Leslie Krigstein, VP of Communications & Government Affairs, Transcarent
On September 3, 2025, I attended the House Energy & Commerce Committee’s Health Subcommittee’s timely hearing on the hottest topic in not just healthcare — but across our economy, artificial intelligence (AI).
Titled, “Examining Opportunities to Advance American Health Care through the Use of Artificial Intelligence Technologies,” the hearing highlighted where AI is already delivering value in healthcare, and where it must go next to truly improve care quality and affordability. The group also covered more challenging issues like AI use for care denial or misrepresentations from chatbots.
The key takeaways from the hearing put a spotlight on how healthcare organizations can work toward responsible innovation including:
Keeping a human in the loop. Trust is fragile. AI should augment clinical judgment, never replace it. People deserve clear disclosure when AI is used and plain-English reasons for recommendations.
Moving beyond paperwork relief. Cutting administrative burden matters, but the real promise of AI is in better care, easier access, and lower costs—delivered responsibly across the AI lifecycle.
Being an enabler, not a gatekeeper. Prior authorization drew scrutiny. AI must not be used to deny necessary care. It should connect people to personalized, high-quality services, how and when they want them.
From “paperwork relief” to a consumer-directed health experience
A striking takeaway from the hearing was the bipartisan interest in moving beyond back-office efficiency to solutions that will have a meaningful impact for all of us, health consumers—helping people plan care, understand costs, and follow a personalized path to better health. That’s exactly where AI can shine:
Clarity at Moments That Matter. Plain-language explanations of benefits and coverage, in a person’s preferred language and modality, reduces confusion and helps people act with confidence.
Next-Best-Step Guidance. Personalized prompts that help people manage chronic conditions, close preventive gaps, and reach a clinician when new symptoms arise—without toggling portals or waiting on hold.
Accountable Affordability. Transparent navigation that surfaces quality and cost, connects to Centers of Excellence when appropriate, and supports informed decisions—with human clinicians available whenever needed, just one touch away.
We shared our precedent-setting vision of responsible innovation – and our promise to put people back in charge of their health and care.
What Congress can do now
In our submission, we urged policymakers to advance a framework that protects people and accelerates responsible innovation:
Transparency & Explainability. Require clear disclosure when AI is used and accessible rationales for recommendations.
Modernized Privacy & Security. Update federal protections to cover digital health tools beyond HIPAA’s traditional scope.
Equity-by-Design. Encourage bias testing and inclusive design, from development through deployment and monitoring.
Human Oversight. Ensure AI augments—not replaces—clinical judgment and does not automate coverage denials.
Risk-Based Regulation. Differentiate high-risk clinical AI from lower-risk administrative tools to avoid chilling innovation.
Workforce Enablement. Invest in AI fluency across the health workforce—clinicians, administrators, and developers alike.
These steps would build on the Subcommittee’s focus and help translate AI’s promise into everyday improvements people can see and feel.
Our commitment
Transcarent serves more than 20 million people today, primarily through employers and health plans that share our commitment to a simpler, higher-quality, more affordable health and care experience. We are the first to put the power of doctor-informed generative AI into the hands of the healthcare consumer and we’re grateful that Congress is engaging deeply on how to responsibly guide AI innovation. We stand ready to partner with Members of Congress and staff to ensure policy keeps pace with innovation—so AI not only reduces administrative burden, but truly delivers a consumer-directed, high-quality, transparent, and affordable health experience for every person.
Transcarent's Statement for the Record to the House Committee on Energy & Commerce Subcommittee on Health Hearing on, “Examining Opportunities to Advance American Health Care through
the Use of Artificial Intelligence Technologies,” September 3, 2025
Transcarent was founded in 2020 to change the healthcare status quo and provide consumers with greater choice and control. Our mission is to make high-quality, affordable care easily accessible to everyone, regardless of geography, income, education, disability, or language. Achieving this mission requires collaborative action from all stakeholders across the healthcare system.
