectory.
Moving Beyond the "Finite Game"
Barad views the current technological skirmishes not as innovation, but as a distraction from the industry’s true moral and economic obligations:
"We’re playing a finite game when there’s an infinite game to be played," Barad declared. "If we play the finite game of today, we’re going to continue on the inflationary route. So we have to figure out how to work together to figure out what the deflationary path for AI is, because that’s what we owe the people, honestly."
The Actuarial Value of Provider Data
To prove that payers are eager for a collaborative approach, Barad recounted a recent direct conversation he initiated with executives at a major national insurance company. He posed a direct question to them: What would be the literal and actuarial value of HSS’s proprietary, linked imaging-and-outcomes data?
According to Barad, the response from the payer’s actuarial team was immediate and striking: "They were like, we would salivate over it."
This enthusiasm underscores the profound limitation of standard insurance databases. While insurers possess robust data for routine procedures and standard patient journeys, they are largely blind to the nuances of complex, multi-stage procedures. Barad noted that a significant portion of the patient population at HSS consists of complex cases—patients undergoing their third, fourth, or fifth revision surgeries. Standard claims data cannot capture the intricate clinical realities of these complex interventions, making provider-generated data an invaluable asset for accurate actuarial modeling.
Reinventing "Gold Carding" and Prior Authorization
Barad argues that the ultimate prize of data collaboration is not just faster appeals, but the complete reinvention of how utilization management is structured. He points to gold carding—a regulatory and contractual practice where health plans exempt high-performing, trusted providers from prior authorization requirements—as a concept ripe for modernization.
In its current iteration, gold carding is often a blunt instrument governed by rigid flowcharts, static cost thresholds, and historical volume metrics. Barad envisions a modernized, AI-driven framework built upon shared data repositories:
"Today’s version is a blunt instrument based on flowcharts and cost thresholds rather than actual outcomes… Built the right way, [gold carding] could instead be personalized down to each patient. Authorization would be baked into a care pathway, not requested after the fact."
By integrating clinical repositories directly with payer underwriting models, authorization would cease to be a disruptive administrative speed bump. Instead, it would be dynamically embedded into a unified, evidence-based care pathway agreed upon by both clinician and insurer before treatment even begins.
Future Outlook: The Deflationary Path for Healthcare AI
As artificial intelligence continues to mature, the healthcare sector stands at a critical fork in the road.
If payers and providers continue on their current trajectory, the future will feature hyper-optimized adversarial systems: AI-driven denial engines locked in an endless war with AI-driven appeal generators. This path guarantees that administrative bloat will worsen, consuming resources that should otherwise be dedicated to patient care, clinician retention, and medical innovation.
Conversely, embracing Ashis Barad’s vision of data collaboration points toward a deflationary future. By breaking down organizational silos and merging deep clinical registries with broad actuarial databases, the healthcare industry can achieve several transformative milestones:
- Eradication of Redundant Administrative Waste: Transitioning from reactive prior authorization to integrated, pathway-baked authorization will eliminate billions of dollars spent annually on administrative appeals and bureaucratic friction.
- True Patient-Centric Personalization: Moving away from blanket rules and flowcharts will allow treatment plans to be tailored to individual patient profiles, resulting in higher quality care and better long-term outcomes, particularly in complex specialties like orthopedics, oncology, and cardiology.
- Restoration of Trust: Aligning the technological incentives of payers and providers can help heal the historically adversarial relationship between the two pillars of the U.S. healthcare system, fostering a culture of mutual accountability.
Ultimately, Barad’s message serves as both a warning and an invitation. The technological tools at our disposal possess immense power, but their ultimate value depends entirely on how they are deployed. Until payers and providers realize that they are playing on the same team, the algorithmic arms race will continue to inflate costs. But if industry leaders possess the courage to share their data and align their algorithms, artificial intelligence can finally fulfill its true promise: driving down costs while elevating the standard of human health.