In April 2025, Transcarent merged with Accolade to form the One Place for Health and Care. Our platform combines generative AI-powered WayFinding with comprehensive care experiences for cancer, surgery, and weight health, with health advocacy, expert medical opinion, pharmacy benefits, and virtual primary care services. This unified platform provides a broad array of options to guide people to the care they need when they need it, all in the service of delivering better health outcomes at lower costs.
The experience begins with an app on a Member’s phone, where they can access care through our affiliated virtual clinics in seconds or find high-quality providers in their local community. This level of access is especially critical for the roughly 100 million Americans¹ who do not have a regular primary care provider. A personalized digital experience with virtual urgent and primary care accessible in just 60 seconds results in lower medical costs, fewer unnecessary emergency room visits, and improved prevention and chronic disease management.
Today, Transcarent serves more than 20 million Americans, primarily those receiving their health benefits from their employer or through commercial markets. Our clients are among the country’s most forward-thinking self-insured employers and health plans. These employers and plans share a common goal: to simplify healthcare for their people while ensuring better outcomes and sustainable costs. Transcarent is proud to partner with them in pursuit of this goal.
Improving Outcomes, Enhancing Access, and Lowering Costs
The Transcarent model produces measurable improvements in access, quality, and affordability:
Getting the Right Care the First Time: Easy access to care results in a 17% reduction in higher-cost site of care visits across emergency rooms, urgent care, and specialty offices².
Avoided Surgeries: Expert second opinions prevent unnecessary procedures in approximately 3 out of every 100 cases—resulting in better outcomes for patients and savings of over $22,000 per avoided surgery³.
High Engagement: Our platform achieves a Net Promoter Score consistently above 80, far surpassing the healthcare industry average⁴.
Accessible to All: Our services are designed to reach all populations—regardless of location, income, or digital literacy—through inclusive technology, language support, and accessible design features.
How Transcarent Uses AI in Healthcare
Transcarent’s AI strategy is built to enhance, not replace, the relationship between people and their care teams. Our AI tools serve as a force multiplier for clinicians and a trusted companion for Members navigating a complex system.
WayFinding: Launched in May 2024, WayFinding is the first application of generative AI focused on improving the experience of the health consumer. By combining instant access to care providers with benefits navigation and clinical guidance on one easy to use platform, WayFinding personalizes each individual’s experience, orienting and guiding them through their health and care journeys, with human support never more than a tap away.
Clinical Support: Transcarent integrates AI into our affiliated virtual clinic to enhance efficiency and safety. Before a visit, an AI assistant gathers relevant history and symptoms, structuring inputs for the clinician to review. This reduces administrative burden and allows clinicians to focus on diagnosis and care planning. It can also assist in post-visit documentation, follow-up, and care gap reminders.
Chronic Condition Prevention and Risk Identification: AI models identify Members at elevated risk for costly or preventable conditions by analyzing claims, engagement patterns, and onboarding surveys. These insights prompt timely outreach, health education, and intervention to avoid unnecessary progression of disease.
WayFinding, First-of-its-Kind AI-Powered Solution to Improve the Health Consumer Experience
In May 2024, Transcarent introduced WayFinding, the first application of generative AI focused on improving the experience of the health consumer. WayFinding is a HIPAA-compliant, HITRUST certified, generative AI-powered navigation tool that enables users to discover, understand, and utilize their health benefits from their mobile device or computer. WayFinding responds to both voice and text inputs, supports multiple languages, and incorporates plan-specific details at the individual Member level to guide individuals through coverage questions, care decisions, and provider selection—without requiring them to toggle between portals, wait on hold, or decipher insurance jargon.
Members use WayFinding to schedule appointments, refill prescriptions, review test results, and get clinical guidance. When combined with our affiliated virtual clinic and on-demand care team, Members can initiate and complete care journeys without delay or confusion. It also improves prevention through proactive health outreach and reminders.
We know it’s working. A self-funded employer with 20,000 employees implemented WayFinding and saw meaningful results – including engaging 42% of their population in only 5 months, an average of $66 in PMPM savings, and a 9% reduction in ER visits.
Notably, this approach is not intended to replace human interaction, but to offer choice in how we experience health and care. WayFinding ensures that when a human conversation is needed, the Member is already informed of the ability to speak directly to a human and connected to the right resource. The result is a dramatically improved care experience, higher satisfaction, and greater employee trust in their employer-sponsored benefits.
When AI deconstructs the complexities of documentation, approvals, and decision trees to guide individuals through their healthcare journey, people can use all their benefits more easily and efficiently, understand why and what is happening with their health at any given time, and feel confident that they are achieving the best outcome at the lowest cost. By making benefits information easily accessible, without needing dozens of Member ID numbers or passwords, all integrated in one place, allows health consumers and their employers to have confidence that all benefits available to them are being used. When we empower people with the tools to find their way to better health, everyone – Members, providers, and payers - benefit.
AI Driving Accessibility in Healthcare
Trustworthy, HIPAA-covered, generative AI products could provide educational materials that are tailored to the patient’s level of health literacy and education, in the patient’s preferred language, including content that addresses the actual questions that the patient asked during their visit, helping to relieve their most salient healthcare concerns. Our AI Care Assistant, a generative AI chatbot working hand in hand with a doctor, can enable a medical visit to go for as long as it needs by conversing with the patient, answering all their questions fluently in the language of their choosing, and allowing them to ask for clarification or simplification. This is one way that generative AI can reduce the structural biases of the healthcare system. It moves us from “one size fits all” to “many sizes for many needs.”
Other impactful uses of generative AI in healthcare include, but are not limited to:
Personalized behavioral modification plans to reduce chronic disease risk, considering specific patient preferences, budget, geographic constraints, and family support.
Organizing and synthesizing research and expert information for healthcare practitioners, patients, and families.
Training and education for medical professionals, personalized to individual needs and levels of expertise.
Guiding and supporting families and patients through complex medical decisions.
For Medicare populations, the Centers for Medicare and Medicaid Services (CMS) could apply generative AI-powered chat solutions to support beneficiaries that may struggle to understand their benefits, provider networks, and care options, especially older adults and those with low health literacy. AI-powered platforms like Transcarent’s WayFinding can act as digital health assistants that explain benefits, clarify eligibility, and answer free-form questions in plain language, across multiple languages and formats, including with voice prompts. Additionally, AI-powered solutions can aid beneficiaries in selecting which benefits may best match their lifestyle and healthcare needs. It could be personalized based on the information CMS has about the individual beneficiary and apply that information to questions posed by the beneficiary or their caregiver at the time of enrollment.
AI-forward, multi-lingual voice and chat interfaces will be easier for beneficiaries and caregivers to engage with versus websites and apps. These new experiences enable users to interact with complex digital products while having no familiarity with the product features themselves. The conversational interface is likely to be a common future user experience pattern. The biggest benefit is that people with limited or no experience can use AI-powered digital products without needing specific instructions. They can speak or write what they are looking to do, and the digital product will lead them through their next steps.
Policy Priorities for Responsible AI in Healthcare
While we are optimistic about the potential for AI to enhance care quality, access, and efficiency, we urge Congress to establish a thoughtful policy framework that ensures safety, equity, and innovation.
Transparency and Explainability: Patients and clinicians must understand when AI is involved in the decision-making process and have access to clear explanations of AI-generated recommendations.
Privacy and Data Protections: AI tools handling personal health information must be subject to robust privacy and security safeguards, including modernized federal privacy standards that cover digital health tools not subject to HIPAA.
Bias Auditing and Equity-by-Design: Developers and deployers of AI systems must test for bias and ensure tools work equitably across diverse populations. AI has the power to reduce structural barriers in health care and should be designed and governed intentionally.
Role of Clinicians and Human Oversight: AI should be used to augment—not override—clinical judgment. Clinical AI tools should preserve human decision-making and avoid automating care denials or coverage decisions.
Certification and Risk-Based Regulation: Federal oversight should distinguish between high-risk, clinical AI applications, and lower-risk tools such as administrative navigation. Regulatory clarity is needed, but it must be risk-proportionate and not stifle innovation.
Support for Health Care Workforce Enablement: Federal investment is needed to build AI fluency across the health care workforce, including training for clinicians, administrators, and digital health developers.
Conclusion
Consumers are ready for their experience with the healthcare industry to operate at parity with the rest of the services they rely on in their daily lives. Employers are ready and willing to lead the way in transforming healthcare. They are demanding more, not just lower costs, but a better experience for their employees, improved outcomes, and greater accountability. Transcarent is proud to help them meet that mandate through technology-enabled, high-touch, and value-aligned solutions.
Congress has a vital role to play in ensuring that healthcare innovation is not held back by outdated policies or anticompetitive practices. We urge this Committee to support legislation that expands access to actionable data, encourages innovation in benefit design, and strengthens transparency across the healthcare ecosystem.
We appreciate the opportunity to share our perspective and would welcome the chance to work with Members and staff to advance these shared goals.
Addendum
Transcarent’s approach to oversight and governance to the AI solutions
Transcarent has an AI Governance Committee and AI Ethics Principles built on a STERDy and human-centered foundation (at Transcarent, “human-centered” refers to our Members, patients, clinicians, and workforce members). Our principles leverage the Organization for Economic Cooperation and Development (OECD.AI) principles as a foundation, with customization to tailor the principles to our business and our values. These principles coexist with the Transcarent Code of Conduct and Ethics.
Security & Privacy: Transcarent has a duty of responsibility to the data sources upon which our AI is built, including being resilient against malicious use, having safeguards to prevent unauthorized access and manipulation, and having internal oversight to avoid uses that violate the privacy of our patients.
Safety: Transcarent prioritizes safety by managing our AI systems to avoid, to the greatest possible extent, risk to people, society, or the environment. When AI systems are used in The Transcarent Clinic, we prioritize patient safety and promote patient and clinician-centered AI. Transcarent should use AI in furtherance of the health and care of its Members and patients; AI should not be used to refuse access to services or to override a decision by a workforce member or affiliated physician.
Truth: Transcarent’s AI systems should be technically accurate as well as aligned with true, fair, and just outcomes. Context and nuance are important factors and may avoid unjust or inaccurate outcomes.
Transparency: Transcarent informs individuals when they are interacting with AI systems through Transcarent, whether in its AI models, products, or any other decisions generated by AI.
Equitable Design: Transcarent designs and deploys AI systems that are equitable end-to-end. We believe a critical component of equitable design is to include diversity of thought in teams responsible for governing AI, training, testing, assessing, and monitoring.
Explainability: Transcarent can explain decisions made by AI to individuals affected by that decision. This applies when AI is provided by a vendor or other third party as much as when it is provided directly by Transcarent.
Respect: Transcarent develops, deploys, and uses AI systems that are respectful of the rights of third parties. For example, Transcarent will (a) take measures to avoid infringing on third-party IP rights, (b) respect individuals’ privacy and data rights as well as their right to be free from nuisance, harassment, offensive speech, and the like, and (c) take measures to avoid spreading misinformation.
Data Minimization: Transcarent makes privacy-informed and intentional choices when developing and training its AI models so that it trains only the data necessary to improve the model.
¹ https://www.nachc.org/usa-today-a-third-of-americans-dont-have-a-primary-care-provider-
according-to-nachc-report/?utm_source=chatgpt.com https://www.nachc.org/wp-content/
uploads/2023/06/Closing-the-Primary-Care-Gap_Full-Report_2023_digital-final.pdf
² Transcarent Book of Business Data, as of 5/31/2025
³ Transcarent Book of Business Data, as of 5/31/2025
⁴ Transcarent Book of Business Data, as of 5/31/2025
